Sleep disorders in children with attention-deficit/hyperactivity disorder

Keywords: sleep disturbance, children with ADHD, SDSC, CSHS.


Background Attention-deficit/hyperactivity disorder (ADHD) is a neurobehavioral abnormality that commonly occurs among children. Sleep disorders are comorbid with ADHD. Sleep disorders in Indonesian children with ADHD have not been widely studied.

Objective To understand the proportion and factors that influence sleep disorders in children with ADHD.

Methods This cross-sectional study involved 54 children aged 3-14 years who had been diagnosed with ADHD by a pediatric growth and development consultant using DSM-5 criteria. The subjects were consecutively selected from March to August 2017 at the Child Development Polyclinic, Dr. Sardjito Hospital, Yogyakarta. Sleep data were collected using the Sleep Disturbances Scale for Children (SDSC) and the Children’s Sleep Hygiene Scale (CSHS).

Results Of the 54 children with ADHD (46 males and 8 females), 35 (64.8%) experienced sleep disorders. The majority (26 subjects, 48.1%) had the disorder of initiating and maintaining sleep. Children with the combined (inattention and hyperactive-impulsive) type of ADHD experienced significantly greater sleep disturbance compared to the inattention type or hyperactive-impulsive type (OR=3.750; 95% CI 1.133 to 12.41; P=0.027). Poor sleep hygiene was also significantly associated with more severe sleep disorders (r=-0.383, P=0.004).

Conclusion The proportion of sleep disorder in children with ADHD is relatively high, with the majority having a disorder of initiating and maintaining sleep. Children with combined type ADHD experience a higher amount of sleep disorder than those with either the inattention or hyperactive-impulsive types of ADHD. Children with poor sleep hygiene have significantly more severe sleep disorders.


1. Van Cauter E, Leproult R, Plat L. Age-related changes in slow wave sleep and REM sleep and relationship with growth hormone and cortisol levels in healthy men. JAMA. 2000;284:861-8.
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Text revision. Washington DC: American Psychiatric Association 2013. p. 59-65.
3. Marcdante K, Kliegman R, Jenson H, Behrman R. Gangguan pemusatan perhatian/hiperaktivitas. In: Suryawan A, Chairulfatah A, Pulungan AB, Endaryanto A, Pudjiadi A, Kurniawan A, editors. Nelson, Ilmu Kesehatan Anak Esensial. 6th edition. Jakarta; Ikatan Dokter Anak Indonesia: 2014. p. 52-5.
4. Gamayanti IL. Aspek psikologis anak dengan gangguan pemusatan hiperaktifitas, suatu ilustrasi khusus. In: Susanti D, Sunartini H, Sutomo R. Hubungan antara defisiensi besi dengan attention-deficit/hyperactivity disorder pada anak. Sari Pediatr. 2015;17:29-34.
5. Spruyt K, Gozal D. Pediatric sleep questionnaires as diagnostic or epidemiological tools: a review of currently available instruments. Sleep Med Rev. 2011;15:19-32.
6. Corkum P, Tannock R, Moldofsky H. Sleep disturbances in children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 1998;37:637-646.
7. Lycett K, Sciberras E, Mensah FK, Gulenc A, Hiscock H. Behavioral sleep problems in children with attention-deficit/hyperactivity disorder (ADHD): protocol for a prospective cohort study. BMJ Open. 2014;4:e004070.
8. Steer C, Yemula C. ADHD and sleep problems. 2012. Cutting Edge Psychiatry in Practice. 2012; [cited 2017 December 1]. Available from:
9. Bruni, O. The sleep disturbance scale for children ( SDSC ) construction and validation of an instrument to evaluate sleep disturbances in childhood and adolescence. J Sleep Res. 1996;5:251-61.
10. Natalita C, Sekartini R, Poesponegoro H. Skala gangguan tidur untuk anak (SDSC) sebagai instrumen skrining gangguan tidur pada anak sekolah lanjutan tingkat pertama. Sari Pediatr. 2011;12:365-72.
11. Scahill L, Schwab-Stone M. Epidemiology of ADHD in school-age children. Child Adolesc Psychiatrc Clin N Am. 2000;9:541-55.
12. Rucklidge J. Gender differences in attention-deficit/hyperactivity disorder. Psychiatr Clin N Am. 2010;33:357-73.
13. Wedayanti D. Skripsi prevalensi gangguan tidur pada anak dengan gangguan pemusatan perhatian dan hiperaktivitas (GPPH) di poliklinik tumbuh kembang RSUP Sanglah. Denpasar: Universitas Udayana; 2016.
14. LeBourgeois MK, Avis K, Mixon M, Olmi J, Harsh J. Snoring, sleep quality, and sleep across attention-deficit hyperactivity disorder subtypes. Sleep. 2004;27:520-5.
15. Mayes SD, Calhoun SL, Bixler EO, Vgontzas AN, Mahr F, Hillwig-garcia J, Elamir B. ADHD subtypes and comorbid anxiety, depression, and oppositional-defiant disorder: differences in sleep problems. J Pediatrc Psychol. 2009;34:328-37.
16. Chiang H, Gau SS, Ni HC, Chiu YN, Shang CY, Wu YY, et al. Association between symptoms and subtypes of attention-deficit hyperactivity disorder and sleep problems/disorders. J Sleep Res. 2010;19:535-45.
17. Yoon S, Jain U, Shapiro C. Sleep and daytime function in adults with attention-deficit/hyperactivity disorder: subtype differences. Sleep Med. 2013;14:648-55.
18. Ganelin-cohen E, Ashkenasi A. Disordered sleep in pediatric patients with attention deficit hyperactivity disorder: an overview. Isr Med Assoc J. 2013;15:705-09.
19. Stein M. Unravelling sleep problems in treated and untreated children with ADHD. Journal of Child and Adolesc Psychopharmacol. 1999;9:157-68.
20. Cortese S, Faraone S, Konofal E, Lecendreux M. Sleep in children with attention-deficit/hyperactivity disorder: meta-analysis of subjective and objective studies. J Am Acad Child Adolesc Psychiatry. 2009;48:894-908.
21. Weiss MD, Salpekar J. Sleep problems in the child with attention-deficit hyperactivity disorder. Defining aetioloy and appropriate treatments. CNS Drugs 2010;24:811-28.
How to Cite
Permatawati M, Triono A, Sitaresmi M. Sleep disorders in children with attention-deficit/hyperactivity disorder. PI [Internet]. 20Mar.2018 [cited 21Apr.2024];58(1):48-2. Available from:
Received 2017-12-03
Accepted 2018-02-22
Published 2018-03-20