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The bidirectional relationship between sleep problems and internalizing and externalizing problems in children with ADHD: a prospective cohort study.
Sleep Med. 2016 Jan; 17:45-51.SM

Abstract

BACKGROUND

Behavioral sleep problems are common in children with attention deficit hyperactivity disorder (ADHD), and longitudinal studies have found sleep problems to be both a predictor and outcome of internalizing and externalizing problems. We investigated the potential bidirectional relationship between sleep problems and internalizing/externalizing problems.

METHODS

Children with ADHD, aged 5-13 years, were recruited from 21 pediatric practices across Victoria, Australia (N = 270). Across a 12-month period, at three time points, parents reported on their child's sleep problems (Children's Sleep Habits Questionnaire) and emotional and behavioral functioning (Strengths and Difficulties Questionnaire). Data were analyzed using autoregressive cross-lagged panel models.

RESULTS

Sleep problem severity and emotional/behavioral problem severity were very stable across the 12-month period. Sleep problems at baseline predicted emotional problems at six months (r = 0.17, p < 0.01), and emotional problems at baseline predicted sleep problems at six months (r = 0.07, p < 0.05). However, there was no predictive relationship between sleep problems and emotional problems from 6-12 months. No bidirectional relationship was observed between sleep problems and conduct problems.

CONCLUSIONS

In children with ADHD, there is weak evidence of a bidirectional relationship between sleep problems and emotional problems. These symptoms are also very stable over time; therefore, the best treatment approach to improve overall functioning may be to target both sleep and emotional functioning in these children.

Authors+Show Affiliations

Community Child Health, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, Victoria, Australia. Electronic address: melissa.mulraney@mcri.edu.au.Healthy Mothers Healthy Families, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, Victoria, Australia.Community Child Health, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, Victoria, Australia.Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, Victoria, Australia; Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, Australia.Community Child Health, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, Victoria, Australia; The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, Australia; School of Psychology, Deakin University, Burwood Highway, Burwood, Victoria, Australia.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26847973

Citation

Mulraney, Melissa, et al. "The Bidirectional Relationship Between Sleep Problems and Internalizing and Externalizing Problems in Children With ADHD: a Prospective Cohort Study." Sleep Medicine, vol. 17, 2016, pp. 45-51.
Mulraney M, Giallo R, Lycett K, et al. The bidirectional relationship between sleep problems and internalizing and externalizing problems in children with ADHD: a prospective cohort study. Sleep Med. 2016;17:45-51.
Mulraney, M., Giallo, R., Lycett, K., Mensah, F., & Sciberras, E. (2016). The bidirectional relationship between sleep problems and internalizing and externalizing problems in children with ADHD: a prospective cohort study. Sleep Medicine, 17, 45-51. https://doi.org/10.1016/j.sleep.2015.09.019
Mulraney M, et al. The Bidirectional Relationship Between Sleep Problems and Internalizing and Externalizing Problems in Children With ADHD: a Prospective Cohort Study. Sleep Med. 2016;17:45-51. PubMed PMID: 26847973.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The bidirectional relationship between sleep problems and internalizing and externalizing problems in children with ADHD: a prospective cohort study. AU - Mulraney,Melissa, AU - Giallo,Rebecca, AU - Lycett,Kate, AU - Mensah,Fiona, AU - Sciberras,Emma, Y1 - 2015/10/23/ PY - 2015/07/05/received PY - 2015/09/09/revised PY - 2015/09/11/accepted PY - 2016/2/6/entrez PY - 2016/2/6/pubmed PY - 2016/12/15/medline KW - ADHD KW - Externalizing KW - Internalizing KW - Sleep SP - 45 EP - 51 JF - Sleep medicine JO - Sleep Med VL - 17 N2 - BACKGROUND: Behavioral sleep problems are common in children with attention deficit hyperactivity disorder (ADHD), and longitudinal studies have found sleep problems to be both a predictor and outcome of internalizing and externalizing problems. We investigated the potential bidirectional relationship between sleep problems and internalizing/externalizing problems. METHODS: Children with ADHD, aged 5-13 years, were recruited from 21 pediatric practices across Victoria, Australia (N = 270). Across a 12-month period, at three time points, parents reported on their child's sleep problems (Children's Sleep Habits Questionnaire) and emotional and behavioral functioning (Strengths and Difficulties Questionnaire). Data were analyzed using autoregressive cross-lagged panel models. RESULTS: Sleep problem severity and emotional/behavioral problem severity were very stable across the 12-month period. Sleep problems at baseline predicted emotional problems at six months (r = 0.17, p < 0.01), and emotional problems at baseline predicted sleep problems at six months (r = 0.07, p < 0.05). However, there was no predictive relationship between sleep problems and emotional problems from 6-12 months. No bidirectional relationship was observed between sleep problems and conduct problems. CONCLUSIONS: In children with ADHD, there is weak evidence of a bidirectional relationship between sleep problems and emotional problems. These symptoms are also very stable over time; therefore, the best treatment approach to improve overall functioning may be to target both sleep and emotional functioning in these children. SN - 1878-5506 UR - https://www.unboundmedicine.com/medline/citation/26847973/The_bidirectional_relationship_between_sleep_problems_and_internalizing_and_externalizing_problems_in_children_with_ADHD:_a_prospective_cohort_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1389-9457(15)02012-2 DB - PRIME DP - Unbound Medicine ER -