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Associations Between Psychiatric Comorbidities and Sleep Disturbances in Children With Attention-Deficit/Hyperactivity Disorder

Accardo, Jennifer A. MD, MSCE*; Marcus, Carole L. MBBCh†,‡; Leonard, Mary B. MD, MSCE§,‖; Shults, Justine PhD§; Meltzer, Lisa J. PhD#; Elia, Josephine MD¶,**

Journal of Developmental & Behavioral Pediatrics: February/March 2012 - Volume 33 - Issue 2 - p 97–105
doi: 10.1097/DBP.0b013e31823f6853
Original Articles

Objective: Children with attention-deficit/hyperactivity disorder (ADHD) often have sleep complaints and also higher rates of psychiatric comorbidities such as mood and anxiety disorders that may affect sleep. The authors hypothesized that children with ADHD and psychiatric comorbidities would have higher overall sleep disturbance scores as measured by a sleep questionnaire than children with ADHD without comorbidities. Methods: This cross-sectional analysis in an academic center studied 317 children with ADHD; 195 subjects had no comorbid conditions, 60 were anxious and 62 were depressed. Participants completed the Schedule for Affective Disorders and Schizophrenia for School-Age Children–Present State, 4th Revised Edition and the Children's Sleep Habits Questionnaire. Results: Median age (range) was 8.9 (6–18.7) years; 78% were male. Median (interquartile range) Total Sleep Disturbance Score (TSDS) on Children's Sleep Habits Questionnaire for subjects with no comorbidities was 44 (40–49); anxiety, 48 (43–54); and depression, 46 (41–52). Compared with subjects without comorbidities, TSDS in anxious subjects was greater (p = .008). TSDS in depressed subjects was not significantly different. Compared with subjects without comorbidities, anxious subjects had higher Bedtime Resistance, Sleep Onset Delay, and Night Wakings subscales (p = .03, .007, and .007, respectively); depressed subjects had higher Sleep Onset Delay and Sleep Duration subscales (p = .003 and .01, respectively). Conclusions: Anxiety in children with ADHD contributed to higher overall sleep disturbance scores, compared with children with ADHD alone. Both comorbidities were associated with higher Sleep Onset Latency subscale scores. Further study of the impact of psychiatric comorbidities on sleep in children with ADHD is warranted.

From the *Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD; †The Children's Hospital of Philadelphia, Sleep Center, Philadelphia, PA; ‡Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA; §Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA; ‖Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA; ¶Department of Child and Adolescent Psychiatry, The Children's Hospital of Philadelphia, Philadelphia, PA; #Department of Pediatrics, National Jewish Health, Denver, CO; **Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA.

Received February 2011; accepted October 2011.

This work was supported in parts by National Institute of Health grants R01 HL58585, K23 MH066275, K24 DK076808, T32 HL007713-14, U54 RR023567, and UL1 RR024134.

Disclosure: Dr. Marcus has received research funding for an investigator-initiated study, the subject of which is unrelated to this article. The other authors declare no conflict of interest.

Address for reprints: Jennifer Accardo, MD, MSCE, Kennedy Krieger Institute, 801 North Broadway, Baltimore, MD 21205; e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.