Impact of Sleep Disruption on Academic Performance in Children with ADHD

Thesis Abstract

Children with attention-deficit/hyperactivity disorder (ADHD) frequently experience sleep disruption, which may exacerbate daytime inattention, executive dysfunction, and behavioral dysregulation, collectively compromising academic performance. This study investigates the extent to which sleep disruption mediates or moderates the relationship between ADHD symptoms and school achievement, aiming to elucidate mechanisms that can inform targeted interventions. The objectives are (1) to quantify associations between objective and subjective sleep disturbance metrics and standardized academic outcomes in children with ADHD; (2) to determine whether sleep disruption mediates the impact of ADHD symptom severity on academic performance; (3) to assess whether bedtime resistance and sleep hygiene behaviors moderate the ADHD–academic performance link; and (4) to examine the differential effects of sleep disruption on math versus language performance. The study adopts a cross-sectional, multi-site design with a longitudinal follow-up component over six months. The population comprises children aged 8–12 years diagnosed with ADHD according to DSM-5 criteria, recruited from pediatric neurology clinics and school-based programs in three metropolitan regions. A sample of 420 participants is targeted, with stratified sampling to ensure representation across ADHD presentation (predominantly inattentive, hyperactive-impulsive, combined) and sociodemographic backgrounds. Data collection integrates (a) objective sleep measures via actigraphy for two weeks and overnight polysomnography in a subsample of 120; (b) subjective sleep assessment using the Children's Sleep Habits Questionnaire and the Child Sleep Diary; (c) ADHD symptom severity via the Conners’ Parent and Teacher Rating Scales; (d) academic performance through standardized test scores (e.g., reading and mathematics), school grade reports, and teacher-rated academic engagement; and (e) covariates including comorbid learning disorders, medication status, sleep duration, and socioeconomic indicators. Validity and reliability will be ensured through standardized administration, pilot testing of instruments, and cross-informant corroboration. Data will be analyzed using structural equation modeling to test mediation and moderation hypotheses, hierarchical linear modeling to account for nested data (students within schools), and multiple regression to estimate unique contributions of sleep variables after controlling for ADHD symptomatology and covariates. Mediation analysis will examine whether sleep disruption explains the pathway from ADHD severity to academic outcomes, while moderation analysis will evaluate whether sleep hygiene practices alter this relationship. Additional analyses will compare cognitive domains by academic area (quantitative vs. verbal) and investigate potential sex differences. The theoretical framework integrates the Executive Function/ADHD model and the Sleep–Cognition framework, drawing on established theories such as the Attentional Resource Allocation model and the Inhibition–Control theory to interpret how sleep disruption may undermine working memory, cognitive flexibility, and sustained attention essential for academic tasks. Anticipated findings include a significant negative association between objective sleep fragmentation and standardized math and reading scores, with sleep disruption partially mediating the ADHD–academic performance link and sleep hygiene acting as a moderator that attenuates this relationship. The study is expected to contribute to knowledge by delineating the specific sleep parameters most predictive of academic difficulties in children with ADHD, identifying potential targets for behavioral and educational interventions, and informing clinical guidelines on sleep management as a core component of ADHD care. The main conclusion is that sleep quality, beyond mere duration, substantially influences academic outcomes in this population, particularly for tasks demanding executive control. Recommendations will emphasize integrated treatment approaches combining sleep optimization (e.g., sleep hygiene training, cognitive-behavioral strategies for insomnia, and judicious medication planning) with school-based supports (timed testing, differentiated instruction, and teacher collaboration) to mitigate educational impairments in children with ADHD.