JMIR Publications

ABSTRACT

Background:

Children with Attention Deficit Hyperactivity Disorder (ADHD) or Autism Spectrum Disorder (ASD) frequently experience sleep and circadian rhythms disturbances, emotion dysregulation, and learning difficulties. Although these dimensions are strongly interconnected, they have rarely been investigated together within a single experimental framework.

Objective:

This study aims to determine how experimentally induced social stress affects emotional and physiological reactivity, sleep and circadian functioning, and sleep-dependent learning in children with these neurodevelopmental conditions.

Methods:

A total of 30 children aged 7-12 years, including 15 with ADHD and 15 with ASD, were recruited. Participants first underwent clinical, neuropsychological, and questionnaire-based assessments, followed by two weeks of home actigraphy, sleep and dream diaries, and timed urine sampling for the assessment of 6-sulfatoxymelatonin and cortisol. They subsequently completed a 50-hour sleep-laboratory protocol using a within-subject design. On consecutive afternoons, each child underwent both a neutral virtual-reality condition and a virtual-reality adaptation of the Trier Social Stress Test. Stress responses were assessed using self-reported emotional ratings, salivary cortisol, electrodermal activity, heart rate variability, respiratory sinus arrhythmia, and eye tracking. Sleep and circadian outcomes were measured using video-polysomnography, actigraphy, and urinary melatonin and cortisol profiles. Declarative memory, vigilance, inhibitory control, and emotional processing were assessed before and after stress exposure and following overnight sleep. Linear mixed-effects models will be used to examine the effects of condition, diagnostic group, and time, as well as their interactions.

Results:

The study was registered on ClinicalTrials.gov in June 2024 (NCT06479668). Recruitment began in September 2024. Data collection was completed in May 2026, and data analyses are currently ongoing.

Conclusions:

This multimodal protocol will provide an integrated assessment of the mechanisms linking social stress, emotion regulation, sleep physiology, circadian rhythms, and cognition in children with ADHD or ASD. The findings may identify transdiagnostic psychophysiological markers and clarify how stress-related sleep and learning difficulties differ between neurodevelopmental conditions. They may also support the development of more individualized assessment and intervention strategies.