title: The bidirectional relationship between sleep problems and internalizing and externalizing problems in children with ADHD: a prospective cohort study.
abstract: BACKGROUND
  Behavioral sleep problems are common in children with attention deficit hyperactivity disorder (ADHD), and longitudinal studies have found sleep problems to be both a predictor and outcome of internalizing and externalizing problems. We investigated the potential bidirectional relationship between sleep problems and internalizing/externalizing problems.
  
  
  METHODS
  Children with ADHD, aged 5-13 years, were recruited from 21 pediatric practices across Victoria, Australia (N = 270). Across a 12-month period, at three time points, parents reported on their child's sleep problems (Children's Sleep Habits Questionnaire) and emotional and behavioral functioning (Strengths and Difficulties Questionnaire). Data were analyzed using autoregressive cross-lagged panel models.
  
  
  RESULTS
  Sleep problem severity and emotional/behavioral problem severity were very stable across the 12-month period. Sleep problems at baseline predicted emotional problems at six months (r = 0.17, p < 0.01), and emotional problems at baseline predicted sleep problems at six months (r = 0.07, p < 0.05). However, there was no predictive relationship between sleep problems and emotional problems from 6-12 months. No bidirectional relationship was observed between sleep problems and conduct problems.
  
  
  CONCLUSIONS
  In children with ADHD, there is weak evidence of a bidirectional relationship between sleep problems and emotional problems. These symptoms are also very stable over time; therefore, the best treatment approach to improve overall functioning may be to target both sleep and emotional functioning in these children.
authors: Community Child Health, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, Victoria, Australia. Electronic address: melissa.mulraney@mcri.edu.au.
authors: Melissa
authors: M
authors: Mulraney
authors: Healthy Mothers Healthy Families, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, Victoria, Australia.
authors: Rebecca
authors: R
authors: Giallo
authors: Community Child Health, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, Victoria, Australia.
authors: Kate
authors: K
authors: Lycett
authors: Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, Victoria, Australia; Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, Australia.
authors: Fiona
authors: F
authors: Mensah
authors: Community Child Health, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, Victoria, Australia; The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, Australia; School of Psychology, Deakin University, Burwood Highway, Burwood, Victoria, Australia.
authors: Emma
authors: E
authors: Sciberras
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications* / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D004644:Emotions; D005260:Female; D006801:Humans; D007389:Internal-External Control; D008297:Male; D010290:Parents; D011446:Prospective Studies; D012893:Sleep Wake Disorders / Q000209:etiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D014739:Victoria
keywords: ADHD; Externalizing; Internalizing; Sleep