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Child Psychiatrist /Adult Psychiatrist

Sleep Problems Affect Communication, Symptom Severity in Children With ADHD, ASD

Sleep dysfunction affects symptom severity and communication among children with ASD or ADHD.


Children With ADHD

Sleep problems mediated the relationship between symptom severity and communication difficulties among children with attention-deficit/hyperactivity disorder (ADHD) or with autism spectrum disorder (ASD), according to findings published in Autism Research. These results highlight the need to develop sleep interventions for these populations.


Sleep problems are commonly reported among children with ADHD and ASD. However, it remains unclear how this disturbed sleep could potentially contribute to or exacerbate ADHD and ASD symptoms. Investigators from the Universitat de València in Spain hypothesized that children with ADHD and ASD would have more sleep problems than typically developing children and that these sleep problems and associated symptom severity would be associated with reduced communication skills among cases.


The investigators recruited children (N=122) aged 7 to 12 years with ADHD (n=43) or ASD (n=47) from specialized psychoeducational care centers and matched (by age and intelligence quotient [IQ]) the cases with children who were developing typically (n=32). All study participants were assessed for sleep problems using the Sleep Disturbance Scale for Children (SDSC), for communication skills using the Children’s Communication Checklist second edition (CCC-2), and for symptom severity using a diagnostic interview for ADHD or the Autism Diagnostic Interview-Revised (ADI-R) instrument.


The ADHD, ASD, and control groups comprised 90.7%, 89.3%, and 65.6% boys (P =.006); were 9.29, 9.37, and 8.75 years of age, on average; and their IQ was 98.94, 98.37, and 100.4, respectively.


In a multivariate analysis, a significant main effect of group was observed for SDSC scores (F[12,214], 4.76; P <.001), in which there were significant group differences for all SDSC dimensions. In a post-hoc analysis, the ADHD and ASD groups differed significantly from the controls on all SDSC dimensions, except for sleep breathing disorders and sleep hyperhidrosis.


Out of a total of 45 pairwise comparisons assessing the correlations between sleep problems, communication skills, and symptom severity, 37 significant correlations were observed among children with ADHD and 25 correlations were observed among children with ASD.


Among children with ADHD and ASD, total sleep problem scores correlated (all P £.05) with structural communication (r, ADHD: 0.61; ASD: 0.33), pragmatic communication (r, ADHD: 0.55; ASD: 0.47), and symptoms severity (r, ADHD: 0.42; ASD: 0.32).


In the multiple regression analyses, sleep problems and symptoms severity explained 44% of the variance in structural language and 35% of the variance in pragmatic language among children with ADHD. For children with ASD, sleep problems and symptoms severity explained 22% of the variance in structural communication dysfunction and 49% of the variance in pragmatic communication dysfunction.


In the final models, for both groups, symptom severity, sleep problems, and communication skills were all significantly related with indirect effects of symptom severity on communication skills mediated through sleep problems.


Study authors concluded, “The results of the mediation analysis indicate that in both groups, sleep problems mediate the relationship between symptoms and communication skills, so sleep difficulties have an indirect and partial effect on the communication challenges that these children experience.”


Study limitations include the small sample size, imbalance in participant gender, and lack of participation of children with intellectual disabilities.


This article originally appeared on Psychiatric Advisor

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