The Moderated Moderating Effect of Sleep Deprivation and Negative Parenting Attitudes on the Association between ADHD Traits and Anxiety among Middle School Students

Background: This study examined the moderated moderating effect of sleep deprivation and negative parenting attitudes on the association between attention-deficit/hyperactivity disorder (ADHD) traits and anxiety among middle school students.Methods: Data from 1,948 middle school students were obtained from the 2021 Mental Health Survey of Adolescents and analyzed using the PROCESS Macro Model 3. Results: ADHD traits positively influenced anxiety, and the moderated moderating effect of sleep deprivation and negative parenting attitudes was statistically significant. Under conditions of low or stable negative parenting attitudes, severe sleep deprivation exacerbated the association between ADHD traits and anxiety. Conversely, the moderating effect of sleep deprivation was completely offset under conditions of high negative parenting attitudes, resulting in increased anxiety, regardless of the adolescents’ sleep status.Conclusions: Based on these findings, this study has implications for the importance of sleep and parental attitudes in reducing anxiety among middle school students with ADHD traits.