Jurnal Keterapian Fisik Vol.
No.
November 2024 https://doi.
org/10.
37341/jkf.
Original Research Parenting Experiences in Shaping Sleep Routines for Children with Attention-Deficit Hyperactivity Disorder (ADHD):
Phenomenological Study Ainulia Salsabila RahmaningrumA*.
Tri Budi SantosoA.
Tri Winarno3 Applied BachelorAos Program in Occupational Therapy.
Department of Occupational Therapy.
Poltekkes Kemenkes Surakarta.
Indonesia Department of Occupational Therapy.
Poltekkes Kemenkes Surakarta.
Indonesia
ABSTRACT
Background: Parenting styles influence sleep routines and problems in children with Attention-Deficit/Hyperactivity Disorder (ADHD).
sleep quality includes efficiency, latency, duration, and wakefulness after onset.
This study explores the experience of implementing bedtime routines based on caregiver parenting styles and their implications for the quality of sleep for children with ADHD.
Methods: Qualitative study with a phenomenological non-probability sampling .
urposive samplin.
Participants consisted of 8 caregivers .
others, aunts, grandmother.
of children with ADHD at YPAC Surakarta.
semi-structured in-depth interviews were conducted 2Ae3 times per participant and analyzed thematically with credibility and confirmability tests.
ARTICLE HISTORY
Received: June 5th, 2024
Accepted: November 5th, 2025
KEYWORDS
caregivers, parenting styles, sleep
CONTACT
Ainulia Salsabila Rahmaningrum ainuliasalsabilarahmaningrum@gm Department Occupational Therapy.
Poltekkes Kemenkes Surakarta.
Jln.
Letjen Sutoyo.
Mojosongo.
Surakarta.
Indonesia.
Results: Three main themes emerged: .
Caregiver parenting styles .
mplementation and influence on slee.
, .
Types of parenting styles based on Baumrind's aspects, .
Sleep quality of children with ADHD .
leep quality, sleep problems, supporting factor.
Authoritarian parenting was linked to a stable sleep schedule but had no impact on efficiency.
democratic parenting influenced emotional regulation.
permissive parenting had no apparent effect on sleep quality.
neglectful parenting was associated with sleep-onset insomnia without a clear cause.
Conclusion: Variations in parenting styles result in different profiles of impact on sleep quality indicators.
Education and harmonization of parenting styles are recommended in pediatric occupational therapy services.
Cite this as:
Rahmaningrum.
Santoso.
, & Winarno.
Parenting Experiences in Shaping Sleep Routines for Children with Attention-Deficit/Hyperactivity Disorder (ADHD): A Phenomenological Study.
Journal of Physical Therapy, 9.
, 127Ae135.
https://doi.
org/10.
37341/jkf.
INTRODUCTION
Children's sleep quality is influenced by biological factors, including circadian rhythms, homeostasis, brain activity, and hormone secretion.
In addition, socioenvironmental factors such as culture, interaction, parenting style, bedtime routines, and http://jurnalketerapianfisik.
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127 screen time also play a role.
Operationally, sleep quality is assessed based on four elements: efficiency, latency, duration, and wakefulness after sleep onset (WASO) (Lynn et al.
, 2.
In children with Attention-Deficit/Hyperactivity Disorder (ADHD), disturbances in one of the elements of sleep quality often stem from behavior, parenting style, presleep routines, child-caregiver interactions, and the home environment.
The literature you cite shows that sleep latency tends to be longer in highly permissive parenting styles, democratic parenting reduces anxiety but is not always directly related to improved sleep quality, while neglectful parenting is associated with internalizationexternalization problems that can worsen sleep.
Overly rigid authoritative/authoritarian parenting styles can also increase pre-sleep stress and ultimately affect sleep efficiency (French et al.
, 2023.
Larsson et al.
, 2.
Globally.
ADHD has a prevalence of about 5% in school-aged children.
In the group of children with ADHD, sleep disorders are reported in up to A70%, which is much higher than in healthy children (A20Ae30%).
Common problems include resistance at bedtime, difficulty initiating sleep, fragmented sleep with episodes of wakefulness during the night, and shorter sleep duration of approximately 30Ae60 minutes compared to peers (French et al.
, 2.
Specifically related to parenting, bedtime routines are a tangible vehicle that manifests parenting values and strategies.
In democratic and authoritarian parenting styles, caregivers tend to set more fixed schedules.
however, an emphasis on discipline without sensitivity to the child's emotions can trigger resistance or pre-sleep stress, which impacts efficiency and WASO.
Conversely, permissive parenting provides comfort but is often inconsistent in establishing sleep habits.
neglectful parenting is associated with irregular schedules and a lack of facilitation when children wake up at You have outlined these patterns in the foundation section and will link them to the real experiences of caregivers (Cortese et al.
, 2.
The novelty of this study lies in exploring the lived experiences of caregiversAi including non-maternal figures such as aunts and grandmothersAiwithin an Indonesian cultural context, a setting rarely examined in ADHD sleep studies.
The research was conducted at YPAC Surakarta with in-depth interviews of 8 caregiver participants .
unts, mothers, and grandmother.
to map the variations in the application of parenting patterns and their implications for children's sleep.
In line with this description of the phenomenon, the purpose of this study is to explore the experience of implementing bedtime routines based on caregiver parenting patterns and their impact on the sleep quality of children with ADHD.
MATERIALS AND METHODS
Design This study used a qualitative design with a realist phenomenological approach to deeply understand caregivers' conscious experiences when implementing parenting styles and bedtime routines and their impact on the sleep quality of children with ADHD.
The research design was chosen because the research questions focused on "how the experience" and the meaning attached by caregivers to parenting practices and bedtime routines (Hays & McKibben, 2021.
Zapata-Berrero & Yalaz, 2.
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128 Setting and Time The research was conducted at YPAC Surakarta .
hild therapy servic.
Data collection was carried out from September 5 to October 29, 2022, in the consultation or therapy room and or the participant's home as agreed.
Participants and Criteria Participants were 8 primary caregivers .
others, grandmothers, aunt.
of children with ADHD who were currently receiving or had previously received therapy services at YPAC Surakarta.
Inclusion criteria: .
primary caregiver with an interaction intensity of Ou10Ae12 hours/day.
living in the same house or being a daily caregiver.
able to communicate well verbally.
willing to sign a consent form to participate.
Exclusion criteria: .
occasional caregivers .
ot primary caregiver.
conditions that hinder in-depth interviews .
, hearing/speech impairments that cannot be facilitate.
withdrawal before the interview is completed.
Non-probability technique, purposive sampling, with consideration of role variations .
other/grandmother/aun.
and parenting style variations .
emocratic, authoritarian, permissive, neglectfu.
so that a variety of experiences are represented.
The sample size was set at 8 participants based on data saturation: themes and subthemes began to repeat, and no new information emerged from the 7th participant.
the 8th participant was used for confirmation and consolidation of categories.
Sampling was purposive and ended when data saturation occurredAino new codes emerged after the 7th participant.
this was confirmed by two independent coders during iterative Data Collection Techniques Data collection was conducted through semi-structured in-depth interviews conducted 2Ae3 times per participant, lasting A45Ae60 minutes/session, audio recorded with permission, accompanied by field notes .
eflective memo.
Supporting observations of pre-sleep routines .
, bedtime setting, calming strategies, responses when children wake up at nigh.
were made using a brief observation sheet.
Documentation: when available, photos/recordings of sleep schedules posted at home, family rule sheets, or therapy notes .
ithout identifying dat.
(LaMarre & Chamberlain.
Interview Guidelines and Validity The primary instrument is a semi-structured interview guide, developed from the following framework: .
parenting practices .
ules, consistency, communication, .
pre-sleep routines .
edtime, wind-down activities, screen exposure, calming strategie.
sleep quality indicators .
fficiency, latency, duration, wakefulness after sleep onse.
supporting or inhibiting factors.
Content validity was assessed by experts .
ediatric occupational therapists and/or sleep health specialist.
who provided feedback on clarity, relevance, and language Expert input was used to revise the order of questions, clarify technical terms, and add probes to explore the depth of the narrative.
A pilot test of the guidelines was conducted on one caregiver outside the study sample to ensure comprehensibility and interview flow.
the results were used to refine the wording of questions and adjust the duration.
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129 Data Analysis Audio data were transcribed verbatim and spot-checked against the recordings.
Analysis used thematic analysis with the following steps: .
open coding .
nitial coding close to the dat.
grouping codes into categories.
axial coding .
onnecting categoriesAicausal conditions, context, strategies, consequence.
formulation of themes and subthemes.
The mapping of parenting styles referred to Baumrind's framework to maintain the objectivity of the categorization (Abfalter et al.
, 2021.
Bannister-Tyrrell & Meiqari, 2.
Data Validity (Trustworthines.
Credibility: brief member checking .
larification of meaning at the end/beginning of the following sessio.
, triangulation of methods .
nterviewsAeobservationsAefield note.
, and peer debriefing on codes/themes.
Dependability: audit trail .
rotocol, guideline versions, analytical decision.
, codebook with definitions and sample quotations, and codeAerecode on transcript subsets.
Confirmability: researcher reflection .
eflective memos on researcher assumptions/position.
, storage of raw data and traceable analytical decisions.
Transferability: thick description of context .
arenting profiles, home dynamics, sleep habit.
to help readers assess transferability to similar contexts (Zapata-Berrero & Yalaz, 2.
Ethical Feasibility All participants signed a written consent form .
nformed consen.
was maintained using anonymous codes (P1AeP.
, and data were stored securely.
Participation was voluntary, with the right to withdraw at any time without consequences for therapy services.
This study has received ethical approval from the Health Research Ethics Committee of the Surakarta Ministry of Health Polytechnic (KEPK).
RESULTS
The number of participants in this study was 8 people, consisting of caregivers, mothers, grandmothers, and aunts.
All participants were primary caregivers of children with a minimum of 10-12 hours of interaction with the child per day.
The main occupations of the participants .
rimary caregiver.
were domestic helpers, housewives, and office workers.
Data on the 8 participants can be seen in the following table:
Table 1.
Participant Characteristics Age Diagnosis Participant Gender Caregiver Caregiver Occupation Education Child (Year.
Female Aunt
ADHD
Housewife High School
Female Aunt
ADHD
Worker
High school
Female Mother
ADHD
Housewife Bachelor
Female Mother
ADHD
Housewife Female Mother
ADHD
Housewife Female Mother
ADHD
Housewife Female Grandmother ADHD Housewife High school Female Grandmother ADHD Housewife High School http://jurnalketerapianfisik.
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130 Based on the thematic analysis conducted in this study, three general themes emerged, consisting of .
Caregiver Parenting Styles with the sub-themes of Application of Parenting Styles and Caregivers Applying Parenting Styles .
Types of Caregiver Parenting Styles, with sub-themes: Types of Caregiver Parenting Styles Based on Baumrind's Parenting Style Aspects .
Sleep Quality of Children with ADHD, with sub-themes: Sleep Quality.
Sleep Problems, and Supporting Aspects of Sleep Quality.
In detail, the themes and sub-themes are outlined in the following table:
Table 2.
Research Themes and Subthemes Theme Caregiver parenting style Types of Caregiver Parenting Styles Sleep quality of children with ADHD Sub-Theme Application of parenting styles The effect of parenting style implementation on sleep quality Types of Caregiver Parenting Styles Based on Aspects Baumrind Parenting Style Sleep Quality Sleep problems Supporting aspects of sleep quality Theme 1: Caregiver Parenting Style Application of Parenting Styles The analysis shows variations in the application of parenting styles by primary caregivers .
others, grandmothers, aunt.
with the aim of shaping children's behavior.
democratic and authoritarian styles tend to emphasize rules and discipline, while permissive and neglectful styles show lower consistency in rules because they tend to follow the children's wishes.
Consistency in rules is evident in children's responses and changes in daily behavior, for example, as stated below:
AuAYes, firm but following the childAAy (P.
The Influence of Parenting Styles on Sleep Quality Caregivers assess the impact of parenting styles on sleep primarily through presleep routines and adherence to schedules.
In authoritarian parenting, sleep schedules tend to be more stable.
democratic parenting has a more noticeable effect when children are able to communicate bidirectionally.
permissive parenting often faces pre-sleep emotional instability even though soothing helps.
neglectful parenting often does not provide comfort when children wake up at night, resulting in reduced sleep duration.
AuASometimes they go to sleep at 10, wake up at 11, and wake up again at 3AAy (P.
Theme 2: Types of Caregiver Parenting Styles (Baumrind Framewor.
Distribution of Parenting Styles and Classification Based on Objectivity Tests Parenting style types were determined using Baumrind's aspects and objectivity tests at different times to improve accuracy.
The final distribution showed 5 democratic caregivers, 1 authoritarian caregiver, and 2 caregivers who added a variety of Thus, the majority of practices emphasized firmness accompanied by http://jurnalketerapianfisik.
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131 reasoning or negotiation, while a small number displayed strict one-way control or high flexibility that reduced consistency.
AuYes, firm but follows the child.
Ay (P.
Characteristics of Parenting Practices by Type In authoritarian practices, communication is more one-way with an emphasis on some caregivers mentioned the use of reprimands or punishment when behavior was inappropriate.
In democratic practices, two-way communication and negotiation are emphasized to build understanding with the child.
In permissive practices, caregivers prioritize the child's comfort and avoid enforcing rules.
Neglectful practices are characterized by low emotional involvement and the delegation of responsibility to others.
AuAno yellingA no pinchingAAy (P.
AuAexplained logicallyAAy (P.
AuAnot forcedA their emotions are unstableAAy (P.
AuAdonAot hand them over to the nannyAAy (P.
Theme 3.
Sleep Quality in Children with ADHD Sleep Quality (Efficiency.
Latency.
Duration, and WASO) In general, democratic parenting is associated with longer wakefulness and adherence to schedules.
authoritarian parenting is often accompanied by difficulty falling asleep despite strict schedules.
permissive/neglectful parenting shows great variability depending on the child's condition.
WASO .
aking after sleep onse.
is reflected in repeated waking patterns as described in the following statements:
AuAat 10 PM, slept at 11 PM, woke upA at 3 AMAAy (P.
Sleep Problems Issues include resistance to sleep, difficulty initiating sleep, restless or active sleep, and nighttime awakenings that reduce sleep quality.
A number of caregivers linked these difficulties to hyperactivity and unstable emotional regulation.
this study did not find severe nightmares as reported in some psychiatric comorbidity literature.
These findings emphasize the need for consistent routines and calming responses, especially in children with high hyperactivity.
AuAso they canAot sleep because theyAore addicted to their phonesAAy (P.
AuAeven though we turn off the TV at 9 or 10 PM, their reactions still go all over the placeAy (P.
Supporting Aspects of Sleep Quality (Routines and Environmen.
Wind-down practices such as turning off the lights, rocking or cuddling, gentle pats, prayers or songs, and temperature/ventilation adjustments were reported to be helpful, as stated below:
AuAat the beginningA the lights are turned offA sleepAAy (P.
Often on their stomach because they're used to it there.
Later, they go back to lying on their back and then on their stomach again" (P.
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DISCUSSION
The findings of this study reveal three themes, namely: .
Caregiver parenting .
Types of caregiver parenting patterns.
Sleep quality of children with ADHD.
The discussion is outlined in the following paragraphs.
The first theme.
Caregiver Parenting Patterns, shows that consistency in rules and pre-sleep calming strategies are key.
Caregivers with warm- -firm practices .
egotiation accompanied by clear boundarie.
tend to be successful in reducing resistance to sleep and stabilizing nighttime routines.
Conversely, inconsistent practicesAisuch as indulging children's desires without limitsAiare associated with prolonged sleep latency and more frequent nighttime awakenings (Kalaskar et al.
, 2021.
Lewis et al.
, 2.
The second theme.
Caregiver Parenting Styles, highlights democratic parenting in fostering children's emotional regulation, leading to a calmer pre-sleep environment.
Authoritarian parenting does organize schedules, but rigid control can increase pre-sleep stress, so its benefits are not always reflected in objective indicators.
Permissive and neglectful practices tend to result in irregular routines, minimal soothing, and ultimately disrupt the consistency of family sleep habits (Kim et al.
, 2023.
Zubedat et al.
, 2.
The third theme of ADHD Children's Sleep Quality is that subjective improvements, such as children being more cooperative, do not automatically increase efficiency, shorten latency, increase duration, or reduce awakenings after sleep onset.
The dominant issues are difficulty initiating sleep, restless/active sleep, and repeated nighttime awakenings that fragment sleep (Bruni et al.
, 2.
Supporting aspectsAi such as screen-free wind-down, consistent calming techniques, room light/temperature regulation, and consistency in rules across caregiversAineed to be implemented simultaneously so that findings at the experiential level are truly converted into measurable improvements in sleep indicators (Cortese et al.
, 2024.
Marten et al.
, 2.
The clinical implications of this research for occupational therapy are the need for a layered caregiver education package: .
agreeing on a fixed sleep schedule and a brief screen-free wind-down ritual.
training in calming strategies appropriate to the child's profile .
, rhythmic touch, short stories, breathing technique.
encouraging consistency in rules across caregivers so that messages do not conflict.
This practice should be accompanied by simple monitoring, e.
, a daily log card containing sleep times, latency, number of awakenings, and trigger notesAiso that families and therapists can observe changes over time.
In service delivery, therapists can integrate emotion regulation training and routine skills as measurable occupational goals, rather than just general counseling (Liang et al.
, 2.
At the program and service policy level, study results support the development of clinic-community modules that combine parenting education with sleep hygiene for families of children with ADHD.
Modules can be short and repetitive .
, three weekly session.
with online boosters to maintain compliance.
Additionally, collaboration with schools/other therapists is important to align day-night expectations .
hysical activity, nap duration, device shutdow.
This multi-agency approach is expected to reduce WASO and latency through cross-environmental consistency (Checa-Ros et al.
, 2023.
Larsson et al.
, 2.
Limitations of this study include data primarily derived from interviews, making it susceptible to recall bias and social bias.
observations are supplementary and may not fully capture nighttime dynamics.
Without objective sleep measures .
, actigraph.
or standardized instruments .
ChildrenAos Sleep Habits Questionnair.
, changes in efficiency/latency/duration/WASO cannot be quantitatively confirmed.
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133 should therefore be interpreted as contextual qualitative evidence mapping mechanisms and intervention points, not broad generalizations.
Further research is recommended using a mixed-methods design: in-depth phenomenology combined with objective/standardized measures .
ctigraphy/sleep diary/CSHQ) to verify changes in efficiency, latency, duration, and WASO.
CONCLUSION
The research findings indicate that parenting styles influence the effects of sleep routines on children with ADHD.
Authoritarian parenting tends to result in stable schedules, but there is no strong evidence of improved sleep efficiency.
Democratic parenting styles are more consistent in supporting emotional regulation, thereby facilitating the sleep initiation process, although the objective impact remains dependent on environmental management and routine consistency.
Conversely, permissive parenting styles are often associated with low consistency and less structured sleep habits, while neglectful tendencies are associated with insomnia onset and sleep Occupational therapy interventions need to target parenting education that is aligned with the family context and the establishment of consistent sleep routines, so that changes in the caregiver's experience can be converted into measurable improvements in sleep quality indicators.
ACKNOWLEDGEMENT
The authors would like to thank the Director of Poltekkes Kemenkes Surakarta.
REFERENCES