Sleep hygiene and its relation to sleep in adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD)

Objective: Adolescents with ADHD frequently experience sleep problems which contribute to greater impairment across multiple domains of functioning. Sleep hygiene, practices that can both protect against and worsen sleep problems, may be particularly challenging for adolescents with ADHD. To better understand sleep hygiene practices and their relation to sleep problems in this group, this study compares sleep hygiene across adolescents with ADHD without sleep problems (ADHD-), adolescents with ADHD and co occurring sleep problems (ADHD+), and non ADHD peers (NT), and examines group differences in the associations between sleep hygiene and sleep parameters using objective (actigraphy) and subjective (sleep diaries) assessments.Method: Participants were 153 adolescents (13¬¬–17 years) comprising three groups: ADHD+ (n = 64), ADHD- (n = 25), and NT (n = 64). Groups were compared on multiple sleep hygiene practices using pre-specified path models. Group was explored as a moderator in the relation between sleep hygiene and sleep outcomes. Results: ADHD- exhibited significantly better sleep hygiene than both ADHD+ and NT, with the latter two having comparable sleep hygiene. The ADHD+ group reported significantly fewer weekly hours of exercise than the ADHD- and the NT group. Explorative analysis showed that across groups, better sleep hygiene was positively associated with total sleep time and earlier bedtimes (actigraphy and diary). Associations with sleep onset latency were variable; significant effects emerged for objective weekday measures in ADHD+ only. Some differential associations of sleep hygiene and sleep parameters between groups emerged. Conclusion: Adolescents with ADHD do not consistently demonstrate poorer sleep hygiene than non-ADHD peers. Findings underscore substantial heterogeneity in how sleep hygiene relates to sleep among adolescents with ADHD.