Abstract
Introduction
Circadian rhythm disturbances, including delayed circadian rhythm and increased motor activity, are commonly seen in attention-deficit hyperactivity disorder (ADHD). Previous research suggested a link between circadian rhythm disturbances and poor psychosocial functioning in children, but such a relationship has not been examined in children with ADHD. This study aimed at examining the association between circadian-related parameters and psychosocial functioning in children with ADHD.
Methods
Seventy-nine children with ADHD were recruited into this study (age range: 6–12 years, 75.9% male). They were assessed by parent-report questionnaires on sleep problems (Children’s Sleep Habits Questionnaire, CSHQ), ADHD symptoms (Strengths and Weaknesses of ADHD Symptoms and Normal Behaviour Scale, SWAN), and psychosocial functioning (Strengths and Difficulties Questionnaire, SDQ). Actigraphic data collected for seven consecutive days were analyzed using parametric and nonparametric methods. The relationship between circadian parameters and psychosocial functioning was analyzed using multiple regression while controlling for age, sex, ADHD medication, total sleep time, and CSHQ total score.
Results
Later acrophase was significantly associated with higher scores on SDQ emotional problems (St. β = 0.30, p = 0.03) and SWAN inattention subscale (St. β = 0.27, p = 0.043). Lower relative amplitude was associated with higher scores on SDQ hyperactivity symptoms (St. β = -0.29, p = 0.045) and SDQ total difficulties (St. β = -0.31, p = 0.036). Higher levels of mean activity level during the least active 5-h period (L5) were related to higher scores on SDQ peer problems (St. β = 0.38, p = 0.021), SDQ internalizing problems (St. β = 0.38, p = 0.020) and SDQ total difficulties (St. β = 0.33, p = 0.036). Later onset of L5 was associated with increased SDQ emotional problems (St. β = 0.26, p = 0.046).
Conclusion
Circadian rest-activity rhythm disturbances (delayed phase, blunted rest-activity rhythms, higher level of nocturnal activity, and later onset of nocturnal rest) were associated with poor psychosocial functioning in children with ADHD. Further longitudinal studies are needed to examine the effects of circadian disruption on psychosocial functioning in children with ADHD.
Support (if any)
This work was supported by the Health and Medical Research Fund (Project No.: 30160604).
Distracted from sleep : chronic sleep onset insomnia in children with attention-deficit/hyperactivity disorder
