Results of a clinical trial published in the British Medical Journal reported that behavioural sleep intervention in children with ADHD aids students in school attendance and ease ADHD symptoms.
Sleep is crucial to kids, especially during adolescence. Children who miss out on this essential rest time tend to have a poorer quality of life and encounter more difficulties in succeeding at school. Behavioural problems, daily functioning, mental health and school attendance are all negatively affected by sleep deprivation. Sleep problems include trouble with falling asleep and staying asleep.
Children with ADHD have a higher rate of sleep difficulties than the average. Could their lack of quality sleep have an effect on their symptoms? In other words, does poor sleep make ADHD worse?
Did Sleep Help?
Australian researchers posited that helping kids with ADHD to get a full night’s slumber could help them to function better the next day. The team, led by Frank Oberklaid, University of Melbourne, reported in 2015 that helping kids with ADHD sleep better, improved their ADHD symptoms after three to six months. The improvement was mostly found in their ability to concentrate as reported by parents and teachers. Secondary benefits included children reporting better quality of life scores and parents being late to work or having to miss work less often. The researchers attributed this to the kids finding it easier to deal with their morning routine.
Sleeping Sound
“Sleeping Sound with ADHD Study’ was a randomized controlled trial designed to assess how behavioural sleep intervention affected children with ADHD and sleeping difficulties.
The trial was blind in that teachers, doctors and researchers notionally did not know which kids were getting an intervention. Importantly, parents knew if their child was getting sleep therapy, and they were also free to tell the teachers and paediatricians so. Results relying on family reporting could not be objective and may have been over interpreted by the researchers.
The researchers recruited 244 children, between the ages of 5–12 years, who had been diagnosed with ADHD. The children were split into two groups, one would receive sleep interventions while the other would continue on as normal. Parents of children in the intervention group were coached by psychologists or paediatricians on sleep practices over the phone. Interventions included working on sleep hygiene, and making an individually tailored behavioural plan depending on what the child’s sleep disorder was. At the start of the study period, and then at three months and six months parents, teachers and health care professionals completed a questionnaire. The questions related to ADHD symptoms, quality of life measures, school performance, behavioural issues, school attendance and time keeping.
Slumber On
After the researchers established that children who received sleep intervention slept better at three months and six months, they looked into the effects of sleep on behaviour.
Overall, a reduction in ADHD symptoms was seen at three and six months in the intervention group, compared with the control group. The families in the intervention group reported overall improvements in ADHD symptoms, sleep, behaviour, health-related quality of life, and daily functioning. In addition, the teachers of the children in the treatment group also reported an improvement in behaviour.
The absolute changes were small. This might be because they did not compare only children with statistically significant improvements in sleep with the controls. Another possibility is that self-reporting can bias results. Parents knew they were doing something to help their kids so they were likely very sensitive to any perceived improvement.
Reserve Judgement
The study suggests that the improvement seen in the intervention group was mediated through an increase in duration and/or quality of sleep. The authors claim addressing sleep problems in children with ADHD results in significant, prolonged benefits. They suggest that clinically addressing sleep disturbances can result in meaningful improvement across a variety of outcome measures.
Hiscock, H, Sciberras, E, Mensah, F, Gerner, B, Efron, D, Khano, S,Oberklaid, F. “Impact of a behavioural sleep intervention on symptoms and sleep in children with attention deficit hyperactivity disorder, and parental mental health: randomized controlled trial”BMJ 2015;350:h68
Written by Deborah Tallarigo, PhD
