The Relationship Between ADHD Symptom Severity and Sleep Disturbance Using Accelerometer and the Subjective Sleep Disturbance Scale

Abstract

Objective:

There is limited evidence regarding the relationship between the severity of ADHD symptoms and the level of sleep disruption in early adolescent children. This study aimed to better understand this relationship by studying early adolescents from the Adolescent Brain Cognitive Development (ABCD) Study at the 2-year follow-up visit (mean age 12.0, n = 4,414).

Methods:

The “Attention Problems” scale of the Child Behavior Checklist (CBCL) was used to measure the severity of ADHD symptoms for study participants. Sleep was assessed both subjectively with the Sleep Disturbance Scale for Children (SDSC) via parent report and objectively by wrist-worn accelerometer assessment of sleep duration.

Results:

Total sleep disturbance showed a moderate positive correlation with ADHD symptoms (r = .41, p < .001). In contrast, there was only a very small negative correlation between accelerometer-measured sleep duration and ADHD symptoms (r = −.05, p < .001). Multivariate linear regression with total SDSC score as the dependent variable, adjusting for demographics, medication use, and puberty stage, showed a positive association of ADHD symptoms with total SDSC score (β = .41, 95% CI [0.38–0.44]; p < .001). A longitudinal linear mixed-effects model analysis with total SDSC score as the dependent variable also showed a positive association with ADHD symptoms with total SDSC score (β = .34, 95% CI [0.32–0.35]; p < .001). In contrast, multivariate linear regression with total sleep duration (in minutes) as the dependent variable showed only a very small negative association (β = −.03, 95% CI [−0.0–0.00]; p < .05).

Conclusions:

Our study shows that increased severity of ADHD symptoms is associated with worse sleep disturbance as measured by subjective parent reports; however, there is a very weak relationship between ADHD symptoms and objectively measured total sleep duration. The contrasting results are consistent with prior literature, and could be due to unmeasured variables such as deep sleep percentage or non-REM EEG delta wave power that are not captured by actigraphy. Alternatively, there is the possibility of mono-informant bias, as both the CBCL and SDSC are parent-reported, and parents may perceive relationship between worse ADHD symptoms and worse sleep disturbances, though the difference is objectively negligible.

Keywords

ADHD-associated problems sleep disorders adolescence stimulants puberty

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References

American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association.

Ayano

Tsegay

Gizachew

Necho

Yohannes

Abraha

Demelash

Anbesaw

Alati

(2023). Prevalence of attention deficit hyperactivity disorder in adults: Umbrella review of evidence generated across the globe. Psychiatry Research, 328, 115449. https://doi.org/10.1016/j.psychres.2023.115449

Bagot

K. S.

Matthews

S. A.

Mason

Squeglia

L. M.

Fowler

Gray

Herting

May

Colrain

Godino

Tapert

Brown

Patrick

(2018). Current, future and potential use of mobile and wearable technologies and social media data in the ABCD study to increase understanding of contributors to child health. Developmental Cognitive Neuroscience, 32, 121–129. https://doi.org/10.1016/j.dcn.2018.03.008

Baird

A. L.

Coogan

A. N.

Siddiqui

Donev

R. M.

Thome

(2012). Adult attention-deficit hyperactivity disorder is associated with alterations in circadian rhythms at the behavioural, endocrine and molecular levels. Molecular Psychiatry, 17(10), 988–995. https://doi.org/10.1038/mp.2011.149

Becker

S. P.

(2020). ADHD and sleep: Recent advances and future directions. Current Opinion in Psychology, 34, 50–56. https://doi.org/10.1016/j.copsyc.2019.09.006

Blakemore

S. J.

Mills

K. L.

(2014). Is adolescence a sensitive period for sociocultural processing? Annual Review of Psychology, 65, 187–207. https://doi.org/10.1146/annurev-psych-010213-115202

Bondopadhyay

Diaz-Orueta

Coogan

A. N.

(2021). The role of the circadian system in attention deficit hyperactivity disorder. Advances in Experimental Medicine and Biology, 1344, 113–127. https://doi.org/10.1007/978-3-030-81147-1_7

Bozinovic

McLamb

O'Connell

Olander

Feng

Haagensen

Bozinovic

(2021). U.S. national, regional, and state-specific socioeconomic factors correlate with child and adolescent ADHD diagnoses pre-COVID-19 pandemic. Scientific Reports, 11(1), 22008. https://doi.org/10.1038/s41598-021-01233-2

Brevik

E. J.

Lundervold

A. J.

Halmøy

Posserud

M. B.

Instanes

J. T.

Bjorvatn

Haavik

(2017). Prevalence and clinical correlates of insomnia in adults with attention-deficit hyperactivity disorder. Acta Psychiatrica Scandinavica, 136(2), 220–227. https://doi.org/10.1111/acps.12756

10.

Bruni

Ottaviano

Guidetti

Romoli

Innocenzi

Cortesi

Giannotti

(1996). The sleep disturbance scale for children (SDSC). Construction and validation of an instrument to evaluate sleep disturbances in childhood and adolescence. Journal of Sleep Research, 5(4), 251–261. https://doi.org/10.1111/j.1365-2869.1996.00251.x

11.

Chang

L. Y.

Wang

M. Y.

Tsai

P. S.

(2016). Diagnostic accuracy of rating scales for attention-deficit/hyperactivity disorder: A meta-analysis. Pediatrics, 137(3), e20152749. https://doi.org/10.1542/peds.2015-2749

12.

Cheng

T. W.

Magis-Weinberg

Guazzelli Williamson

Ladouceur

C. D.

Whittle

S. L.

Herting

M. M.

Uban

K. A.

Byrne

M. L.

Barendse

M. E. A.

Shirtcliff

E. A.

Pfeifer

J. H.

(2021). A researcher’s guide to the measurement and modeling of puberty in the ABCD study (R) at baseline. Frontiers in Endocrinology, 12, 608575. https://doi.org/10.3389/fendo.2021.608575

13.

Chen

W. J.

Faraone

S. V.

Biederman

Tsuang

M. T.

(1994). Diagnostic accuracy of the child behavior checklist scales for attention-deficit hyperactivity disorder: A receiver-operating characteristic analysis. Journal of Consulting and Clinical Psychology, 62(5), 1017–1025. https://doi.org/10.1037/0022-006X.62.5.1017

14.

Corkum

Tannock

Moldofsky

(1998). Sleep disturbances in children with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 37(6), 637–646. https://doi.org/10.1097/00004583-199806000-00014

15.

Cortese

Faraone

S. V.

Konofal

Lecendreux

(2009). Sleep in children with attention-deficit/hyperactivity disorder: Meta-analysis of subjective and objective studies. Journal of the American Academy of Child and Adolescent Psychiatry, 48(9), 894–908. https://doi.org/10.1097/CHI.0b013e3181ac09c9

16.

Crowley

S. J.

Wolfson

A. R.

Tarokh

Carskadon

M. A.

(2018). An update on adolescent sleep: New evidence informing the perfect storm model. Journal of Adolescence, 67, 55–65. https://doi.org/10.1016/j.adolescence.2018.06.001

17.

Dash

G. F.

Carter

Karalunas

S. L.

Hudson

K. A.

Fair

Feldstein Ewing

S. W.

(2023). Twin study of caffeine use, ADHD, and disrupted sleep in ABCD youth. Health Psychology, 42(12), 889–893. https://doi.org/10.1037/hea0001252

18.

de Zambotti

Baker

F. C.

Willoughby

A. R.

Godino

J. G.

Wing

Patrick

Colrain

I. M.

(2016). Measures of sleep and cardiac functioning during sleep using a multi-sensory commercially-available wristband in adolescents. Physiology & Behavior, 158, 143–149. https://doi.org/10.1016/j.physbeh.2016.03.006

19.

Díaz-Román

Mitchell

Cortese

(2018). Sleep in adults with ADHD: Systematic review and meta-analysis of subjective and objective studies. Neuroscience and Biobehavioral Reviews, 89, 61–71. https://doi.org/10.1016/j.neubiorev.2018.02.014

20.

Duffy

K. A.

Helwig

N. E.

(2024). Resting-state functional connectivity predicts attention problems in children: Evidence from the ABCD study. Neurosciences, 5(4), 445–461. https://doi.org/10.3390/neurosci5040033

21.

Feng

Zhi

Luo

Calhoun

Sui

(2025). Genetic etiology link to brain function underlying ADHD symptoms and its interaction with sleep disturbance: An ABCD study. Neuroscience Bulletin, 41, 1041–1053. https://doi.org/10.1007/s12264-025-01349-9

22.

Garavan

Bartsch

Conway

Decastro

Goldstein

R. Z.

Heeringa

Jernigan

Potter

Thompson

Zahs

(2018). Recruiting the ABCD sample: Design considerations and procedures. Developmental Cognitive Neuroscience, 32, 16–22. https://doi.org/10.1016/j.dcn.2018.04.004

23.

Giddens

N. T.

Juneau

Manza

Wiers

C. E.

Volkow

N. D.

(2022). Disparities in sleep duration among American children: Effects of race and ethnicity, income, age, and sex. Proceedings of the National Academy of Sciences of the United States of America, 119(30), e2120009119. https://doi.org/10.1073/pnas.2120009119

24.

Godino

J. G.

Wing

de Zambotti

Baker

F. C.

Bagot

Inkelis

Pautz

Higgins

Nichols

Brumback

Chevance

Colrain

I. M.

Patrick

Tapert

S. F.

(2020). Performance of a commercial multi-sensor wearable (Fitbit charge HR) in measuring physical activity and sleep in healthy children. PLoS One, 15(9), e0237719. https://doi.org/10.1371/journal.pone.0237719

25.

Haghayegh

Khoshnevis

Smolensky

M. H.

Diller

K. R.

Castriotta

R. J.

(2019). Accuracy of wristband fitbit models in assessing sleep: Systematic review and meta-analysis. Journal of Medical Internet Research, 21(11), e16273. https://doi.org/10.2196/16273

26.

Harrison

J. N.

Cluxton-Keller

Gross

(2012). Antipsychotic medication prescribing trends in children and adolescents. Journal of Pediatric Health Care, 26(2), 139–145. https://doi.org/10.1016/j.pedhc.2011.10.009

27.

Heeringa

S. G.

Berglund

P. A.

(2020). A guide for population-based analysis of the adolescent brain cognitive development (ABCD) study baseline data. bioRxiv. https://doi.org/doi:10.1101/2020.02.10.942011

28.

Kim

E. H.

Jenness

J. L.

Miller

A. B.

Halabi

de Zambotti

Bagot

K. S.

Baker

F. C.

Pratap

(2023). Association of demographic and socioeconomic indicators with the use of wearable devices among children. JAMA Network Open, 6(3), e235681. https://doi.org/10.1001/jamanetworkopen.2023.5681

29.

Kim

W. P.

Kim

H. J.

Pack

S. P.

Lim

J. H.

Cho

C. H.

Lee

H. J.

(2023). Machine learning-based prediction of attention-deficit/hyperactivity disorder and sleep problems with wearable data in children. JAMA Network Open, 6(3), e233502. https://doi.org/10.1001/jamanetworkopen.2023.3502

30.

Langberg

J. M.

Molitor

S. J.

Oddo

L. E.

Eadeh

H. M.

Dvorsky

M. R.

Becker

S. P.

(2020). Prevalence, patterns, and predictors of sleep problems and daytime sleepiness in young adolescents with ADHD. Journal of Attention Disorders, 24(4), 509–523. https://doi.org/10.1177/1087054717690810

31.

Larsson

Anckarsater

Råstam

Chang

Lichtenstein

(2012). Childhood attention-deficit hyperactivity disorder as an extreme of a continuous trait: A quantitative genetic study of 8,500 twin pairs. Journal of Child Psychology and Psychiatry, 53(1), 73–80. https://doi.org/10.1111/j.1469-7610.2011.02467.x

32.

Lewis-de Los Angeles

W. W.

Liu

R. T.

(2021). History of depression, elevated body mass index, and waist-to-height ratio in preadolescent children. Psychosomatic Medicine, 83(9), 1075–1081. https://doi.org/10.1097/PSY.0000000000000982

33.

Liang

Qiu

S. X.

(2023). Objectively measured sleep continuity in children and adolescents with ADHD: A systematic review and meta-analysis. Psychiatry Research, 328, 115447. https://doi.org/10.1016/j.psychres.2023.115447

34.

Lunsford-Avery

J. R.

Carskadon

M. A.

Kollins

S. H.

Krystal

A. D.

(2025). Sleep physiology and neurocognition among adolescents with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 64(2), 276–289. https://doi.org/10.1016/j.jaac.2024.03.005

35.

Mancini

V. O.

Rudaizky

Pearcy

B. T. D.

Marriner

Pestell

C. F.

Gomez

Bucks

R. S.

Chen

(2019). Factor structure of the sleep disturbance scale for children (SDSC) in those with attention deficit and hyperactivity disorder (ADHD). Sleep Medicine: X, 1, 100006. https://doi.org/10.1016/j.sleepx.2019.100006

36.

Marten

Keuppens

Baeyens

Boyer

B. E.

Danckaerts

Cortese

Van der Oord

(2023). Sleep parameters and problems in adolescents with and without ADHD: A systematic review and meta-analysis. JCPP Advances, 3(3), e12151. https://doi.org/10.1002/jcv2.12151

37.

Maxwell

S. E. C, D.

Mitchell

M. A.

(2007). Bias in cross-sectional analyses of longitudinal mediation. Psychological Methods, 12, 23–44. https://doi.org/10.1037/1082-989X.12.1.23

38.

Maxwell

S. E.

Cole

D. A.

Mitchell

M. A.

(2011). Bias in cross-sectional analyses of longitudinal mediation: Partial and complete mediation under an autoregressive model. Multivariate Behavioral Research, 46, 816–841. https://doi.org/10.1080/00273171.2011.606716

39.

Mignolli

Scialpi

Valente

Berardi

Galeoto

Tofani

(2022). Sleep disturbance scale for children: Italian validation in autism spectrum disorder population. International Journal of Environmental Research and Public Health, 19(16), https://doi.org/10.3390/ijerph191610163

40.

Mohamed

S. M. H.

Börger

N. A.

Geuze

R. H.

van der Meere

J. J.

(2015). Brain lateralization and self-reported symptoms of ADHD in a population sample of adults: A dimensional approach. Frontiers in Psychology, 6, 1418. https://doi.org/10.3389/fpsyg.2015.01418

41.

Neuchat

E. E.

Bocklud

B. E.

Kingsley

Barham

W. T.

Luther

P. M.

Ahmadzadeh

Shekoohi

Cornett

E. M.

Kaye

A. D.

(2023). The role of alpha-2 agonists for attention deficit hyperactivity disorder in children: A review. Neurology International, 15(2), 697–707. https://doi.org/10.3390/neurolint15020043

42.

Nikles

Mitchell

G. K.

de Miranda Araújo

Harris

Heussler

H. S.

Punja

Vohra

Senior

H. E. J.

(2020). A systematic review of the effectiveness of sleep hygiene in children with ADHD. Psychology Health & Medicine, 25(4), 497–518. https://doi.org/10.1080/13548506.2020.1732431

43.

Owens

Gruber

Brown

Corkum

Cortese

O’Brien

Stein

Weiss

(2013). Future research directions in sleep and ADHD: Report of a consensus working group. Journal of Attention Disorders, 17(7), 550–564. https://doi.org/10.1177/1087054712457992

44.

Pagerols

Bosch

Prat

Pagespetit

È.

Cilveti

Chaparro

Esteve

Casas

(2023). The sleep disturbance scale for children: Psychometric properties and prevalence of sleep disorders in Spanish children aged 6-16 years. Journal of Sleep Research, 32(4), e13871. https://doi.org/10.1111/jsr.13871

45.

Raney

J. H.

Testa

Jackson

D. B.

Ganson

K. T.

Nagata

J. M.

(2022). Associations between adverse childhood experiences, adolescent screen time and physical activity during the COVID-19 pandemic. Academic Pediatrics, 22(8), 1294–1299. https://doi.org/10.1016/j.acap.2022.07.007

46.

Shaw

Gilliam

Liverpool

Weddle

Malek

Sharp

Greenstein

Evans

Rapoport

Giedd

(2011). Cortical development in typically developing children with symptoms of hyperactivity and impulsivity: Support for a dimensional view of attention deficit hyperactivity disorder. American Journal of Psychiatry, 168(2), 143–151. https://doi.org/10.1176/appi.ajp.2010.10030385

47.

Shen

Luo

Chamberlain

S. R.

Morgan

Romero-Garcia

Zhao

Touchette

É.

Montplaisir

Vitaro

Boivin

Tremblay

R. E.

Zhao

X. M.

Robaey

Feng

Sahakian

B. J.

(2020). What is the link between attention-deficit/hyperactivity disorder and sleep disturbance? A multimodal examination of longitudinal relationships and brain structure using large-scale population-based cohorts. Biological Psychiatry, 88(6), 459–469. https://doi.org/10.1016/j.biopsych.2020.03.010

48.

Snitselaar

M. A.

Smits

M. G.

van der Heijden

K. B.

Spijker

(2017). Sleep and circadian rhythmicity in adult ADHD and the effect of stimulants. Journal of Attention Disorders, 21(1), 14–26. https://doi.org/10.1177/1087054713479663

49.

Sung

Hiscock

Sciberras

Efron

(2008). Sleep problems in children with attention-deficit/hyperactivity disorder: Prevalence and the effect on the child and family. Archives of Pediatrics & Adolescent Medicine, 162(4), 336–342. https://doi.org/10.1001/archpedi.162.4.336

50.

Surman

C. B.

Roth

(2011). Impact of stimulant pharmacotherapy on sleep quality: Post hoc analyses of 2 large, double-blind, randomized, placebo-controlled trials. Journal of Clinical Psychiatry, 72(7), 903–908. https://doi.org/10.4088/JCP.11m06838

51.

Turan

Garner

Isaiah

Palatino

Ernst

Wang

Chang

(2025). Fitbit-measured sleep duration in young adolescents is associated with functional connectivity in attentional, executive control, memory, and sensory networks. Sleep, 48. https://doi.org/10.1093/sleep/zsaf088

52.

Türkmen Noyan

Direk

G. B.

Örengül

A. C.

(2024). A randomized controlled trial of effects of sleep hygiene training and progressive muscle relaxation training in children with ADHD. Sleep Medicine, 117, 169–176. https://doi.org/10.1016/j.sleep.2024.03.001

53.

van Andel

Bijlenga

Vogel

S. W. N.

Beekman

A. T. F.

Kooij

J. J. S.

(2021). Effects of chronotherapy on circadian rhythm and ADHD symptoms in adults with attention-deficit/hyperactivity disorder and delayed sleep phase syndrome: A randomized clinical trial. Chronobiology International, 38(2), 260–269. https://doi.org/10.1080/07420528.2020.1835943

54.

Wajszilber

Santiseban

J. A.

Gruber

(2018). Sleep disorders in patients with ADHD: Impact and management challenges. Nature and Science of Sleep, 10, 453–480. https://doi.org/10.2147/NSS.S163074

55.

Zhang

Choi

K. W.

Delaney

S. W.

Pingault

J. B.

Tiemeier

(2023). Shared genetic risk in the association of screen time with psychiatric problems in children. JAMA Network Open, 6(11), e2341502. https://doi.org/10.1001/jamanetworkopen.2023.41502

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