Grant #: R305A160126 (Institute of Education Sciences)
PI: Stephen Becker, PhD (Cincinnati Children’s) and Joshua Langberg, PhD (Virginia Commonwealth University)
Co-I: Albert Farrell, PhD, (Virginia Commonwealth University); Jeff Epstein, PhD; Dean Beebe, PhD

Sleep problems are related to poorer cognitive performance and higher rates of behavior problems and academic impairment. Sleep problems are considerably more common in certain subgroups of adolescents, and prevalence rates approach 50% for adolescents diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). This is noteworthy because adolescents with ADHD exhibit severe academic impairment, including significantly lower school grades and achievement scores, and high rates of suspensions and school dropout, as well as greater social impairment such as peer rejection and loneliness in comparison to peers without ADHD. Remarkably little is known about how sleep problems prospectively contribute to the educational functioning of middle and high school age adolescents. Currently, evidence-based interventions for students with ADHD do not address sleep in any way. Further, schools do not routinely evaluate or even screen for sleep problems when students are referred for psychoeducational testing as best-practice guidelines for doing so are not available. Another important question is why the prevalence rates of sleep problems are so high in adolescents with ADHD? It has been hypothesized that this variability is due to “problematic nights” resulting from a combination of factors, including high rates of comorbid mental health conditions, family factors, and homework problems such as procrastination and homework completion difficulties that negatively impact bedtime, sleep latency, and sleep quality. These factors may serve as malleable risk factors for sleep difficulties for all students, but given their especially high prevalence in families with adolescents with ADHD, may account for the high prevalence of sleep problems in this population. The primary objective of this study is to conduct a two-site (Virginia Commonwealth University [VCU] and Cincinnati Children’s Hospital Medical Center prospective longitudinal study of adolescents with ADHD (8th grade and ages 13-14 at the start of the study) and a comparison group that includes a comprehensive assessment of sleep, academic and social functioning, and malleable risk factors that may predict the presence of sleep problems. Adolescents with (N = 150) and without ADHD (N = 150) will be recruited from secondary school settings. Participants will be followed for 2.5 years as they transition from middle to high school since this transition is often associated with disruptions in academic and sleep functioning. Subjective ratings and objective measures of sleep and academic and social functioning, as well as potential predictors of sleep problems, will be collected at five timepoints spaced equally apart. Findings generated from this study will lead to best-practice policy recommendations for how and when schools can include the assessment of sleep as part of psychoeducational evaluations and inform intervention development.

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