Adolescents with ADHD often experience insomnia, yet the mechanisms underlying this relationship, particularly among Middle Eastern populations, are underexplored. Grounded in the cognitive-emotional framework of insomnia, the present study examined the mediating roles of self-compassion, emotion dysregulation, and experiential avoidance in the association between ADHD symptoms and insomnia severity among Iranian adolescents. This cross-sectional study involved 354 adolescents (47.5% female; M = 16.47 years, SD = 1.31) drawn from secondary schools in Tehran via multi-stage cluster sampling procedures. Respondents completed the Adult ADHD Self-Report Scale, Insomnia Severity Index, Acceptance and Action Questionnaire–II, Self-Compassion Scale–Short Form, and Difficulties in Emotion Regulation Scale–Short Form. We employed path analysis using maximum likelihood estimation to evaluate direct and indirect effects, with model fit assessed using standard indices. Bootstrap procedures with 2,000 resamples were used to test indirect effects. ADHD symptoms were positively correlated with insomnia severity (inattention: r = 0.42, hyperactivity: r = 0.54, p < 0.01). Path analysis revealed excellent model fit (χ²/df = 2.150, RMSEA = 0.057, CFI = 0.998). Hyperactivity ( β = 0.285, p = 0.001), emotion dysregulation ( β = 0.242, p = 0.001), and experiential avoidance ( β = 0.292, p = 0.001) directly predicted insomnia severity, while inattention did not ( β = -0.047, p = 0.44). Experiential avoidance and emotion dysregulation significantly mediated the ADHD and insomnia relationship ( p ≤ 0.008), while self-compassion did not show a significant mediation effect ( p ≥ 0.056). Emotion dysregulation and experiential avoidance are key mediators linking ADHD symptoms to insomnia severity in Iranian adolescents, highlighting the need for targeted interventions addressing emotional processes to improve sleep outcomes in this population. The cross-sectional design preventing causal inferences, reliance on self-report measures, and sampling from a single city, necessitating longitudinal and multi-site research with objective measures. Not applicable.
Bajestan et al. (2026) studied this question.