ADHD News & Research

Sleep Interventions May Improve ADHD Symptoms in Children

A small study found that children who undergo doctor-guided “sleep hygiene” interventions not only sleep better; they also show a decrease in ADHD symptoms like hyperactivity.

November 23, 2016

A good night’s sleep improves any child’s mood, social interactions, and overall health, but parents cannot always implement and maintain better sleep habits on their own. Now, a new study suggests that frustrated families should seek help from their doctors. More specifically, the research shows that a sleep hygiene routine, implemented and overseen by a primary care provider, improves ADHD symptoms and promotes overall wellbeing in children.

The study, a 20-week pilot program, focused on 23 children with ADHD who were also found to have a sleep disorder. These children registered scores of 42 or higher on the Child Sleep Habits Questionnaire (CHSQ), a commonly used measure of sleep disorders in children. To measure ADHD symptoms, the subjects’ parents fill out the Vanderbilt Assessment Scales before and after the sleep hygiene intervention.

The intervention itself comprised several factors:
• consistent bedtime and awakening schedule
• daily physical activity and spending some time outdoors every day
• consistent pre-sleep routine
• elimination of naps
• avoiding heavy meals, caffeine, and physical exertion before bed
• avoiding screen time at least 2 hours before bed
• removing TV, computers, and mobile phones from the bedroom.

Parents watched a video explaining the routine, discussed how to implement it with their doctor, took a written copy home with them, and underwent several follow-up appointments to ensure they were following it to the best of their ability.

After six weeks, the children were tested again. Their CSHQ scores decreased by an average of nearly 7 points, indicating vastly improved sleep quality for the majority of the children. Their Vanderbilt scores decreased by an average of 4 points as well, indicating “a significant decrease in ADHD behaviors.”

“The results substantiate the benefits of assessing sleep and instructing parents on clinical guideline-based behavior interventions incorporated into a sleep hygiene routine,” the study’s authors write. “The intervention was cost effective, conducive to a busy clinical setting, and easily tailored for use in pediatric primary care.”

For all its positive aspects, however, the study was smaller than anticipated — partially because many eligible families declined to participate, which “surprised” the researchers. Most cited lack of time or ability to follow-through on the sleep routine — a factor that needs to be carefully considered by physicians when attempting to advocate for similar programs in their offices, the researchers write.

“As providers, we need to acknowledge how time requested for study participation, whether real or perceived by families, affects their willingness to participate in a collaboratively developed, individualized treatment plan,” they conclude. “We will consider providing sleep assessment surveys via electronic mail or before the follow-up visit, to decrease in-office time requirements and improve participation.”

The study was published in the November/December 2016 issue of the Journal of Pediatric Health Care.