ADHD symptoms and maturity – a study in primary school children

Aim: To study if age and non-behavioural measures of biological maturity have any associations with attention deficit hyperactivity disorder (ADHD).
Methods: Two hundred fifty-one children 7 to 9 years of age in a Swedish school were screened for ADHD-symptom. ADHD-symptoms were estimated by Conners Abbreviated Questionnaire by both parents and teachers. Motor function, body weight and body height were measured. Skeletal age was estimated through hand radiographs.
Results: Height, weight and skeletal bone-age did correlate significantly with age (rs = 0.44–0.69, p < 0.001) but not with ADHD symptom scores. Motor dysfunction had a weak negative correlation with age (rs =−0.21, p < 0.05). Parent and teacher scores of ADHD-symptoms did not correlate with age.
Conclusion: This study showed that the variables measuring general biological maturity had a strong association with age, whereas motor dysfunction and ADHD symptoms had no significant association with age. ADHD symptoms did not correlate with the variables measuring general biological maturity. These results do not support the hypothesis that a general biological immaturity is an important etiologic factor for ADHD symptomatology.     

Executive functions and physical aggression after controlling for attention deficit hyperactivity disorder, general memory, and IQ

This study examined the role of ADHD in the association between physical aggression and two types of executive functions. Boys received a cognitive-neuropsychological test battery over the ages of 13, 14, and 15 years. Diagnostic Interview Schedule for Children (DISC 2.25) data were collected from the boys and one parent between ages 14 and 16, and an IQ estimate was obtained at age 15. Three groups, differing in stability and level of physical aggression since kindergarten, were formed: Stable Aggressive, Unstable Aggressive, and Non-aggressive. Composite scores of validated executive function tests of working memory representing subjective ordering and conditional association learning were formed. A MANCOVA (N = 149) using ADHD status, teacher-rated negative emotionality, general memory abilities, and IQ as covariates was performed on the two composite scores. ADHD and teacher-rated emotionality did not provide significant adjustment to the dependent variables. Number of ADHD symptoms was negatively associated only with general memory and IQ. General memory contributed significantly to adjusting for conditional association test scores. Group differences indicated lower conditional association scores for Unstable Aggressive boys relative to the other groups. Both IQ and general memory abilities interacted with subjective ordering within the groups. Specifically, Stable Aggressive boys performed poorly on this measure and did not benefit from increases in IQ whereas Nonaggressive boys performed best and were not disadvantaged by lower general memory abilities. This suggests a relationship exists between aspects of working memory and a history of physical aggression regardless of ADHD and IQ.     

Small body size at birth and behavioural symptoms of ADHD in children aged five to six years

Background:  Behavioural disorders with a neurodevelopmental background, such as attention deficit hyperactivity disorder (ADHD), have been associated with a non-optimal foetal environment, reflected in small body size at birth. However, the evidence stems from highly selected groups with birth outcomes biased towards the extreme low end of the distribution in birth weight. Whether a similar association exists among the normal range of term birth is unclear.
Methods:  The ADHD Rating Scale was filled in by the biological mothers and fathers of children aged five to six years who were born healthy at term. Information on weight (kg), height (cm), head circumference (cm), and gestational age at birth were obtained from hospital records, and the ponderal index (kg/m³), a commonly used measure of thinness, and head circumference-to-length ratio were calculated.
Results:  Behavioural symptoms of ADHD were predicted by a lower ponderal index, a smaller head circumference, and a smaller head circumference-to-length ratio ( β 's: −.12 to −.14, p 's < .05). Adjustments for length of gestation, mother's age, tobacco and alcohol use during pregnancy, pre-pregnancy body mass index (BMI), or parity, the monthly gross income of the family, child's BMI at the age of five to six years or gender did not change the associations.
Conclusion:  These results suggest that physiological adaptation in utero , indicated by small body size at birth, within term gestational range may increase the susceptibility to behavioural symptoms of ADHD.     

Value of the dexamethasone suppression test in anorexia nervosa

Patients suffering from anorexia nervosa were assessed for variables of weight, dexamethasone-suppression-test and depressive symptomatology at three stages of inpatient treatment. With increase of body weight we found a highly significant decrease of plasma cortisol concentrations and depressive symptoms. During refeeding there also was a significant association between the degree of weight deficit (in % of ideal body weight) and plasma cortisol level, but the dexamethasone-suppression-test-result did not correlate with depression scores. However in 8 patients whose clinical condition deteriorated although their weight remained stable the dexamethasone-suppression-test results became abnormal again. The authors hypothesize that--besides the effect of weight loss--the dexamethasone-suppression-test might reflect the influence of other psychobiological factors which still have to be investigated.     

ADHD symptoms and maturity – a follow‐up study in school children

Aim: To test the hypothesis that there is a subgroup of children with attention deficit hyperactivity disorder (ADHD) who show a decline in ADHD‐symptoms that is associated with signs of biological maturation, a phenomenon referred to as a ‘maturation catch‐up’. Methods: The parents of 147 children who were given an examination in grades one and two 1999–2000 that included assessment of ADHD‐symptoms and estimation of skeletal bone‐age by use of hand radiographs (which was repeated in the eighth grade), were contacted 2008–2009 and were asked to answer questions concerning ADHD‐symptoms and behavioural maturity in their children. The response frequency was 67%. A complete dataset was achieved in 57 children. A reduction of Conners scores for ADHD‐symptoms of eight or more between the evaluations was defined as a marked reduction in symptoms. Results: When the children with a marked symptom reduction (n = 6) were compared with children without such a reduction (n = 51), we found a significant difference in skeletal maturation (p < 0.05). Conclusion: This study gives support to the theory that there is a group of children with ADHD‐symptoms who have a biological maturational‐lag who will show a decrease in their ADHD‐symptoms as they show a maturation catch‐up with increasing age.     

Long-term relationships between symptoms of Attention Deficit Hyperactivity Disorder and self-esteem in a prospective longitudinal study of twins

Aim: To study the long-term relationship between symptoms of Attention Deficit Hyperactivity Disorder and the developing self-esteem in a population-based sample of twins. Methods: The cohort is all twin pair families born in Sweden between May 1985 and December 1986 (n = 1.480). Wave 1 took place in 1994 when the twins were 8 years old and wave 2 in 1999 when the children were 13 years old. In wave 1 and 2 the parents completed questionnaires regarding ADHD-symptoms about their children. In wave 2 the twins completed a questionnaire about self-esteem and Youth Self Report (YSR). ADHD-symptoms and self-esteem were analyzed in the total study group. Results: There was a long-term relationship between high scores of parental-reported ADHD-symptoms at 8 and 13 years of age and low scores in measures of self-reported self-esteem at 13 years of age. In the cotwin control method controlling for YSR internalizing problem, paired comparisons within the twin pairs revealed that a high score of ADHD-symptoms at age 8 was related to significantly lower scores at age 13 in the self-esteem.

Conclusions: The long-term relationships between ADHD-symptoms and a low self-esteem in a population-based sample were confirmed by the co-twin analyses.     

Maternal pre‐pregnancy obesity and risk for inattention and negative emotionality in children

Objective: This study aimed to replicate and extend previous work showing an association between maternal pre‐pregnancy adiposity and risk for attention deficit hyperactivity disorder (ADHD) symptoms in children. Methods: A Swedish population‐based prospective pregnancy–offspring cohort was followed up when children were 5 years old (N = 1,714). Mothers and kindergarten teachers rated children’s ADHD symptoms, presence and duration of problems, and emotionality. Dichotomized outcomes examined difficulties of clinical relevance (top 15% of the distribution). Analyses adjusted for pregnancy (maternal smoking, depressive symptoms, life events, education, age, family structure), birth outcomes (birth weight, gestational age, infant sex) and concurrent variables (family structure, maternal depressive symptoms, parental ADHD symptoms, and child overweight) in an attempt to rule out confounding. Results: Maternal pre‐pregnancy overweight and obesity predicted high inattention symptom scores and obesity was associated with a two‐fold increase in risk of difficulties with emotion intensity and emotion regulation according to teacher reports. Means of maternal ratings were unrelated to pre‐pregnancy body mass index (BMI). Presence and duration of problems were associated with both maternal over and underweight according to teachers. Conclusions: Despite discrepancies between maternal and teacher reports, these results provide further evidence that maternal pre‐pregnancy overweight and obesity are associated with child inattention symptoms and extend previous work by establishing a link between obesity and emotional difficulties. Maternal adiposity at the time of conception may be instrumental in programming child mental health, as prenatal brain development depends on maternal energy supply. Possible mechanisms include disturbed maternal metabolic function. If maternal pre‐pregnancy obesity is a causal risk factor, the potential for prevention is great.     

注意缺陷多动障碍与突触体联系蛋白25基因的关联研究

目的 探讨中国汉族人群中注意缺陷多动障碍(ADHD)与突触体联系蛋白25(SNAP-25)基因微卫星(STR)和单核苷酸多态性(SNP)的关系.方法 本组100例,均为学龄期的ADHD患儿,通过唾液取样获取他们及其父母的DNA样本.同时选取符合年龄段的正常儿童97名作为对照组,DNA样本从血液中提取.检测100个ADHD核心家系和97个对照的SNAP-25基因STR,同时对rs363006和rs362549两段SNP进行基因分型,并进行病例对照的关联分析和传递不平衡检验(TDT).结果 SIR病例对照分析结果显示ADHD组和对照组(TAAA)n的等位基因频率和基因型频率差异无统计学意义(P均＞0.05);rs363006和rs362549两段SNP的家系TDT研究表明,SNAP-25基因和ADHD之间不存在关联(P均＞0.05).按照亚型分组后,rs362549在注意缺陷型中有优先传递等位基因A的趋势(x2=8.00,P＜0.01),而在混合型中有优先传递等位基因G的趋势(x2=4.122,P＜0.05).结论 SNAP-25基因STR和上述两段SNP和ADHD之间也许不存在关联,但rs362549这段SNP的多态性和ADHD亚型可能存在关联,尚需扩大样本进一步验证才能得出确切结论.     

Family dynamics and preadolescent girls with ADHD: the relationship between expressed emotion, ADHD symptomatology, and comorbid disruptive behavior

BACKGROUND: Despite the strong biological underpinnings of attention-deficit/hyperactivity disorder (ADHD), family factors remain salient influences on the course of the disorder. However, relatively little is known about how family-level variables relate to ADHD in girls and whether these variables are linked primarily to core ADHD symptomatology or to comorbid aggressive conditions. METHODS: We investigated the relationship between parental expressed emotion (EE), measured via the five-minute speech sample (FMSS), and ADHD as well as comorbid disruptive behavior disorders, in a diverse sample of 131 girls aged 6-12 years. RESULTS: High parental EE was associated with both ADHD and aggression, whether these constructs were measured categorically or continuously. The EE component of criticism, as opposed to emotional overinvolvement (EOI), showed the stronger associations with both constructs. ADHD subtypes (Inattentive vs. Combined) were equivalent with respect to prediction from high EE status. Whereas linkages with EE were stronger for ADHD than for aggression and withstood control of comorbid aggression, the converse was not true--i.e., the link between EE and aggression did not hold with control of ADHD. Multiple regression analyses revealed that the associations were independent of parenting stress and maternal depression; exploratory analyses revealed interactions between EE and (a) maternal depression and (b) Child Verbal IQ with respect to predictions of disruptive behavior. CONCLUSIONS: These findings add to a growing body of literature on ADHD in girls and highlight a pivotal link between family dynamics and the spectrum of ADHD-related behaviors. They also indicate that inattentive symptoms may be equally challenging to parents as hyperactive/impulsive symptoms.     

Are girls with ADHD at risk for eating disorders? Results from a controlled, five-year prospective study

OBJECTIVE: To evaluate the association between attention-deficit/hyperactivity disorder (ADHD) and eating disorders in a large adolescent population of girls with and without ADHD. METHOD: We estimated the incidence of lifetime eating disorders (either anorexia or bulimia nervosa) using Cox proportional hazard survival models. Comparisons between ADHD girls with and without eating disorders were then made on measures of comorbidity, course of ADHD, and growth and puberty. RESULTS: ADHD girls were 3.6 times more likely to meet criteria for an eating disorder throughout the follow-up period compared to control females. Girls with eating disorders had significantly higher rates of major depression, anxiety disorders, and disruptive behavior disorder compared to ADHD girls without eating disorders. Girls with ADHD and eating disorders had a significantly earlier mean age at menarche than other ADHD girls. No other differences in correlates of ADHD were detected between ADHD girls with and without eating disorders. CONCLUSIONS: ADHD significantly increases the risk of eating disorders. The presence of an eating disorder in girls with ADHD heightens the risk of additional morbidity and dysfunction.     

Autistic traits in a population-based ADHD twin sample

BACKGROUND: Most diagnostic nomenclatures do not allow for the concurrent diagnosis of autism and attention-deficit/hyperactivity disorder (ADHD). Clinic-based studies suggest autistic symptoms are common in children with ADHD, but such studies are prone to referral bias. This study assesses whether children with ADHD selected from the general twin population have elevated levels of autistic traits. METHODS: Nine hundred forty-six twins identified by Missouri birth records were assigned to DSM-IV ADHD diagnoses and seven population-derived ADHD subtypes defined through latent class analysis of DSM-IV ADHD symptoms. The Social Responsiveness Scale (SRS) was used as a quantitative measure of autistic traits. Linear regression was used to evaluate whether mean SRS scores differed between ADHD diagnostic groups. RESULTS: Mean SRS scores for DSM-IV predominantly inattentive subtype and combined subtype ADHD groups were significantly higher than for subjects without DSM-IV ADHD (p < .001, both comparisons). Five of the population-derived ADHD subtypes (talkative-impulsive, mild and severe inattentive, mild and severe combined) had significantly higher mean SRS scores compared to the latent class subtype with few ADHD symptoms (p < .001, all comparisons). DSM-IV combined subtype and the population-derived severe combined subtype had the highest mean total SRS scores and the highest mean scores for each of the three autism symptom domains, with a substantial proportion of individuals scoring in the clinically significant range. CONCLUSIONS: This study provides population-based evidence for clinically significant elevations of autistic traits in children meeting diagnostic criteria for ADHD. These results have implications for the design and interpretation of studies of both disorders.     

Motor function and methylphenidate effect in children with attention deficit hyperactivity disorder

Aim: Hyperactivity, impulsivity and poor attention are the core problems of ADHD and central stimulant medication is the preferred treatment. Many children with ADHD also display motor problems. The present study investigated the presence of motor problems in subjects who showed positive response to central stimulants on ADHD symptoms, compared with non‐responders. Method: This is a retrospective study of 73 children diagnosed ADHD, aged 5–17 years, who had been assessed with parts of the ‘Motor Function Neurological Assessment’ (MFNU) and evaluated with regard to effect of central stimulant medication. The sample was divided into two subgroups based on the responses to methylphenidate: Medicine responders and Non medicine responders. Results: Stimulant responders showed significantly more motor problems than the non‐responders on all sub‐tests and on the total problem score of the MFNU. Motor problems were present both in younger (age 5–10 years) and older (11–17 years) stimulant responders. There were no gender differences in motor performance. Conclusion: Our findings indicate that the probability of positive effect of central stimulants on core problems of ADHD is higher when motor problems are present in addition to ADHD symptoms, than when motor problems are absent.     

Psychiatric morbidity in two low birth weight groups assessed by diagnostic interview in young adulthood

Aim: To study the prevalence and characteristics of psychiatric symptoms and disorders in young adults born with low birth weight. Methods: At 20 years of age 44 very low birth weight (VLBW: birth weight ≤1500 g), 55 term born small for gestational age (SGA: birth weight <10th percentile) and 75 control subjects born 1986–1988 were assessed using the interview Schedule for Affective Disorders and Schizophrenia for School‐age children and Structured Clinical Interview for DSM‐IV Personality Disorders, Children’s Global Assessment Scale and Attention deficit hyperactivity disorder (ADHD) Rating Scale IV; self‐report and parent report. Results: Fourteen (33%) VLBW versus six (8%) control participants had a definite psychiatric disorder: OR = 5.6 (1.9–15.9). In the term SGA group, 14 (26%) had a disorder: OR = 3.9 (1.4–11.0) vs controls. Anxiety disorders and ADHD were the most frequent diagnoses. The differences were not explained by gender, assessment age or parental socioeconomic status. ADHD Rating Scale mean scores were higher in parent reports in the VLBW group and in self‐reports in the term SGA group compared with the control group. Conclusion: Children born with low birth weight whether caused by preterm birth or by growth retardation at term seem to be at increased risk for psychiatric disorders as young adults.     

睡眠质量对注意缺陷多动障碍儿童症状的影响:工作记忆的中介作用北大核心CSCD

目的探讨注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)儿童工作记忆在睡眠质量与症状之间的中介作用。方法采用随机整群抽样法从新疆维吾尔自治区喀什市2所小学3~5年级学生中筛选出符合条件的ADHD儿童(110例)及正常对照儿童(124例)为研究对象,采用SNAP-Ⅳ评估量表、匹兹堡睡眠质量指数量表(Pittsburgh Sleep Quality Index,PSQI)、工作记忆任务测试进行调查并比较。结果ADHD组儿童主观睡眠质量、入睡时间、睡眠效率、睡眠障碍评分及PSQI总分高于正常对照组(P<0.001),睡眠质量问题的发生率也高于正常对照组(P<0.001);ADHD儿童工作记忆得分低于正常对照组(P<0.001)。ADHD组工作记忆得分与PSQI总分呈负相关(r_(s)=-0.271,P<0.001),与症状得分呈负相关(r_(s)=-0.439,P<0.001);ADHD组PSQI总分与症状得分呈正相关(r_(s)=0.540,P<0.001)。工作记忆在睡眠质量对ADHD儿童症状影响中起部分中介效应,占总效应的18.10%。结论部分ADHD儿童存在睡眠质量问题,且工作记忆在ADHD儿童睡眠质量与症状之间起中介作用。     

Perinatal risk factors interacting with catechol O‐methyltransferase and the serotonin transporter gene predict ASD symptoms in children with ADHD

Background: Symptoms of autism spectrum disorder (ASD) and attention‐deficit/hyperactivity disorder (ADHD) often co‐occur. Given the previously found familiality of ASD symptoms in children with ADHD, addressing these symptoms may be useful for genetic association studies, especially for candidate gene findings that have not been consistently replicated for ADHD. Methods: We studied the association of the catechol O‐methyltransferase (COMT) Val158Met polymorphism and the serotonin transporter (SLC6A4/SERT/5‐HTT) 5‐HTTLPR insertion/deletion polymorphism with ASD symptoms in children with ADHD, and whether these polymorphisms would interact with pre‐ and perinatal risk factors, i.e., maternal smoking during pregnancy and low birth weight. Analyses were performed using linear regression in 207 Dutch participants with combined type ADHD of the International Multicenter ADHD Genetics (IMAGE) study, and repeated in an independent ADHD sample (n = 439) selected from the TRracking Adolescents’ Individual Lives Survey (TRAILS). Dependent variables were the total and subscale scores of the Children’s Social Behavior Questionnaire (CSBQ). Results: No significant main effects of COMT Val158Met, 5‐HTTLPR, maternal smoking during pregnancy and low birth weight on ASD symptoms were found. However, the COMT Val/Val genotype interacted with maternal smoking during pregnancy in increasing stereotyped behavior in the IMAGE sample (p = .008); this interaction reached significance in the TRAILS sample after correction for confounders (p = .02). In the IMAGE sample, the 5‐HTTLPR S/S genotype interacted with maternal smoking during pregnancy, increasing problems in social interaction (p = .02), and also interacted with low birth weight, increasing rigid behavior (p = .03). Findings for 5‐HTTLPR in the TRAILS sample were similar, albeit for related CSBQ subscales. Conclusions: These findings suggest gene–environment interaction effects on ASD symptoms in children with ADHD.     

Changing cognitive outcome in preterm infants with hyaline membrane disease

One hundred seventy-four preterm survivors of hyaline membrane disease, born 1961 through 1971, were followed up for at least six years with serial psychological and neurological evaluations. This relatively mature population had a mean birth weight of 2,133 g and gestational age of 34.6 weeks. All children had consecutive preschool and school age psychological tests. The mean preschool test score was 91 (SD = 13) and the mean school age score was 101 (SD = 16). The ten-point difference between the mean preschool and school age test scores was significant. Perinatal variables and indexes of disease severity did not correlate with test scores. Higher test scores were correlated with higher paternal educational and employment levels. Improving test scores by school age may be due to test instruments that measure different cognitive skills and/or the diminishing effects of prematurity.     

注意缺陷多动障碍儿童共患对立违抗性障碍与父母养育方式的相关性北大核心CSCD

目的探讨注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)儿童共患对立违抗性障碍(oppositional defiant disorder,ODD)与父母养育方式的相关关系。方法采用病例对照研究方法纳入482例ADHD儿童作为研究对象,其中未共患ODD(单纯ADHD组)322例,ADHD共患ODD(ADHD共患ODD组)160例,收集两组患儿一般人口学资料和父母养育方式量表评估得分情况。采用多因素logistic回归分析法探究父母养育方式与ADHD患儿共患ODD的关系。结果单纯ADHD组和ADHD共患ODD组父母养育方式得分(含拒绝因子、情感温暖因子、过度保护因子和偏爱因子)和一般人口学资料差异均无统计学意义(P>0.05)。在ADHD注意缺陷型患儿中,患儿年龄越大,父亲文化程度越低,共患ODD风险越大(P<0.05),而父母养育方式与共患ODD无显著关联(P>0.05)。结论ADHD患儿是否共患ODD与父母养育方式无明显相关性,临床工作中,应减少对ADHD共患ODD患儿父母都有养育方式不良的刻板印象,从多角度寻找共患ODD的原因,以提供合理的干预建议。     

Growth of adolescents who were born at extremely low birth weight without major disability

OBJECTIVE: To compare growth between adolescents who were born at extremely low birth weight (ELBW, /=2500 g).Design/Methods: Cross-sectional design. Fifty-three ELBW and 53 NBW adolescents without a major neurodevelopmental disability were matched by sex, race, age, and socioeconomic status. Anthropometrics (z scores), bone age, body composition (Lunar DPX-L densitometry), and sexual maturity were assessed. ELBW adolescents were classified as being born small for gestational age (SGA) or not (NSGA). RESULTS: Subjects were 58.5% female, 43.4% black, and 56.6% white. The mean birth weight for ELBW subjects was 849 g and 3355 g for NBW subjects. The mean age was 14.85 years. On average, ELBW adolescents were 4.8 cm shorter and 9.1 kg lighter than NBW adolescents. ELBW adolescents had lower mean z scores for height (P <.0001), weight (P <.0001), and head circumference (P <.0001) than NBW adolescents. ELBW/SGA subjects had lower mean z scores for height (P <.0001) and weight (P =.001) than NBW subjects. Head circumference z scores were lower for the ELBW/SGA group than the ELBW/NSGA group or the NBW group (P =. 003). Sexual maturity and relative body composition were similar between groups. Bone age, measured in SD units, was more advanced in the ELBW group (0.86 vs. 0.42, P =.039). CONCLUSIONS: ELBW adolescents who survive without a major neurodevelopmental disability attain lower growth measurements compared with NBW adolescents but have similar sexual maturation and relative body composition.     

Twin-Sibling Differences in Parental Reports of ADHD, Speech, Reading and Behaviour Problems

Differences between twins and siblings in behaviour problems were investigated in a non-selected sample of 1938 families with children aged 4-12 years. Families were sent a questionnaire based on DSM-III-R criteria for Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), Conduct Disorder (CD) and Separation Anxiety (SA), which was validated by formal clinical interview. The questionnaire also included measures of speech and reading problems. There were significant differences between twins and siblings for ADHD symptoms, but not for symptoms of ODD, CD or SA. Twins and siblings differed significantly for gestational age, birth weight, speech and reading problems. While there was little evidence for birth weight or gestational age contributing to the difference in ADHD symptoms, there was a strong association between ADHD symptoms and speech and reading problems.     

Parental and self-report of sleep in children with attention-deficit/hyperactivity disorder

OBJECTIVE: To determine the prevalence of parent-reported and self-reported sleep disturbances in a sample of school-aged children with attention-deficit/ hyperactivity disorder (ADHD). DESIGN: Cross-sectional survey questionnaire. SETTING: A multidisciplinary ADHD evaluation clinic in a children's teaching hospital (ADHD sample) and 3 elementary schools in southern New England (control sample). PARTICIPANTS: Forty-six unmedicated, school-aged children (mean age, 89.4 +/- 18.7 months; 74% male) diagnosed as having ADHD by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria who had been screened for marked symptoms of sleep-disordered breathing, and 46 normal control children (mean age, 86.5 +/- 16.9 months; 70% male). INTERVENTION: None. MAIN OUTCOME MEASURE: Sleep habits and sleep disturbances reported by parents and children. RESULTS: Children with ADHD had significantly higher (more sleep-disturbed) scores on all sleep subscales of the Children's Sleep Habits Questionnaire (parent measure) than did controls; average sleep duration as reported by parents was also significantly shorter in the ADHD group. Children with ADHD also reported their own sleep to be more disturbed than controls did on the Sleep Self-report, particularly on items relating to bedtime struggles (P range, .05-.001). There was a much higher correlation between parent and child sleep report items for the children with ADHD (mean correlation, 0.55) than for the control children. CONCLUSIONS: Sleep disturbances, particularly at bedtime, are frequently reported by both parents and children with ADHD. Children undergoing evaluation for ADHD should be routinely screened for sleep disturbances, especially symptoms of sleep-disordered breathing. The causes of sleep-onset delay in children with ADHD should be considered in designing intervention strategies for children with difficulty falling and staying asleep.