Impact of a behavioral intervention, delivered by pediatricians or psychologists, on sleep problems in children with ADHD: a cluster‐randomized, translational trial

Abstract

Background:We have demonstrated the efficacy of a brief behavioral intervention for sleep in children with ADHD in a previous randomized controlled trial and now aim to examine whether this intervention is effective and costeffective when delivered by pediatricians or psychologists in community settings. Methods: Translational, clusterrandomized trial of a behavioral intervention versus usual care from 19th January, 2015 to 30th June, 2017. Participants (n = 361) were children aged 5-13 years with ADHD and parent report of a moderate/severe sleep problem who met criteria for American Academy of Sleep Medicine criteria for chronic insomnia disorder, delayed sleep-wake phase disorder, or were experiencing sleep-related anxiety. Participants were randomized at the level of the pediatrician (n = 61) to intervention (n = 183) or usual care (n = 178). Families in the intervention group received two consultations with a pediatrician or a psychologist covering sleep hygiene and tailored behavioral strategies. Results: In an intention-to-treat analysis, at 3 and 6 months respectively, the proportion of children with moderate to severe sleep problems was lower in the intervention (28.0%, 35.8%) compared with usual care group (55.4%, 60.1%; 3 month: risk ratio (RR): 0.51, 95% CI 0.37, 0.70, p < .001; 6 month: RR: 0.58; 95% CI 0.45, 0.76, p < .001). Intervention children had improvements across multiple Children's Sleep Habits Questionnaire subscales at 3 and 6 months. No benefits of the intervention were observed in other domains. Cost-effectiveness of the intervention was AUD 13 per percentage point reduction in child sleep problem at 3 months. Conclusions: A low-cost brief behavioral sleep intervention is effective in improving sleep problems when delivered by community clinicians. Greater sample comorbidity, lower intervention dose or insufficient clinician supervisions may have contributed to the lack benefits seen in our previous trial.

Impact of sleep restriction on affective functioning in adolescents with attention‐deficit/hyperactivity disorder

“…Taking a different approach, directly treating sleep may lead to improvements in mood and emotion regulation. There is some evidence that improving sleep also improves emotional functioning in school‐aged children with ADHD (Hiscock et al, 2015; Keshavarzi et al, 2014; Sciberras et al, 2020), though improvements in emotional functioning were not found when a brief sleep intervention was delivered by community‐based clinicians (Hiscock et al, 2019). Studies have yet to evaluate evidence‐based cognitive‐behavioral sleep interventions in adolescents with ADHD, which will be important given the developmental changes and contexts that occur in adolescence that have implications for intervention delivery.…”

The Impact of Sleep Deprivation on Continuous Performance Task Among Young Men With ADHD

“…Therefore, an important clinical implication of the results is that ensuring sufficient sleep and avoiding conditions of sleep deprivation may be critical elements when addressing cognitive deficits related to ADHD. One way to achieve this goal is through a brief behavioral sleep intervention, such as CBT-i adjusted for ADHD, which has been shown to be effective at improving sleep problems in ADHD patients (Hiscock et al, 2019;Jernelöv et al, 2019).…”

Evening circadian preference is associated with sleep problems and daytime sleepiness in adolescents with ADHD

“…Nevertheless, our findings underscore the importance of examining both circadian preference and function in adolescents with ADHD. For some adolescents with ADHD and co-occurring sleep problems, sleep hygiene and behavioral interventions may be sufficient (e.g., Hiscock et al, 2019;Hiscock et al, 2015). However, if circadian factors contribute to, or exacerbate, sleep problems, more intensive interventions (e.g., Harvey et al, 2018) or circadian-specific interventions (e.g., bright light therapy) may be needed.…”

“…It is well-established that sleep problems and daytime sleepiness commonly co-occur with attention-deficit/hyperactivity disorder (ADHD) (Becker, 2020;Hiscock & Sciberras, 2019). Metaanalyses have demonstrated that school-aged children (Cortese, Faraone, Konofal, & Lecendreux, 2009) and adults (Díaz-Román, Mitchell, & Cortese, 2018) with ADHD are more likely than their peers without ADHD to have sleep problems, which independently contribute to poorer functioning (Sung, Hiscock, Sciberras, & Efron, 2008).…”