Do You Really Lose When You Snooze? Sleep Correlates of Externalizing and Attention Problems Among Pediatric Patients with ADHD, ASD, and Comorbid Diagnosis

ABSTRACT Introduction The primary aim of this retrospective study was to assess differential associations between sleep disturbances with externalizing/internalizing problems, ADHD profiles (inattention, hyperactivity/impulsivity), and social impairment among children with ADHD, autism spectrum disorder (ASD), and comorbid diagnoses (ASD+ADHD). Methods Caregivers of patients with ADHD (N = 28), ASD (N = 29), and ASD+ADHD (N = 57) completed the Child Behavior Checklist, Conners 3rd Edition, and Pediatric Sleep Questionnaire to assess externalizing/internalizing problems, social functioning, ADHD presentations, and sleep disturbances. Results Findings indicated that among the ASD+ADHD group, select sleep factors contributed to 17% of the variance in externalizing problems, 16% in hyperactivity/impulsivity, and 15% in inattention problems, despite controlling for intellectual functioning and stimulant use; whereas no associations were observed among ASD or ADHD groups. Conclusions In brief, sleep may impact behavioral and attention dysregulation more intimately among those with ASD+ADHD, underscoring the need to incorporate sleep screening measures in diagnostic evaluations and in treatment considerations for behavioral dysregulation.