(Reuters Health) - Kids with attention-deficit hyperactivity disorder (ADHD) and sleep problems showed slight improvement in their symptoms after undergoing a behavioral sleep intervention, Australian researchers say.
The daytime improvement in ADHD symptoms was partly the result of the kids getting a better night’s sleep, and possibly of parents’ learning methods for dealing with behavior problems, the study found.
“Our previous work found that sleep problems were common in children with ADHD and associated with poorer behavior, ADHD symptoms, quality of life and day-to-day functioning, such as getting ready for school,” said lead author Dr. Harriet Hiscock, a pediatrician at Murdoch Children’s Research at the Royal Children’s Hospital in Victoria.
“We also found that children with ADHD and sleep problems had poorer school attendance and their parents had poorer mental health and work attendance,” Hiscock told Reuters Health in an email. “We wanted to see if we could change some of these outcomes by improving the child’s sleep.”
About five percent of U.S. children have ADHD, according to the American Psychiatric Association. Boys are more than twice as likely as girls to be diagnosed with ADHD, according to the Centers for Disease Control and Prevention.
For their study, published in The BMJ, Hiscock and colleagues enrolled the families of 244 children aged 5 to 12 with ADHD and sleep problems who attended 21 pediatric clinics in Victoria.
Half of the families received the intervention, which included two personal consultations with clinicians who had been trained to determine kids’ sleep problems and deliver personalized sleep management programs to the families. The families also had one follow-up phone consultation.
The intervention included guidance for parents on things like setting children’s bedtimes, establishing routines, avoiding caffeine and keeping electronics out of the bedroom.
The remaining families continued their regular care and served as a comparison group.
Parents in both groups kept sleep diaries and filled out questionnaires about their children’s behavior, sleep problems, quality of life and daily functioning at the beginning of the study and again three and six months later. Parents also answered questions about their own mental health.
In addition, the children’s teachers filled out ADHD rating scales during the study and kids were tested for working memory, such as the ability to count backwards without losing track.
The study team found that at both three and six months, the children in the intervention group had a slight improvement in ADHD symptoms, especially for inattentive symptoms. Their sleep difficulties were also reduced more than those of kids in the comparison group.
Along the same lines, teachers reported greater reductions in school-related behavior problems among children in the intervention group at three and six months.
“Managing behavioral sleep problems in children with ADHD is feasible and highly effective - it improves not only sleep, but also child behavior, ADHD symptoms, quality of life and working memory,” Hiscock said.
Hiscock said that parents could do this on their own but would likely need some support and guidance from a trained health professional.
“They can certainly take the first steps, i.e., establishing good sleep hygiene by ensuring a bedtime routine, set bedtime and a media-free bedroom,” she said.
Hiscock said she thinks that pediatricians should ask about sleep problems in children with ADHD and offer evidence-based solutions such as the one used in the study.
“I think it adds to the body of literature that suggests that behavioral interventions can be quite efficacious for this group of kids and you don’t necessarily have to treat their insomnia with medication,” Dr. Judith Owens told Reuters Health.
“One thing that was a little different in this study from other studies was that they seemed to find improvements in daytime behavior as well,” said Owens, a sleep medicine specialist at Children’s National Health System in Washington, D.C. who wasn’t involved in the study.
Parents are often overwhelmed and exhausted by the end of the day and often don’t enforce healthy sleep practices said Owens, who also ran an ADHD clinic for 25 years.
Taking those steps, such as enforcing a regular bedtime, establishing a bedtime routine, and keeping a policy of no electronics in the evening is a good place to start, although it may not fix the problem entirely, she added.
“If you don’t do those basic things then all the rest of the interventions aren’t going to be nearly as successful,” Owens said.
SOURCE: bmj.co/1tsra4o The BMJ, online January 20, 2105.