SLEEP 2011 Abstract Supplement

B. Clinical Sleep Science XI. Pediatrics
0802
CONTRIBUTIONS OF CIRCADIAN TENDENCIES AND
BEHAVIORAL PROBLEMS TO SLEEP ONSET INSOMNIA IN
CHILDREN WITH ADHD
Gruber R 1 , Carrier J 2
1
McGill University, Montreal, QC, Canada, 2 University of Montreal,
Montreal, QC, Canada
Introduction: Attention-deficit/hyperactivity disorder (ADHD) is characterized
by impulsivity/hyperactivity and inattention. It is estimated
to occur in 3-7.5% of school-aged children, thus making ADHD one
of the most prevalent child psychiatric conditions. Although the presence
of Sleep-Onset Insomnia has been noted among 1/3 of children
with ADHD, the causes of such sleep issues remain unclear. Within the
current literature, both biological and behavioral explanations for sleep
problems in this population have been advanced, suggesting different interventional
strategies, depending on the pathophysiological mechanism
that is in fact at play. The goal of this study was to determine the relative
contributions of biological (circadian tendencies) and behavioral
(externalizing problems) factors to sleep onset insomnia experienced by
children with ADHD.
Methods: 75 children (26 ADHD, 49 Controls), aged 7 to 11 years old
(mean age = 8.61, SD = 1.27), participated in the study. Participants
were asked to cease medication for the duration of the study and to avoid
consuming products containing caffeine (such as chocolate or cola).
Sleep was evaluated using polysomnography and the Child Sleep Habits
Questionnaire. Externalizing problems were evaluated using the Child
Behavioral Checklist and circadian tendency was evaluated using Child
Morning-Evening Preference Scale. ADHD was diagnosed using DSM-
IV criteria.
Results: Multiple Linear Regression Analyses was used to determine
the contributions of externalizing problems versus circadian tendencies
to sleep onset delay and bedtime resistance. Externalizing problems
yielded significant independent contributions only 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.
Conclusion: Externalization and circadian tendency were associated
with a different bedtime problems. Thus, circadian phase delay and bedtime
refusal may both be common, but are two distinct problems. As
such, each may require a different interventional strategy.
Support (If Any): Health Research (CIHR; grant number 153139) and
the Fonds de la recherche en santé (FRSQ; grant number 10091)
0803
ATTENTION AND HYPERACTIVITY SYMPTOMS AT
KINDERGARTEN ENTRY ASSOCIATED WITH LESS SLEEP
IN PRESCHOOL
Gaylor E 1 , Burnham MM 3 , Beebe DW 2,4 , Wei X 1
1
Center for Education and Human Services, SRI International, Menlo
Park, CA, USA, 2 Division of Behavioral Medicine and Clinical
Psychology (MLC 3015), Cincinnati Children’s Hospital Medical
Center, Cincinatti, OH, USA, 3 Department of Educational Psychology,
Counseling, & Human Development, University of Nevada, Reno,
Reno, NV, USA, 4 Dept of Pediatrics, U of Cincinnati College of
Medicine, Cincinatti, OH, USA
Introduction: Although Attention-Deficit/ Hyperactivity Disorder
(ADHD) is not generally diagnosed until the school age years, the onset
of developmentally inappropriate inattention and hyperactivity/impulsivity
is often much younger. Sleep problems, particularly difficulty falling
asleep and staying asleep, are frequently reported in children and
adolescents with ADHD. However, the direction of causation, if any, has
been difficult to determine. Longitudinal studies may provide a window
into the direction of this complex relationship.
Methods: The analyses use data from the preschool and kindergarten
waves of the Early Childhood Longitudinal Study - Birth Cohort
(ECLS-B) study. The ECLS-B dataset includes a contemporary, representative
sample of children and their families living in the United States
and followed longitudinally. The sample consisted of approximately
6,860 children who had data on the variables of interest across the preschool
and kindergarten waves. Parent-reported bedtime and wake time,
obtained via interview at both time points, were used to calculate total
nighttime sleep duration. Parents were also asked to rate their children’s
behavior on brief measures of attention/task persistence and hyperactivity/impulsivity.
Results: We performed two sets of regression analyses to identify
whether (a) sleep duration in preschool-age children predicts attention
and hyperactivity at kindergarten entry and (b) attention and hyperactivity
symptoms at preschool predict sleep duration at kindergarten. Each
analysis controlled for the outcome of interest at the preschool time
point, as well as gender, ethnicity and family income. Less sleep at preschool
significantly predicted worse parent-reported hyperactivity (β=-
0.06, P