Exploring the Relationship of Sleep, Screen Time, and Physical Activity With Deficient Emotional Self-regulation in Children With and Without ADHD

Objective: This study examines associations between sleep problems, screen time, physical activity, and deficient emotional self-regulation (DESR) in children with and without attention-deficit hyperactivity disorder (ADHD). Methods: A total of 74 children aged 6 to 10 years participated in this cross-sectional study, including 43 inpatients diagnosed with ADHD and 31 control participants. DESR was assessed using a composite derived from Child Behavior Checklist subscales. Parents provided information on children's sleep, screen time, and physical activity using questionnaire measures. Hierarchical regression and group comparisons were conducted to examine associations between lifestyle factors and DESR. Results: Children with ADHD exhibited more sleep problems and higher screen time than controls. Sleep problems were strongly associated with DESR after adjusting for ADHD diagnosis. Screen time was positively correlated with DESR but was not independently associated with DESR in multivariate models. Physical activity was not associated with DESR, and no group differences in physical activity were observed. Conclusion: In this inpatient sample, sleep problems showed the most robust association with DESR, particularly among children with ADHD. These findings highlight sleep as a potentially important clinical target. Future studies should use longitudinal designs and objective measures to clarify directionality and mechanisms.