Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Sleeping, TV, Cognitively Stimulating Activities, Physical Activity, and Attention-Deficit Hyperactivity Disorder Symptom Incidence in Children: A Prospective Study

Peralta, Gabriela, P., MSc*,†,‡; Forns, Joan, PhD*,†,‡; García de la Hera, Manuela, MPH, PhD‡,§; González, Llúcia, MSc‖,¶; Guxens, Mònica, MD*,†,‡,**; López-Vicente, Mónica, PhD*,†,‡,††; Sunyer, Jordi, MD, PhD*,†,‡,††; Garcia-Aymerich, Judith, MD, PhD*,†,‡

Journal of Developmental & Behavioral Pediatrics: April 2018 - Volume 39 - Issue 3 - p 192–199
doi: 10.1097/DBP.0000000000000539
Original Articles
Watch video abstract

Objective: To analyze associations between time spent sleeping, watching TV, engaging in cognitively stimulating activities, and engaging in physical activity, all at 4 years, and (1) attention-deficit/hyperactivity disorder (ADHD) symptoms and (2) behavior problems, both assessed at 7 years, in ADHD-free children at baseline.

Method: In total, 817 participants of the Infancia y Medio Ambiente birth cohort, without ADHD at baseline, were included. At the 4-year follow-up, parents reported the time that their children spent sleeping, watching TV, engaging in cognitively stimulating activities, and engaging in physical activity. At the 7-year follow-up, parents completed the Conners' Parent Rating Scales and the Strengths and Difficulties Questionnaire, which measure ADHD symptoms and behavior problems, respectively. Negative binomial regression models were used to assess associations between the activities at 4 years and ADHD symptoms and behavior problems at 7 years.

Results: Children (48% girls) spent a median (p25–p75) of 10 (10–11) hours per day sleeping, 1.5 (0.9–2) hours per day watching TV, 1.4 (0.9–1.9) hours per day engaging in cognitively stimulating activities, and 1.5 (0.4–2.3) hours per day engaging in physical activity. Longer sleep duration (>10 hours per day) was associated with a lower ADHD symptom score (adjusted incidence rate ratio = 0.97, 95% confidence interval, 0.95–1.00). Longer time spent in cognitively stimulating activities (>1 hours per day) was associated with lower scores of both ADHD symptoms (0.96, 0.94–0.98) and behavior problems (0.89, 0.83–0.97). Time spent watching TV and engaging in physical activity were not associated with either outcomes.

Conclusion: A shorter sleep duration and less time spent in cognitively stimulating activities were associated with an increased risk of developing ADHD symptoms and behavior problems.

This article has supplementary material on the web site:

*ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain;

Universitat Pompeu Fabra (UPF), Barcelona, Spain;

CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain;

§Department of Public Health, Miguel Hernandez University, Campus San Juan, Alicante, Spain;

Universitat Jaume I de Castelló, Castelló, Spain;

Unidad Mixta de Investigación en Epidemiología, Ambiente y Salud, FISABIO-Universitat Jaume I -Universitat de València, Valencia, Spain

**Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre, Sophia Children's Hospital, Rotterdam, the Netherlands;

††IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.

Address for reprints: Judith Garcia-Aymerich, MD, PhD, ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Doctor Aiguader, 88, 08003 Barcelona, Spain; e-mail:

This study was funded by grants from EU Commission (FP7-ENV-2011 cod 282957, HEALTH.2010.2.4.5-1, and 261357), and from Spain: Instituto de Salud Carlos III (Red INMA G03/176, CB06/02/0041, PI041436, PI081151 incl. FEDER funds; FIS-FEDER 03/1615, 04/1509, 04/1112, 04/1931, 05/1079, 05/1052, 06/1213, 07/0314, 09/02647, 11/0178, 11/01007, 11/02591, 11/02038, 13/1944, 13/2032, 14/0891, 14/1687, and MS13/00054), CIBERESP, Generalitat de Catalunya-CIRIT 1999SGR 00241, Generalitat de Catalunya-AGAUR 2009 SGR 501, Fundació La marató de TV3 (090430), and the Conselleria de Sanitat, Generalitat Valenciana.

Disclosure: The authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

See the Video Abstract at

Received June , 2017

Accepted November , 2017

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.