This randomized controlled trial studied 244 children aged 5 to 12 with an ADHD diagnosis and moderate to severe behavioral sleep problems. They were recruited from 21 general pediatric practices in Victoria, Australia, between 2010 and 2012. Most were boys taking stimulant medication who also had another emotional or behavioral condition.
Families received either a brief behavioral sleep program or usual care. Parents in the program group reported a small drop in their child's ADHD symptoms compared with usual care at three months. The gap grew slightly by six months. Teachers, however, rated ADHD symptoms about the same in both groups.
Sleep problems fell more clearly. At three months, moderate or severe sleep problems remained in 56% of children on usual care. For children in the program, the figure was 30%. By six months the gap had narrowed (46% versus 34%) and was no longer statistically reliable.
Parents also reported better behavior, quality of life and daily functioning, and teachers reported fewer behavior difficulties. Parents' own depression, anxiety and stress did not change. A later analysis suggested that half of the symptom benefit at three months came through better sleep (50%).
Parents knew which group they were in, which may have inflated their reports. Only a small subset wore sleep-tracking devices (54 children at three months).
The study suggests that behavioral sleep strategies, such as a set bedtime, bedtime routines and a media-free bedroom, delivered by trained clinicians over two consultations and a follow-up call, improved these children's sleep and modestly reduced their ADHD symptoms.
The numbers Stats and what the terms mean
The statistics behind the plain-language claims above.
- Hiscock, 2015: parent-reported ADHD symptoms compared with usual care, effect size -0.3 at three months and -0.4 at six months.
What the terms mean:
- Effect size shows how big a difference is. Roughly, 0.2 is small, 0.5 is moderate and 0.8 is large. A minus sign shows the direction of the change, not its size.
Source: Hiscock H, Sciberras E, Mensah F, et al.. 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 (2015). doi:10.1136/bmj.h68