Poor sleep in childhood may be a red flag for ADHD

3 minute read


Nightmares, waking and trouble falling asleep may may predict symptoms in preadolescence.


Issues with sleep in childhood could be an early indicator of ADHD, a new study suggests. 

Kids aged eight to nine with sleep problems such as trouble falling asleep, waking up during the night, experiencing nightmares, not feeling rested after sleep or sleeping more or less than usual were 18% more likely to develop overall ADHD symptoms at ages 10-11. 

They were also 14% more likely to develop opposition symptoms, 20% more likely to develop inattention symptoms, and 18% more likely to develop hyperactivity symptoms. 

In this prospective study conducted in Spain, maternal recruitment occurred at 13 weeks’ gestation and resulted in data from over 1200 children, nearly half of whom were female. Data was collected throughout pregnancy and birth, and offspring were assessed during early childhood (age one to five), middle childhood (age eight to nine), and preadolescence (age 10-11). 

While some children were found to have these ADHD symptoms at age five, sensitivity analyses which excluded these children still found significant correlation between sleep issues at ages eight to nine and ADHD symptoms in preadolescence. Gender was also included in covariate and regression models as a significant variable, but data did not indicate whether there were sex-related disparities. 

Dr Rachael Sharman, senior lecturer and researcher in psychology at the University of the Sunshine Coast told The Medical Republic that the study was well designed and accounted for a range of possible covariates, but there was a particular finding that was unexpected. 

As someone who specialises in child and adolescent development, she found the most intriguing finding to be the association between parental employment, sleep problems and ADHD score. 

Socioeconomic factors, especially paternal employment, appeared to be related to the connection between sleep issues and ADHD symptoms. Surprisingly, the study found that children of employed fathers had a higher risk of ADHD than those with unemployed fathers, although sleep problem scores remained similar regardless of paternal employment status. 

“The relationship [paternal employment and ADHD] is completely unclear and also unexpected, but they’ve not been able to untangle any causal factors there,” Dr Sharman said.  

“This to me suggests there is indeed something else going on here, and that while poor sleep is a variable of interest, more needs to be done to understand why the child is sleeping poorly, and it is the answer to that question that may well hold the key as to risk of later developing ADHD.”  

European Journal of Pediatrics, online September 2023 

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