Sleep problems in relation to emotion dysregulation in children with ADHD

Sleep disturbances are highly prevalent in children with attention-deficit/hyperactivity disorder (ADHD). Although situation-inappropriate emotion regulation is a well-established characteristic of ADHD, and sleep problems have been linked to such emotion dysregulation (EDR) in children more broadly, the nature of this relationship in ADHD remains insufficiently understood. EDR in ADHD is typically characterized by emotion lability, most prominently through heightened negative emotions. However, increasing evidence suggests that children with ADHD also struggle with lability in regulating positive affect. In this study, we applied a four-factor model of EDR-negative emotion lability, positive emotion lability, socially inappropriate affect, and socially incongruent affect-to examine associations between sleep disturbances and EDR in a sample of children with ADHD. Caregivers of 139 children aged 8-12 years completed the Children's Sleep Habits Questionnaire and the Emotion Regulation Checklist. Based on prior evidence, we hypothesized that sleep disturbances would be more strongly related to emotion lability than to socially inappropriate or socially incongruent affect. Multiple linear regression analyses supported this hypothesis: sleep disturbances were primarily associated with emotion lability, particularly fluctuations in positive affect. These findings provide clinically relevant insights into the interplay between sleep and EDR in ADHD and extend the focus beyond the traditional emphasis on negative emotion lability.