The relationship of sluggish cognitive tempo, internet addiction and emotional dysregulation with sleep disorders in adolescents with attention defisit/hyperactivity disorder

ABSTRACT Introduction and Objective: ADHD is a neurodevelopmental disorder characterized by core symptoms such as developmentally inappropriate inattention, impulsivity and/or hyperactivity. It is thought that there is a bidirectional relationship between ADHD and sleep problems. Our first aim in this study was to investigate the frequency of sleep disturbances, clinically significant Sluggish Cognitive Tempo (SCT) and risky internet use in adolescents with ADHD. Another aim of our study was to determine the relationship between Sluggish Cognitive Tempo (SCT), internet addiction, emotional dysregulation and ADHD symptoms with sleep disturbances and sleep quality in adolescents with ADHD. It was also aimed to investigate the factors predicting the presence of risky internet use. Method: The study included 176 patients aged between 11-18 years, male and female, diagnosed with ADHD according to DSM-5. In addition, DSM-IV-Based Screening and Assessment Scale for Attention Deficit and Disruptive Behavior Disorders (ADDB DSM-IV Assessment Scale) completed by the parents was used to support the diagnosis of ADHD. Sociodemographic Data Form completed by the clinician, Difficulties in Emotion Regulation Scale-Brief Form (DERS-16), Sleep Quality Scale And Sleep Variables Questionnaire (SQS-SVQ), Young's Internet Addiction Test (YIAT), DSM-IV Based Screening and Assessment Scale for Attention Deficit and Disruptive Behavior Disorders (ADDB DSM-IV Assessment Scale), Child and Adolescent Behavior Inventory Sluggish Cognitive Tempo Scale (CABI-SCT), and Sleep Disturbance Scale for Children (SDSC) were completed by the parents of the patients. Results: Among participants with ADHD, clinically significant levels of Sluggish Cognitive Tempo (SCT) were observed in 33.5%, 53.4% had a score of 42 or above on the Sleep Disturbance Scale for Children (SDSC), indicating a risk for sleep disorders, and 21% demonstrated risky internet use (YIAT ≥50). A statistically significant positive correlation was found between the level of sleep disturbances and Sluggish Cognitive Tempo (SCT) levels, ADHD inattention and hyperactivity/impulsivity scores, and sleep quality (p<0.05). In adolescents with ADHD, the presence of clinically significant Sluggish Cognitive Tempo (SCT) and higher levels of hyperactivity/impulsivity symptoms were found to significantly predict sleep disturbances (F=7.172; p<0.001; R²=28.00%). Furthermore, the presence of clinically significant Sluggish Cognitive Tempo (SCT) was associated with several subtypes of sleep disorders. Additionally, in adolescents with ADHD, the presence of clinically significant Sluggish Cognitive Tempo (SCT), risky internet use, and higher levels of emotional dysregulation were significantly associated with lower sleep quality (F=5.756; p<0.001; R²=23.78%). Emotional dysregulation was found to be the only significant predictor of risky internet use (p=0.016; OR=1.03). Conclusion: Problems such as sleep disturbances, risky internet use, and Sluggish Cognitive Tempo (SCT) are frequently observed in adolescents diagnosed with ADHD, and routine assessment of these clinical conditions is crucial for early detection. Effective management of hyperactivity/impulsivity symptoms and appropriate treatment of Sluggish Cognitive Tempo (SCT) may contribute to improvements in sleep disturbances. In particular, addressing emotional dysregulation may help enhance sleep quality and reduce problematic internet use in adolescents with ADHD. Treatment and intervention strategies should not only aim to manage core ADHD symptoms but also incorporate interventions targeting sleep disorders such as sleep hygiene education and cognitive behavioral therapy (CBT) as well as therapeutic approaches addressing SCT and emotional dysregulation. KEYWORDS: ADHD, Sleep Disorders, Sluggish Cognitive Tempo, Internet Addiction, Emotional Dysregulation