Open Access Research article

Contributions of circadian tendencies and behavioral problems to sleep onset problems of children with ADHD

Reut Gruber125*, Laura Fontil2, Lana Bergmame2, Sabrina T Wiebe12, Rhonda Amsel1, Sonia Frenette34 and Julie Carrier34

Author Affiliations

1 McGill University, Montreal, QC, Canada

2 Attention, Behavior and Sleep Lab, Douglas Mental Health University Institute, Montreal, QC, Canada

3 Centre du Sommeil et des Rythmes Biologiques, Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada

4 Département de Psychologie, Université de Montréal, Montreal, QC, Canada

5 Department of Psychiatry, McGill, University, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Verdun, QC, H4H 1R3, Canada

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BMC Psychiatry 2012, 12:212  doi:10.1186/1471-244X-12-212

Published: 28 November 2012



Children with attention-deficit/hyperactivity disorder (ADHD) are two to three times more likely to experience sleep problems. The purpose of this study is to determine the relative contributions of circadian preferences and behavioral problems to sleep onset problems experienced by children with ADHD and to test for a moderation effect of ADHD diagnosis on the impact of circadian preferences and externalizing problems on sleep onset problems.


After initial screening, parents of children meeting inclusion criteria documented child bedtime over 4 nights, using a sleep log, and completed questionnaires regarding sleep, ADHD and demographics to assess bedtime routine prior to PSG. On the fifth night of the study, sleep was recorded via ambulatory assessment of sleep architecture in the child’s natural sleep environment employing portable polysomnography equipment. Seventy-five children (26 with ADHD and 49 controls) aged 7–11 years (mean age 8.61 years, SD 1.27 years) participated in the present study.


In both groups of children, externalizing problems yielded significant independent contributions to the explained variance in parental reports of bedtime resistance, whereas an evening circadian tendency contributed both to parental reports of sleep onset delay and to PSG-measured sleep-onset latency. No significant interaction effect of behavioral/circadian tendency with ADHD status was evident.


Sleep onset problems in ADHD are related to different etiologies that might require different interventional strategies and can be distinguished using the parental reports on the CSHQ.

Sleep onset insomnia; Externalizing problems; Sleep problems; ADHD; Circadian tendencies; Behavioral problems