Evaluation of the Validity of Sleep Disturbance Scale for Children (SDSC) in Attention Deficit Hyperactivity Disorder (ADHD)

Abstract

Background: Attention Deficit Hyperactivity Disorder (ADHD) is prevalent in children and tightly associated with sleep disorders, emphasizing the clinical importance of diagnosing sleep disorders in this population. Here, we aimed to assess the validity of the Sleep Disturbance Scale for Children (SDSC) in children with ADHD. Methods: This cross-sectional study, conducted between 2020 and 2021, involved 204 children diagnosed with ADHD and 202 healthy children as controls. Participants were recruited utilizing a convenience sampling approach through schools, community centers, and pediatric clinics. Demographic data were collected for all participants, and their parents completed the SDSC. The results of the two groups were analyzed and compared using the factor analysis method to examine question-answering patterns and item discrimination for ADHD disorder. Results: The mean total SDSC score was significantly higher in ADHD patients compared to controls (68.1 ± 20.4 versus 57.3 ± 18.2; P < 0.05). ADHD cases also exhibited significantly higher scores in disorders of initiating and maintaining sleep (DIMS) (21.6 ± 7.5 versus 18.1 ± 26.9; P < 0.001), sleep disorder of breathing (SDB) (5.5 ± 3.5 versus 4.9 ± 2.5; P = 0.006), disorder of arousal (DA) (5.9 ± 4.0 versus 4.4 ± 2.7; P < 0.001), sleep–wake transition disorders (SWTD) (17.8 ± 6.6 versus 14.6 ± 6.2; P < 0.001), and sleep hyperhidrosis (SHY) (4.5 ± 3.5 versus 3.6 ± 3.1; P = 0.013) subscales. However, the area under the curve (AUCs) of all subscales were unsatisfactory (ranging from 0.54 to 0.63). Conclusion: ADHD patients displayed notably higher SDSC scores, particularly in the DIMS domain, which exhibited the highest sensitivity. These findings emphasize the clinical relevance of using SDSC for diagnosing and addressing sleep disorders in individuals with ADHD. © 2025 Iran University of Medical Sciences. All rights reserved.