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Relationship of Children’s Daytime Behavior Problems with Bedtime Routines/Practices: A Family Context and the Consideration of Faux-ADHD

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RELATIONSHIP OF CHILDREN'S DAYTIME BEHAVIOR PROBLEMS WITH BEDTIME ROUTINES/PRACTICES: A FAMILY CONTEXT AND THE CONSIDERATION OF FAUX-ADHD

AUTHORS: Robert M. Pressman, Ph.D., ABPP,a and Steve C. Imber, Ph.Db

aNew England Center for Pediatric Psychology, Providence, Rhode Island and bRhode Island College, Providence, Rhode Island

Key Words: ADHD, Faux-ADHD, Assault, Bedtime, Bed-sharing, Treatment

Acceptance Date: June 13, 2011

Publication Date: September 20,  2011

Presentation Date: August 6, 2011.  American Psychological Association, Grand Hyatt Washington Hotel, Washington, D.C.

Copyright: © 2011 American Journal of Family Therapy. 

WHAT THIS STUDY ADDS: There are clear links between two bedtime habits—bed sharing and non-specific bedtimes—and several problem daytime behaviors, most notably ADHD-like behaviors or Faux-ADHD.  Of additional interest was a strong link between bed sharing and assault by a child against a parent.
 
WHAT’S KNOWN ON THIS SUBJECT: Except in reference to a narrow range of medical issues, there is limited evidence published regarding the specific effects of bedtime routines on daytime behavior.  Prior to our study, there have been no major ADHD studies that examine specific bedtime habits as possible precursors of childhood ADHD.  Furthermore, there is no evidence to indicate that bedtime habits are routinely assessed during intake procedures.

OBJECTIVE: Our study was initiated to confirm or reject a relationship between bed sharing and non-specific bedtimes with daytime behavior problems of children.

METHODS:  Our study consisted of 704 parents of children, ages 2-13, who were being seen in pediatricians’ offices.  Selection of offices was made by cluster sampling in Providence, RI, resulting in 14 data collection sites.  Data were collected by a questionnaire constructed to assess categorical responses.

Results:  The following were clearly determined:

  1. Children who did not sleep in their own beds had ADHD-like behaviors 7 times more frequently than children who always slept in their own beds.
  2. Children who did not sleep in their own beds hit, pushed, or kicked their parents 13 times more frequently than children who always slept in their own beds.
  3. Children who did not have a regular bedtime had ADHD-like behaviors 8 times more frequently than children who had a regular bedtime.
  4. Children who did not have a regular bedtime hit, pushed, or kicked their parents 10 times more frequently than children who had a regular bedtime.

 

Data collected indicated that approximately 33% of children are recommended ADHD medication, although prevalence studies of actual ADHD range only 3%-10%.

Conclusions and Recommendations:  There is a clear link between bed sharing and non-specific bedtimes with ADHD-like behaviors or Faux-ADHD. We strongly recommend that:

  1. Bedtime habits are assessed at intake.
  2. Bedtime problems identified in this study be eliminated and the presence of Faux-ADHD be explored before ADHD medication is considered.