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Judith A. Owens, MD, MPH; Rolanda Maxim, MD; Chantelle Nobile, BA; Melissa McGuinn, BA; Michael Msall, MD

Arch Pediatr Adolesc Med. 2000;154:549-555.

Objective  To determine the prevalence of parent-reported and self-reported sleep disturbances in a sample of school-aged children with attention-deficit/hyperactivity disorder (ADHD).

Design  Cross-sectional survey questionnaire.

Setting  A multidisciplinary ADHD evaluation clinic in a children's teaching hospital (ADHD sample) and 3 elementary schools in southern New England (control sample).

Participants  Forty-six unmedicated, school-aged children (mean age, 89.4±18.7 months; 74% male) diagnosed as having ADHD by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria who had been screened for marked symptoms of sleep-disordered breathing, and 46 normal control children (mean age, 86.5±16.9 months; 70% male).

Intervention  None.

Main Outcome Measure  Sleep habits and sleep disturbances reported by parents and children.

Results  Children with ADHD had significantly higher (more sleep-disturbed) scores on all sleep subscales of the Children's Sleep Habits Questionnaire (parent measure) than did controls; average sleep duration as reported by parents was also significantly shorter in the ADHD group. Children with ADHD also reported their own sleep to be more disturbed than controls did on the Sleep Self-report, particularly on items relating to bedtime struggles (P range, .05-.001). There was a much higher correlation between parent and child sleep report items for the children with ADHD (mean correlation, 0.55) than for the control children.

Conclusions  Sleep disturbances, particularly at bedtime, are frequently reported by both parents and children with ADHD. Children undergoing evaluation for ADHD should be routinely screened for sleep disturbances, especially symptoms of sleep-disordered breathing. The causes of sleep-onset delay in children with ADHD should be considered in designing intervention strategies for children with difficulty falling and staying asleep.

From the Departments of Pediatrics (Drs Owens, Maxim, and Msall) and Child and Family Psychiatry (Mss Nobile and McGuinn), Brown University School of Medicine, Providence, RI.

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