Attention-deficit/hyperactivity disorder and sleep problems

grantor: University of Toronto'Objective'. This thesis tests two opposing explanations for sleep difficulties in children with ADHD: (1) sleep problems are intrinsic to ADHD; and (2) sleep problems are extrinsic to ADHD. 'Method'. Three research studies were conducted as part of this thesis. The first study was a box-score analysis of previous research that evaluated for consistency in findings across studies and highlighted methodological issues. The second study tested the specificity of sleep problems to ADHD utilizing sleep questionnaires completed by parents of four groups of children (n = 172): unmedicated ADHD, medicated ADHD, clinical, and normal comparison groups. The third study examined six sleep parameters in 50 children (25 ADHD, 25 normal comparison) to verify sleep problems in children with ADHD through the use of multiple measures (i.e., questionnaires, sleep diaries, and actigraphy). 'Results'. The main finding from each study is outlined below. Firstly, it was found that across previous research, there is little consistent evidence for sleep problems in children with ADHD. Secondly, sleep problems were not found to be specific to ADHD, but were also found in a clinical comparison group. Moreover, specific sleep problems were related to stimulant medication use and comorbidity (e.g., oppositional defiant disorder and anxiety disorders). Thirdly, although sleep problems were reported by parents on a retrospective questionnaire, the majority of these sleep problems were not verified through sleep diaries or actigraphy. The only consistent finding across measures were that children with ADHD had longer sleep duration and more bedtime resistance (i.e., challenging behaviours). 'Conclusions'. The majority of the results across the three studies provide support for the notion that many of the commonly reported sleep problems in children with ADHD may be extrinsic in nature. More specifically, challenging behaviours during bedtime routines may account for these sleep problems. Clinically, it would seem that behavioural interventions should be the first line of treatment for sleep problems in children with ADHD.Ph.D