Prevalence of attention-deficit/hyperactivity disorder symptoms and their associations with sleep schedules and sleep-related problems among preschoolers in mainland China

Abstract

BackgroundAttention-deficit/hyperactivity disorder (ADHD) among children is an increasing public health concern. The identification of behavioral risk factors, including sleep quality, has important public health implications for prioritizing behavioral intervention strategies for ADHD. Herein, this study aimed to investigate the prevalence of high levels of ADHD symptoms and to explore the association between sleep schedules, sleep-related problems and ADHD symptoms among preschoolers aged 3 to 6 years in mainland China.MethodsA cross-sectional study was conducted, comprising a large sample of 15,291 preschoolers in Ma’anshan city of Anhui Province in China. ADHD symptoms were assessed by the 10-item Chinese version of the Conners Abbreviated Symptom Questionnaire (C-ASQ). Sleep-related variables included caregivers’ responses to specific questions addressing children’s daytime and nighttime sleep schedules, as well as sleep-related behaviors. Data on other factors were also collected, such as socio-demographic characteristics, TV viewing duration on weekdays and weekends, and outdoor activities. Logistic regression models were used to analyze the relationships between sleep schedules, sleep-related problems and ADHD symptoms.ResultsApproximately 8.6% of the total sample of preschoolers had high levels of ADHD symptoms, with boys having higher levels than girls (9.9% vs. 7.2%). In the logistic regression analysis, after adjusting for TV viewing duration, outdoor activities, and socio-demographic characteristics, delayed bedtime was significantly associated with a risk of high levels of ADHD symptoms, with odds ratios (OR) of 2.50 [95% confidence interval (CI): 2.09 ~ 3.00] and 2.04 (95% CI: 1.72 ~ 2.42) for weekdays and weekends, respectively. Longer time falling asleep (≥ 31 min) (OR = 1.76, 95% CI: 1.47 ~ 2.11), no naps (OR = 1.57, 95% CI: 1.34 ~ 1.84) and frequent sleep-related problems (OR = 4.57, 95% CI: 3.86 ~ 5.41) were also significantly associated with an increased risk of high levels of ADHD symptoms, while longer sleep duration (> 8.5 h) was associated with a decreased risk of high levels of ADHD symptoms (OR = 0.76, 95% CI: 0.67~ 0.87).ConclusionsADHD symptoms are prevalent in preschoolers in Ma’anshan region, China. Undesirable sleep schedules and sleep-related problems among preschoolers confer a risk of ADHD symptoms, highlighting the finding that beneficial and regular sleep habits potentially attenuate ADHD symptoms among preschoolers.

Prevalence and Epidemiological Characteristics of ADHD in Pre-School and School Age Children in the Province of Tarragona, Spain

“…This could be due to the fact that Conners ECGI includes not only items about restlessness-impulsivity but also emotional lability, which may be more observable or higher in girls. There was a notably high rate of symptoms in the clinical range (Conners T ≥ 70) reported by parents in both pre-school (26.2%) and school-age children (34%, reaching a value of 42% in boys), which is clearly higher than the rates reported by other authors (Aboul-ata & Amin, 2018; Canals et al, 2018; Cao et al, 2018; Cerrillo-Urbina et al, 2018; Joshi & Angolkar, 2018; Yadegari et al, 2018). Although the high rate of symptoms detected in boys will be related to the high prevalence of ADHD in males (4% in pre-schoolers and 11.9% in school-age children), it could also be due to the characteristics of the screening test used to assess the risk symptoms (Conners ECGI and Conners 3 ADHD Index).…”

ADHD: Causes and alternative types of intervention

“…A systematic review of 30 short-and longterm studies underlined the clinical benefits of physical exercise in behavioral and cognitive deficits in children with ADHD (Ng et al, 2017). Regarding sleep schedules, a study by Cao et al (2018), with a sample of 15,291 preschool children in China, showed that delayed sleep time was closely associated with the risk of developing ADHD symptoms, while longer sleep times (> 8.5 hours) were associated with a reduced risk of developing ADHD symptoms. When it comes to using electronic media, children with ADHD can be particularly vulnerable to overuse.…”

Association Between Greenness Surrounding Schools and Kindergartens and Attention-Deficit/Hyperactivity Disorder in Children in China

“…17 The C-ASQ is derived from the Revised Conners Parent Rating Scale and has been translated and validated for use in Chinese population. 18…”