(PS1-D88) Characteristics and Sleep Behaviors of Adolescents with ADHD: Associations with Daytime Sleepiness

Adolescents with attention-deficit/hyperactivity disorder (ADHD) experience daytime sleepiness that can negatively affect their functioning. To help adolescents reduce their daytime sleepiness, we need to understand why they are prone to experience these concerns. The aim of this study is to examine the relationship between core difficulties of adolescents with ADHD (i.e., emotion regulation & impulsivity) and daytime sleepiness above and beyond sleep hygiene, medication use, and ADHD symptoms.  

As part of a randomized controlled trial of an intervention for high school students with ADHD, 119 adolescents in grades 9-11(78.2% male; 78.2% White) completed the Pediatric Daytime Sleepiness Scale, the Adolescent Sleep Hygiene Scale (ASHS), and the Barratt Impulsiveness Scale (BIS) at the end of the intervention. Parents rated adolescents’ ADHD symptoms at the beginning and end of the intervention using the ADHD Rating Scale-5 and completed the Difficulties in Emotion Regulation Scale (DERS) at the end of the intervention. Parents also reported the number of days adolescents took stimulant medication in a week.

Hierarchical linear regression models were used to examine post-treatment associations between factors of impulsivity (model 1) and emotion regulation (model 2) with daytime sleepiness after controlling for ADHD symptoms, medication use, and treatment condition (i.e., intervention or control group). Associations between impulsivity (model 3) and emotion regulation (model 4) with daytime sleepiness, after controlling for treatment condition and sleep hygiene were also evaluated to examine the differences between child characteristics (i.e., medication use and ADHD symptoms) and child behaviors (i.e., sleep hygiene). After controlling for medication use, ADHD symptoms, and treatment condition, BIS factors jointly accounted for a significant portion of variance in daytime sleepiness, F(10, 108)=9.33, p < .001. After controlling for sleep hygiene, BIS factors jointly accounted for a significant amount of variance in daytime sleepiness, F(15, 103)=7.9, p < .001. After controlling for treatment condition, ADHD symptoms, and medication use, DERS factors accounted for a significant amount of variance in daytime sleepiness, F(10, 108)=1.98, p = .042. However, only adolescents’ difficulty engaging in goal directed behavior (difficulty concentrating/accomplishing tasks when experiencing negative emotions) was significantly associated with daytime sleepiness (B = 0.27, p = .027). After controlling for sleep hygiene and treatment condition, DERS factors jointly accounted for a significant portion of variance in daytime sleepiness, F(15, 103)=3.86, p < .001. Again, only difficulty engaging in goal directed behavior was significantly associated with daytime sleepiness (B = 0.25, p = .022).

Results of this study suggest impulsivity and difficulties engaging in goal directed behavior are associated with daytime sleepiness for adolescents with ADHD above and beyond well-documented variables associated with sleep problems. It may be that teens with ADHD who experience high levels of impulsivity or elevated difficulty engaging in goal-directed behavior may be particularly prone to sleepiness during the school day.