The Role of Cognitive Disengagement Syndrome Symptoms in the Association Between ADHD Symptoms and Sleep Problems: Findings from An Epidemiological Survey

Cognitive Disengagement Syndrome (CDS), a transdiagnostic construct characterized by sluggishness and daydreaming, was associated with Attention-Deficit/ Hyperactivity Disorder (ADHD). Our study investigated the mediating role of CDS in the relationship between ADHD and sleep disturbances in a Turkish epidemiological sample. The sample consisted of 268 children aged 7-11 from four Turkish cities. Parents completed inattention (IN) and hyperactivity/impulsivity (HI) subscales of Turgay’s ADHD Rating Scale IV for ADHD symptoms, Barkley’s Child Attention Scale (BCAS) for CDS symptoms, and Children’s Sleep Habits Questionnaire (CSHQ) for sleep problems. Correlation analyses revealed significant associations between IN and CSHQ scores (r=0.406, p=0.001), HI and CSHQ scores (r=0.381, p<0.001), and BCAS and CSHQ scores (r=0.404, p<0.001). Regression models demonstrated that CDS fully mediated the relationship between IN symptoms and sleep disturbances. When CDS was included in the model, the direct effect of IN on sleep problems became non-significant (β=0.094, p=0.284), whereas CDS remained a significant predictor (β=0.249, p=0.001). HI symptoms, however, retained a direct association with sleep disturbances (β=0.304, p<0.001), independent of CDS. Maternal age was inversely correlated with CSHQ scores (r=−0.148, p=0.033), but the relationship was not significant in regression analysis (β=−0.092, p=0.144). These findings emphasize that CDS may serve as a critical mechanism through which IN symptoms influence sleep disturbances. The mediating role of CDS provides a transdiagnostic framework for understanding how attentional difficulties contribute to sleep disturbances and underlines the importance of addressing CDS symptoms as a critical target for interventions aimed at improving sleep quality in children with ADHD.