Abstract
Sleep problems are highly prevalent in ADHD and autism spectrum disorder (ASD). Better insight in the etiology is of clinical importance since intervention and prevention strategies of sleep problems are directed at underlying mechanisms. We evaluated the association of sleep problems and sleep patterns with sleep hygiene (behavioral/environmental practices that influence sleep quality, e.g. caffeine use), access to electronic media, chronotype, and anxiety/depression in children aged 6–12 years with ADHD, ASD, or typical development (TD) using parental questionnaires. ANOVA and linear regression analyses were adjusted for age and sex. Children with ADHD and ASD showed more sleep problems (63.6 and 64.7%, vs 25.1% in TD) and shorter sleep duration than controls, while differences between ADHD and ASD were not significant. Sleep hygiene was worse in ADHD and ASD compared to TD, however, the association of worse sleep hygiene with more sleep problems was only significant in ASD and TD. There was a significant association of access to electronic media with sleep problems only in typically developing controls. Chronotype did not differ significantly between groups, but evening types were associated with sleep problems in ADHD and TD. Associations of greater anxiety/depression with more sleep problems were shown in ADHD and TD; however, anxiety/depression did not moderate the effects of chronotype and sleep hygiene. We conclude that sleep problems are highly prevalent in ADHD and ASD, but are differentially related to chronotype and sleep hygiene. In ASD, sleep problems are related to inadequate sleep hygiene and in ADHD to evening chronotype, while in TD both factors are important. Clinical implications are discussed.
Highlights
Sufficient and healthy sleep has proven to be important for developing children and adolescents [1]
Significant between group differences were found for disorders of initiating and maintaining sleep (DIMS), F(3,352) = 19.62, p < 0.001, as well as for DA, F(3,351) = 3.85, p = 0.01, sleep–wake transition disorders (SWTD), F(3,352) = 7.94, p < 0.001, disorders of excessive somnolence (DES), F(3,351) = 9.58, p < 0.001, SHY, F(3,352) = 4.18, p < 0.01, and total sleep problem score (TSP), F(3,352) = 19.15, p < 0.001 (Table 2)
Sleep onset during weekdays was around 30–45 min later in attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorders (ASD) than in controls
Summary
Sufficient and healthy sleep has proven to be important for developing children and adolescents [1]. In a significant part of the population (~30%) those internal circadian rhythms are relatively advanced or delayed with respect to the clock time [7] Those individuals are commonly referred to by ‘morning types’ or ‘evening types’, and the term used to denote this fairly stable trait is ‘chronotype’. Children with a high preference for eveningness (evening chronotypes) experience a discrepancy between social time and internal biological time, which is called ‘social jetlag’ During schooldays they show a significantly reduced sleep length due to their inability to fall asleep at night, and they struggle to wake up in the morning before the circadian pacemaker exerts its activating action on the psychophysiological arousal system [8]. Given the strong association of chronotype with behavioral and emotional problems the issue is important in child psychiatry
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