Sleep Difficulties Show Up Early in Children with ADHD

December 1, 2022

Sleep disturbances in early childhood are associated with early signs of attention-deficit/hyperactivity disorder (ADHD), Duke Center for Autism researchers have found. In a study funded by the National Institutes of Health (NIH), center researchers studied 646 children over time, and found that toddlers whose parents reported high levels of sleep problems, such as bedtime struggles and nighttime waking, also were more likely to have difficulties in sustaining attention and hyperactivity, which are behaviors related to ADHD. Naomi Davis, PhD, assistant professor of psychiatry and behavioral sciences and a psychologist and researcher at the Duke Center for Autism, led the study.

Families in the study filled out questionnaires about their children’s behavior and development at two time points, first when children were 18-24 months old and again when children were around age three. Davis and her team grouped children based on parent-reported levels of ADHD-related behaviors when they were three years old. The investigators found that those who were deemed “high risk” for ADHD had significantly more parent-reported sleep problems compared to the three-year-olds who were at lower risk for ADHD.

Importantly, the study team noted that these sleep-behavior associations were also true for children over time. Toddler sleep problems were associated with preschool ADHD symptoms, and toddler ADHD symptoms were associated with preschool sleep symptoms. These associations were found over time, even when the researchers took into account associations between sleep and ADHD in the preschool period.

Researchers have studied naturalistic and stimulant interventions for sleep disorders in children with autism. As a member of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology, Duke Center for Autism Director Geraldine Dawson, PhD, co-authored, “Practice guideline: Treatment for insomnia and disrupted sleep behavior in children and adolescents with autism spectrum disorder,” addressing recommendations for autistic children.

For those with ADHD, Davis explains that more research is needed and a holistic approach will work best.

“Put simply, the sleep-behavior association seems to start early and hang together over time,” said Davis. “Because sleep and attention problems seem to be associated over time, we need to work to find strategies that help identify young children who are at risk for both these challenges. Supports and interventions will likely be more effective if a ‘whole-child’ approach is used — one that starts early and addresses both sleep and behavior challenges together."

Jessica Lunsford-Avery, PhD, also an assistant professor of psychiatry and behavioral sciences and a co-investigator on the study with Davis, shared some of the research findings in a poster, “Associations between Sleep Problems and ADHD Symptoms in Early Childhood: A Longitudinal, Primary-Care Based Study,” at the Associated Professional Sleep Societies Annual Meeting in June 2022.

“We need to dig deeper into the factors and implications of early sleep and attention problems to create supports and solutions that work for families,” said Davis.

Williams Buckley, A., Hirtz, D., Oskoui, M., Armstrong, M. J., Batra, A., Bridgemohan, C., Coury, D., Dawson, G., Donley, D., Findling, R. L., Gaughan, T., Gloss, D., Gronseth, G., Kessler, R., Merillat, S., Michelson, D., Owens, J., Pringsheim, T., Sikich, L., Stahmer, A., Ashwal, S. (2020). Practice guideline: Treatment for insomnia and disrupted sleep behavior in children and adolescents with autism spectrum disorder: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology, 94(9), 392–404.