Impact of a behavioral intervention, delivered by pediatricians or psychologists, on sleep problems in children with ADHD: a cluster-randomized, translational trial

Harriet Hiscock; Melissa Mulraney; Helen Heussler; Nicole Rinehart; Tibor Schuster; Anneke C Grobler; Lisa Gold; Shalika Bohingamu Mudiyanselage; Nicole Hayes; Emma Sciberras

doi:10.1111/jcpp.13083

Impact of a behavioral intervention, delivered by pediatricians or psychologists, on sleep problems in children with ADHD: a cluster-randomized, translational trial

J Child Psychol Psychiatry. 2019 Nov;60(11):1230-1241. doi: 10.1111/jcpp.13083. Epub 2019 Jun 11.

Authors

Harriet Hiscock^{1

2

3}, Melissa Mulraney^{2

3}, Helen Heussler⁴, Nicole Rinehart⁵, Tibor Schuster^{6

7}, Anneke C Grobler^{3

6}, Lisa Gold⁸, Shalika Bohingamu Mudiyanselage⁸, Nicole Hayes⁴, Emma Sciberras^{1

3

5}

Affiliations

¹ Centre for Community Child Health, The Royal Children's Hospital, Parkville, VIC, Australia.
² Health Services, Murdoch Children's Research Institute, Parkville, VIC, Australia.
³ Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
⁴ Mater Research Institute, University of Queensland, Brisbane, QLD, Australia.
⁵ Deakin Child Study Centre, School of Psychology, Deakin University, Geelong, VIC, Australia.
⁶ Clinical Epidemiology and Biostatistics Unit and Melbourne Children's Trials Centre, Murdoch Children's Research Institute, Parkville, VIC, Australia.
⁷ Department of Family Medicine, McGill University, Montreal, QC, Canada.
⁸ School of Health and Social Development, Deakin University, Geelong, VIC, Australia.

PMID: 31184382
DOI: 10.1111/jcpp.13083

Abstract

Background: We have demonstrated the efficacy of a brief behavioral intervention for sleep in children with ADHD in a previous randomized controlled trial and now aim to examine whether this intervention is effective and cost-effective when delivered by pediatricians or psychologists in community settings.

Methods: Translational, cluster-randomized trial of a behavioral intervention versus usual care from 19th January, 2015 to 30th June, 2017. Participants (n = 361) were children aged 5-13 years with ADHD and parent report of a moderate/severe sleep problem who met criteria for American Academy of Sleep Medicine criteria for chronic insomnia disorder, delayed sleep-wake phase disorder, or were experiencing sleep-related anxiety. Participants were randomized at the level of the pediatrician (n = 61) to intervention (n = 183) or usual care (n = 178). Families in the intervention group received two consultations with a pediatrician or a psychologist covering sleep hygiene and tailored behavioral strategies.

Results: In an intention-to-treat analysis, at 3 and 6 months respectively, the proportion of children with moderate to severe sleep problems was lower in the intervention (28.0%, 35.8%) compared with usual care group (55.4%, 60.1%; 3 month: risk ratio (RR): 0.51, 95% CI 0.37, 0.70, p < .001; 6 month: RR: 0.58; 95% CI 0.45, 0.76, p < .001). Intervention children had improvements across multiple Children's Sleep Habits Questionnaire subscales at 3 and 6 months. No benefits of the intervention were observed in other domains. Cost-effectiveness of the intervention was AUD 13 per percentage point reduction in child sleep problem at 3 months.

Conclusions: A low-cost brief behavioral sleep intervention is effective in improving sleep problems when delivered by community clinicians. Greater sample comorbidity, lower intervention dose or insufficient clinician supervisions may have contributed to the lack benefits seen in our previous trial.

Keywords: Sleep; attention-deficit/hyperactivity disorder; effectiveness; randomized controlled trial.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Attention Deficit Disorder with Hyperactivity* / epidemiology
Child
Child, Preschool
Community Health Services
Comorbidity
Female
Humans
Male
Outcome and Process Assessment, Health Care*
Pediatricians
Psychology
Sleep Initiation and Maintenance Disorders / epidemiology
Sleep Initiation and Maintenance Disorders / therapy
Sleep Wake Disorders / epidemiology
Sleep Wake Disorders / therapy*