Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep MedicineMay 31, 2022

How Insomnia Symptoms Relate to Daytime Behavior and Thinking Skills in Children with ADHD

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Updated Mar 27, 2026

Abstract

Children with ADHD and insomnia symptoms scored highest on measures of inattention and hyperactivity, indicating significant behavioral challenges.

Children with ADHD and insomnia symptoms exhibited more severe ADHD symptoms compared to those without insomnia and healthy controls.
Cognitive performance on sustained attention and processing speed tests was poorer in children with ADHD and insomnia symptoms.
The study involved assessments of 36 children with ADHD and insomnia symptoms, 27 children with ADHD without insomnia, and 21 healthy controls.
Findings suggest a potential link between insomnia symptoms and cognitive impairments in children diagnosed with ADHD.

Simplified

STUDY OBJECTIVES: The current study aimed to examine the association of insomnia symptoms with daytime behavior and cognitive functioning in children with attention-deficit/hyperactivity disorder (ADHD).

METHODS: Thirty-six children with ADHD and insomnia symptoms, 27 children with ADHD without insomnia symptoms, and 21 age-matched healthy controls were recruited in this study (age range: 6-12 years, 70% male). They were assessed by parent-report questionnaires on insomnia symptoms (Children's Sleep Habits Questionnaire) and ADHD symptoms (Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Scale [SWAN]), and completed a battery of cognitive tests including the Continuous Performance Test (CPT) for sustained attention, Letter-digit test for processing speed, Digit Span forward test and-back task for working memory, Tower of London (TOL) test for planning skills and Bergs Card Sorting Test (BCST) for set-shifting ability. N

RESULTS: Children with ADHD and insomnia symptoms had the highest scores on SWAN total and inattention and hyperactivity subscales, followed by children with ADHD without insomnia and healthy controls (all< .05). After controlling for potential confounders, children with ADHD and insomnia symptoms showed poorer performance on the CPT and Letter-digit test as compared with children with ADHD without insomnia and healthy controls (all< .05). P P

CONCLUSIONS: Insomnia symptoms are associated with more severe ADHD symptoms and cognitive impairments in children with ADHD, especially deficits in sustained attention and processing speed. Future longitudinal studies are needed to explore the long-term impacts of insomnia symptoms and the effects of sleep-focused intervention on cognitive functioning in children with ADHD.

CITATION: Li X, Shea KSC, Chiu WV, et al. The associations of insomnia symptoms with daytime behavior and cognitive functioning in children with attention-deficit/hyperactivity disorder.. 2022;18(8):2029-2039. J Clin Sleep Med

Funding

Competing interests

All the authors have read and approved the manuscript. Work for this study was performed in the Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong. This study was funded by the Health Care and Promotion Fund (Project No.: 30160604) Food and Health Bureau, Hong Kong. The funding body had no role in the study design, data collection, data analysis, data interpretation, the writing of the report, or the decision to submit the paper for publication. The funding was awarded to Dr. Shirley Xin Li. The authors report no conflicts of interest.

PubMed

How Insomnia Symptoms Relate to Daytime Behavior and Thinking Skills in Children with ADHD

Abstract

Funding

Competing interests

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Abstract

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