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Impact of a behavioural sleep intervention on symptoms and sleep in children with attention deficit hyperactivity disorder, and parental mental health: randomised controlled trial

Hiscock, Harriet, Sciberras, Emma, Mensah, Fiona, Gerner, Bibi, Efron, Daryl, Khano, Sonia and Oberklaid, Frank 2015, Impact of a behavioural sleep intervention on symptoms and sleep in children with attention deficit hyperactivity disorder, and parental mental health: randomised controlled trial, BMJ, vol. 350, pp. 1-14, doi: 10.1136/bmj.h68.

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Title Impact of a behavioural sleep intervention on symptoms and sleep in children with attention deficit hyperactivity disorder, and parental mental health: randomised controlled trial
Author(s) Hiscock, Harriet
Sciberras, EmmaORCID iD for Sciberras, Emma orcid.org/0000-0003-2812-303X
Mensah, Fiona
Gerner, Bibi
Efron, Daryl
Khano, Sonia
Oberklaid, Frank
Journal name BMJ
Volume number 350
Article ID h68
Start page 1
End page 14
Total pages 14
Publisher BMJ Publishing Group
Place of publication London, Eng.
Publication date 2015-01-20
ISSN 1756-1833
Keyword(s) attention deficit disorder with hyperactivity
behavior therapy
child
memory
mental disorders
parents
psychiatric status rating scales
quality of life
severity of illness index
sleep wake disorders
science & technology
life sciences & biomedicine
Summary OBJECTIVE: To examine whether behavioural strategies designed to improve children's sleep problems could also improve the symptoms, behaviour, daily functioning, and working memory of children with attention deficit hyperactivity disorder (ADHD) and the mental health of their parents.

DESIGN: Randomised controlled trial.

SETTING: 21 general paediatric practices in Victoria, Australia.

PARTICIPANTS: 244 children aged 5-12 years with ADHD attending the practices between 2010 and 2012.

INTERVENTION: Sleep hygiene practices and standardised behavioural strategies delivered by trained psychologists or trainee paediatricians during two fortnightly consultations and a follow-up telephone call. Children in the control group received usual clinical care.

MAIN OUTCOME MEASURES: At three and six months after randomisation: severity of ADHD symptoms (parent and teacher ADHD rating scale IV-primary outcome), sleep problems (parent reported severity, children's sleep habits questionnaire, actigraphy), behaviour (strengths and difficulties questionnaire), quality of life (pediatric quality of life inventory 4.0), daily functioning (daily parent rating of evening and morning behavior), working memory (working memory test battery for children, six months only), and parent mental health (depression anxiety stress scales).

RESULTS: Intervention compared with control families reported a greater decrease in ADHD symptoms at three and six months (adjusted mean difference for change in symptom severity -2.9, 95% confidence interval -5.5 to -0.3, P=0.03, effect size -0.3, and -3.7, -6.1 to -1.2, P=0.004, effect size -0.4, respectively). Compared with control children, intervention children had fewer moderate-severe sleep problems at three months (56% v 30%; adjusted odds ratio 0.30, 95% confidence interval 0.16 to 0.59; P<0.001) and six months (46% v 34%; 0.58, 0.32 to 1.0; P=0.07). At three months this equated to a reduction in absolute risk of 25.7% (95% confidence interval 14.1% to 37.3%) and an estimated number needed to treat of 3.9. At six months the number needed to treat was 7.8. Approximately a half to one third of the beneficial effect of the intervention on ADHD symptoms was mediated through improved sleep, at three and six months, respectively. Intervention families reported greater improvements in all other child and family outcomes except parental mental health. Teachers reported improved behaviour of the children at three and six months. Working memory (backwards digit recall) was higher in the intervention children compared with control children at six months. Daily sleep duration measured by actigraphy tended to be higher in the intervention children at three months (mean difference 10.9 minutes, 95% confidence interval -19.0 to 40.8 minutes, effect size 0.2) and six months (9.9 minutes, -16.3 to 36.1 minutes, effect size 0.3); however, this measure was only completed by a subset of children (n=54 at three months and n=37 at six months).

CONCLUSIONS: A brief behavioural sleep intervention modestly improves the severity of ADHD symptoms in a community sample of children with ADHD, most of whom were taking stimulant medications. The intervention also improved the children's sleep, behaviour, quality of life, and functioning, with most benefits sustained to six months post-intervention. The intervention may be suitable for use in primary and secondary care.Trial registration Current Controlled Trials ISRCTN68819261.
Language eng
DOI 10.1136/bmj.h68
Field of Research 170106 Health, Clinical and Counselling Psychology
111403 Paediatrics
111714 Mental Health
Socio Economic Objective 920410 Mental Health
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2015, The Authors
Free to Read? Yes
Use Rights Creative Commons Attribution non-commercial licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30079144

Document type: Journal Article
Collections: School of Psychology
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.