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  • Clinical Research Article
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Sleep and internalizing problems in primary school children with attention-deficit hyperactivity disorder

Pediatric Research (2024)Cite this article

Abstract

Background

Internalizing and externalizing problems have received great attention, and children with ADHD exhibit high rates of comorbid internalizing and externalizing disorders. This study aimed to explore the relationship between sleep and internalizing problems in children with attention-deficit hyperactivity disorder (ADHD) and the probable mediating role of externalizing problems.

Methods

A total of 203 primary school children diagnosed with ADHD for the first time were recruited for this study. Children with ADHD were evaluated by Children’s Sleep Habits Questionnaire (CSHQ), Strengths and Difficulties Questionnaire (SDQ). Internalizing problems were represented by emotional symptoms and peer problems of SDQ, and externalizing problems were represented by conduct problems and hyperactivity-inattention problems of SDQ. Multi-step linear regression analysis was used to investigate the mediating effect of externalizing problems on the relationship between sleep and internalizing problems.

Results

Sleep in children with ADHD was associated with emotional problems in internalizing problems, and conduct problems in externalizing problems mediated the association between sleep and emotional problems.

Conclusion

For children with ADHD, when it is difficult to identify internalizing problems, especially emotional problems, we can take sleep and externalizing problems as clues to improve our clinical ability to recognize and deal with emotional problems.

Impact

  1. 1.

    We first explored the possible mediating role of conduct problems between sleep and emotional problems in primary school children with ADHD.

  2. 2.

    When it is difficult to identify internalizing problems, especially emotional problems, we can take sleep and externalizing problems as clues to improve our clinical ability to recognize emotional problems for children with ADHD.

  3. 3.

    For children with ADHD with potential internalizing problems, especially emotional problems, interventions for their sleep and externalizing problems may be the possible methods to deal with.

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Data availability

Deidentified individual participant data (including data dictionaries) will be made available, in addition to study protocols, the statistical analysis plan, and the informed consent form. The data will be made available upon publication to researchers who provide a methodologically sound proposal for use in achieving the goals of the approved proposal. Proposals should be submitted to du_lin@jlu.edu.cn; or donghanyu@jlu.edu.cn

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Acknowledgements

The authors are deeply thankful to all the families who contributed their time to this study in order to better understand ADHD.

Funding

All phases of this study were supported by The Health science and technology capacity improvement project of Jilin Province, 2022LC104; Provincial science and Technology Department project, 20230203067SF; Youth Development Fund of the First Hospital of Jilin University, JDYY14202328; The Health science and technology capacity improvement project of Jilin Province, 2023LC005.

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Authors and Affiliations

  1. Department of Developmental and Behavioral Pediatrics, Children’s Medical Center, The First Hospital of Jilin University, Changchun, China

    Han-Yu Dong, Chun-Yue Miao, Yang Xue, Yu Zhang, Ling Shan, Fei-Yong Jia & Lin Du

  2. The Child Health Clinical Research Center of Jilin Province, Changchun, China

    Han-Yu Dong, Chun-Yue Miao, Yang Xue, Yu Zhang, Ling Shan, Fei-Yong Jia & Lin Du

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  1. Han-Yu Dong
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Contributions

Conceptualization, Han-Yu Dong and Fei-Yong Jia; Methodology, Chun-Yue Miao, Yang Xue; Software, Chun-Yue Miao, Yang Xue; Validation, Yu Zhang and Ling Shan; Formal Analysis, Chun-Yue Miao, Yang Xue; Investigation, Han-Yu Dong; Resources, Lin Du; Data Curation, Yu Zhang and Ling Shan; Writing – Original Draft Preparation, Han-Yu Dong; Writing – Review & Editing, Lin Du; Visualization, Fei-Yong Jia; Supervision, Lin Du; Project Administration, Lin Du; Funding Acquisition, Fei-Yong Jia, Han-Yu Dong and Ling Shan, All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Lin Du.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of the first hospital of Jilin University. Informed consent was obtained from all subjects involved in the study.

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Dong, HY., Miao, CY., Xue, Y. et al. Sleep and internalizing problems in primary school children with attention-deficit hyperactivity disorder. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03213-4

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