Sleep Intervention Improves Mental Health Symptoms for Pediatric ADHD Patients

Stephen P. Becker, MD

Patients with attention deficit/hyperactivity disorder (ADHD) are notoriously poor sleepers, which could lead to other mental health issues.

But a new study shows behavioral sleep intervention programs could be effective in drastically reducing the percentage of adolescent patients with poor sleep issues, which generally maintains up to 3 months following treatment.

A team, led by Stephen P. Becker, MD, Cincinnati Children’s Hospital Medical Center, tested the feasibility, acceptability, and preliminary effectiveness of a behavioral sleep intervention in adolescent patients with ADHD.

In the open trial, the investigators examined 14 patients between 13-17 years with ADHD and co-occurring sleep issues. The participants received cognitive-behavioral-based Transdiagnostic Sleep and Circadian Intervention for Youth (TranS-C).

The investigators also collected adolescent, parent, and teacher ratings, actigraphy, and daily sleep diaries at pre-intervention, post-intervention, and at the 3-month follow-up mark.

Sleep Improvements

Overall, patients experienced moderate to large improvements in a number of metrics, including sleep, mental health symptoms, and daily life executive function between the baseline period and the post-treatment period. These improvements generally remained at the 3-month follow-up.

At the pre-intervention period, 71.4% of patients were classified as poor sleepers. However, following treatment this was reduced to 21.4% of patients, but rose to 28.6% of participants at the 3-month follow-up.

“This study provides strong preliminary evidence that TranS-C improves sleep and associated outcomes in adolescents with ADHD and co-occurring sleep problems,” the authors wrote. “A randomized controlled trial is needed to rigorously test the efficacy of TranS-C in this population.”

Why Patients With ADHD Struggle With Sleep

Earlier this year, investigators found a new explanation as to why patients with ADHD suffer from greater rates of sleep issues, including insomnia and excessive sleepiness.

A team, led by Sachin Lokuge, S.T.A.R.T. Clinic for Mood and Anxiety Disorder, examined whether impaired reward processing evidenced by anhedonia is linked to sleep disturbances and whether this association is more pronounced in ADHD patients.

The data was presented in a poster during the 2021 American Psychiatric Association Annual Meeting.

Impaired sleep is a known risk factor for several negative health outcomes, such as deficits in executive function, attention, and impulse control, which all happen to be symptoms of ADHD. About half of ADHD patients report sleep disturbances, with delayed sleep onset being the most commonly reported symptom.

Sleep deprivation is also linked to reduced dorsolateral prefrontal activity, as well as difficulty regulating attentional resources. This could help explain the inability to attend to a stimulus in the presence of distractions or engage in goal-directed behavior.

In the study, the researchers assessed 89 ADHD patients using the MINI Plus ADHD module 5.0.0 and measured sleep anomalies, including sleepiness (ESS), insomnia (ISI), and quality (SQS). In addition, they measured anhedonia using the FCPS and SHAPS.

Overall, the patients with ADHD reported greater impairment on sleep quality (P = 0.009), insomnia (P = 0.004), and sleepiness (P = 0.029).

The patients with higher sleep quality scores also had lower SHAPS scores, regardless of ADHD diagnosis (β = -0.235; P = 0.012).

The association of ADHD diagnosis and sleepiness scores was influenced by SHAPS scores (b = 0.199, P = 0.039), to where the significance of the relationships increased with higher SHAPS scores.

The study, “Impact of a Behavioral Sleep Intervention in Adolescents With ADHD: Feasibility, Acceptability, and Preliminary Effectiveness From a Pilot Open Trial,” was published online in the Journal of Attention Disorders.