0497 Associations between Sleep Problems and ADHD Symptoms in Early Childhood: A Longitudinal, Primary-Care Based Study

Abstract

Abstract Introduction Sleep problems are common, impairing correlates of ADHD. These associations may emerge as early as toddlerhood, suggesting sleep-focused interventions in early development may improve ADHD-related outcomes. However, previous research has been limited by cross-sectional methodology and small, clinically-referred samples. Thus, relationships between sleep and ADHD symptoms over time and in non-clinical samples remain unknown. The current study evaluated concurrent and longitudinal relationships between sleep problems and ADHD symptoms in early childhood in a large, non-clinical sample. Methods Children were recruited from primary care clinics at an academic medical center and assessed at two time points: T1 (n=1806, mean age: 20 months) and T2 (n=646, mean age: 37 months). Sleep problems and ADHD symptoms were evaluated via the caregiver-reported Child Behavior Checklist (CBCL) Sleep and DSM-Oriented ADHD scales, respectively. At T2, caregivers also completed the ADHD Rating Scale (ADHD-RS), which includes inattention and hyperactive/impulsive subscales. Associations between sleep and ADHD were examined using Pearson correlations at each time point. Stability of and longitudinal relationships between sleep and ADHD symptoms were also examined. Results Greater sleep problems were correlated with elevated CBCL ADHD at T1 (r=.40, p<.001) and T2 (r=.49, p<.001). At T2, greater sleep problems were also related to increased ADHD-RS scores (r=.44, p<.001), with similar relationships for inattention (r=.41) and hyperactivity/impulsivity (r=.43). Sleep problems (r=.51, p<.001) and CBCL ADHD (r=.52, p<.001) were moderately stable over time. Using the CBCL, partial correlations indicated that T1 sleep was associated with T2 ADHD after controlling for T1 ADHD (r=.11, p<.01); T1 ADHD was associated with T2 sleep problems after controlling for T1 sleep problems (r=.17, p<.001). Conclusion Sleep disturbances and ADHD symptoms were bi-directionally associated in a non-clinical sample of young children recruited in primary care. Results are consistent with conceptualization of ADHD as a 24-hour disorder and suggest that incorporating behavioral sleep techniques into empirically-based ADHD treatments may improve clinical outcomes for young children displaying ADHD symptoms. Future research may focus on 1) optimizing identification of toddlers and preschoolers at risk for sleep problems and ADHD and 2) developing interventions that can be delivered in primary care settings. Support (If Any) P50HD093074 , K23MH108704