Sleep Problems in Chinese Children with ADHD Symptoms: Associations with Emotional and Behavioral Difficulties

Background Children with attention-deficit/hyperactivity disorder (ADHD) symptoms are frequently reported to experience more sleep problems than their peers without ADHD symptoms; however, this association has not been well examined in children in China. Moreover, it remains unclear whether the coexistence of ADHD symptoms and sleep problems is associated with greater emotional and behavioral difficulties. Methods Participants were drawn from a large cross-sectional study of 12,343 students from 14 primary schools in Shenzhen, China. ADHD symptoms and emotional and behavioral problems were assessed using the Conners’ Parent Rating Scale. Parents also completed questionnaires assessing their children’s sleep duration and sleep problems. A total of 330 children with ADHD symptoms and 10,273 control children were identified and included in the analyses. Results Compared with controls, students with ADHD symptoms had shorter sleep duration and more sleep problems, particularly among female students, those aged 10–15 years, those reporting average or poor family relationships, and those with average or poor interpersonal satisfaction. Among students with ADHD symptoms, those who also had sleep problems showed significantly higher levels of psychosomatic symptoms, anxiety symptoms, and learning problems than those with ADHD symptoms alone (p < 0.05). Conclusions Chinese students with ADHD symptoms experience substantial sleep problems, which are associated with greater emotional and behavioral difficulties. These findings highlight the importance of identifying and addressing sleep problems as part of interventions for children with ADHD symptoms.