More than 6 million children in America have been diagnosed with attention deficit hyperactivity disorder (ADHD). Now, a new study co-led by the University of Missouri has uncovered a surprising correlation: Untreated youth with ADHD not only have significantly higher rates of obesity, they also tend to exceed recommendations for screen time and fail to meet basic sleep guidelines.
ADHD individuals who are not on medication
Mizzou’s Crystal Lim, an associate professor in the College of Health Sciences, and other researchers analyzed the results of a nationally representative survey of tens of thousands of youth ages 11 to 17. Parents in three groups (those without ADHD, those on medication, and those not on medication) were asked how much time their children spent sleeping, watching screens, and exercising each day.
Lim and the research team concluded that while getting more sleep and limiting screen time are healthy behaviors for all children, prioritizing these two goals may be especially helpful for young people with ADHD and not undergoing drug treatment, since obesity is more widespread in this group.
Lim added that while common stimulant medications for attention deficit hyperactivity disorder, such as Adderall, can have appetite suppression as a side effect, not all ADHD medications are stimulants, and medication is only one small piece of the puzzle.
“If some families are not interested in medications, identifying sleep as a key health behavior to target to improve their health may help reduce their risk of obesity,” Lim said.
“As a clinical psychologist, I meet with families regularly and provide them with evidence-based strategies to create healthy, lasting behavior changes, including goal setting, monitoring progress in healthy behaviors, and parental example.”
In recent years, not only has awareness of ADHD grown, but so has the issue of pediatric obesity. Lim’s research is designed to help children with both disorders.
As childhood obesity rates have skyrocketed in the United States since 1990, particularly in rural and underserved areas, Lim has been on a mission to help families and schools encourage healthy lifestyle behaviors for children of all ages. In 2022, Lim published a study examining childhood obesity prevention programs in rural schools with the ultimate goal of emphasizing the importance of both nutrition and exercise, rather than just one or the other.
After working at an obesity clinic in Mississippi, a state where 40 percent of adults were obese in 2021, Lim was drawn to Mizzou for the opportunities for interdisciplinary collaboration within the College of Health Sciences and with other Mizzou departments and schools.
“Collaborating with psychologists, health professionals, therapists, and researchers at Mizzou has been great because my work is at the intersection of all of that,” Lim said. “I’m currently involved in projects related to mobile apps to help young people improve their health behaviors, and being in an environment with interdisciplinary collaboration has been exciting.”
In the future, Lim hopes her research can encourage children and families to adopt healthy behaviors in their daily lives.
“My goal is to offer strategies for how we can modify our evidence-based treatments as clinical psychologists, in a practical way, to best help children and families,” Lim said.
“For me it has been very rewarding to see how passionate families are about helping their children, so I want to help as many people as I can.”
As summer approaches, Lim offers the following tips for any family considering how the end of the school year might impact their children’s sleep, screen time, and exercise routines:
•Establish a bedtime routine to always go to bed at the same time.
•It is recommended to stop accessing the Internet at a specific time.
•Avoid keeping TVs or other screens in bedrooms.
•Avoid eating large meals immediately before going to bed.
•Encourage physical activity throughout the day through activities such as swimming, sports, or summer camps.
•Create a cool, dark environment to promote sleep
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•Use screen time as a reward after completing chores, educational activities, or physical activity.
The study “Understanding health behaviors that modify the risk for obesity in ADHD” was published in Journal of Pediatric Psychology.
Sleep disturbances in childhood increase the risk of developing ADHD symptoms
A study shows the close relationship between childhood sleep disorders and the development of ADHD symptoms in preadolescence. The study, published in the European Journal of Pediatrics, represents an important advance in understanding the causes of ADHD, a neurodevelopmental disorder that affects approximately 7.5% of children.
The study was led by Llúcia González-Safont, a researcher in the field of epidemiology and public health (CIBERESP) at the Faculty of Nursing and Podiatry of the University of Valencia and a visiting professor at the Universitat Jaume I of Castellón, Spain.
The research team, which also includes researcher Marisa Rebagliato, from the Predepartmental Unit of Medicine of the UJI, worked with 1,244 boys and girls from Gipuzkoa, Sabadell and Valencia, more specifically, the cohorts participating in the INMA project. On the one hand, they assessed sleep disorders at the age of 8 or 9 using the Child Behavior Checklist (CBCL) for ages 6-18 and, on the other hand, they examined the manifestations of ADHD using the Conners Parent Rating Scale (CPRS-R:S).
Sleep is a complex physiological state, partly responsible for physical and mental performance and for the development and healthy maintenance of learning processes, declarative and procedural memory, generalization of knowledge, and emotional processing. Disturbances in it have immediate and far-reaching consequences.
Added to this evidence are the results of the work of CIBER researchers, which allow to correlate sleep problems in childhood with the development of ADHD symptoms in adulthood. The conclusions of the study could be useful to implement policies and actions that promote the right conditions to develop healthy sleep habits during childhood.
Several studies have previously shown that sleep disorders and ADHD are common in childhood, with a prevalence of 20% for sleep disorders and 3-7.5% for ADHD. Sleep disorders are more prevalent in children with ADHD, affecting between 25% and 73.3% of them.
In this context, the work of CIBER researchers has established a strong relationship between sleep disturbances at ages 8 and 9 and the development of ADHD symptoms at ages 10 and 11. The association between sleep disturbances and ADHD symptoms was maintained after excluding from the initial analysis children who had shown previous clinical problems (for example, those born small for their gestational age, premature children, and those who had symptoms compatible with a diagnosis of ADHD before and at the same time as the onset of sleep disturbances).
This highlights the strong correlation between sleep disorders and ADHD.
Dr. González emphasized: “These results should be interpreted with caution. Although not all children with sleep disorders will develop ADHD symptoms, detecting them at an early stage, with questionnaires that are easy to apply in pediatric visits, could help prevent or mitigate future symptoms of behavioral problems such as ADHD. It would therefore be useful to incorporate this type of screening tool into primary care programs such as the Children’s Health Programme.”
The results of the study were also presented at the Congress of the Spanish Society of Epidemiology, where its authors received recognition for one of the best communications by CIBERESP staff.
Study Links Household Chaos to Sleep Quality Among Teens With ADHD Symptoms
A study presented at the SLEEP 2024 annual meeting found that household chaos and sleep hygiene are important factors in the relationship between sleep quality and ADHD symptoms in adolescents.
Structural equation modeling results show that household chaos and sleep hygiene were significant mediators of the relationship between ADHD symptoms and poor sleep quality. The results suggest that improving daily routine and family stability is an important strategy to consider when trying to improve sleep quality in adolescents with ADHD symptoms.
“These findings begin to explain some contextual factors that may help explain the increased sleep difficulties observed in youth with more severe ADHD symptoms,” said lead author and co-principal investigator Jamie Flannery, a doctoral candidate in developmental psychology at the University of Notre Dame in South Bend, Indiana.
“This suggests that when ADHD symptoms are severe, some aspects of the individual (poor sleep hygiene) and the family environment (household chaos) are associated with poor sleep quality in adolescents.”
The American Academy of Sleep Medicine recommends that adolescents ages 13 to 18 get 8 to 10 hours of sleep. Healthy sleep is associated with better health outcomes, including: attention, behavior, learning, memory, emotional regulation, quality of life, and improved mental and physical health.
Researchers collected data from 259 mother-adolescent pairs from across the United States. Mothers used a scale to rate the severity of their adolescents’ ADHD symptoms, while adolescents completed three separate surveys about sleep quality, home environment, and sleep hygiene.
Flannery stressed that it is important for adolescents and their families to know that it is not just individual characteristics that influence their sleep.
“Although improving sleep hygiene in youth with ADHD can be helpful, a family unit characterized by a lack of structure, routine, and stability can compromise the quality of the adolescent’s sleep,” Flannery said.
The research summary was recently published in an online supplement of the journal Sleep and was presented on Monday, June 3, at SLEEP 2024 in Houston.
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