Skip to main content
NCBI home page
Sage Choice logoLink to Sage Choice
. 2023 Feb 17;27(6):635–642. doi: 10.1177/10870547231155871

Associations Between ADHD, Sleep Problems, and Mental Health Symptoms in Adolescents

George Loram 1,✉, Mathew Ling 1,2, Tim Silk 1,3,4, Emma Sciberras 1,3,4
PMCID: PMC10068403  PMID: 36799467

Abstract

Objective:

This study examined associations between objective and subjective sleep parameters, and mental health symptoms (internalizing symptoms, externalizing symptoms, and irritability) and whether these relationships differed for adolescents with and without ADHD.

Method:

Participants were 373 adolescents aged 10 to 19 years (M = 13.21, SD = 2.37). Sleep was measured both via actigraphy and self- and parent-report scales. Mental health symptoms were measured via a range of validated measures.

Results:

Few relationships were detected when examining actigraphy variables. Subjective sleep parameters were associated with almost all mental health variables. Some relationships were moderated by ADHD status, generally consistent with stronger relationships between subjective sleep quality and mental health in the non-ADHD group.

Conclusion:

Sleep problems, particularly subjective difficulties, are associated with a range of mental health outcomes, regardless of the presence of ADHD. Sleep problems may be a beneficial intervention target for adolescents experiencing mental health issues.

Keywords: ADHD, sleep difficulties, mental health

ADHD is often associated with sleep problems, with prevalence estimates for sleep problems in adolescents with ADHD ranging from 23% to 73% (Langberg et al., 2017; Reale et al., 2017). Adolescents with ADHD also experience more mental health difficulties than their peers, including symptoms of anxiety and depression (Barkley, 2015; Pliszka, 2000; Schatz & Rostain, 2006; Tung et al., 2016). Additionally, adolescence is a time of great change, particularly in the domain of sleep (Carskadon, 2011; Crowley et al., 2018). A circadian shift toward “eveningness” is seen, with adolescents staying up later, and, when environmental circumstances allow, waking up later (Crowley et al., 2018). This is combined with less parental oversight of sleep schedules and sleep hygiene, increased prioritization of social groups, increasing academic demands, and increased use of devices before bedtime (Bruni et al., 2015; Crowley et al., 2018), with these factors converging to result in adolescents generally getting less sleep than recommended (Maslowsky & Ozer, 2014). In addition to these changes, adolescence also marks a sharp increase in mental health difficulties (Paus et al., 2008), with 14 years of age being the peak age of onset of any mental health condition (Kessler et al., 2005). There is growing evidence of the connection between sleep problems and mental health symptoms in adolescents.

Sleep deficiency appears to be implicated in emotional regulation and processing, which is in turn linked to many common mental health difficulties (Goldstein & Walker, 2014). Of particular concern, sleep problems have also been shown to predict suicidal ideation and behavior (Kearns et al., 2020). Experimental studies have also found that sleep restriction can result in greater subjective experiences of anxiety, anger, confusion, and low energy, and higher visible levels of oppositionality and irritability (Baum et al., 2014). However, despite adolescents with ADHD experiencing more mental health issues than those without ADHD, little is known specifically about the association between sleep problems and mental health symptoms in adolescents with ADHD. Adolescents with ADHD experience more sleep problems than peers without ADHD, which, in turn, are related to poorer mental health outcomes (Lunsford-Avery et al., 2016). In adolescence, the relationship between sleep problems and ADHD symptom severity is partially mediated by internalizing and externalizing symptoms (Frick et al., 2022; Hysing et al., 2016). Sleep problems can also predict later externalizing symptoms and depressive symptoms in adolescents with ADHD (Becker et al., 2015). Taken together, these studies highlight the possible links between sleep and mental health symptomatology for adolescents with ADHD.

However, there are still a number of key questions that are yet to be examined. Firstly, while the existing evidence suggests a relationship between sleep and mental health symptomatology in adolescents with ADHD, it is unknown whether this relationship is different for those without ADHD. In children, some research (Virring et al., 2016) suggests that sleep problems are not attributable to co-occurring diagnoses alone. Therefore, there is a need to elucidate the nature of these relationships in order to better design and target interventions for adolescents experiencing issues in these areas. Secondly, much of the previous research examining these relationships specifically has utilized subjective measurement of sleep, rather than objective methods (e.g., Becker et al., 2015; Frick et al., 2022). Thirdly, past studies have tended to examine a small number of symptom domains. Given that co-occurrence of mental health symptoms is the rule rather than the exception in adolescents (Merikangas et al., 2009), it will be useful to concurrently consider a number of symptom domains in order to increase external validity of results. Finally, most previous studies have considered how the presence of co-occurring mental health conditions is associated with the occurrence of sleep problems in adolescents with ADHD (e.g., Becker et al., 2018; Frick et al., 2022) rather than considering mental health symptoms as a potential consequence of sleep problems.

Therefore, this study aims to examine whether the association between objective (assessed via actigraphy - sleep period; sleep duration; sleep efficiency; wake after sleep onset) and subjective (parent- and self-reported) sleep parameters, and mental health symptoms (internalizing symptoms, externalizing symptoms, and irritability) differs for adolescents with and without ADHD.

Methods

Participants

Participants were 373 adolescents aged 10 to 19 years (M = 13.21, SD = 2.37). Data was accessed from the ongoing Healthy Brain Network (HBN) initiative (https://healthybrainnetwork.org/; Alexander et al., 2017). Participants were included in the initial data collection if they were: aged between 5 and 21 years, were English-speaking, and did not have a serious neurological disorder or a recent diagnosis of bipolar, schizophrenia, or schizoaffective disorder. Participants were included in the current study if they were aged between 10 and 19 years and had at least three nights of actigraphy data available, in line with recommendations made by Littner et al. (2003). No significant differences were found between participants with and without sufficient actigraphy data on any measured variable, with the exception of sleep period and sleep duration (Supplemental Table 1).

Measures

ADHD and Co-Occurring Difficulties Assessment

Participants and their parents/guardians were administered the Schedule for Affective Disorders and Schizophrenia—Children’s Version (K-SADS) by a trained member of the clinical team. Selected modules (Neurodevelopmental disorders) from the K-SADS were used in reaching a consensus diagnosis of ADHD. Previous studies have established the validity and reliability of the measure (de la Peña et al., 2018). Results from the K-SADS were combined with other clinical information (i.e., interviews with parent and child; historical records) to reach a consensus diagnosis of ADHD based on Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition (DSM-5) criteria. Other modules from the K-SADS were also used in assessing the presence of other diagnosable conditions (e.g., depressive disorders and anxiety disorders). Where clinical information indicated the presence of autism spectrum disorder, additional assessments were conducted (Autism Diagnostic Interview—Revised [ADI-R]; Autism Diagnostic Observation Schedule, Second Edition [ADOS-2]).

Mental Health Symptoms

Mental health symptoms were assessed using a variety of validated measures. For all measured domains, self- and parent-report scales were administered. Depressive symptoms were measured using the Moods and Feelings Questionnaire (MFQ; Angold et al., 1995), which consists of a series of descriptive phrases regarding how the individual has been feeling or acting recently. Anxiety symptoms were measured using the Screen for Anxiety Related Disorders (SCARED; Birmaher et al., 1999), which is a 41-item scale used to screen for a number of anxiety disorders. Symptoms of irritability were measured using the Affective Reactivity Index (ARI; Stringaris et al., 2012), a 9-item scale for the dimensional assessment of irritability. For the assessment of externalizing behaviors, the externalizing scale from the parent-reported Child Behavior Checklist (CBCL; Achenbach & Rescorla, 2001) and the adolescent-reported Youth Self Report (YSR) was used. Reliability was high for all measures, ranging from ω = .89 to .95.

Objectively Assessed Sleep

Actigraphy was used to measure objective adolescent sleep parameters. Participants were provided with a wrist-mounted actigraph (ActiGraph wGT3X-BT), which was typically returned within 3 to 4 weeks. Raw data were processed using the R package “GGIR” (Migueles et al., 2019; van Hees et al., 2015, 2018). The sleep parameters included in the study were: sleep period, sleep duration, wake after sleep onset (WASO), and sleep efficiency. Participants were excluded from the dataset if they had less than three nights of actigraphy data available, which excluded 81 participants. For the remaining participants, an average of 16 nights of actigraphy data were collected (SD = 8.81, range = 3–36).

Parent-reported Sleep

The Sleep Disturbance Scale for Children (SDSC) is a parent-reported 27-item questionnaire (Bruni et al., 1996). In the current study, the total and “Disorders of Initiating and Maintaining Sleep” (DIMS) scores were used (total ω = .83, DIMS ω = .85). Each item was rated using a 5-point rating scale from 1 = “never” to 5 = “always (daily),” indicating the frequency of the sleep problem over the past 6 months, with higher scores indicating poorer sleep quality.

Self-reported Sleep

The YSR, which is the self-reported version of the CBCL (Achenbach & Rescorla, 2001), was used to assess self-reported sleep problems. Two questions from the measure were used:“I sleep less than most kids during day and/or night” and “I have trouble sleeping.” These items were scored using a three-point response scale: (0 = “Not True [as far as you know],” 1 = “Somewhat or Sometimes True,” and 2 = “Very True or Often True”).

Procedure

The broader study, including data collection, was approved by the Chesapeake Institutional Review Board. The current study was approved by the Deakin University Human Research Ethics Committee (2019-325). Participants or their legal guardians (if they were under 18 years of age) completed a pre-screening interview. Participants then attended a HBN office in either Staten Island or Midtown Manhattan to participate in testing. Participants typically attended four testing sessions. Participants taking stimulant medication were asked to discontinue their medication during days of in-person testing.

During their first visit, participants were provided with an actigraph device. Participants were instructed to wear this during both waking and sleeping hours, and brought the device back at each visit to be recharged.

Statistical Analysis

All statistical analyses were conducted in the R environment (R Core Team, 2020), using the RStudio Integrated Development Environment. We conducted a separate multiple regression model for each combination of sleep variable (predictor) and mental health variable (outcome). Objective and subjective sleep variables were analyzed in an identical fashion, with actigraphy data collapsed into average values for each participant. For each model, we also included age, sex, ADHD status, and an interaction term (sleep variable interacting with ADHD) as predictors.

Results

Sample Characteristics

The mean age was 13.21 (SD = 2.37), with females accounting for approximately one-third of the sample (34.9%). When examining the ADHD group specifically, females made up 27.9% of the sample, compared with 46.4% in the non-ADHD group. ADHD was the most common diagnosis in the overall sample (62.5%), followed by anxiety disorders (27.9%) and autism spectrum disorder (17.2%). Rates of co-occurring diagnoses were similar in ADHD vs. non-ADHD groups, except for externalizing disorders (conduct, oppositional defiant), which were more prevalent in the ADHD group (ADHD: 14.6%, non-ADHD: 9.3%), and autism spectrum disorder, which was detected at nearly double the rate in the ADHD group (ADHD: 21%, non-ADHD: 10.7%). The average sleep period (i.e., time from sleep onset to sleep offset) in the overall sample was 7.57 hours (SD = 2.41 hours), while sleep duration (sleep period minus night awakenings) was 6.13 hours (SD = 2.08 hours).

Associations Between Sleep and Mental Health Symptoms

Sleep Measured Using Actigraphy

Adjusted analyses are detailed in Supplemental Table 2. When examining the entire sample, sleep period was not associated with any mental health variables. Shorter sleep duration was associated with higher self-reported depressive symptoms (β = −.04, p = .042) and self-reported externalizing behaviors (β = −.08, p = .025). Lower sleep efficiency was associated with higher levels of self- and parent-reported depressive symptoms (β = −.05, p = .003; β = −.14, p = .008), and self-reported anxiety symptoms (β = −.07, p = .034). Greater levels of wake after sleep onset were associated with higher levels of self- and parent-reported depressive symptoms (β = .04, p = .005; β = .12, p = .005), as well as self- and parent reported anxiety symptoms (β = .09, p = .023; β = .09, p = .028).

We also examined whether these relationships differed depending on ADHD status. The associations between sleep duration and mental health did not differ. For the relationship between sleep efficiency and self-reported depressive symptoms, the relationship differed depending on the presence of ADHD (β = .14, p = .005), and additionally, we saw a group effect of ADHD (β = .05, p = .008). The same finding emerged when examining the relationship between WASO and self-reported depressive symptoms (ADHD: β = .05, p = .004; Interaction: β = −.14, p = .006). We also found a differential relationship when examining WASO and self-reported irritability (β = −.12, p = .024), despite the overall relationship not being significant. When visually examining these interactions, a general trend was seen where the direction of the association changed depending on ADHD status (i.e., from positive to negative). In general, shorter or more disrupted sleep was associated with higher levels of mental health symptoms in the non-ADHD group, whereas lower levels of sleep problems were associated with higher levels of mental health symptoms in the ADHD group. See Supplemental Figure 1 for an illustration of this trend.

Sleep Measured Using Self- and Parent-Reported Measures

Endorsement of the self-reported sleep question “I sleep less than most kids” was associated with greater levels of almost all measured mental health variables (depression, anxiety, parent-reported irritability, self-reported externalizing behavior; βs = .13–0.38, p’s < .001–.042) when examining the sample overall. Endorsement of the self-reported question “I have trouble sleeping,” was also associated with greater levels of most measured mental health variables (depression, anxiety, irritability, self-reported externalizing behavior; β’s = .12–.41, p’s = <.001–.015) when examining the overall sample. We also saw a group effect of ADHD for parent-reported depression (β = .10, p = .026) and both reporters of externalizing behavior (self-report: β = .17, p = .025; parent-report: β = .22, p = .001). When examining interactions, the relationship between the question “I have trouble sleeping” and parent-reported externalizing behaviors differed based on ADHD status (β = −.13, p = .026), despite the overall effect not being significant. The interaction followed a similar pattern to the interactions found when examining actigraphy variables. No other relationships differed depending on ADHD status. See Supplemental Table 3 for further details.

When examining parent-reported sleep variables, a similar pattern was observed, with sleep problems associated with many mental health variables (depression, anxiety, parent-reported irritability, externalizing behaviors; SDSC total β’s = .12–.58, p’s = <.001–.029; SDSC DIMS β’s = .13–.44, p’s = <.001–.005). Some of these relationships (depression, self-reported externalizing behavior) differed between ADHD and non-ADHD groups (β’s = −.11 to −.24, p’s = <.001–.048), and a group effect of ADHD status was seen in several models (depression, self-reported anxiety, self-reported irritability, self-reported externalizing behavior; β’s = .03–.24, p’s = <.001–.049). A general pattern emerged whereby for relationships where the main effect was significant, the non-ADHD group had a stronger relationship between sleep difficulties and greater mental health symptoms (See Supplemental Figure 2). Where the main effect was non-significant, the relationship changed direction depending on ADHD status, following a pattern similar to that described previously. See Supplemental Table 3 for further details.

Discussion

Overall, there was mixed evidence for an interaction between ADHD status, sleep problems, and mental health. For objectively measured sleep, some interactions based on ADHD status were detected primarily when examining depressive symptoms, with the direction of the relationship between sleep and depression depending on ADHD status. There was minimal evidence for an interaction of ADHD status when examining self-reported sleep. For parent-reported sleep problems, an interaction of ADHD status was detected for depression, anxiety, and externalizing behaviors, showing a general trend of stronger relationships between sleep and mental health variables among adolescents without ADHD compared to those with ADHD.

When examining the direct relationships between sleep and mental health variables, we found inconsistent evidence depending on whether sleep was measured objectively or subjectively. When examining objective sleep variables, sleep efficiency and wake after sleep onset (WASO) were both associated with self- and parent-reported depression, as well as self-reported anxiety. WASO was additionally associated with parent-reported anxiety. When examining subjectively measured sleep variables, we found much stronger evidence for a relationship between sleep and mental health. Self-reported sleep problems were associated with all measured mental health variables, while parent-reported sleep problems were associated with almost all measured variables. Importantly, this study provided a novel examination of whether the relationships between sleep and mental health are different for adolescents with and without ADHD.

There is little research that has specifically examined whether the relationship between sleep and mental health differs depending on ADHD status. Becker et al. (2019) found that sleep problems were associated with depression, anxiety, and externalizing conditions in a sample of adolescents with and without ADHD, partially concurring with our results. However, this comparison is made cautiously, as our study analyzed mental health in a dimensional rather than categorical fashion, and additionally, Becker et al. (2019) did not examine whether the relationship between sleep and mental differed depending on ADHD status.

Overall, minimal evidence was found for a differential relationship between sleep and mental health based on ADHD status. For objectively measured sleep, the relationship between both sleep efficiency and WASO and self-reported depression differed depending on group. Surprisingly, the direction of the relationship differed depending on group. We generally saw that in the non-ADHD group, shorter or more disrupted sleep was associated with higher depressive symptoms, while the opposite was seen in the ADHD group. However, we also saw a positive main effect between ADHD status and mental health symptoms, which may partially explain the differences in the relationships we saw.

The relationship between self-reported sleep and mental health did not differ depending on ADHD status. However, when examining parent-report sleep, we found that the relationship between sleep problems and depression consistently differed depending on the presence of ADHD. This interaction was also seen to a lesser extent when examining anxiety symptoms. The relationship between parent-reported sleep and externalizing symptoms also differed depending on group. When visually examining plots, a general pattern was seen whereby the relationship between sleep and mental health was stronger in the non-ADHD group. Again, we saw a main effect of ADHD status in many of these models, indicating that ADHD status was associated with higher levels of mental health symptoms. This may partially explain why the relationship between sleep and mental health was not as strong in the ADHD group. It is also possible that adolescents with ADHD are being more closely managed and supported through psychological and pharmacological interventions, and thus sleep problems are less impactful on their mental health.

We found that the actigraphy variables sleep efficiency and WASO were associated with internalizing symptoms. Previous research has shown that shorter sleep duration and lower sleep efficiency were associated with higher levels of self-reported depressive symptoms in adolescents (Tu et al., 2017). This is partially consistent with our results, which found an association between lower sleep efficiency and higher WASO and higher levels of self- and parent-reported depression. Our results are also partially consistent with Baum et al. (2014), who experimentally restricted sleep and found that poorer sleep was associated with higher levels of anxiety, irritability, and externalizing behaviors, but not depressive symptoms.

When considering subjective sleep variables, we found that sleep problems (self- and parent-report) were associated with almost all measured mental health variables. This is generally consistent with past research on the association between poor sleep and internalizing mental health symptoms. Alfano et al. (2009) found that subjectively reported sleep problems were associated with depressive and anxiety symptoms in adolescents. Similarly, a large, multi-site study found that lower subjectively-reported sleep duration was associated with higher levels of emotional problems and anxiety (Sarchiapone et al., 2014). Our results are also generally consistent with findings that suggest subjective sleep parameters are more consistently related to mental health symptoms than objective sleep parameters (Baddam et al., 2018). It is important to note, however, that the subjective sleep measures used ask participants to reflect on their sleep over the past 6 months, so it is possible that participants are responding based on past experiences of their sleep, or their child’s sleep. For this reason, future research could also incorporate more intensive forms of subjective sleep measurement, such as sleep diaries.

Strengths of the current study include comprehensive measurement of sleep, including an average of 16.6 nights of actigraphy data. Strengths of the sample include participants sourced from the general population, whereas many studies in this area utilize clinic-referred samples, improving the generalizability of results. Additionally, the sample covers a wide age range.

Limitations of the study should also be noted. The cross-sectional nature of the study precludes any casual inferences from being made. Additionally, data on medication use were not analyzed in the current study. With regards to sleep measurement, variables such as sleep onset latency were not measured, due to the absence of sleep diary collection in the dataset. Additionally, some research has found that actigraphy tends to overestimate the amount of sleep and underestimate the amount of wakefulness throughout the night (Ancoli-Israel et al., 2003; Sadeh & Acebo, 2002). Mental health symptoms were measured at one point in time, in contrast to actigraphy, which was measured continuously over a number of days. This meant that some fidelity of actigraphy data was sacrificed when conducting statistical analyses, as actigraphy data had to be collapsed into average variables for each participant. For this reason, future research should consider variability of sleep night-to-night, as emerging evidence has suggested that this variable may be associated with functional outcomes (e.g., Becker et al., 2017).

This study indicates that the relationship between sleep and mental health is similar for adolescents with and without ADHD. These relationships generally did not differ between groups for objective sleep measures, but relationships between parent-reported sleep and some mental health outcomes differed between ADHD and non-ADHD groups, potentially because adolescents with ADHD have higher baseline levels of these symptoms. The study also builds on previous research indicating that poor sleep is associated with a number of mental health symptom domains in adolescents. As sleep problems are a highly modifiable intervention target that can improve mental health symptoms (Blake & Allen, 2020; Blake et al., 2017), this study reinforces the importance of clinicians targeting sleep problems when treating adolescents with mental health difficulties, regardless of whether ADHD is present or not.

Supplemental Material

sj-docx-1-jad-10.1177_10870547231155871 – Supplemental material for Associations Between ADHD, Sleep Problems, and Mental Health Symptoms in Adolescents
Click here for additional data file. (14.9KB, docx)

Supplemental material, sj-docx-1-jad-10.1177_10870547231155871 for Associations Between ADHD, Sleep Problems, and Mental Health Symptoms in Adolescents by George Loram, Mathew Ling, Tim Silk and Emma Sciberras in Journal of Attention Disorders

sj-docx-2-jad-10.1177_10870547231155871 – Supplemental material for Associations Between ADHD, Sleep Problems, and Mental Health Symptoms in Adolescents
Click here for additional data file. (27.6KB, docx)

Supplemental material, sj-docx-2-jad-10.1177_10870547231155871 for Associations Between ADHD, Sleep Problems, and Mental Health Symptoms in Adolescents by George Loram, Mathew Ling, Tim Silk and Emma Sciberras in Journal of Attention Disorders

sj-docx-3-jad-10.1177_10870547231155871 – Supplemental material for Associations Between ADHD, Sleep Problems, and Mental Health Symptoms in Adolescents
Click here for additional data file. (29.5KB, docx)

Supplemental material, sj-docx-3-jad-10.1177_10870547231155871 for Associations Between ADHD, Sleep Problems, and Mental Health Symptoms in Adolescents by George Loram, Mathew Ling, Tim Silk and Emma Sciberras in Journal of Attention Disorders

sj-png-4-jad-10.1177_10870547231155871 – Supplemental material for Associations Between ADHD, Sleep Problems, and Mental Health Symptoms in Adolescents
Click here for additional data file. (86.7KB, png)

Supplemental material, sj-png-4-jad-10.1177_10870547231155871 for Associations Between ADHD, Sleep Problems, and Mental Health Symptoms in Adolescents by George Loram, Mathew Ling, Tim Silk and Emma Sciberras in Journal of Attention Disorders

sj-png-5-jad-10.1177_10870547231155871 – Supplemental material for Associations Between ADHD, Sleep Problems, and Mental Health Symptoms in Adolescents
Click here for additional data file. (84KB, png)

Supplemental material, sj-png-5-jad-10.1177_10870547231155871 for Associations Between ADHD, Sleep Problems, and Mental Health Symptoms in Adolescents by George Loram, Mathew Ling, Tim Silk and Emma Sciberras in Journal of Attention Disorders

Author Biographies

George Loram is an early career psychologist currently finalising his Doctor of Psychology (Clinical) training at Deakin University. His research areas are ADHD, sleep, mental health, and the relationships between these concepts.

Mathew Ling is currently the Research and Evaluation Lead at Neami Australia. He is an honorary fellow at Deakin University, co-founder of the Misinformation lab, and Chairperson of the Melbourne Open Research Network steering committee. His research has principally been focussed on understanding susceptibility to misinformation in the health domain, and strategies to remedy it. He also acts as a consultant in research methods and analytics, and is a self-avowed evangelist for Open sciences and the R programming language.

Tim Silk is a cognitive neuroscientist at Deakin University, specializing in paediatric neurodevelopmental imaging in order to understand the brain-behaviour interface. Tim heads the Brain and Cognitive Development Lab, and currently leads The Neuroimaging of the Children’s Attention Project (NICAP).

Emma Sciberras is a senior clinical psychologist working in the Developmental Assessment and Management Program at the Alfred Child & Youth Mental Health Service (CYMHS). She is also an Associate Professor in the School of Psychology at Deakin University. Her research areas are child mental health, sleep and neurodevelopment disorders including ADHD.

Footnotes

Author Contributions: All authors were involved in the conceptualization and development of the current study (inc. aims, method, statistical plan, and interpretation of results). Data analysis was completed by G.L. with support from M.L. G.L. completed the draft manuscript, with input from E.S., T.S., and M.L.

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: E.S. is supported by an Australian National Health and Medical Research Council (NHMRC) Career Development Fellowship (1037159) and a Medical Research Future Fund Investigator Grant (1194297). G.L. is supported through an Australian Government Research Training Program Scholarship.

Supplemental Material: Supplemental material for this article is available online.

References

  1. Achenbach T. M., Resorta L. A. (2001). Manual for ASEBA school-age forms and profiles. University of Vermont, Research Center for Children, Youth, & Families. [Google Scholar]
  2. Alexander L. M., Escalera J., Ai L., Andreotti C., Febre K., Mangone A., Vega-Potler N., Langer N., Alexander A., Kovacs M., Litke S., O’Hagan B., Andersen J., Bronstein B., Bui A., Bushey M., Butler H., Castagna V., Camacho N., . . . Milham M. P. (2017). An open resource for transdiagnostic research in pediatric mental health and learning disorders. Scientific Data, 4(1), 1. 10.1038/sdata.2017.181 [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Alfano C. A., Zakem A. H., Costa N. M., Taylor L. K., Weems C. F. (2009). Sleep problems and their relation to cognitive factors, anxiety, and depressive symptoms in children and adolescents. Depression and Anxiety, 26(6), 503–512. 10.1002/da.20443 [DOI] [PubMed] [Google Scholar]
  4. Ancoli-Israel S., Cole R., Alessi C., Chambers M., Moorcroft W., Pollak C. P. (2003). The role of actigraphy in the study of sleep and circadian rhythms. Sleep, 26(3), 342–392. 10.1093/sleep/26.3.342 [DOI] [PubMed] [Google Scholar]
  5. Angold A., Costello E., Messer S., Pickles A., Winder F., Silver D. (1995). The development of a questionnaire for use in epidemiological studies of depression in children and adolescents. International Journal of Methods in Psychiatric Research, 5, 237–249. [Google Scholar]
  6. Baddam S. K. R., Canapari C. A., van Noordt S. J. R., Crowley M. J. (2018). Sleep disturbances in child and adolescent mental health disorders: A review of the variability of objective sleep markers. Medical Sciences, 6(2), 46. 10.3390/medsci6020046 [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Barkley R. A. (2015). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (ACCESS ONLINE; 4th ed.). The Guilford Press. http://ezproxy.deakin.edu.au/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cat00097a&AN=deakin.b3090042&authtype=sso&custid=deakin&site=eds-live&scope=site [Google Scholar]
  8. Baum K. T., Desai A., Field J., Miller L. E., Rausch J., Beebe D. W. (2014). Sleep restriction worsens mood and emotion regulation in adolescents. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 55(2), 180–190. 10.1111/jcpp.12125 [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Becker S. P., Cusick C. N., Sidol C. A., Epstein J. N., Tamm L. (2018). The impact of comorbid mental health symptoms and sex on sleep functioning in children with ADHD. European Child & Adolescent Psychiatry, 27(3), 353–365. 10.1007/s00787-017-1055-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Becker S. P., Langberg J. M., Eadeh H.-M., Isaacson P. A., Bourchtein E. (2019). Sleep and daytime sleepiness in adolescents with and without ADHD: Differences across ratings, daily diary, and actigraphy. Journal of Child Psychology and Psychiatry, 60(9), 1021–1031. 10.1111/jcpp.13061 [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Becker S. P., Langberg J. M., Evans S. W. (2015). Sleep problems predict comorbid externalizing behaviors and depression in young adolescents with attention-deficit/hyperactivity disorder. European Child & Adolescent Psychiatry, 24(8), 897–907. 10.1007/s00787-014-0636-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Becker S. P., Sidol C. A., Van Dyk T. R., Epstein J. N., Beebe D. W. (2017). Intraindividual variability of sleep/wake patterns in relation to child and adolescent functioning: A systematic review. Sleep Medicine Reviews, 34, 94–121. 10.1016/j.smrv.2016.07.004 [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Birmaher B., Brent D. A., Chiappetta L., Bridge J., Monga S., Baugher M. (1999). Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): A replication study. Journal of the American Academy of Child and Adolescent Psychiatry, 38(10), 1230–1236. 10.1097/00004583-199910000-00011 [DOI] [PubMed] [Google Scholar]
  14. Blake M. J., Allen N. B. (2020). Prevention of internalizing disorders and suicide via adolescent sleep interventions. Current Opinion in Psychology, 34, 37–42. 10.1016/j.copsyc.2019.08.027 [DOI] [PubMed] [Google Scholar]
  15. Blake M. J., Sheeber L. B., Youssef G. J., Raniti M. B., Allen N. B. (2017). Systematic review and meta-analysis of adolescent cognitive–behavioral sleep interventions. Clinical Child and Family Psychology Review, 20(3), 227–249. 10.1007/s10567-017-0234-5 [DOI] [PubMed] [Google Scholar]
  16. Bruni O., Ottaviano S., Guidetti V., Romoli M., Innocenzi M., Cortesi F., Giannotti F. (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. 10.1111/j.1365-2869.1996.00251.x [DOI] [PubMed] [Google Scholar]
  17. Bruni O., Sette S., Fontanesi L., Baiocco R., Laghi F., Baumgartner E. (2015). Technology use and sleep quality in preadolescence and adolescence. Journal of Clinical Sleep Medicine, 11(12), 1433–1441. 10.5664/jcsm.5282 [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Carskadon M. A. (2011). Sleep in adolescents: The perfect storm. Pediatric Clinics of North America, 58(3), 637–647. 10.1016/j.pcl.2011.03.003 [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Crowley S. J., Wolfson A. R., Tarokh L., Carskadon M. A. (2018). An update on adolescent sleep: New evidence informing the perfect storm model. Journal of Adolescence, 67, 55–65. 10.1016/j.adolescence.2018.06.001 [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. de la Peña F. R., Villavicencio L. R., Palacio J. D., Félix F. J., Larraguibel M., Viola L., Ortiz S., Rosetti M., Abadi A., Montiel C., Mayer P. A., Fernández S., Jaimes A., Feria M., Sosa L., Rodríguez A., Zavaleta P., Uribe D., Galicia F., . . . Ulloa R. E. (2018). Validity and reliability of the kiddie schedule for affective disorders and schizophrenia present and lifetime version DSM-5 (K-SADS-PL-5) Spanish version. BMC Psychiatry, 18(1), 193. 10.1186/s12888-018-1773-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Frick M. A., Meyer J., Isaksson J. (2022). The role of comorbid symptoms in perceived stress and sleep problems in adolescent ADHD. Child Psychiatry & Human Development. Advance online publication. 10.1007/s10578-022-01320-z [DOI] [PMC free article] [PubMed]
  22. Goldstein A. N., Walker M. P. (2014). The role of sleep in emotional brain function. Annual Review of Clinical Psychology, 10(1), 679–708. 10.1146/annurev-clinpsy-032813-153716 [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Hysing M., Lundervold A. J., Posserud M.-B., Sivertsen B. (2016). Association between sleep problems and symptoms of attention deficit hyperactivity disorder in adolescence: Results from a large population-based study. Behavioral Sleep Medicine, 14(5), 550–564. 10.1080/15402002.2015.1048448 [DOI] [PubMed] [Google Scholar]
  24. Kearns J. C., Coppersmith D. D. L., Santee A. C., Insel C., Pigeon W. R., Glenn C. R. (2020). Sleep problems and suicide risk in youth: A systematic review, developmental framework, and implications for hospital treatment. General Hospital Psychiatry, 63, 141–151. 10.1016/j.genhosppsych.2018.09.011 [DOI] [PubMed] [Google Scholar]
  25. Kessler R. C., Berglund P., Demler O., Jin R., Merikangas K. R., Walters E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62(6), 593–602. 10.1001/archpsyc.62.6.593 [DOI] [PubMed] [Google Scholar]
  26. Langberg J. M., Molitor S. J., Oddo L. E., Eadeh H.-M., Dvorsky M. R., Becker S. P. (2017). Prevalence, patterns, and predictors of sleep problems and daytime sleepiness in young adolescents with ADHD. Journal of Attention Disorders, 24(4), 509–523. 10.1177/1087054717690810 [DOI] [PubMed] [Google Scholar]
  27. Littner M., Kushida C. A., Anderson W. M., Bailey D., Berry R. B., Davila D. G., Hirshkowitz M., Kapen S., Kramer M., Loube D., Wise M., Johnson S. F., & Standards of Practice Committee of the American Academy of Sleep Medicine. (2003). Practice parameters for the role of actigraphy in the study of sleep and circadian rhythms: An update for 2002. Sleep, 26(3), 337–341. 10.1093/sleep/26.3.337 [DOI] [PubMed] [Google Scholar]
  28. Lunsford-Avery J. R., Krystal A. D., Kollins S. H. (2016). Sleep disturbances in adolescents with ADHD: A systematic review and framework for future research. Clinical Psychology Review, 50, 159–174. 10.1016/j.cpr.2016.10.004 [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Maslowsky J., Ozer E. (2014). Developmental trends in sleep duration in adolescence and young adulthood: Evidence from a national US sample. The Journal of Adolescent Health, 54(6), 691–697. 10.1016/j.jadohealth.2013.10.201 [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Merikangas K. R., Nakamura E. F., Kessler R. C. (2009). Epidemiology of mental disorders in children and adolescents. Dialogues in Clinical Neuroscience, 11(1), 7–20. 10.31887/DCNS.2009.11.1/krmerikangas [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Migueles J. H., Rowlands A. V., Huber F., Sabia S., van Hees V. T. (2019). GGIR: A research community–driven open source r package for generating physical activity and sleep outcomes from multi-day raw accelerometer data. Journal for the Measurement of Physical Behaviour, 2(3), 3. [Google Scholar]
  32. Paus T., Keshavan M., Giedd J. N. (2008). Why do many psychiatric disorders emerge during adolescence? Nature Reviews Neuroscience, 9(12), 12. 10.1038/nrn2513 [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Pliszka S. R. (2000). Patterns of psychiatric comorbidity with attention-deficit/hyperactivity disorder. Child and Adolescent Psychiatric Clinics of North America, 9(3), 525–540. 10.1016/S1056-4993(18)30105-6 [DOI] [PubMed] [Google Scholar]
  34. R Core Team. (2020). R: The R project for statistical computing. https://www.r-project.org/
  35. Reale L., Bartoli B., Cartabia M., Zanetti M., Costantino M. A., Canevini M. P., Termine C., Bonati M., Conte S., Renzetti V., Salvoni L., Molteni M., Salandi A., Trabattoni S., Effedri P., Filippini E., Pedercini E., Zanetti E., Fteita N., . . . on behalf of Lombardy ADHD Group. (2017). Comorbidity prevalence and treatment outcome in children and adolescents with ADHD. European Child & Adolescent Psychiatry, 26(12), 1443–1457. 10.1007/s00787-017-1005-z [DOI] [PubMed] [Google Scholar]
  36. Sadeh A., Acebo C. (2002). The role of actigraphy in sleep medicine. Sleep Medicine Reviews, 6(2), 113–124. 10.1053/smrv.2001.0182 [DOI] [PubMed] [Google Scholar]
  37. Sarchiapone M., Mandelli L., Carli V., Iosue M., Wasserman C., Hadlaczky G., Hoven C. W., Apter A., Balazs J., Bobes J., Brunner R., Corcoran P., Cosman D., Haring C., Kaess M., Keeley H., Keresztény A., Kahn J.-P., Postuvan V., . . . Wasserman D. (2014). Hours of sleep in adolescents and its association with anxiety, emotional concerns, and suicidal ideation. Sleep Medicine, 15(2), 248–254. 10.1016/j.sleep.2013.11.780 [DOI] [PubMed] [Google Scholar]
  38. Schatz D. B., Rostain A. L. (2006). ADHD with comorbid anxiety: A review of the current literature. Journal of Attention Disorders, 10(2), 141–149. 10.1177/1087054706286698 [DOI] [PubMed] [Google Scholar]
  39. Stringaris A., Goodman R., Ferdinando S., Razdan V., Muhrer E., Leibenluft E., Brotman M. A. (2012). The Affective Reactivity Index: A concise irritability scale for clinical and research settings. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 53(11), 1109–1117. 10.1111/j.1469-7610.2012.02561.x [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Tu K. M., Marks B. T., El-Sheikh M. (2017). Sleep and mental health: The moderating role of perceived adolescent-parent attachment. Sleep Health, 3(2), 90–97. 10.1016/j.sleh.2016.12.003 [DOI] [PubMed] [Google Scholar]
  41. Tung I., Li J. J., Meza J. I., Jezior K. L., Kianmahd J. S. V., Hentschel P. G., O’Neil P. M., Lee S. S. (2016). Patterns of comorbidity among girls with ADHD: A meta-analysis. Pediatrics, 138(4), e20160430. 10.1542/peds.2016-0430 [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. van Hees V. T., Sabia S., Anderson K. N., Denton S. J., Oliver J., Catt M., Abell J. G., Kivimäki M., Trenell M. I., Singh-Manoux A. (2015). A novel, open access method to assess sleep duration using a wrist-worn accelerometer. PLoS ONE, 10(11), e0142533. 10.1371/journal.pone.0142533 [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. van Hees V. T., Sabia S., Jones S. E., Wood A. R., Anderson K. N., Kivimäki M., Frayling T. M., Pack A. I., Bucan M., Trenell M. I., Mazzotti D. R., Gehrman P. R., Singh-Manoux B. A., Weedon M. N. (2018). Estimating sleep parameters using an accelerometer without sleep diary. Scientific Reports, 8(1), 12975. 10.1038/s41598-018-31266-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Virring A., Lambek R., Thomsen P. H., Møller L. R., Jennum P. J. (2016). Disturbed sleep in attention-deficit hyperactivity disorder (ADHD) is not a question of psychiatric comorbidity or ADHD presentation. Journal of Sleep Research, 25(3), 333–340. 10.1111/jsr.12377 [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

sj-docx-1-jad-10.1177_10870547231155871 – Supplemental material for Associations Between ADHD, Sleep Problems, and Mental Health Symptoms in Adolescents
Click here for additional data file. (14.9KB, docx)

Supplemental material, sj-docx-1-jad-10.1177_10870547231155871 for Associations Between ADHD, Sleep Problems, and Mental Health Symptoms in Adolescents by George Loram, Mathew Ling, Tim Silk and Emma Sciberras in Journal of Attention Disorders

sj-docx-2-jad-10.1177_10870547231155871 – Supplemental material for Associations Between ADHD, Sleep Problems, and Mental Health Symptoms in Adolescents
Click here for additional data file. (27.6KB, docx)

Supplemental material, sj-docx-2-jad-10.1177_10870547231155871 for Associations Between ADHD, Sleep Problems, and Mental Health Symptoms in Adolescents by George Loram, Mathew Ling, Tim Silk and Emma Sciberras in Journal of Attention Disorders

sj-docx-3-jad-10.1177_10870547231155871 – Supplemental material for Associations Between ADHD, Sleep Problems, and Mental Health Symptoms in Adolescents
Click here for additional data file. (29.5KB, docx)

Supplemental material, sj-docx-3-jad-10.1177_10870547231155871 for Associations Between ADHD, Sleep Problems, and Mental Health Symptoms in Adolescents by George Loram, Mathew Ling, Tim Silk and Emma Sciberras in Journal of Attention Disorders

sj-png-4-jad-10.1177_10870547231155871 – Supplemental material for Associations Between ADHD, Sleep Problems, and Mental Health Symptoms in Adolescents
Click here for additional data file. (86.7KB, png)

Supplemental material, sj-png-4-jad-10.1177_10870547231155871 for Associations Between ADHD, Sleep Problems, and Mental Health Symptoms in Adolescents by George Loram, Mathew Ling, Tim Silk and Emma Sciberras in Journal of Attention Disorders

sj-png-5-jad-10.1177_10870547231155871 – Supplemental material for Associations Between ADHD, Sleep Problems, and Mental Health Symptoms in Adolescents
Click here for additional data file. (84KB, png)

Supplemental material, sj-png-5-jad-10.1177_10870547231155871 for Associations Between ADHD, Sleep Problems, and Mental Health Symptoms in Adolescents by George Loram, Mathew Ling, Tim Silk and Emma Sciberras in Journal of Attention Disorders

Articles from Journal of Attention Disorders are provided here courtesy of SAGE Publications

RESOURCES