Changes in sleep duration and disturbances during Covid-19 lockdown and internalizing-externalizing behaviors in children with attention deficit hyperactivity disorders

Maria Grazia Melegari; Raffaele Ferri; Martina Giallonardo; Renato Donfrancesco; Oliviero Bruni

doi:10.1016/j.sleep.2022.11.001

Changes in sleep duration and disturbances during Covid-19 lockdown and internalizing-externalizing behaviors in children with attention deficit hyperactivity disorders

Sleep Med. 2023 Jan:101:183-189. doi: 10.1016/j.sleep.2022.11.001. Epub 2022 Nov 5.

Authors

Maria Grazia Melegari¹, Raffaele Ferri², Martina Giallonardo³, Renato Donfrancesco⁴, Oliviero Bruni⁵

Affiliations

¹ Department of Developmental and Social Psychology, Sapienza University, Rome, Italy; Consortium Humanitas, Lumsa University, Rome, Italy. Electronic address: mgraziamelegari@gmail.com.
² Sleep Research Centre, Oasi Research Institute - IRCCS, Troina, Italy. Electronic address: rferri@oasi.en.it.
³ Independent Researcher (previously at Department of Developmental and Social Psychology) Sapienza University, Rome, Italy. Electronic address: giallonardomartina@gmail.com.
⁴ Roma 3 University Rome, Italy. Electronic address: renato.donfrancesco@yahoo.it.
⁵ Department of Developmental and Social Psychology, Sapienza University, Rome, Italy. Electronic address: oliviero.bruni@uniroma1.it.

Abstract

Objective: To examine how changes in sleep patterns and sleep problems occurring between the pre-pandemic and the Covid-19 lockdown period influenced mood-behavioral functioning of children with Attention Deficit Hyperactivity Disorder (ADHD).

Methods: Parents of 992 children with ADHD (85.4% boys, mean age: 11.52 years, SD = 3.17), recruited from the Italian ADHD family association, completed a modified version of the Sleep Disturbance Scale for Children and filled out 11 emotional behavioral items selected from the Child Behavior Checklist (CBCL) 6-18 questionnaire. Subgroups identified based on sleep duration changes ("maintained", "increased", "reduced") and of sleep problems during lockdown ("onset", "remission", "maintained", "no sleep problem") were analyzed to evaluate the association with internalizing and externalizing scores.

Results: Sleep duration showed no or low influence on internalizing and externalizing behaviors after control for age, sex, and socioeconomic status. Patients with ADHD with "no sleep problem" showed significant lower scores in internalizing and externalizing behaviors than those who "maintained" or had "onset" of different sleep problems. The effect sizes were higher for internalizing than externalizing behaviors. Lower internalizing scores were found in those who remitted difficulty in falling asleep, daytime sleepiness, nightmares, vs. the "maintained" or "onset" groups and those who remitted hypnic jerks vs. the "onset" group. Children with ADHD who "maintained" sleep terrors reported higher internalizing and mainly externalizing scores than the other groups.

Conclusion: Sleep problems negatively influence daytime functioning of patients with ADHD. but mood and behavioral domains show different susceptibility to the changes of sleep problems, and different vulnerability to specific sleep problems.

Keywords: ADHD; Covid 19; Internalizing and externalizing behaviors; Lockdown; Sleep disorder; Sleep duration.

MeSH terms

Attention Deficit Disorder with Hyperactivity* / complications
Attention Deficit Disorder with Hyperactivity* / epidemiology
Attention Deficit Disorder with Hyperactivity* / psychology
COVID-19* / complications
Child
Communicable Disease Control
Female
Humans
Male
Sleep Duration
Sleep Wake Disorders* / complications