Poster #38 - Insufficient Sleep in Children with Behavior Problems and Caregiver Stress: A U.S. National Study

• In Event: Poster Session 14

Abstract

Sleep problems are prevalent among children with attention-deficit/hyperactivity disorder (ADHD) and comorbid oppositional defiant/conduct disorders (ODD/CD; Noble et al., 2012; Hvolby et al. 2021). Children experiencing these concerns also have caregivers who report feeling more stress (Byars et al., 2011; Leitch et al., 2019). However, the way insufficient sleep impacts the association between behavioral problems and caregiver stress is unclear. The current study examined how insufficient sleep moderated the link between child ADHD, child ODD/CD, and caregiver stress. Additionally, sex differences regarding child ODD/CD, insufficient child sleep, and caregiver stress are unclear as most studies treat child sex as a covariate (e.g., Hvolby et al. 2020) rather than examine sex-specific associations. Thus, our study also examined whether and how sex differences influenced links among child ADHD, child ODD/CD, insufficient child sleep, and caregiver stress. Understanding of these associations is needed to inform treatment approaches and outcomes.
Data were acquired from the 2018/2019 National Survey of Children’s Health, a nationally representative survey of parents or caregivers conducted across the United States. The current study used data for children 6-17 years old with a final analytic sample size of 41,541 youth with complete data across measures representing a total weighted sample of 47,357,862 US youth. Weighted percentages of the children were primarily female (50.9%) and identified as Non-Hispanic White (50.3%) followed by Hispanic (25.7%), Non-Hispanic Black (13.6%), and Multiracial (10.5%). Caregivers were asked demographic information and completed measures assessing caregiver stress, child sleep duration, and current child ADHD and ODD/CD diagnoses.
See Table 1 for associations of sleep, ADHD, and ODD/CD with caregiver stress. Overall child ADHD (β=0.52, p<.001) and ODD/CD (β=1.26, p<.001) were each uniquely associated with increased caregiver stress, while adequate child sleep duration (β=-0.11, p<.001) was related to decreased caregiver stress. However, these findings were qualified by a significant two-way interaction that revealed that caregiver stress among children with comorbid ADHD and ODD/CD was not significantly greater than that of children with ODD/CD alone (Figure 1 displays the interaction). Significant interactions between sleep and ODD/CD on caregiver stress were generally not observed, except potentially in females with ADHD (β=0.25, p=.052).
The present findings highlight associations between child ADHD, ODD/CD, sleep duration, and caregiver stress. Overall, sleep duration does not appear to moderate the relation between child ADHD and ODD/CD and caregiver stress. At the population level, the influence of child sleep duration on caregiver stress was small in magnitude, while the influence of child ADHD and ODD/CD were considerably higher than the national average. Sex-specific influences for adequate sleep’s association with lower caregiver stress were generally not observed, except potentially for females with ADHD. Future research should consider other aspects of sleep such as sleep onset latency, sleep termination, and sleep disorders that are associated with child ADHD and ODD/CD and how those aspects contribute to caregiver stress. Our findings underscore the importance of considering strategies to reduce both youth symptoms and caregiver stress simultaneously. Additionally, ensuring adequate sleep for all children is recommended.

Authors

• Tre D Gissandaner, New York State Psychiatric Institute
  Presenting Author

• Melanie A Stearns

• Dustin E Sarver

• Benjamin Walker

• Hannah Ford