Abstract
Adolescents with attention-deficit/hyperactivity disorder (ADHD) are at heightened risk of experiencing academic difficulties due to organizational deficits. Impairment can be exacerbated through poor sleep hygiene and excessive daytime sleepiness, prevalent sleep challenges for adolescents with ADHD. Given established relationships among sleep, memory consolidation, and executive functioning, sleep hygiene and daytime sleepiness may affect academic and organizational treatment outcomes. The current study examined the influence of pre-treatment daytime sleepiness and sleep hygiene on academic and organizational treatment outcomes in a randomized controlled trial of a multicomponent intervention for 171 high school students with ADHD. Participants were assigned to either the treatment group (n = 85, Mage = 15.0, SD = 0.8, 80% male, 71% White/Non-Hispanic) or the control group (n = 86, Mage = 15.1, SD = 0.9, 78% male, 87% White/Non-Hispanic). Multiple regression analyses with an interaction term were conducted, finding significant main effects for poor pre-treatment sleep hygiene and excessive daytime sleepiness predicting worse post-treatment GPA, organizational skills, academic problems, and homework problems. A significant moderation effect was found such that greater pre-treatment daytime sleepiness was associated with more post-treatment homework problems, but only for the control group. Incorporating efforts to improve sleep hygiene and daytime sleepiness in interventions for adolescents with ADHD may enhance treatment-induced improvements. Future studies should utilize objective sleep measures to gain greater understanding of sleep’s impact on adolescents’ response to psychosocial treatment.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Abikoff, H., & Gallagher, R. (2008). Assessment and remediation of organizational skills deficits in children with ADHD. In K. McBurnett & L. Pfiffner (Eds.), Attention deficit hyperactivity disorder: Concepts, controversies and new directions (pp. 137–152). Taylor & Francis Group LLC.
Allen, J. D. (2005). Grades as valid measures of academic achievement of classroom learning. The Clearing House: A Journal of Educational Strategies, Issues and Ideas, 78(5), 218–223. https://doi.org/10.3200/TCHS.78.5.218-223
Anesko, K. M., Schoiock, G., Ramirez, R., & Levine, F. M. (1987). The homework problem checklist: Assessing children’s homework difficulties. Behavioral Assessment, 9(2), 179–185.
Becker, S. P. (2020). ADHD and sleep: Recent advances and future directions. Current Opinion in Psychology, 34, 50–56. https://doi.org/10.1016/j.copsyc.2019.09.006
Becker, S. P., Epstein, J. N., Tamm, L., Tilford, A. A., Tischner, C. M., Isaacson, P. A., Simon, J. O., & Beebe, D. W. (2019a). Shortened sleep duration causes sleepiness, inattention, and oppositionality in adolescents with attention-deficit/hyperactivity disorder: Findings from a crossover sleep restriction/extension study. Journal of the American Academy of Child and Adolescent Psychiatry, 58(4), 433–442. https://doi.org/10.1016/j.jaac.2018.09.439
Becker, S. P., Langberg, J. M., Eadeh, H., Isaacson, P. A., & Bourchtein, E. (2019b). Sleep and daytime sleepiness in adolescents with and without ADHD: Differences across ratings, daily diary, and actigraphy. The Journal of Child Psychology and Psychiatry, 60(9), 1021–1031. https://doi.org/10.1111/JCPP.13061
Coogan, A. N., & McGowan, N. M. (2017). A systematic review of circadian function, chronotype and chronotherapy in attention deficit hyperactivity disorder. ADHD Attention Deficit Hyperactivity Disorder, 9, 129–147. https://doi.org/10.1007/s12402-016-0214-5
Corkum, P., Rigney, G., Howlett, M., & Weiss, S. (2019). Healthy sleep practices (sleep hygiene) in children with ADHD. In Hiscock H., & Sciberras E. (Eds.), Sleep and ADHD: An evidence-based guide to assessment and treatment (pp. 119–149). Elsevier. https://doi.org/10.1016/B978-0-12-814180-9.00005-3
Crowley, S. J., Wolfson, A. R., Tarokh, L., & Carskadon, M. A. (2018). An update on adolescent sleep: New evidence informing the perfect storm model. Journal of Adolescence, 67, 55–65. https://doi.org/10.1016/j.adolescence.2018.06.001
Dewald, J. F., Meijer, A. M., Oort, F. J., Kerkhof, G. A., & Bögels, S. M. (2010). The influence of sleep quality, sleep duration and sleepiness on school performance in children and adolescents: A meta-analytic review. Sleep Medicine Reviews, 14(3), 179–189. https://doi.org/10.1016/j.smrv.2009.10.004
Dickinson, E. R., & Adelson, J. L. (2016). Choosing among multiple achievement measures applying multitrait–multimethod confirmatory factor analysis to state assessment, ACT, and student GPA data. Journal of Advanced Academics, 27(1), 4–22. https://doi.org/10.1177/1932202X15621905
Diekelmann, S., & Born, J. (2010). The memory function of sleep. Nature Review Neuroscience, 11, 114–126. https://doi.org/10.1038/nrn2762
Drake, C., Nickel, C., Burduvali, E., Roth, T., Jefferson, C., & Badia, P. (2003). The pediatric daytime sleepiness scale (PDSS): Sleep habits and school outcomes in middle-school children. Sleep, 26(4), 455–460. https://doi.org/10.1093/sleep/26.4.455
Duckworth, A. L., & Seligman, M. E. (2005). Self-discipline outdoes IQ in predicting academic performance of adolescents. Psychological Science, 16(12), 939–944. https://doi.org/10.1111/j.1467-9280.2005.01641.x
DuPaul, G. J., & Langberg, J. M. (2014). Educational impairments in children with ADHD. In Barkley R. A. (Ed.), Attention-deficit/hyperactivity disorder: A handbook for diagnosis and treatment (4th edn., pp. 169–190). The Guilford Press.
DuPaul, G. J., Power, T. J., Anastopoulos, A. D., & Reid, R. (2016). ADHD rating scale-5 for children and adolescents: Checklists, norms, and clinical interpretation. The Guilford Press.
Harsh, J. R., Easley, A., & LeBourgeois, M. K. (2002). A measure children’s sleep hygiene. Sleep, 25, A316-A317. https://aquila.usm.edu/fac_pubs/3620
Evans, S. W., Langberg, J. M., Schultz, B. K., Vaughn, A., Altaye, M., Marshall, S. A., & Zoromski, A. K. (2016). Evaluation of a school-based treatment program for young adolescents with ADHD. Journal of Consulting and Clinical Psychology, 84(1), 15–30. https://doi.org/10.1037/ccp0000057
Faul, F., Erdfelder, E., Buchner, A., & Lang, A.-G. (2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41, 1149–1160. https://doi.org/10.3758/BRM.41.4.1149
Fried, R., Petty, C., Faraone, S. V., Hyder, L. L., Day, H., & Biederman, J. (2016). Is ADHD a risk factor for high school dropout? A controlled study. Journal of Attention Disorders, 20(5), 383–389. https://doi.org/10.1177/1087054712473180
Hysing, M., Harvey, A. G., Linton, S. J., Askeland, K. G., & Sivertsen, B. (2016). Sleep and academic performance in later adolescence: Results from a large population-based study. Journal of Sleep Research, 25(3), 318–324. https://doi.org/10.1111/jsr.12373
Kredlow, M. A., Eichenbaum, H., & Otto, M. W. (2018). Memory creation and modification: Enhancing the treatment of psychological disorders. American Psychologist, 73(3), 269–285. https://doi.org/10.1037/amp0000185.supp
Langberg, J. M., Epstein, J. N., Becker, S. P., Girio-Herrera, E., & Vaughn, A. J. (2012). Evaluation of the homework, organization, and planning skills (HOPS) intervention for middle school students with ADHD as implemented by school mental health providers. School Psychology Review, 41(3), 342–364. https://doi.org/10.1080/02796015.2012.12087514
Langberg, J. M., Dvorsky, M. R., Marshall, S., & Evans, S. W. (2013). Clinical implications of daytime sleepiness for the academic performance of middle school-aged adolescents with attention deficit hyperactivity disorder. Journal of Sleep Research, 22(5), 542–548. https://doi.org/10.1111/jsr.12049
Langberg, J. M., Molitor, S. J., Oddo, L. E., Eadeh, H., Dvorsky, M. R., & Becker, S. P. (2017). Prevalence, patterns, and predictors of sleep problems and daytime sleepiness in young adolescents with ADHD. Journal of Attention Disorders, 24(4), 509–523. https://doi.org/10.1177/1087054717690810
LeBourgeois, M. K., Giannotti, F., Cortesi, F., Wolfson, A. R., & Harsh, J. (2005). The relationship between reported sleep quality and sleep hygiene in Italian and American adolescents. Pediatrics, 115, 257–265. https://doi.org/10.1542/peds.2004-0815H
Lin, C. Y., Strong, C., Scott, A. J., Broström, A., Pakpour, A. H., & Webb, T. L. (2018). A cluster randomized controlled trial of a theory-based sleep hygiene intervention for adolescents. Sleep, 41(11), 1–11. https://doi.org/10.1093/sleep/zsy170
Martin, C. A., Hiscock, H., Rinehart, N., Heussler, H. S., Hyde, C., Fuller-Tyszkiewicz, M., McGillivray, J., Austin, D. W., Chalmers, A., & Sciberras, E. (2020). Associations between sleep hygiene and sleep problems in adolescents with ADHD: A cross-sectional study. Journal of Attention Disorders, 24(4), 545–554. https://doi.org/10.1177/1087054718762513
Miles, J. (2005). R-squared, adjusted r-squared. Encyclopedia of Statistics in Behavioral Science. https://doi.org/10.1002/0470013192.bsa526
Miller F. G., & Lazowski L. E. (2001). The Adolescent SASSI-2 Manual: Identifying substance use disorders. SASSI Institute.
Owens, J. A., Au, R., Carskadon, M., Millman, R., Wolfson, A., Braverman, P. K., Adelman, W., Breuner, C., Levine, D., Marcell, A., & O’Brien, R. F. (2014). Insufficient sleep in adolescents and young adults: An update on causes and consequences. Pediatrics, 134(3), e921–e932. https://doi.org/10.1542/peds.2014-1696
Owens, J. A., Babcock, D., & Weiss, M. (2020). Evaluation and treatment of children and adolescents with excessive daytime sleepiness. Clinical Pediatrics, 59(4–5), 340–351. https://doi.org/10.1177/0009922820903434
Sharman, R., & Illingworth, G. (2020). Adolescent sleep and school performance—The problem of sleepy teenagers. Current Opinion in Physiology, 15, 23–28. https://doi.org/10.1016/j.cophys.2019.11.006
Shochat, T., Cohen-Zion, M., & Tzischinsky, O. (2014). Functional consequences of inadequate sleep in adolescents: A systematic review. Sleep Medicine Reviews, 18(1), 75–87. https://doi.org/10.1016/j.smrv.2013.03.005
Sibley, M. H., Altszuler, A. R., Morrow, A. S., & Merrill, B. M. (2014). Mapping the academic problem behaviors of adolescents with ADHD. School Psychology Quarterly, 29(4), 422–437. https://doi.org/10.1037/spq0000071
Stein, M. A., Weiss, M., & Hlavaty, L. (2012). ADHD treatments, sleep, and sleep problems: Complex associations. Neurotherapeutics, 9, 509–517. https://doi.org/10.1007/s13311-012-0130-0
Storfer-Isser, A., Lebourgeois, M. K., Harsh, J., Tompsett, C. J., & Redline, S. (2013). Psychometric properties of the adolescent sleep hygiene scale. Journal of Sleep Research, 22(6), 707–716. https://doi.org/10.1111/jsr.12059
Wallace, M. L., McMakin, D. L., Tan, P. Z., Rosen, D., Forbes, E. E., Ladouceur, C. D., Ryan, N. D., Siegle, G. J., Dahl, R. E., Kendall, P. C., Mannarino, A., & Silk, J. S. (2017). The role of day-to-day emotions, sleep, and social interactions in pediatric anxiety treatment. Behaviour Research and Therapy, 90, 87–95. https://doi.org/10.1016/j.brat.2016.12.012
Wechsler, D. (2011). Wechsler abbreviated scale of intelligence—second edition (WASI-II). NCS Pearson.
Weller, E. B., Weller, R. A., Fristad, M. A., Rooney, M. T., & Schecter, J. (2000). Children’s interview for psychiatric syndromes (ChIPS). Journal of the American Academy of Child & Adolescent Psychiatry, 39(1), 76–84. https://doi.org/10.1097/00004583-200001000-00019
Zalta, A. K., Dowd, S., Rosenfield, D., Smits, J. A. J., Otto, M. W., Simon, N. M., Meuret, A. E., Marques, L., Hofmann, S. G., & Pollack, M. H. (2013). Sleep quality predicts treatment outcomes in CBT for social anxiety disorder. Depression and Anxiety, 30(11), 1114–1120. https://doi.org/10.1002/da.22170
Funding
The funding was provided by Institute of Education Sciences (Grant Nos. R305A140356, R305A140356).
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Nelson, A.K., DuPaul, G.J., Evans, S.W. et al. Adolescents with ADHD: Sleep as a Predictor of Academic and Organization Treatment Response. School Mental Health 14, 831–843 (2022). https://doi.org/10.1007/s12310-022-09523-4
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12310-022-09523-4