Inattention or insufficient sleep? A look at the association between sleep disturbances and ADHD symptoms in teens

Introduction: Children and teens with ADHD often report sleep disturbances; however, less literature has examined the role sleep plays in ADHD symptoms. Most of the studies to-date focus on children and adults with ADHD despite numerous reports that teens chronically experience sleep restriction as evidenced by the average teen reporting a school-night sleep duration of ~7.5 hours (at least 2 hours short of their actual need: 9-10 hours). In addition to insufficient sleep, teens are at increased risk of sleep disorders such as insomnia and delayed sleep phase. Next-day consequences of these conditions are frequently daytime sleepiness, moodiness, and inattention. Thus, it is important to assess the association of sleep disorder symptoms with reported ADHD symptoms in teens. The hypothesis was that teens who evidenced sleep disorder symptoms would exhibit more ADHD symptoms. Methods: Participants were 30 normal-to-obese teens (mean grade=10th, mean age=15.4 yrs, 80% females, 17% Hispanic) who reported shortened and irregular sleep patterns, but no history of sleep disorders. Following parental and teen consent, both parents and teens completed questionnaires inquiring about sleep and health. Parents and teens completed the Sleep Disorder Inventory for Students (SDISP and SDISA, respectively). Teens also reported on daytime sleepiness (Pediatric Daytime Sleepiness Scale: PDSS) and circadian phase preference (Composite Scale of Morningness: CS). Roughly one week later, parent-reported ADHD symptoms were collected using the ADHD-IV, a standardized ADHD screener. These data were collected as part of a larger, prospective study examining sleep and health in teens. Regression analyses examined parent- and teen-reported sleep disorder symptoms as a predictor of parent-reported ADHD symptoms with sex, grade, and age as covariates. Additional analyses are being conducted that will include self-reported sleep. Results: Analyses showed teen-reported daytime sleepiness predicted parent-reported ADHD symptoms (beta=0.43, P=0.030). Trend findings were found such that parent-reported ADHD symptoms were predicted by parent- and teen-reported sleep disorder symptoms (beta=0.34, P=0.087 and beta=0.35, P=0.094, respectively). Phase preference was not a significant predictor of ADHD symptoms. Conclusions: These findings provide evidence that daytime sleepiness, frequently the by-product of insufficient sleep the night before, is perceived as ADHD symptoms by parents. In addition, trend findings suggest that increased reported sleep disorder symptoms in teens without a history of sleep disorders also manifest as ADHD symptoms. Additional studies examining the effect of improving sleep should be done to further elucidate the connection between sleep and ADHD symptoms.