Factors Associated with Sleep Problems in Children with ADHD: Focusing on Emotional Regulation, Emotional Intensity and Internalizing Symptoms

Abstract

The current study aimed to investigate sleep problems in children with Attention Deficit Hyperactivity Disorder (ADHD) within a framework highlighting emotion regulation (ER), emotional intensity (EI), oppositional defiant symptoms, and internalizing symptoms. A total of 100 children with ADHD and 50 controls aged 6–14 were recruited from University Hospital, and were assessed with semi-structured interviews. Parents completed the Children’s Sleep Habits Questionnaire, Conners’ Parent Rating Scale–Revised-Short, Emotion Regulation Scale for Children–Adult Form, and the Revised Children Anxiety and Depression Scale-Parent. Group comparisons, correlations, multiple regressions, and serial mediation models were conducted, adjusting for age, gender, and other covariates. After correction for multiple comparisons, sleep parameters and internalizing symptoms did not differ between groups. In the ADHD group, total sleep problems were correlated with ADHD and oppositional symptoms, EI, ER, and internalizing symptoms. Regression models indicated that internalizing symptoms predicted total sleep problems, while EI predicted night wakings. Across mediation models, internalizing symptoms consistently mediated associations between ADHD/oppositional symptoms and total sleep problems, with EI/ER contributing indirectly via internalization. Findings suggest that sleep problems related to ADHD are related to pathways of emotional distress, emphasizing the importance of assessing internalizing symptoms concurrently with behavioral/emotional processes during the evaluation of sleep problems.