Bidirectional Associations Between Maternal Mental Health and Child Sleep Problems in Children With ADHD: A Longitudinal Study

Background: Children with attention-deficit/hyperactivity disorder (ADHD) experience more sleep problems than their typically developing peers. In addition, their parents experience higher rates of mental health difficulties relative to parents of children without ADHD. Cross-sectional studies have reported associations; however, longitudinal studies have not yet been conducted. This study aimed to investigate potential bidirectional relationships between sleep problems in children with ADHD and maternal mental health difficulties (i.e. overall mental health, depression, anxiety, stress) over a 12-month period. Methods: Female caregivers of 379 children with ADHD (5-13 years) reported on their child's sleep (Children's Sleep Habits Questionnaire) and their own mental health (Depression Anxiety Stress Scale) at three time points over a 12-month period (baseline, 6-months, and 12-months). Autoregressive cross-lagged panel analyses were used to analyze the data, controlling for child age, child sex, ADHD symptom severity, ADHD medication use, comorbidities (autism spectrum disorder, internalizing disorders, and externalizing disorders), caregiver age, and socioeconomic disadvantage. Results: Child sleep problems and maternal mental health difficulties were highly stable across the 12-month period. In addition, longitudinal relationships were evident, with child sleep problems at 6-months predicting both overall maternal mental health difficulties and maternal anxiety at 12-months. However, child sleep problems at 6-months did not predict maternal depression or maternal stress at 12-months. There was little evidence that maternal mental health difficulties predicted child sleep problems over the 12-month period. Conclusion: This study demonstrates that despite the stability in child sleep problems and maternal mental health difficulties over time, sleep problems in children with ADHD contribute to later maternal mental health difficulties. This suggests that sleep interventions to improve child sleep may lead to an improvement in maternal mental health over time. It also suggests a need to be aware of the potential mental health difficulties being experienced by mothers who have children with sleep problems.