Sleep Disturbance in Children and Adolescents with ADHD

102 Pages·2015·0.67 MB·English

Lehigh University
Lehigh Preserve
Theses and Dissertations
2011
Sleep Disturbance in Children and Adolescents
with ADHD: Unique Effects of Medication,
ADHD Subtype, and Comorbid Status
Jocelyn Rachael Helwig
Lehigh University
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Helwig, Jocelyn Rachael, "Sleep Disturbance in Children and Adolescents with ADHD: Unique Effects of Medication, ADHD
Subtype, and Comorbid Status" (2011).Theses and Dissertations.Paper 1321.
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Sleep Disturbance in Children and Adolescents with ADHD:
Unique Effects of Medication, ADHD Subtype, and Comorbid Status

by
Jocelyn R. Helwig

Presented to the Graduate and Research Committee
of Lehigh University
in Candidacy for the Degree of
Doctor of Philosophy
in
School Psychology

Lehigh University
May 2011

i
Copyright by Jocelyn R. Helwig
2011
ii
Approved and recommended for acceptance as a dissertation in partial fulfillment
of the requirements of Doctor of Philosophy.

___________________________
(date)
__________________________
Dissertation Director
George J. DuPaul, Ph.D.
Professor, School Psychology

Accepted ___________________
(date)
Committee Members

_
__________________________
Patricia H. Manz, Ph.D.
Associate Professor, School
Psychology

__________________________
Lisa J. Meltzer, Ph.D.
Assistant Professor, Pediatrics
National Jewish Health

__________________________
Thomas J. Power, Ph.D.
Professor of School Psychology in
Pediatrics and Education
University of Pennsylvania

iii
ACKNOWLEDGEMENTS
The completion of this dissertation project would not have been possible without
the help and support of others, to whom I am eternally grateful.
First, I would like to thank my family. To my mother and father, for instilling in
me a passion for learning, for leading me to appreciate the value of education, and for
their continued belief in me through many, many years of school. Thank you for shaping
me into the person I am today. To my fiancé, without your immense patience, love, and
support, none of this would have been possible. To my brother, who patiently allowed
me to practice countless new testing and evaluation procedures with him through the
years. Thank you for your friendship and I look forward to working with you as a
colleague in the future as you enter the field of psychology.
Next, I would like to thank the faculty at Lehigh University, especially those of
whom are members of my committee. To my advisor, George DuPaul, it has been an
honor working with you for the previous eight years. I remain eternally grateful of your
support and guidance during both my undergraduate and graduate school training. To
Lisa Meltzer, who opened my eyes to the fascinating world of pediatric sleep medicine,
thank you for always seeing the potential in me. To Tom Power, your love for research is
palpable and you will always inspire me to reach higher. To Patti Manz, who was always
a bright spot during the long days of graduate school, your encouragement during the
development and implementation of this project will never be forgotten.
Finally, thank you to my fellow graduate students and recent graduates of the
program. A special thanks to Erin Leichman, who completed IOA quickly and
efficiently. Thank you all for your support and friendship.
iv
TABLE OF CONTENTS
1. Abstract 1
2. Introduction 3
2.1 Sleep Disturbance in Children with ADHD 3
2.2 Influence of Medication 5
2.3 Influence of ADHD Subtype 5
2.4 Influence of Comorbidity 6
2.5 Limitations of Current Research 7
2.6 Purpose of Research 7
a. Research Questions and Hypotheses 8
3. Literature Review 10
3.1 Review and Consequences of ADHD 10
3.2 Review and Consequences of Sleep Disturbance 12
3.3 Medication as a Contributing Factor 17
3.4 ADHD Subtype as a Contributing Factor 20
3.5 Comorbidity as a Contributing Factor 23
3.6 Contributions of the Proposed Study 24
4. Methods 26
4.1 Participants and Setting 26
4.2 Measures 27
4.3 Procedures 28
4.4 Data Analyses 29
a. Research Question #1 30
b. Research Question #2 31
5. Results 34
5.1 Demographic Characteristics 34
5.2 Frequency of Sleep Diagnoses and Sleep Medication 35
5.3 Reported Sleep Problems and Treatments 38
5.4 Frequencies within Participants and across Variables 39
5.5 Diagnosis of ADHD Process 43
5.6 Research Question #1 44
5.7 Research Question #2 45
6. Discussion 48
6.1 Research Question #1 48
6.2 Research Question #2 50
6.3 Other Notable Findings 54
6.4 Limitations 56
6.5 Clinical Implications 58
6.6 Directions for Future Research 58
6.7 Conclusion 59
7. Tables 62
8. Figures 84
9. References 85
10. Biography 93

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LIST OF TABLES

1. Demographic Variables According to Study Group 61
2. Percent of Sleep Diagnosis 62
3. Percent of Prescribed Sleep Medication 63
4. Percent of Parent and/or Child Reported Sleep Problem and 64
Treatment Recommendations
5. Frequency of Sleep Diagnosis, Sleep Medication, and Sleep 65
Problems within Participants
6. Frequency of Sleep Diagnosis and Sleep Medication across 66
Variables in the Overall Sample of Children with ADHD
7. Frequency of Sleep Diagnosis and Sleep Medication across 67
Variables in the Overall Sample of Control Children without
ADHD
8. Frequency of Sleep Diagnosis and Sleep Medication across 68
Variables in the Overall Subsample of Children with ADHD
9. Frequency of Sleep Diagnosis and Sleep Medication across 69
Variables in the Overall Sample of Adolescents with ADHD
10. Frequency of Sleep Diagnosis and Sleep Medication across 70
Variables in the Overall Sample of Control Adolescents without
ADHD
11. Frequency of Sleep Diagnosis and Sleep Medication across 71
Variables in the Overall Subsample of Adolescents with ADHD
12. Percent of ADHD Diagnoses by Provider Type 72
13. ADHD Diagnosis Process by Primary Care Physicians 73
14. Logistic Regression Model used to Predict Sleep Disorder 74
Diagnoses in the Sample of Children with and without
ADHD Overall Group
15. Logistic Regression Model used to Predict Prescribed Sleep 75
Medication in the Sample of Children with and without ADHD
Overall Group
16. Logistic Regression Model used to Predict Sleep Disorder 76
Diagnoses in the Sample of Adolescents with and without
ADHD Overall Group
17. Logistic Regression Model used to Predict Prescribed Sleep 77
Medication in the Sample of Adolescents with and without
ADHD Overall Group
18. Logistic Regression Model used to Predict Sleep Disorder 78
Diagnoses in the Sample of Children with ADHD Overall Group
19. Logistic Regression Model used to Predict Prescribed Sleep 79
Medication is the Sample of Children with ADHD Overall Group
20. Logistic Regression Model used to Predict Sleep Problems in 80
the Sample of Children with ADHD Subgroup
21. Logistic Regression Model used to Predict Sleep Disorder 81
Diagnoses in the Sample of Adolescents with ADHD Overall
Group
vi
22. Logistic Regression Model used to Predict Prescribed Sleep 82
Medication in the Sample of Adolescents with ADHD Overall
Group
23. Logistic Regression Model used to Predict Sleep Problems in 83
the Sample of Adolescents with ADHD Subgroup

vii
LIST OF FIGURES

1. Visual Depiction of the Samples used in each Statistical Analysis 84

viii
ABSTRACT
ADHD is among the most common childhood psychiatric disorders, estimated to affect
approximately 3% to 5% of elementary school-aged children, with 11% to 37% reporting
sleep disturbance (American Psychiatric Association, 2000; Owens, Spirito, McGuinn, &
Nobile, 2000). Disturbed sleep can result in daytime sleepiness and behavioral
difficulties that affect cognitive functions in children, such as attention and memory, as
well as exacerbate symptoms of ADHD (Fallone, Owens, & Deane, 1998; Owens, 2005).
The primary aim of this study was to determine the prevalence of ICD-9 sleep disorders,
prescribed sleep medications, and complaints of sleep problems as diagnosed by pediatric
primary care providers in children and adolescents with ADHD across medication status,
ADHD subtype, and comorbidity. Electronic medical records were reviewed for 5,881
patients (6-18 years) diagnosed with ADHD and 5,881 patients without ADHD matched
by age, gender, and primary care practice and seen for a well-child visit in 2007.
Information was collected on ICD-9 sleep diagnoses, medications potentially used to treat
sleep disorders, demographic variables, medications commonly used to treat symptoms of
ADHD, ICD-9 ADHD subtype, and comorbidity. A secondary analysis was conducted
on 556 participants to examine parent and/or patient complaint of sleep problems.
Results indicated that children and adolescents with ADHD were more likely to be
diagnosed with a sleep disorder or prescribed a sleep medication compared to their
pediatric counterparts with no ADHD diagnosis. The significance of medications
commonly used to treat symptoms of ADHD, ICD-9 ADHD subtype, and comorbidity as
risk factors of sleep disturbance was discussed. This is one of the first studies to
highlight the subgroups of children and adolescents with ADHD significantly more likely
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