The Mediating Role of Sleep Problems in the Association Between Attention-Deficit/Hyperactivity Disorder and Self-Injurious Thoughts and Behaviors in Children Aged 9-12 in the United States.

PURPOSE: Given the association of attention-deficit/hyperactivity disorder (ADHD) with self-injurious thoughts and behaviors (SITBs) among adolescents/adults, and the high prevalence of SITBs in preadolescents, this study aims to identify modifiable preadolescent factors by investigating the sleep problems' mediating role.

METHODS

Utilizing data from the Adolescent Brain Cognitive Development Study, ADHD diagnosis at baseline (ages 9-11) and SITBs at 2-year follow-up were assessed using the Kiddie Schedule for Affective Disorders and Schizophrenia. Sleep problems were measured with the Sleep Disturbance Scale for Children at baseline, 1-year, and 2-year follow-up. Logistic regression was used to examine the associations between ADHD and SITBs. Latent profile analysis identified sleep profiles based on six dimensions of the Sleep Disturbance Scale for Children. Mediation models assessed the mediating role of sleep problems.

RESULTS

Among the 8,328 youth included, 7.5% had parent-reported ADHD. These individuals exhibited higher odds of SITBs (adjusted odds ratio = 2.72 [95% confidence interval, 2.27-3.25]F). Sleep problems accounted for 34.5% of the association with SITBs among youth with ADHD. Three sleep profiles were identified, with one profile characterized by sleep initiation/maintenance difficulties and excessive somnolence mediating 22.6% of the association with SITBs. In youth with ADHD, temporal patterns of time-limited, intermittent, and chronic sleep disturbance significantly mediated 12.9%, 30.6%, and 48.0% of the association with SITBs, respectively.

DISCUSSION: Sleep problems significantly mediated the relationship between ADHD and SITBs in preadolescents. Difficulties in sleep initiation/maintenance and excessive somnolence made substantial contributions to the mediating effect. The mediating effect strengthened with the prolonged persistence of sleep disturbances.