Contributions of circadian tendencies and behavioral problems to sleep onset problems of children with ADHD

BACKGROUND: Children with attention-deficit/hyperactivity disorder (ADHD) are two to three times more likely to experience sleep problems. The purpose of this study is to determine the relative contributions of circadian preferences and behavioral problems to sleep onset problems experienced by children with ADHD and to test for a moderation effect of ADHD diagnosis on the impact of circadian preferences and externalizing problems on sleep onset problems. METHODS: After initial screening, parents of children meeting inclusion criteria documented child bedtime over 4 nights, using a sleep log, and completed questionnaires regarding sleep, ADHD and demographics to assess bedtime routine prior to PSG. On the fifth night of the study, sleep was recorded via ambulatory assessment of sleep architecture in the child’s natural sleep environment employing portable polysomnography equipment. Seventy-five children (26 with ADHD and 49 controls) aged 7–11 years (mean age 8.61 years, SD 1.27 years) participated in the present study. RESULTS: In both groups of children, externalizing problems yielded significant independent contributions to the explained variance in parental reports of bedtime resistance, whereas an evening circadian tendency contributed both to parental reports of sleep onset delay and to PSG-measured sleep-onset latency. No significant interaction effect of behavioral/circadian tendency with ADHD status was evident. CONCLUSIONS: Sleep onset problems in ADHD are related to different etiologies that might require different interventional strategies and can be distinguished using the parental reports on the CSHQ

Evaluation of an internet-based behavioral intervention to improve psychosocial health outcomes in children with insomnia (Better Nights, Better Days): Protocol for a randomized controlled trial

Background: Up to 25% of 1- to 10-year-old children experience insomnia (ie, resisting bedtime, trouble falling asleep, night awakenings, and waking too early in the morning). Insomnia can be associated with excessive daytime sleepiness and negative effects on daytime functioning across multiple domains (eg, behavior, mood, attention, and learning). Despite robust evidence supporting the effectiveness of behavioral treatments for insomnia in children, very few children with insomnia receive these treatments, primarily due to a shortage of available treatment resources. Objective: The Better Nights, Better Days (BNBD) internet-based program provides a readily accessible electronic health (eHealth) intervention to support parents in providing evidence-based care for insomnia in typically developing children. The purpose of the randomized controlled trial (RCT) is to evaluate the effectiveness of BNBD in treating insomnia in children aged between 1 and 10 years. Methods: BNBD is a fully automated program, developed based on evidence-based interventions previously tested by the investigators, as well as on the extant literature on this topic. We describe the 2-arm RCT in which participants (500 primary caregivers of children with insomnia residing in Canada) are assigned to intervention or usual care. Results: The effects of this behavioral sleep eHealth intervention will be assessed at 4 and 8 months postrandomization. Assessment includes both sleep (actigraphy, sleep diary) and daytime functioning of the children and daytime functioning of their parents. Results will be reported using the standards set out in the Consolidated Standards of Reporting Trials statement. Conclusions: If the intervention is supported by the results of the RCT, we plan to commercialize this program so that it is sustainable and available at a low cost to all families with internet access

Children\u27s Sleep during COVID-19: How Sleep Influences Surviving and Thriving in Families

Objective The COVID-19 pandemic has the potential to disrupt the lives of families and may have implications for children with existing sleep problems. As such, we aimed to: (1) characterize sleep changes during the COVID-19 pandemic in children who had previously been identified as having sleep problems, (2) identify factors contributing to sleep changes due to COVID-19 safety measures, and (3) understand parents and children s needs to support sleep during the pandemic. Methods Eighty-five Canadian parents with children aged 4 14 years participated in this explanatory sequential, mixed-methods study using an online survey of children s and parents sleep, with a subset of 16 parents, selected based on changes in their children s sleep, participating in semi-structured interviews. Families had previously participated in the Better Nights, Better Days (BNBD) randomized controlled trial. Results While some parents perceived their child s sleep quality improved during the COVID-19 pandemic (14.1%, n 12), many parents perceived their child s sleep had worsened (40.0%, n 34). Parents attributed children s worsened sleep to increased screen time, anxiety, and decreased exercise. Findings from semi-structured interviews highlighted the effect of disrupted routines on sleep and stress, and that stress reciprocally influenced children s and parents sleep. Conclusions The sleep of many Canadian children was affected by the first wave of the COVID-19 pandemic, with the disruption of routines influencing children s sleep. eHealth interventions, such as BNBD with modifications that address the COVID-19 context, could help families address these challenges

The Association between Sleep and Theory of Mind in School Aged Children with ADHD

Theory of Mind (ToM) is defined as the ability to infer a range of internal mental states of others, including beliefs, intentions, desires, and emotions. These abilities are associated with children’s ability to socialize effectively with peers. ToM impairments are associated with peer rejection and psychiatric disorders such as Attention-Deficit/Hyperactivity Disorder (ADHD). Previous studies have found poor sleep negatively impacts executive functioning (EF) and emotional information processing, which are essential for the effective use of ToM. Youth with ADHD have EF deficits and sleep problems. However, the relationship between sleep, executive functioning, and ToM in children with ADHD has not been studied. In this review, we propose that the poor social and interpersonal skills characterizing individuals with ADHD could be explained by the impact of poor sleep on the emotional and cognitive mechanisms underlying ToM

Association between the Munich Chronotype Questionnaire and Wrist Actigraphy

Chronotype refers to individuals’ preferences for timing of sleep and wakefulness. It can be quantified by measuring the midpoint time between the start and end of sleep during free days. Measuring chronotype is helpful to diagnose circadian rhythm sleep-wake disorders. The Munich Chronotype Questionnaire (MCTQ) is a self-reported measure of chronotype that calculates the midpoint of sleep on free days based on self-reported bed and wake times. Self-reports of sleep are prone to bias. The objective was to examine the agreement between the MCTQ-derived midpoint and an objective measure obtained using wrist actigraphy. The sleep of 115 participants aged 18–34 (mean = 24, SD = 4.6) was monitored with actigraphy for 4 to 6 consecutive nights. The corrected midpoint of sleep on free days was derived from sleep start and end times on both free days and scheduled days. The corrected midpoint of sleep on free days as measured by the MCTQ was 4:56 (SD = 1 : 16) and by actigraphy was 4:51 (SD = 1 : 23). They were not significantly different (t(87)=0.66, p=0.51). A strong correlation was found between these two measurements (r(88)=0.73, p<0.001). The 95% limits of agreement were between −1:37:19 and 2:14:38. MCTQ and actigraphy provide similar results for the corrected midpoint of sleep on free days

Pre-pandemic sleep behavior and adolescents’ stress during Covid-19: a prospective longitudinal study

International audienceAbstract Objective To prospectively document changes in adolescents’ sleep before versus during the COVID-19 pandemic, and to examine their impact on adolescents’ perceived stress. Methods Sixty-two typically developing adolescents participated in the study before (Time 1: January 15 to March 13, 2020) and during (Time 2: May 15 to June 30, 2020) the COVID-19 pandemic in Canada. At Time 1, each participant’s sleep pattern was assessed in the home environment using actigraphy and sleep logs for seven consecutive nights. Adolescents completed a battery of questionnaires in which they reported on their sleep schedule, duration, and quality, as well as their activities at bedtime, their daytime sleepiness, and their social/emotional behavior. The participants’ parents provided demographic information. At Time 2, each participant completed a sleep log, the same battery of questionnaires regarding sleep, and the Perceived Stress Scale. Results (1) Adolescents’ reported sleep was of longer duration and on a delayed schedule during the COVID-19 pandemic compared to pre-pandemic. (2) A larger proportion of adolescents reported meeting or exceeding the recommended amount of sleep during the COVID-19 pandemic compared to pre-pandemic sleep. (3) “Social jet lag” disappeared during the COVID-19 pandemic. (4) A shorter reported sleep duration and higher level of arousal at bedtime at Time 1 were significant predictors of adolescents’ perceived stress at Time 2—during the COVID-19 pandemic. (5) A higher levels of arousal at bedtime and lower reported sleep quality at Time 2 were concurrently associated with higher levels of perceived stress among adolescents, even when we controlled for the levels of pre-pandemic emotional or behavioral issues, sleep duration, or sleep quality. Conclusion Sleep duration and cognitive-emotional arousal, which are both modifiable behaviors, were associated with adolescents’ perceived stress during the COVID-19 pandemic. These behaviors could be useful targets for preventive interventions aiming to reduce adolescents’ stress in the face of stressogenic situations, such as the COVID-19 pandemic

Parental social capital and children's sleep disturbances

Objectives Sleep plays a critical role in the health and well-being of children. Individual and household factors, including parent's social connections, may impact children's sleep. Our study assessed the association between children's sleep disturbances and parent's social capital in a sample of Canadian households. Design Cross-sectional, observational study. Settings and participants Data came from 339 children and their parents who completed a telephone and follow-up survey in 2013 as part of the Canada Brain-to-Society study. Participants were parents (73.1% female) with children aged 6 to 12 years residing in Montreal, Canada. Measurements Parental social capital was assessed using a position generator, and children's sleep disturbances were measured with the Children's Sleep Habits Questionnaire. Other household demographic and socioeconomic characteristics were measured, including parental and child age and sex, foreign-born status, and income. Linear regression was used to examine the association between parental social capital and children's sleep disturbances while controlling for possible confounders. Results Parental social capital was negatively associated with children's sleep disturbances (β = −0.02, SE = 0.01, P < .05), when controlling for demographic factors (sex of parent, household income, foreign-born status, parent's age, sex and age of child, suggesting that children of parents with higher social capital had fewer sleep disturbances. Conclusions Parents with higher social capital tended to have children with few total sleep disturbances than did parents with lower social capital. Parental social capital may be a potentially modifiable aspect of the home environment that has implications for children's health