Sleep Problems Moderate the Association Between Tic Severity and Cognitive Function in Children: Effects Beyond ADHD Symptoms

Background Tic disorders are common neurodevelopmental conditions in children and adolescents, often accompanied by cognitive difficulties and sleep disturbances. Sleep problems may influence the extent to which tic severity affects cognitive performance, yet this potential moderating role remains largely unexplored. Understanding these interactions is critical for optimizing clinical management. Methods A total of 101 children and adolescents (ages 6–14) with tic disorders were recruited. Tic severity was assessed using the Yale Global Tic Severity Scale (YGTSS), and sleep was measured via the Children’s Sleep Habits Questionnaire (CSHQ). Cognitive performance was evaluated using a battery including the Continuous Performance Test (CPT) and Go/No-Go tasks. Moderation analyses were conducted in R to examine whether sleep dimensions moderated the relationship between tic severity and cognition, and whether these effects persisted after controlling for Attention-deficit/hyperactivity disorder (ADHD) symptoms. Results Across 23 significant moderation models, specific sleep dimensions—including sleep onset delay, bedtime resistance, sleep duration and other sleep aspects—significantly moderated the associations between tic severity and cognitive performance. These effects remained significant after controlling for ADHD symptoms. No direct correlations were observed between tic severity and sleep, highlighting the contextual role of sleep in cognitive performance. Conclusions Sleep problems independently shape the impact of tic severity on cognition. Assessment and management of sleep problems may mitigate cognitive deficits, suggesting that targeted sleep interventions could be an important component of comprehensive care for children and adolescents with tic disorders.