Physical activity and sleep were independently and jointly associated with ADHD prevalence in children, with the combination of daily PA and optimal/regular sleep showing the strongest inverse association with ADHD odds.
Key Findings
Results
Physical activity, sleep duration, and sleep regularity were each independently associated with ADHD prevalence in adolescents.
Data came from the 2016-2023 National Survey of Children's Health (NSCH), a population-based cross-sectional study.
The analytic sample included 98,182 adolescents aged 13-17, of whom 13,258 had ADHD.
All measures were parent-reported, including PA, sleep duration, sleep regularity, and ADHD severity.
Weighted multivariable logistic regression models were used; all three independent associations had P < 0.05.
Results
Significant interactions between physical activity and both sleep duration and sleep regularity were observed for ADHD prevalence, but not for ADHD severity.
Interaction terms between PA and sleep duration were statistically significant for ADHD prevalence (P < 0.05).
Interaction terms between PA and sleep regularity were also statistically significant for ADHD prevalence (P < 0.05).
Neither interaction was significant for ADHD severity.
ADHD severity was classified as a three-level variable and analyzed using weighted multivariable ordinal regression models.
Results
Children with optimal sleep duration and at least one day per week of physical activity had lower ADHD odds compared to those with long sleep and no weekly PA days.
The reference group was children with long sleep duration and 0 weekly PA days.
The lowest ADHD odds were observed in the 'optimal sleep and daily PA' group (OR = 0.32, 95% CI: 0.21–0.51).
PA was categorized by weekly guideline-meeting days (≥60 min/day) and sleep duration was classified as short/optimal/long using age-specific cutoffs.
Even occasional engagement in PA (≥1 weekly PA days) combined with optimal sleep was associated with lower ADHD odds.
Results
Better sleep regularity combined with more physical activity guideline-meeting days was associated with lower ADHD odds, with the lowest odds in the 'always regular sleep and daily PA' group.
Sleep regularity was classified at four levels.
The 'always regular sleep and daily PA' group had the lowest ADHD odds (OR = 0.25, 95% CI: 0.18–0.36).
The reference group for this comparison was the highest-risk combination of sleep irregularity and no PA days.
A dose-response pattern was suggested, with better sleep regularity and more PA days progressively linked to lower ADHD odds.
Results
Even occasional engagement in regular physical activity was associated with lower odds of ADHD in children.
Children with at least one PA guideline-meeting day per week showed lower ADHD odds compared to those with zero PA days.
This finding held across sleep duration and sleep regularity categories.
The result suggests that any amount of PA above zero may confer benefit for ADHD odds, not just daily PA.
Discussion
Improving sleep regularity was identified as being as important as ensuring optimal sleep duration in relation to ADHD prevalence.
Both sleep duration (short/optimal/long using age-specific classifications) and sleep regularity (four-level classification) were independently associated with ADHD.
Joint analyses showed sleep regularity combined with PA produced OR = 0.25 (95% CI: 0.18–0.36) at best, comparable in magnitude to the optimal sleep duration and daily PA combination (OR = 0.32, 95% CI: 0.21–0.51).
The authors conclude that sleep regularity should be prioritized alongside sleep duration in childhood health assessments.
What This Means
This research suggests that both physical activity and sleep habits are linked to ADHD in children and teenagers. Using data from nearly 100,000 adolescents aged 13–17 collected through a large national U.S. survey between 2016 and 2023, researchers found that kids who were more physically active and who had better sleep — both in terms of getting the right amount of sleep and sleeping at consistent times — were less likely to have ADHD. These associations held up even after accounting for other factors, and each variable (physical activity, sleep duration, sleep regularity) was independently connected to ADHD likelihood.
The most striking finding was that combining good sleep with regular physical activity showed the strongest association with lower ADHD odds. Children who got the right amount of sleep and were physically active every day had about one-third the odds of ADHD compared to children with long sleep and no physical activity. Meanwhile, children who always had regular sleep schedules and were physically active daily had about one-quarter the odds of ADHD compared to the least-active, most irregular sleepers. Importantly, even just one day a week of meeting physical activity guidelines was associated with lower ADHD odds — suggesting that small amounts of activity may still matter.
This research suggests that sleep regularity — sticking to a consistent sleep schedule — may be just as important as sleeping the right number of hours when it comes to children's ADHD risk. The findings highlight the potential value of looking at physical activity and sleep together, rather than in isolation, when thinking about children's health and development. However, because this was a cross-sectional study relying on parent-reported data, it cannot establish that physical activity or sleep directly cause or prevent ADHD — only that they are associated with it.
Shi B, Mou H, Chen Z, He C, Zhang M, Zhang Z, et al.. (2026). Independent and joint associations of physical activity and sleep with ADHD in a population-based sample of children: A cross-sectional study.. General hospital psychiatry. https://doi.org/10.1016/j.genhosppsych.2026.01.016