Top

Published in:

01-03-2018 | Original Contribution

The impact of comorbid mental health symptoms and sex on sleep functioning in children with ADHD

Authors: Stephen P. Becker, Caroline N. Cusick, Craig A. Sidol, Jeffery N. Epstein, Leanne Tamm

Published in: European Child & Adolescent Psychiatry | Issue 3/2018

Abstract

Children with attention-deficit/hyperactivity disorder (ADHD) display more sleep problems than their peers, but it remains unclear whether comorbid mental health symptoms [i.e., anxiety, depression, oppositional-defiant disorder (ODD)] are uniquely related to sleep functioning. It is also largely unknown whether boys and girls with ADHD differ in their sleep functioning. This study (1) examined whether boys or girls with ADHD differ in their sleep functioning, (2) evaluated comorbid symptoms as uniquely related to sleep functioning domains, and (3) explored whether sex moderated associations between comorbid symptoms and sleep. Participants were 181 children (ages 7–13; 69% male; 82% White) diagnosed with ADHD. Parents completed measures assessing their child’s ADHD symptoms, comorbid symptoms, and sleep functioning. Girls had poorer sleep functioning than boys across most sleep functioning domains. Sixty percent of children met cutoff criteria for having sleep problems, though rates differed significantly between girls (75%) and boys (53%). No differences in rates of sleep problems were found between ADHD subtypes/presentations or between younger and older children. In path models including ADHD and comorbid symptom dimensions, anxiety symptoms were uniquely associated with increased bedtime resistance and sleep anxiety, ADHD hyperactive-impulsive symptoms were associated with more night wakings and more parasomnia behaviors, and ODD and depressive symptoms were associated with shorter sleep duration. Depression was also uniquely associated with increased daytime sleepiness and overall sleep problems. Sex did not moderate associations between comorbid symptoms and sleep problems. This study provides important preliminary evidence that girls with ADHD experience more sleep problems than boys with ADHD. Findings also demonstrate that the associations between comorbid symptoms and sleep functioning in children with ADHD vary based on both the specific symptoms and sleep domains examined.

Cortese S, Faraone SV, Konofal E, Lecendreux M (2009) Sleep in children with attention-deficit/hyperactivity disorder: meta-analysis of subjective and objective studies. J Am Acad Child Adolesc Psychiatry 48:894–908. doi:10.1097/CHI.0b013e3181ac09c9 PubMed

Kirov R, Brand S (2014) Sleep problems and their effect in ADHD. Expert Rev Neurother 14:287–299. doi:10.1586/14737175.2014.885382 CrossRefPubMed

Owens JA (2006) The ADHD and sleep conundrum redux: moving forward. Sleep Med Rev 10:377–379. doi:10.1016/j.smrv.2006.08.002 CrossRefPubMed

Sung V, Hiscock H, Sciberras E, Efron D (2008) Sleep problems in children with attention-deficit/hyperactivity disorder: prevalence and the effect on the child and family. Arch Pediatr Adolesc Med 162:336–342. doi:10.1001/archpedi.162.4.336 CrossRefPubMed

Hansen BH, Skirbekk B, Oerbeck B, Wentzel-Larsen T, Kristensen H (2014) Associations between sleep problems and attentional and behavioral functioning in children with anxiety disorders and ADHD. Behav Sleep Med 12:53–68. doi:10.1080/15402002.2013.764525 CrossRefPubMed

Gruber R, Wiebe S, Montecalvo L, Brunetti B, Amsel R, Carrier J (2011) Impact of sleep restriction on neurobehavioral functioning of children with attention deficit hyperactivity disorder. Sleep 34:315–323CrossRefPubMedPubMedCentral

Sciberras E, DePetro A, Mensah F, Hiscock H (2015) Association between sleep and working memory in children with ADHD: a cross-sectional study. Sleep Med 16:1192–1197. doi:10.1016/j.sleep.2015.06.006 CrossRefPubMed

Pliszka SR (2015) Comorbid psychiatric disorders in children with ADHD. In: Barkley RA (ed) Attention-deficit hyperactivity disorder: a handbook for diagnosis and treatment, 4th edn. Guilford, New York, pp 140–168

Tung I, Li JJ, Meza JI, Jezior KL, Kianmahd JS, Hentschel PG, O’Neil PM, Lee SS (2016) Patterns of comorbidity among girls with ADHD: a meta-analysis. Pediatrics. doi:10.1542/peds.2016-0430 PubMed

10.

Becker SP, Pfiffner LJ, Stein MA, Burns GL, McBurnett K (2016) Sleep habits in children with attention-deficit/hyperactivity disorder predominantly inattentive type and associations with comorbid psychopathology symptoms. Sleep Med 21:151–159. doi:10.1016/j.sleep.2015.11.011 CrossRefPubMed

11.

Langberg JM, Molitor SJ, Oddo LE, Eadeh HM, Dvorsky MR, Becker SP (2017) Prevalence, patterns, and predictors of sleep problems and daytime sleepiness in young adolescents with ADHD. J Atten Disord. doi:10.1177/1087054717690810 PubMed

12.

Yoon SY, Jain U, Shapiro C (2012) Sleep in attention-deficit/hyperactivity disorder in children and adults: past, present, and future. Sleep Med Rev 16:371–388. doi:10.1016/j.smrv.2011.07.001 CrossRefPubMed

13.

Moreau V, Rouleau N, Morin CM (2014) Sleep of children with attention deficit hyperactivity disorder: actigraphic and parental reports. Behav Sleep Med 12:69–83. doi:10.1080/15402002.2013.764526 CrossRefPubMed

14.

Yürümez E, Kılıç BG (2016) Relationship between sleep problems and quality of life in children with ADHD. J Atten Disord 20:34–40. doi:10.1177/1087054713479666 CrossRefPubMed

15.

Accardo JA, Marcus CL, Leonard MB, Shults J, Meltzer LJ, Elia J (2012) Associations between psychiatric comorbidities and sleep disturbances in children with attention-deficit/hyperactivity disorder. J Dev Behav Pediatr 33:97–105. doi:10.1097/DBP.0b013e31823f6853 PubMedPubMedCentral

16.

Hansen BH, Skirbekk B, Oerbeck B, Richter J, Kristensen H (2011) Comparison of sleep problems in children with anxiety and attention deficit/hyperactivity disorders. Eur Child Adolesc Psychiatry 20:321–330. doi:10.1007/s00787-011-0179-z CrossRefPubMed

17.

Ivanenko A, Crabtree VM, Obrien LM, Gozal D (2006) Sleep complaints and psychiatric symptoms in children evaluated at a pediatric mental health clinic. J Clin Sleep Med 2:42–48PubMed

18.

Virring A, Lambek R, Jennum PJ, Moller LR, Thomsen PH (2014) Sleep problems and daily functioning in children with ADHD: An investigation of the role of impairment, ADHD presentations, and psychiatric comorbidity. J Atten Disord. doi:10.1177/1087054714542001 PubMed

19.

Mayes SD, Calhoun SL, Bixler EO, Vgontzas AN, Mahr F, Hillwig-Garcia J, Elamir B, Edhere-Ekezie L, Parvin M (2009) ADHD subtypes and comorbid anxiety, depression, and oppositional-defiant disorder: differences in sleep problems. J Pediatr Psychol 34:328–337. doi:10.1093/jpepsy/jsn083 CrossRefPubMed

20.

Mick E, Biederman J, Jetton J, Faraone SV (2000) Sleep disturbances associated with attention deficit hyperactivity disorder: the impact of psychiatric comorbidity and pharmacotherapy. J Child Adolesc Psychopharmacol 10:223–231. doi:10.1089/10445460050167331 CrossRefPubMed

21.

Hvolby A, Jorgensen J, Bilenberg N (2008) Actigraphic and parental reports of sleep difficulties in children with attention-deficit/hyperactivity disorder. Arch Pediatr Adolesc Med 162:323–329. doi:10.1001/archpedi.162.4.323 CrossRefPubMed

22.

Corkum P, Moldofsky H, Hogg-Johnson S, Humphries T, Tannock R (1999) Sleep problems in children with attention-deficit/hyperactivity disorder: impact of subtype, comorbidity, and stimulant medication. J Am Acad Child Adolesc Psychiatry 38:1285–1293. doi:10.1097/00004583-199910000-00018 CrossRefPubMed

23.

Lycett K, Mensah FK, Hiscock H, Sciberras E (2014) A prospective study of sleep problems in children with ADHD. Sleep Med 15:1354–1361. doi:10.1016/j.sleep.2014.06.004 CrossRefPubMed

24.

Lycett K, Sciberras E, Mensah FK, Hiscock H (2015) Behavioral sleep problems and internalizing and externalizing comorbidities in children with attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry 24:31–40. doi:10.1007/s00787-014-0530-2 CrossRefPubMed

25.

Hvolby A, Jorgensen J, Bilenberg N (2009) Parental rating of sleep in children with attention deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry 18:429–438. doi:10.1007/s00787-009-0750-z CrossRefPubMed

26.

Becker SP, Langberg JM, Evans SW (2015) Sleep problems predict comorbid externalizing behaviors and depression in young adolescents with attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry 24:897–907. doi:10.1007/s00787-014-0636-6 CrossRefPubMed

27.

Koriakin TA, Mahone EM, Jacobson LA (2015) Sleep difficulties are associated with parent report of sluggish cognitive tempo. J Dev Behav Pediatr 36:717–723. doi:10.1097/DBP.0000000000000224 CrossRefPubMedPubMedCentral

28.

Willcutt EG (2012) The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics 9:490–499. doi:10.1007/s13311-012-0135-8 CrossRefPubMedPubMedCentral

29.

Gershon J (2002) A meta-analytic review of gender differences in ADHD. J Atten Disord 5:143–154. doi:10.1177/108705470200500302 CrossRefPubMed

30.

Arnold LE (1996) Sex differences in ADHD: Conference summary. J Abnorm Child Psychol 24:555–569. doi:10.1007/bf01670100 CrossRefPubMed

31.

Rucklidge JJ (2010) Gender differences in attention-deficit/hyperactivity disorder. Psychiatr Clin N Am 33:357–373. doi:10.1016/j.psc.2010.01.006 CrossRef

32.

Engelhardt CR, Mazurek MO, Sohl K (2013) Media use and sleep among boys with autism spectrum disorder, ADHD, or typical development. Pediatrics 132:1081–1089. doi:10.1542/peds.2013-2066 CrossRefPubMed

33.

Gruber R, Sadeh A (2004) Sleep and neurobehavioral functioning in boys with attention-deficit/hyperactivity disorder and no reported breathing problems. Sleep 27:267–273CrossRefPubMed

34.

Kirov R, Kinkelbur J, Banaschewski T, Rothenberger A (2007) Sleep patterns in children with attention-deficit/hyperactivity disorder, tic disorder, and comorbidity. J Child Psychol Psychiatry 48:561–570. doi:10.1111/j.1469-7610.2007.01729.x CrossRefPubMed

35.

Hoeppner JA, Trommer BL, Armstrong KJ, Rosenberg RS, Picchietti D (1996) Developmental changes of parental-reported sleep disturbance symptoms in children with attention deficit disorder. J Clin Psychol Med Settings 3:235–242. doi:10.1007/BF01993909 CrossRefPubMed

36.

Goraya JS, Cruz M, Valencia I, Kaleyias J, Khurana DS, Hardison HH, Marks H, Legido A, Kothare SV (2009) Sleep study abnormalities in children with attention deficit hyperactivity disorder. Pediatr Neurol 40:42–46. doi:10.1016/j.pediatrneurol.2008.09.007 CrossRefPubMed

37.

Silvestri R, Gagliano A, Aricò I, Calarese T, Cedro C, Bruni O, Condurso R, Germanò E, Gervasi G, Siracusano R, Vita G, Bramanti P (2009) Sleep disorders in children with attention-deficit/hyperactivity disorder (ADHD) recorded overnight by video-polysomnography. Sleep Med 10:1132–1138. doi:10.1016/j.sleep.2009.04.003 CrossRefPubMed

38.

Wiggs L, Montgomery P, Stores G (2005) Actigraphic and parent reports of sleep patterns and sleep disorders in children with subtypes of attention-deficit hyperactivity disorder. Sleep 28:1437–1445CrossRefPubMed

39.

Corkum P, Tannock R, Moldofsky H, Hogg-Johnson S, Humphries T (2001) Actigraphy and parental ratings of sleep in children with attention-deficit/hyperactivity disorder (ADHD). Sleep 24:303–312CrossRefPubMed

40.

Bauermeister JJ, Shrout PE, Chávez L, Rubio-Stipec M, Ramírez R, Padilla L, Anderson A, García P, Canino G (2007) ADHD and gender: Are risks and sequela of ADHD the same for boys and girls? J Child Psychol Psychiatry 48:831–839. doi:10.1111/j.1469-7610.2007.01750.x CrossRefPubMed

41.

Hansen BH, Skirbekk B, Oerbeck B, Wentzel-Larsen T, Kristensen H (2013) Persistence of sleep problems in children with anxiety and attention deficit hyperactivity disorders. Child Psychiatry Hum Dev 44:290–304. doi:10.1007/s10578-012-0325-y CrossRefPubMed

42.

Robison RJ, Reimherr FW, Marchant BK, Faraone SV, Adler LA, West SA (2008) Gender differences in 2 clinical trials of adults with attention-deficit/hyperactivity disorder: a retrospective data analysis. J Clin Psychiatry 69:213–221. doi:10.4088/JCP.v69n0207 CrossRefPubMed

43.

Eme RF (1992) Selective female affliction in the developmental disorders of childhood: a literature review. J Clin Child Psychol 21:354–364CrossRef

44.

Lahey BB, Hartung CM, Loney J, Pelham WE, Chronis AM, Lee SS (2007) Are there sex differences in the predictive validity of DSM-IV ADHD among younger children? J Clin Child Adolesc Psychol 36:113–126. doi:10.1080/15374410701274066 CrossRefPubMed

45.

Becker SP, McBurnett K, Hinshaw SP, Pfiffner LJ (2013) Negative social preference in relation to internalizing symptoms among children with ADHD predominantly inattentive type: girls fare worse than boys. J Clin Child Adolesc Psychol 42:784–795. doi:10.1080/15374416.2013.828298 CrossRefPubMed

46.

Mikami AY, Lorenzi J (2011) Gender and conduct problems predict peer functioning among children with attention-deficit/hyperactivity disorder. J Clin Child Adolesc Psychol 40:777–786. doi:10.1080/15374416.2011.597089 CrossRefPubMedPubMedCentral

47.

Elkins IJ, Malone S, Keyes M, Iacono WG, McGue M (2011) The impact of attention-deficit/hyperactivity disorder on preadolescent adjustment may be greater for girls than for boys. J Clin Child Adolesc Psychol 40:532–545. doi:10.1080/15374416.2011.581621 CrossRefPubMedPubMedCentral

48.

Stein MA, Weiss M, Hlavaty L (2012) ADHD treatments, sleep, and sleep problems: complex associations. Neurotherapeutics 9:509–517. doi:10.1007/s13311-012-0130-0 CrossRefPubMedPubMedCentral

49.

Kidwell KM, Van Dyk TR, Lundahl A, Nelson TD (2015) Stimulant medications and sleep for youth with ADHD: a meta-analysis. Pediatrics 136:1144–1153. doi:10.1542/peds.2015-1708 CrossRefPubMed

50.

Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, Williamson D, Ryan N (1997) Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36:980–988. doi:10.1097/00004583-199707000-00021 CrossRefPubMed

51.

Wolraich ML, Lambert W, Doffing MA, Bickman L, Simmons T, Worley K (2003) Psychometric properties of the Vanderbilt ADHD diagnostic parent rating scale in a referred population. J Pediatr Psychol 28:559–567. doi:10.1093/jpepsy/jsg046 CrossRefPubMed

52.

Chorpita BF, Yim L, Moffitt C, Umemoto LA, Francis SE (2000) Assessment of symptoms of DSM-IV anxiety and depression in children: a revised child anxiety and depression scale. Behav Res Ther 38:835–855CrossRefPubMed

53.

Ebesutani C, Bernstein A, Nakamura BJ, Chorpita BF, Weisz JR (2010) A psychometric analysis of the revised child anxiety and depression scale–parent version in a clinical sample. J Abnorm Child Psychol 38:249–260. doi:10.1007/s10802-009-9363-8 CrossRefPubMed

54.

Ebesutani C, Chorpita BF, Higa-McMillan CK, Nakamura BJ, Regan J, Lynch RE (2011) A psychometric analysis of the revised child anxiety and depression scales—parent version in a school sample. J Abnorm Child Psychol 39:173–185. doi:10.1007/s10802-010-9460-8 CrossRefPubMed

55.

Becker SP, Schindler DN, Luebbe AM, Tamm L, Epstein JN (2017) Psychometric validation of the revised child anxiety and depression scales—parent version (RCADS-P) in children evaluated for ADHD. Assessment. Advance online publication. doi:10.1177/1073191117735886

56.

Owens JA, Spirito A, McGuinn M (2000) The children’s sleep habits questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children. Sleep 23:1043–1051CrossRefPubMed

57.

Lewandowski AS, Toliver-Sokol M, Palermo TM (2011) Evidence-based review of subjective pediatric sleep measures. J Pediatr Psychol 36:780–793. doi:10.1093/jpepsy/jsq119 CrossRefPubMedPubMedCentral

58.

Goodlin-Jones BL, Sitnick SL, Tang K, Liu J, Anders TF (2008) The children’s sleep habits questionnaire in toddlers and preschool children. J Dev Behav Pediatr 29:82–88CrossRefPubMed

59.

Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. L. Erlbaum Associates, Hillsdale

60.

Muthén LK, Muthén BO (1998–2014) Mplus user’s guide (7th ed). Muthén & Muthén, Los Angeles, CA

61.

Holmbeck GN (2002) Post-hoc probing of significant moderational and mediational effects in studies of pediatric populations. J Pediatr Psychol 27:87–96. doi:10.1093/jpepsy/27.1.87 CrossRefPubMed

62.

Cohen J, Cohen P, West SG, Aiken LS (2003) Applied multiple correlation/regression analysis for the behavioral sciences. Lawrence Erlbaum Associates, Mahwah

63.

Cortese S, Brown TE, Corkum P, Gruber R, O’Brien LM, Stein M, Weiss M, Owens J (2013) Assessment and management of sleep problems in youths with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 52:784–796. doi:10.1016/j.jaac.2013.06.001 CrossRefPubMed

64.

Clark LA, Watson D (1991) Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications. J Abnorm Psychol 100:316–336CrossRefPubMed

65.

Koffel E, Watson D (2009) The two-factor structure of sleep complaints and its relation to depression and anxiety. J Abnorm Psychol 118:183–194. doi:10.1037/a0013945 CrossRefPubMedPubMedCentral

66.

Chiang HL, Gau SS, Ni HC, Chiu YN, Shang CY, Wu YY, Lin LY, Tai YM, Soong WT (2010) Association between symptoms and subtypes of attention-deficit hyperactivity disorder and sleep problems/disorders. J Sleep Res 19:535–545. doi:10.1111/j.1365-2869.2010.00832.x CrossRefPubMed

67.

Keshavarzi Z, Bajoghli H, Mohamadi MR, Salmanian M, Kirov R, Gerber M, Holsboer-Trachsler E, Brand S (2014) In a randomized case–control trial with 10-years olds suffering from attention deficit/hyperactivity disorder (ADHD) sleep and psychological functioning improved during a 12-week sleep-training program. World J Biol Psychiatry 15:609–619. doi:10.3109/15622975.2014.922698 CrossRefPubMed

68.

Corkum P, Lingley-Pottie P, Davidson F, McGrath P, Chambers CT, Mullane J, Laredo S, Woodford K, Weiss SK (2016) Better nights/better days—distance intervention for insomnia in school-aged children with/without ADHD: a randomized controlled trial. J Pediatr Psychol 41:701–713. doi:10.1093/jpepsy/jsw031 CrossRefPubMed

69.

Hiscock H, Sciberras E, Mensah F, Gerner B, Efron D, Khano S, Oberklaid F (2015) Impact of a behavioural sleep intervention on symptoms and sleep in children with attention deficit hyperactivity disorder, and parental mental health: randomised controlled trial. BMJ 350:h68. doi:10.1136/bmj.h68 CrossRefPubMedPubMedCentral

70.

Galland BC, Gray AR, Penno J, Smith C, Lobb C, Taylor RW (2017) Gender differences in sleep hygiene practices and sleep quality in New Zealand adolescents aged 15 to 17 years. Sleep Health 3:77–83. doi:10.1016/j.sleh.2017.02.001 CrossRefPubMed

71.

Hysing M, Pallesen S, Stormark KM, Lundervold AJ, Sivertsen B (2013) Sleep patterns and insomnia among adolescents: a population-based study. J Sleep Res 22:549–556. doi:10.1111/jsr.12055 CrossRefPubMed

72.

Skidmore PM, Howe AS, Polak MA, Wong JE, Lubransky A, Williams SM, Black KE (2013) Sleep duration and adiposity in older adolescents from Otago, New Zealand: relationships differ between boys and girls and are independent of food choice. Nutr J 12:128. doi:10.1186/1475-2891-12-128 CrossRefPubMedPubMedCentral

73.

Johnson EO, Roth T, Breslau N (2006) The association of insomnia with anxiety disorders and depression: exploration of the direction of risk. J Psychiatr Res 40:700–708. doi:10.1016/j.jpsychires.2006.07.008 CrossRefPubMed

74.

Dorn LD, Biro FM (2011) Puberty and its measurement: a decade in review. J Res Adolesc 21:180–195. doi:10.1111/j.1532-7795.2010.00722.x CrossRef

75.

Arnett AB, Pennington BF, Willcutt EG, DeFries JC, Olson RK (2015) Sex differences in ADHD symptom severity. J Child Psychol Psychiatry 56:632–639. doi:10.1111/jcpp.12337 CrossRefPubMed

76.

Becker SP, Langberg JM, Byars KC (2015) Advancing a biopsychosocial and contextual model of sleep in adolescence: a review and introduction to the special issue. J Youth Adolesc 44:239–270. doi:10.1007/s10964-014-0248-y CrossRefPubMed

77.

Virring A, Lambek R, Thomsen PH, Moller LR, Jennum PJ (2016) Disturbed sleep in attention-deficit hyperactivity disorder (ADHD) is not a question of psychiatric comorbidity or ADHD presentation. J Sleep Res 25:333–340. doi:10.1111/jsr.12377 CrossRefPubMed

78.

Becker SP, Sidol CA, Van Dyk TR, Epstein JN, Beebe DW (2017) Intraindividual variability of sleep/wake patterns in relation to child and adolescent functioning: a systematic review. Sleep Med Rev 34:94–121. doi:10.1016/j.smrv.2016.07.004 CrossRefPubMed

Title: The impact of comorbid mental health symptoms and sex on sleep functioning in children with ADHD
Authors: Stephen P. Becker
Caroline N. Cusick
Craig A. Sidol
Jeffery N. Epstein
Leanne Tamm
Publication date: 01-03-2018
Publisher: Springer Berlin Heidelberg
Published in: European Child & Adolescent Psychiatry / Issue 3/2018
Print ISSN: 1018-8827
Electronic ISSN: 1435-165X
DOI: https://doi.org/10.1007/s00787-017-1055-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The impact of comorbid mental health symptoms and sex on sleep functioning in children with ADHD

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2018

A double-blind placebo-controlled randomised trial of omega-3 supplementation in children with moderate ADHD symptoms

Dosage of methylphenidate and traumatic brain injury in ADHD: a population-based study in Taiwan

Effectiveness of time-related interventions in children with ADHD aged 9–15 years: a randomized controlled study

Maternal depressive symptoms in childhood and risky behaviours in early adolescence

Towards a better understanding of the many facets of attention-deficit/hyperactivity disorder

A prospective longitudinal investigation of the (dis)continuity of mental health difficulties between mid- to late-childhood and the predictive role of familial factors