Co-Principal Investigator: Stephen Becker (Cincinnati Children's Hospital Medical Center)

Purpose: The purpose of this project is to conduct a prospective longitudinal study of students with and without Attention-Deficit/Hyperactivity Disorder (ADHD) beginning at Grade 8 to assess sleep patterns, academic, and social functioning, and factors that may differentially predict the presence of sleep problems. Sleep problems are considerably more common in individuals with ADHD in comparison to the general population, with approximately 30% of children and 60% of adults with ADHD exhibiting significant sleep problems. Little is known, however, about how sleep problems contribute to the educational functioning of adolescents with ADHD or why prevalence rates are higher among adolescents with ADHD. Longitudinal research is needed to establish how short-term and long-term sleep problems may impact the functioning of adolescents with and without ADHD over time.

Project Activities: The researchers will follow students with and without ADHD from Grade 8 through Grade 10. During this period, researchers will collect data at five time points to assess the impact of sleep on the academic and social functioning of students as they transition from middle to high school.

Products: The findings from this project may lead to best-practice recommendations for how and when schools can include sleep assessments as part of psychoeducational evaluations and may help inform policy decisions about school contextual factors that can impact sleep (e.g., amount of assigned homework). In addition, the findings from this project can be used to inform the development of a school-based intervention that addresses sleep problems.

Structured Abstract

Setting: The study will take place in middle and high schools in Virginia, Ohio, and Kentucky.

Sample: The schools involved in this project will provide a diverse sample of participants from a range of socioeconomic statuses and include a sizeable percentage of students who are minorities and who receive free or reduced price lunch. A total of 300 Grade 8 students, 150 with ADHD and 150 comparison adolescents without ADHD, will participate in the study. Given the higher prevalence of ADHD among males than females, the sample will have a larger number of boys than girls (gender distribution of 3:2).

Intervention: There is no intervention.

Research Design and Methods: Students in Grade 8 with and without ADHD will be recruited across two cohorts as they transition from middle school to high school. This is a critical time point since this transition is often associated with disruptions in both academic and sleep functioning. All potential participants will undergo a full ADHD diagnostic evaluation and assessment of cognitive functioning to meet the inclusion criteria. After obtaining parental consent and student assent, data will be collected across five time points, beginning in grade 8 through Grade 10. At all timepoints, a comprehensive multi-method assessment approach will be used, including the collection of ratings of sleep and functioning from parents, teachers, and students. In addition, all students will wear actigraphs (i.e., watch-like device that objectively measures sleep patterns) and complete daily sleep diaries over a two-week period. During this same time period, students and their teachers will complete daily ratings of daytime sleepiness, and academic/classroom functioning.

Control Condition: In this study, researchers will assess a comparison group of 150 students without ADHD.

Key Measures: Key outcome measures include subjective ratings and objective measures of sleep functioning (Sleep Habits Survey; Pediatric Daytime Sleepiness Scale; Children's Sleep Habits Questionnaire; Teacher's Daytime Sleepiness Questionnaire; Daily Sleep Diary; Daily Teacher Ratings; and Daily Self-Report Ratings). Academic and cognitive function measures include the Wechsler Individual Achievement Test-Abbreviated (WIAT-III), Academic Competence Evaluation Scales, WISC-V Symbol Search, Coding, and Digit Span subtests, and class grades and school attendance. Students' social functioning will be assessed with the Social Skills Improvement System, the Self-Perception Profile for Children, and the Dishion Social Acceptance Scale. Predictors of sleep function will be measured with the Revised Child Anxiety and Depression Scales, Homework Problem Checklist, Homework Performance Questionnaire - Teacher (HPQ-T), Children's Organizational Skills Scale, Conflict Behavior Questionnaire, Alabama Parenting Questionnaire, Child Routines Inventory, Activities and Time Questionnaire, and the Adolescent Sleep, Caffeine Intake, and Technology Use Questionnaire.

Data Analytic Strategy: The research team will analyze the data using autoregressive, latent growth curve models, latent variable models, and mediation models to examine the bidirectional relationships between ADHD, sleep risk factors, sleep functioning, and academic/social functioning outcomes. Researchers will also use multilevel modeling to examine daily-level associations between sleep duration, time spent on homework, and daily academic and social functioning.

Products and Publications

Journal article, monograph, or newsletter

Becker, S.P., and Willcutt, E.G. (2018). Advancing the Study of Sluggish Cognitive Tempo via DSM, RDoC, and Hierarchical Models of Psychopathology. European Child & Adolescent Psychiatry, 1–11.

Becker, S.P. and Langberg J.M. (2017). Difficult to Bed and Difficult to Rise: Complex Interplay Among ADHD, Sleep, and Adolescence. The ADHD Report, 25(1): 7–13.

Langberg, J.M., Molitor, S.J., Oddo, L.E., Eadeh, H.M., Dvorsky, M.R., and Becker, S.P. (2017). Prevalence, Patterns, and Predictors of Sleep Problems and Daytime Sleepiness in Young Adolescents with Attention-Deficit/Hyperactivity Disorder. Journal of Attention Disorders.