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.
abstract: 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.
  
  
  METHODS
  Randomised controlled trial.
  
  
  METHODS
  21 general paediatric practices in Victoria, Australia.
  
  
  METHODS
  244 children aged 5-12 years with ADHD attending the practices between 2010 and 2012.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors: Murdoch Childrens Research Institute, Centre for Community Child Health, Royal Children's Hospital, Parkville VIC 3052, Australia Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia harriet.hiscock@rch.org.au.
authors: Harriet
authors: H
authors: Hiscock
authors: Murdoch Childrens Research Institute, Centre for Community Child Health, Royal Children's Hospital, Parkville VIC 3052, Australia Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
authors: Emma
authors: E
authors: Sciberras
authors: Murdoch Childrens Research Institute, Centre for Community Child Health, Royal Children's Hospital, Parkville VIC 3052, Australia Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia Murdoch Childrens Research Institute, Clinical Epidemiology and Biostatistics Unit, Royal Children's Hospital, Parkville VIC, Australia.
authors: Fiona
authors: F
authors: Mensah
authors: Murdoch Childrens Research Institute, Centre for Community Child Health, Royal Children's Hospital, Parkville VIC 3052, Australia Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
authors: Bibi
authors: B
authors: Gerner
authors: Murdoch Childrens Research Institute, Centre for Community Child Health, Royal Children's Hospital, Parkville VIC 3052, Australia Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
authors: Daryl
authors: D
authors: Efron
authors: Murdoch Childrens Research Institute, Centre for Community Child Health, Royal Children's Hospital, Parkville VIC 3052, Australia Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
authors: Sonia
authors: S
authors: Khano
authors: Murdoch Childrens Research Institute, Centre for Community Child Health, Royal Children's Hospital, Parkville VIC 3052, Australia Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
authors: Frank
authors: F
authors: Oberklaid
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D001521:Behavior Therapy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008568:Memory / Q000502:physiology; D001523:Mental Disorders / Q000209:etiology; D010290:Parents / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000209:etiology / Q000628:therapy*; D011795:Surveys and Questionnaires; D014739:Victoria
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