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Abstract

Background

Internalizing and externalizing problems have received great attention, and children with ADHD exhibit high rates of comorbid internalizing and externalizing disorders. This study aimed to explore the relationship between sleep and internalizing problems in children with attention-deficit hyperactivity disorder (ADHD) and the probable mediating role of externalizing problems.

Methods

A total of 203 primary school children diagnosed with ADHD for the first time were recruited for this study. Children with ADHD were evaluated by Children’s Sleep Habits Questionnaire (CSHQ), Strengths and Difficulties Questionnaire (SDQ). Internalizing problems were represented by emotional symptoms and peer problems of SDQ, and externalizing problems were represented by conduct problems and hyperactivity-inattention problems of SDQ. Multi-step linear regression analysis was used to investigate the mediating effect of externalizing problems on the relationship between sleep and internalizing problems.

Results

Sleep in children with ADHD was associated with emotional problems in internalizing problems, and conduct problems in externalizing problems mediated the association between sleep and emotional problems.

Conclusion

For children with ADHD, when it is difficult to identify internalizing problems, especially emotional problems, we can take sleep and externalizing problems as clues to improve our clinical ability to recognize and deal with emotional problems.

Impact

  1. 1.

    We first explored the possible mediating role of conduct problems between sleep and emotional problems in primary school children with ADHD.

  2. 2.

    When it is difficult to identify internalizing problems, especially emotional problems, we can take sleep and externalizing problems as clues to improve our clinical ability to recognize emotional problems for children with ADHD.

  3. 3.

    For children with ADHD with potential internalizing problems, especially emotional problems, interventions for their sleep and externalizing problems may be the possible methods to deal with.

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Data availability

Deidentified individual participant data (including data dictionaries) will be made available, in addition to study protocols, the statistical analysis plan, and the informed consent form. The data will be made available upon publication to researchers who provide a methodologically sound proposal for use in achieving the goals of the approved proposal. Proposals should be submitted to [email protected]; or [email protected]

References

  1. Battle, D. E. Diagnostic and Statistical Manual of Mental Disorders (Dsm). CoDAS 25, 191–192 (2013).

    PubMed 

    Google Scholar
     

  2. Sayal, K., Prasad, V., Daley, D., Ford, T. & Coghill, D. Adhd in Children and Young People: Prevalence, Care Pathways, and Service Provision. Lancet Psychiatry 5, 175–186 (2018).

    Article 
    PubMed 

    Google Scholar
     

  3. Mayes, S. D. et al. Adhd Subtypes and Comorbid Anxiety, Depression, and Oppositional-Defiant Disorder: Differences in Sleep Problems. J. Pediatr. Psychol. 34, 328–337 (2009).

    Article 
    PubMed 

    Google Scholar
     

  4. Jensen, P. S., Shervette, R. E. 3rd, Xenakis, S. N. & Richters, J. Anxiety and Depressive Disorders in Attention Deficit Disorder with Hyperactivity: New Findings. Am. J. Psychiatry 150, 1203–1209 (1993).

    Article 
    CAS 
    PubMed 

    Google Scholar
     

  5. Gillberg, C. et al. Co-Existing Disorders in Adhd – Implications for Diagnosis and Intervention. Eur. Child Adolesc. Psychiatry 13, I80–I92 (2004).

    Article 
    PubMed 

    Google Scholar
     

  6. Mulraney, M., Giallo, R., Lycett, K., Mensah, F. & Sciberras, E. The Bidirectional Relationship between Sleep Problems and Internalizing and Externalizing Problems in Children with Adhd: A Prospective Cohort Study. Sleep. Med. 17, 45–51 (2016).

    Article 
    PubMed 

    Google Scholar
     

  7. Sciberras, E. et al. Anxiety in Children with Attention-Deficit/Hyperactivity Disorder. Pediatrics 133, 801–808 (2014).

    Article 
    PubMed 

    Google Scholar
     

  8. Jarrett, M. A. & Ollendick, T. H. A Conceptual Review of the Comorbidity of Attention-Deficit/Hyperactivity Disorder and Anxiety: Implications for Future Research and Practice. Clin. Psychol. Rev. 28, 1266–1280 (2008).

    Article 
    PubMed 

    Google Scholar
     

  9. Achenbach, T. M., Ivanova, M. Y., Rescorla, L. A., Turner, L. V. & Althoff, R. R. Internalizing/Externalizing Problems: Review and Recommendations for Clinical and Research Applications. J. Am. Acad. Child Adolesc. Psychiatry 55, 647–656 (2016).

    Article 
    PubMed 

    Google Scholar
     

  10. Van der Ende, J., Verhulst, F. C. & Tiemeier, H. The Bidirectional Pathways between Internalizing and Externalizing Problems and Academic Performance from 6 to 18 Years. Dev. Psychopathol. 28, 855–867 (2016).

    Article 
    PubMed 

    Google Scholar
     

  11. Wiggins, J. L., Mitchell, C., Hyde, L. W. & Monk, C. S. Identifying Early Pathways of Risk and Resilience: The Codevelopment of Internalizing and Externalizing Symptoms and the Role of Harsh Parenting. Dev. Psychopathol. 27, 1295–1312 (2015).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  12. Lunetti, C. et al. Development of Internalizing Symptoms During Adolescence in Three Countries: The Role of Temperament and Parenting Behaviors. Eur. child Adolesc. psychiatry 31, 947–957 (2022).

    Article 
    PubMed 

    Google Scholar
     

  13. Miner, J. L. & Clarke-Stewart, K. A. Trajectories of Externalizing Behavior from Age 2 to Age 9: Relations with Gender, Temperament, Ethnicity, Parenting, and Rater. Dev. Psychol. 44, 771–786 (2008).

    Article 
    PubMed 

    Google Scholar
     

  14. Petersen, I. T., Bates, J. E., Dodge, K. A., Lansford, J. E. & Pettit, G. S. Describing and Predicting Developmental Profiles of Externalizing Problems from Childhood to Adulthood. Dev. Psychopathol. 27, 791–818 (2015).

    Article 
    PubMed 

    Google Scholar
     

  15. Achenbach, T. M. The Classification of Children’s Psychiatric Symptoms: A Factor-Analytic Study. Psychol. Monogr. 80, 1–37 (1966).

    Article 
    CAS 
    PubMed 

    Google Scholar
     

  16. Hughes, E. K. & Gullone, E. Internalizing Symptoms and Disorders in Families of Adolescents: A Review of Family Systems Literature. Clin. Psychol. Rev. 28, 92–117 (2008).

    Article 
    PubMed 

    Google Scholar
     

  17. McRae, E., Stoppelbein, L., O’Kelley, S., Fite, P. & Smith, S. Comorbid Internalizing and Externalizing Symptoms among Children with Adhd: The Influence of Parental Distress, Parenting Practices, and Child Routines. Child Psychiatry Hum. Dev. 51, 813–826 (2020).

    Article 
    PubMed 

    Google Scholar
     

  18. Woodward, L. J. & Fergusson, D. M. Life Course Outcomes of Young People with Anxiety Disorders in Adolescence. J. Am. Acad. Child Adolesc. Psychiatry 40, 1086–1093 (2001).

    Article 
    CAS 
    PubMed 

    Google Scholar
     

  19. Lee, E. J. & Stone, S. I. Co-Occurring Internalizing and Externalizing Behavioral Problems: The Mediating Effect of Negative Self-Concept. J. Youth Adolesc. 41, 717–731 (2012).

    Article 
    PubMed 

    Google Scholar
     

  20. Overbeek, G. et al. Co-Occurrence of Depressive Moods and Delinquency in Early Adolescence: The Role of Failure Expectations, Manipulativeness, and Social Contexts. Int. J. Behav. Dev. 30, 433–443 (2006).

    Article 

    Google Scholar
     

  21. Quach, J. L., Nguyen, C. D., Williams, K. E. & Sciberras, E. Bidirectional Associations between Child Sleep Problems and Internalizing and Externalizing Difficulties from Preschool to Early Adolescence. JAMA Pediatr. 172, e174363 (2018).

    Article 
    PubMed 

    Google Scholar
     

  22. Sung, V., Hiscock, H., Sciberras, E. & Efron, D. Sleep Problems in Children with Attention-Deficit/Hyperactivity Disorder: Prevalence and the Effect on the Child and Family. Arch. Pediatr. Adolesc. Med. 162, 336–342 (2008).

    Article 
    PubMed 

    Google Scholar
     

  23. Becker, S. P. Adhd and Sleep: Recent Advances and Future Directions. Curr. Opin. Psychol. 34, 50–56 (2020).

    Article 
    PubMed 

    Google Scholar
     

  24. Cortese, S., Faraone, S. V., Konofal, E. & Lecendreux, M. Sleep in Children with Attention-Deficit/Hyperactivity Disorder: Meta-Analysis of Subjective and Objective Studies. J. Am. Acad. Child Adolesc. Psychiatry 48, 894–908 (2009).

    PubMed 

    Google Scholar
     

  25. Dimakos, J., Gauthier-Gagné, G., Lin, L., Scholes, S. & Gruber, R. The Associations between Sleep and Externalizing and Internalizing Problems in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: Empirical Findings, Clinical Implications, and Future Research Directions. Child Adolesc. Psychiatr. Clin. North Am. 30, 175–193 (2021).

    Article 

    Google Scholar
     

  26. Wolraich, M. L., Bard, D. E., Neas, B., Doffing, M. & Beck, L. The Psychometric Properties of the Vanderbilt Attention-Deficit Hyperactivity Disorder Diagnostic Teacher Rating Scale in a Community Population. J. Dev. Behav. Pediatr.: JDBP 34, 83–93 (2013).

    Article 
    PubMed 

    Google Scholar
     

  27. Li, D., Jin, Y., Vandenberg, S. G., Zhu, Y. M. & Tang, C. H. Report on Shanghai Norms for the Chinese Translation of the Wechsler Intelligence Scale for Children-Revised. Psychol. Rep. 67, 531–541 (1990).

    CAS 
    PubMed 

    Google Scholar
     

  28. Owens, J. A., Spirito, A. & McGuinn, M. The Children’s Sleep Habits Questionnaire (Cshq): Psychometric Properties of a Survey Instrument for School-Aged Children. Sleep 23, 1043–1051 (2000).

    Article 
    CAS 
    PubMed 

    Google Scholar
     

  29. Goodman, R. The Strengths and Difficulties Questionnaire: A Research Note. J. Child Psychol. psychiatry, allied Discip. 38, 581–586 (1997).

    Article 
    CAS 

    Google Scholar
     

  30. Wolraich, M. L. et al. Psychometric Properties of the Vanderbilt Adhd Diagnostic Parent Rating Scale in a Referred Population. J. Pediatr. Psychol. 28, 559–567 (2003).

    Article 
    PubMed 

    Google Scholar
     

  31. Wolraich, M. L. et al. Assessing the Impact of Parent and Teacher Agreement on Diagnosing Attention-Deficit Hyperactivity Disorder. J. Dev. Behav. Pediatr.: JDBP 25, 41–47 (2004).

    Article 
    PubMed 

    Google Scholar
     

  32. Xiao, Z. H., Wang, Q. H., Luo, T. T. & Zhong, L. Diagnostic Value of Vanderbilt Adhd Parent Rating Scale in Attention Deficit Hyperactivity Disorder. Zhongguo dang dai er ke za zhi = Chin. J. Contemp. Pediatr. 15, 348–352 (2013).


    Google Scholar
     

  33. Goodman, A., Lamping, D. L. & Ploubidis, G. B. When to Use Broader Internalising and Externalising Subscales Instead of the Hypothesised Five Subscales on the Strengths and Difficulties Questionnaire (Sdq): Data from British Parents, Teachers and Children. J. Abnorm. Child Psychol. 38, 1179–1191 (2010).

    Article 
    PubMed 

    Google Scholar
     

  34. Du, Y., Kou, J. & Coghill, D. The Validity, Reliability and Normative Scores of the Parent, Teacher and Self Report Versions of the Strengths and Difficulties Questionnaire in China. Child Adolesc. Psychiatry Ment. Health 2, 8 (2008).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  35. Hatch, B., Nordahl, C. W., Schwichtenberg, A. J., Ozonoff, S. & Miller, M. Factor Structure of the Children’s Sleep Habits Questionnaire in Young Children with and without Autism. J. Autism Dev. Disord. 51, 3126–3137 (2021).

    Article 
    PubMed 

    Google Scholar
     

  36. Veatch, O. J. et al. Shorter Sleep Duration Is Associated with Social Impairment and Comorbidities in Asd. Autism Res.: Off. J. Int. Soc. Autism Res. 10, 1221–1238 (2017).

    Article 

    Google Scholar
     

  37. Li, S. H. et al. [Development and Psychometric Properties of the Chinese Version of Children’s Sleep Habits Questionnaire]. Zhonghua Er Ke Za Zhi 45, 176–180 (2007).

    PubMed 

    Google Scholar
     

  38. Yue, L., Cui, N., Liu, Z., Jia, C. & Liu, X. Patterns of Sleep Problems and Internalizing and Externalizing Problems among Chinese Adolescents: A Latent Class Analysis. Sleep. Med. 95, 47–54 (2022).

    Article 
    PubMed 

    Google Scholar
     

  39. Hoyniak, C. P. et al. Sleep across Early Childhood: Implications for Internalizing and Externalizing Problems, Socioemotional Skills, and Cognitive and Academic Abilities in Preschool. J. Child Psychol. psychiatry, allied Discip. 61, 1080–1091 (2020).

    Article 

    Google Scholar
     

  40. Stein, D. et al. Sleep Disturbances in Adolescents with Symptoms of Attention-Deficit/Hyperactivity Disorder. J. Learn. Disabilities 35, 268–275 (2002).

    Article 

    Google Scholar
     

  41. Lucas, I., Mulraney, M. & Sciberras, E. Sleep Problems and Daytime Sleepiness in Children with Adhd: Associations with Social, Emotional, and Behavioral Functioning at School, a Cross-Sectional Study. Behav. Sleep. Med. 17, 411–422 (2019).

    Article 
    PubMed 

    Google Scholar
     

  42. Sanabra, M., Gómez-Hinojosa, T., Grau, N. & Alda, J. A. Deficient Emotional Self-Regulation and Sleep Problems in Adhd with and without Pharmacological Treatment. J. Atten. Disord. 26, 426–433 (2022).

    Article 
    PubMed 

    Google Scholar
     

  43. Gradisar, M. & Crowley, S. J. Delayed Sleep Phase Disorder in Youth. Curr. Opin. psychiatry 26, 580–585 (2013).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  44. Accardo, J. A. et al. Associations between Psychiatric Comorbidities and Sleep Disturbances in Children with Attention-Deficit/Hyperactivity Disorder. J. Dev. Behav. pediatrics: JDBP 33, 97–105 (2012).

    Article 

    Google Scholar
     

  45. Frick, M. A., Meyer, J. & Isaksson, J. The Role of Comorbid Symptoms in Perceived Stress and Sleep Problems in Adolescent Adhd. Child Psychiatry Hum. Dev. 54, 1141–1151 (2022).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  46. Chervin, R. D., Dillon, J. E., Archbold, K. H. & Ruzicka, D. L. Conduct Problems and Symptoms of Sleep Disorders in Children. J. Am. Acad. Child Adolesc. Psychiatry 42, 201–208 (2003).

    Article 
    PubMed 

    Google Scholar
     

  47. Denis, D. et al. Externalizing Behaviors and Callous-Unemotional Traits: Different Associations with Sleep Quality. Sleep 40, zsx070 (2017).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  48. Giancola, P. R., Mezzich, A. C. & Tarter, R. E. Disruptive, Delinquent and Aggressive Behavior in Female Adolescents with a Psychoactive Substance Use Disorder: Relation to Executive Cognitive Functioning. J. Stud. alcohol 59, 560–567 (1998).

    Article 
    CAS 
    PubMed 

    Google Scholar
     

  49. Scharf, R. J., Demmer, R. T., Silver, E. J. & Stein, R. E. Nighttime Sleep Duration and Externalizing Behaviors of Preschool Children. J. Dev. Behav. Pediatr.: JDBP 34, 384–391 (2013).

    Article 
    PubMed 

    Google Scholar
     

  50. Muratori, P. et al. Linking Sleep to Externalizing Behavioral Difficulties: A Longitudinal Psychometric Survey in a Cohort of Italian School-Age Children. J. Prim. Prev. 40, 231–241 (2019).

    Article 
    PubMed 

    Google Scholar
     

  51. Burke, J. D., Loeber, R., Lahey, B. B. & Rathouz, P. J. Developmental Transitions among Affective and Behavioral Disorders in Adolescent Boys. J. Child Psychol. Psychiatry, allied Discip. 46, 1200–1210 (2005).

    Article 

    Google Scholar
     

  52. Stringaris, A., Lewis, G. & Maughan, B. Developmental Pathways from Childhood Conduct Problems to Early Adult Depression: Findings from the Alspac Cohort. Br. J. psychiatry : J. Ment. Sci. 205, 17–23 (2014).

    Article 

    Google Scholar
     

  53. Costello, E. J., Mustillo, S., Erkanli, A., Keeler, G. & Angold, A. Prevalence and Development of Psychiatric Disorders in Childhood and Adolescence. Arch. Gen. Psychiatry 60, 837–844 (2003).

    Article 
    PubMed 

    Google Scholar
     

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Acknowledgements

The authors are deeply thankful to all the families who contributed their time to this study in order to better understand ADHD.

Funding

All phases of this study were supported by The Health science and technology capacity improvement project of Jilin Province, 2022LC104; Provincial science and Technology Department project, 20230203067SF; Youth Development Fund of the First Hospital of Jilin University, JDYY14202328; The Health science and technology capacity improvement project of Jilin Province, 2023LC005.

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Authors and Affiliations

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Contributions

Conceptualization, Han-Yu Dong and Fei-Yong Jia; Methodology, Chun-Yue Miao, Yang Xue; Software, Chun-Yue Miao, Yang Xue; Validation, Yu Zhang and Ling Shan; Formal Analysis, Chun-Yue Miao, Yang Xue; Investigation, Han-Yu Dong; Resources, Lin Du; Data Curation, Yu Zhang and Ling Shan; Writing – Original Draft Preparation, Han-Yu Dong; Writing – Review & Editing, Lin Du; Visualization, Fei-Yong Jia; Supervision, Lin Du; Project Administration, Lin Du; Funding Acquisition, Fei-Yong Jia, Han-Yu Dong and Ling Shan, All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to
Lin Du.

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The authors declare no competing interests.

Ethics approval and consent to participate

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of the first hospital of Jilin University. Informed consent was obtained from all subjects involved in the study.

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Dong, HY., Miao, CY., Xue, Y. et al. Sleep and internalizing problems in primary school children with attention-deficit hyperactivity disorder.
Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03213-4

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  • Received: 06 January 2024

  • Revised: 28 March 2024

  • Accepted: 01 April 2024

  • Published: 18 April 2024

  • DOI: https://doi.org/10.1038/s41390-024-03213-4

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