Impact of smartphone-related sleep disturbances on cognitive outcomes in school-aged children with attention-deficit/hyperactivity disorder (ADHD) in urban pediatric clinics

Project Abstract

This study investigates how smartphone-related sleep disturbances influence cognitive outcomes in school-aged children diagnosed with attention-deficit/hyperactivity disorder (ADHD) attending urban pediatric clinics. Employing a cross-sectional design, the research recruited 260 children aged 7–12 years, with equal representation of ADHD subtypes and comorbid conditions, along with a matched control group of 60 neurotypical peers. Data were collected through caregiver-filled sleep questionnaires, device usage logs, actigraphy for objective sleep measures over two weeks, and standardized cognitive assessments including measures of attention, working memory, processing speed, and executive function. Smartphone use variables included total screen time after 1900 hours, frequency of device access at night, blue-light exposure, and night awakenings attributed to notifications. Sleep outcomes encompassed sleep onset latency, total sleep time, sleep efficiency, awakenings, and circadian preference. Covariates such as socioeconomic status, parental monitoring, caffeine intake, migraine history, physical activity, and allergic rhinitis were controlled. Descriptive analyses revealed that children with ADHD exhibited longer sleep onset latency and reduced total sleep time compared with controls, with smartphone-related factors significantly exacerbating these disparities. Multivariate regression demonstrated that after adjusting for confounders, higher evening smartphone usage and nocturnal device awakenings were independently associated with poorer cognitive performance in ADHD participants, particularly in inhibitory control, working memory, and sustained attention. Mediation analyses indicated that sleep fragmentation partially mediated the relationship between smartphone use and executive function deficits, suggesting that disrupted sleep architecture drives cognitive inefficiencies. Subgroup analyses showed that children with ADHD who did not use smartphones after 30 minutes of bedtime experienced markedly better sleep continuity and improved cognitive scores, approaching neurotypical controls, whereas heavy late-night use correlated with the largest cognitive decrements. Neuropsychological findings aligned with parent-reported daytime functioning, where greater daytime sleepiness and reduced behavioral regulation were linked to higher smartphone dependency. Objective actigraphy corroborated subjective measures, with ADHD youth displaying prolonged wake after sleep onset and reduced total sleep time in conjunction with elevated smartphone usage. The results remained robust after stratification by ADHD subtype and coexisting learning disorders, though effect sizes varied, being more pronounced in combined-type ADHD. The study highlights the potential for targeted behavioral interventions and family-based sleep hygiene programs to mitigate smartphone-related sleep disturbances. Public health implications include the need for pediatric guidelines regulating nightly device practices and integrating sleep education into ADHD management protocols. Limitations include cross-sectional design precluding causal inferences, potential reporting biases in caregiver questionnaires, and the challenge of isolating smartphone effects from other electronic devices. The findings underscore the critical role of sleep health in cognitive functioning among school-aged children with ADHD and point to actionable strategies to optimize cognitive outcomes through modulated smartphone use and improved sleep patterns in urban clinical settings. Further longitudinal research is recommended to establish causality and to evaluate intervention efficacy over time.

Project Overview

What This Project Is About

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A plain-language overview of how smartphones and sleep patterns may influence attention and thinking abilities in children aged roughly 6 to 12 who have ADHD, studied in city clinics. The project looks at whether messing with sleep through phone use relates to learning, memory, and planning skills in everyday school tasks.

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The Problem It Addresses

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Many children with ADHD already face challenges with focus and memory. Smartphones often disrupt sleep, which can worsen daytime functioning. There is a gap in understanding how bedtime phone habits affect real-world thinking skills in this specific group and setting. This matters for guiding family advice and clinic practices.

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Objectives of the Project

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1. Describe smartphone use patterns at night among school-aged children with ADHD in urban clinics.
2. Assess how sleep quality relates to attention, executive function, and memory tasks.
3. Explore whether sleep disturbance mediates the relationship between smartphone use and cognitive outcomes.
4. Provide practical recommendations for clinicians and families to support better sleep and daytime functioning.

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What You Will Do Step by Step

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1. Review simple literature about sleep, ADHD, and technology use.
2. Recruit a small group of participants from urban pediatric clinics.
3. Collect data on bedtime phone use, sleep quality (easy questions or a sleep diary), and simple cognitive tasks completed in clinic.
4. Analyze patterns to see associations between phone use, sleep, and cognitive scores.
5. Interpret results in plain terms and identify practical tips for families.

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Expected Outcome

Clear findings on whether nightly smartphone use is linked to poorer sleep and, in turn, to weaker cognitive performance in children with ADHD. The project should yield easy-to-use guidance for parents and clinic staff to promote better sleep and daytime functioning.