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Li X, Lau FLF, Chiu WV, Wong CKD, Li AM, Wing YK, Lai YCK, Shea KSC, Li SX. An Open-Label Pilot Trial of a Brief, Parent-Based Sleep Intervention in Children With ADHD. J Atten Disord 2024; 28:1173-1185. [PMID: 38439703 DOI: 10.1177/10870547241233731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
OBJECTIVE To assess the effects of a brief parent-based behavioral sleep intervention in children with ADHD. METHODS Families with a child with ADHD and parent-reported sleep problems received a brief parent-based sleep intervention, which involved two one-to-one consultation sessions and one telephone follow-up with the parent/caregiver. Child's sleep and clinical symptoms, and parental sleep and daytime functioning were assessed at baseline, 2-week post-intervention, and 3-month follow-up. RESULTS Sixty eligible families (mean age of the child: 9.4 ± 1.5 years; boys: 75%) were recruited, and 43 (72%) completed the whole intervention. The intervention resulted in significant improvements in the child's sleep, clinical symptoms, and parental sleep and parenting stress, and these improvements were generally maintained at 3-month follow-up. CONCLUSION The findings supported the promising effects of a brief parent-based sleep intervention on improving sleep and clinical symptoms in children with ADHD and parental sleep and parenting stress. Further randomized clinical trials with long-term follow-up are needed to test the robustness of the effectiveness of the intervention.
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Affiliation(s)
- Xiao Li
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong SAR
| | - Fanny Lok Fan Lau
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong SAR
| | - Waiyan Vivian Chiu
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong SAR
| | - Ching Kwong Dino Wong
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong SAR
| | - Albert Martin Li
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Yee Ching Kelly Lai
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | | | - Shirley Xin Li
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong SAR
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR
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Türkmen Noyan G, Direk GB, Örengül AC. A randomized controlled trial of effects of sleep hygiene training and progressive muscle relaxation training in children with ADHD. Sleep Med 2024; 117:169-176. [PMID: 38554532 DOI: 10.1016/j.sleep.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 02/15/2024] [Accepted: 03/03/2024] [Indexed: 04/01/2024]
Abstract
OBJECT Sleep problems often accompany ADHD and negatively affect ADHD symptoms, however, there are not enough intervention studies on sleep interventions in children with ADHD. The present study investigated the effects of sleep hygiene training (SH) and progressive muscle relaxation exercises (PMR) in children with ADHD. METHOD 57 children aged 6-12 years with ADHD were randomly assigned to the SH and SH + PMR groups and completed the intervention consisting of group training and eight weeks of telephone interviews. The effects of both intervenitons were evaluated via parent, child and clinician report scales and neuropsychological tests. RESULTS Both interventions resulted in significant positive changes in child sleep, ADHD symptoms, functioning, neuropsychological tests and parental sleep quality. Significant differences were found between the interventions in selective attention, peer problems and anxiety scores in favor of the SH + PMR group. CONCLUSION SH may have positive effects on various clinical parameters as well as sleep problems in children with ADHD. Addition of PMR to SH may lead to further improvements in anxiety, peer problems and selective attention. SH and PMR may be a useful tool in the clinical management of children with ADHD with sleep problems.
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Affiliation(s)
- Gaye Türkmen Noyan
- Department of Child and Adolescent Psychiatry, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
| | - Gizem Berna Direk
- Department of Child and Adolescent Psychiatry, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Abdurrahman Cahid Örengül
- Department of Child and Adolescent Psychiatry, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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Lunsford-Avery JR, Bidopia T, Jackson L, Sloan JS. Behavioral Treatment of Insomnia and Sleep Disturbances in School-Aged Children and Adolescents. Psychiatr Clin North Am 2024; 47:103-120. [PMID: 38302200 DOI: 10.1016/j.psc.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Insomnia and related sleep disturbances are prevalent among youth and are associated with adverse consequences, including poorer psychiatric functioning. Behavioral sleep interventions, ranging from brief educational interventions to behavioral therapies (cognitive behavior therapy-insomnia), are associated with positive outcomes for pediatric sleep health. In addition, sleep interventions may improve psychiatric health for children and adolescents with neurodevelopmental and internalizing disorders. Additional research is necessary to clarify the efficacy of these interventions over the long-term and across demographic groups; however, evidence suggests incorporating behavioral sleep strategies may prove beneficial to pediatric patients with sleep disturbances and related psychiatric complaints.
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Affiliation(s)
- Jessica R Lunsford-Avery
- Department of Psychiatry, Duke University School of Medicine, 2400 Pratt Street, Office 7036, 7th Floor, North Pavilion, Durham, NC 27705, USA.
| | - Tatyana Bidopia
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - Leah Jackson
- HRC Behavioral Health & Psychiatry, PA, Chapel Hill, NC, USA
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Chutko LS, Fateeva VV, Surushkina SY. [Attention deficit hyperactivity disorder in children and adolescents: lessons from the COVID-19 pandemic]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:60-65. [PMID: 38261285 DOI: 10.17116/jnevro202412401160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
To limit the spread of the coronavirus infection COVID-19, which has received the status of a pandemic, a lockdown was temporarily introduced. In conditions of isolation, children and adolescents suffering from attention deficit hyperactivity disorder (ADHD) were faced with forced changes in their daily routine in the form of a transition to distance learning, a decrease in physical activity, an increase in time in front of TV screens/computer monitors/tablets, etc. The review provides current evidence on the associations between social restrictions caused by the COVID-19 pandemic and behavioral problems in children and adolescents with ADHD. The main factors that can influence the severity of the disease in children and adolescents are analyzed. Particular attention is paid to the role of parental behavior and its influence on the manifestations of ADHD in children in isolation. The results of numerous observations and online surveys of relatives and children suffering from ADHD have demonstrated a multidirectional trajectory of the disease depending on numerous factors, including relationships with parents and immediate family. Despite the end of the COVID-19 pandemic, the effects of isolation during critical periods of childhood have the potential to increase the burden of mental illness. Treatment of children and adolescents with ADHD during the COVID-19 pandemic should be pathogenetic, taking into account the main symptoms of the disease. When choosing pharmacotherapy, priority should be given to drugs with verified effectiveness and a reliable safety profile.
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Affiliation(s)
- L S Chutko
- N. Bekhtereva Institute of the Human BraIn Russian Academy of Sciences, St. Petersburg, Russia
| | - V V Fateeva
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - S Yu Surushkina
- N. Bekhtereva Institute of the Human BraIn Russian Academy of Sciences, St. Petersburg, Russia
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Malkani MK, Sheridan AMC, Crichton AJ, Bucks RS, Pestell CF. In-person versus online delivery of a behavioral sleep intervention (Sleeping Sound ©) for children with ADHD: protocol for a parallel-group, non-inferiority, randomized controlled trial. BMC Pediatr 2023; 23:502. [PMID: 37803298 PMCID: PMC10557213 DOI: 10.1186/s12887-023-04329-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/25/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Children with Attention-Deficit/Hyperactivity Disorder (ADHD) often experience sleep difficulties such as difficulty initiating and maintaining sleep. Problem sleep may impact children's daily functioning and behaviors and exacerbate ADHD symptoms. Most effective behavioral interventions to improve sleep are conducted in person, limiting accessibility to treatment for individuals in remote or rural communities or those who are unable to attend a clinic. This trial aims to assess the efficacy of delivering an established behavioral intervention online, Sleeping Sound with ADHD©, compared to a face-to-face delivery mode. METHODS This parallel group, non-inferiority, randomized controlled trial (RCT) will include at least 68 children, aged 5-12 years old with ADHD. Families of children will be recruited from private developmental and psychological clinics and social media, within the state of Western Australia (WA). Once written informed consent and baseline questionnaires are completed, families are randomized to receive the behavioral intervention either in-person or online via Telehealth services. The intervention targets the assessment and management of reported sleep problems, through two individual consultations and a follow-up phone call with a trained clinician. The sleep outcomes assessed consist of a parent-reported sleep questionnaire and actigraphy. DISCUSSION To the best of our knowledge, this is the first RCT to investigate sleep treatment modality for children with ADHD. If effective, clinicians can provide an evidence-based sleep intervention in an accessible manner. TRIAL REGISTRATION ANZCTR, ACTRN12621001681842 . Registered 9 December 2021-Retrospectively registered.
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Affiliation(s)
- Maya K Malkani
- School of Psychological Science, University Western Australia, Perth, Australia.
| | - Andrew M C Sheridan
- School of Psychological Science, University Western Australia, Perth, Australia
| | | | - Romola S Bucks
- School of Psychological Science, University Western Australia, Perth, Australia
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Carmela F Pestell
- School of Psychological Science, University Western Australia, Perth, Australia
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Liang X, Qiu H, Tsai CL, Li C, Sit CHP. MVPA and Motor Proficiency between Children with ADHD and Typical Development: Associations with Sleep Quality. Med Sci Sports Exerc 2023; 55:1886-1893. [PMID: 37227227 DOI: 10.1249/mss.0000000000003223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE This study examined the associations of motor proficiency with moderate-to-vigorous physical activity (MVPA) and sleep quality in children with attention-deficit/hyperactivity disorder (ADHD) and children with typical development (TD). METHODS This cross-sectional study included 88 medical-naive children with ADHD age 6-12 yr (mean (SD) age, 8.43 (1.38) yr; 81.8% boys) and 40 age-matched children with TD (mean (SD) age, 8.46 (1.44) yr; 60% boys). MVPA was recorded by a wGT3X-BT accelerometer for 7 consecutive days. Motor proficiency was assessed using the Test of Gross Motor Development-Third Edition. Sleep quality was assessed using a self-report questionnaire. RESULTS Children with ADHD spent significantly less time in MVPA daily, displayed less proficiency in locomotor and ball skills, and reported poorer sleep quality (e.g., longer sleep latency, less sleep duration, and lower sleep efficiency) than children with TD. MVPA guideline attainment and sleep duration significantly predicted locomotor skills development; in turn, locomotor skills predicted MVPA guideline attainment. MVPA and ball skills increased by age in children with ADHD. CONCLUSIONS Our results highlight the importance of promoting MVPA, motor proficiency, and sleep duration in children with ADHD and TD since childhood.
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Affiliation(s)
| | - Hui Qiu
- Department of Educational Administration and Policy, The Chinese University of Hong Kong, Hong Kong, CHINA
| | - Chia-Liang Tsai
- Institute of Physical Education, Health & Leisure Studies, National Cheng Kung University, Tainan, TAIWAN
| | | | - Cindy H P Sit
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, CHINA
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Sadeghi-Bahmani D, Parhoon H, Esmaeili M, Parhoon K, Sadeghi Bahmani L, Khazaie H, Becker SP, Burns GL, Brand S. Validation of the Farsi Version of the Adult Concentration Inventory for Assessing Cognitive Disengagement Syndrome. J Clin Med 2023; 12:4607. [PMID: 37510724 PMCID: PMC10380426 DOI: 10.3390/jcm12144607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
The internal and external validity of cognitive disengagement syndrome (CDS) relative to attention-deficit/hyperactivity disorder-inattention (ADHD-IN) was evaluated herein with Farsi-speaking adults. A total of 837 Iranian adults assessed throughout the whole country (54.72% women, Mage = 23.85; SD = 7.05; age range = 18 to 58 years; 75% between 18 and 24 years old; reporting higher educational training) completed self-report measures of CDS, ADHD-IN, ADHD-hyperactivity/impulsivity (HI), depression, anxiety, and stress. Seven of the fifteen CDS symptoms showed a good convergent (high loadings on the CDS factor) and discriminant (higher loadings on the CDS factor than the ADHD-IN factor) validity. CDS also showed stronger first-order and unique associations with depression than ADHD-IN, whereas ADHD-IN showed stronger first-order and unique associations with ADHD-HI and anxiety than CDS. The first-order and unique associations of CDS and ADHD-IN did not differ in relation to stress. This study is the first to support the validity of the self-report of assessing CDS symptoms with the Adult Concentration Inventory with Farsi-speaking individuals residing in Iran, thus further strengthening the transcultural validity of the CDS, and paving the way for further transcultural research in the field of CDS among adults.
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Affiliation(s)
- Dena Sadeghi-Bahmani
- Department of Psychology, Stanford University, Stanford, CA 94305, USA
- Department of Epidemiology & Population Health, Stanford University, Stanford, CA 94305, USA
| | - Hadi Parhoon
- Department of Psychology, Razi University, Kermanshah 6714414971, Iran;
| | - Maryam Esmaeili
- Department of Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan 8174673441, Iran;
| | - Kamal Parhoon
- Department of Psychology, Kharazmi University, Tehran 1571914911, Iran;
| | - Laleh Sadeghi Bahmani
- Department of Education and Psychology, Shahid Ashrafi Esfahani University, Isfahan 8179949999, Iran;
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah 6714415185, Iran;
| | - Stephen P. Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - G. Leonard Burns
- Department of Psychology, Washington State University, Pullman, WA 99164, USA;
| | - Serge Brand
- Center for Affective, Sleep and Stress Disorders, Psychiatric Clinics of the University of Basel, 4002 Basel, Switzerland;
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise and Health, Faculty of Medicine, University of Basel, 4052 Basel, Switzerland
- Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah 6714415185, Iran
- School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran 1441987566, Iran
- Center for Disaster Psychiatry and Disaster Psychology, Psychiatric Clinics of the University of Basel, 4002 Basel, Switzerland
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Sidol CA, Becker SP, Peugh JL, Lynch JD, Ciesielski HA, Zoromski AK, Epstein JN. Examining bidirectional associations between sleep and behavior among children with attention-deficit/hyperactivity disorder. JCPP ADVANCES 2023; 3:e12157. [PMID: 37753159 PMCID: PMC10519735 DOI: 10.1002/jcv2.12157] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/13/2023] [Indexed: 09/28/2023] Open
Abstract
Background Children with attention-deficit/hyperactivity disorder (ADHD) have more sleep problems than their peers which contribute to behavioral and functional impairments. This study examines the bidirectional relationship between nightly sleep (i.e., total sleep time and sleep efficiency) and daily behavior of children with ADHD. Method Forty-three children (ages 6-13 [mean = 9.05, 54% male, 77% medicated]) participated in a 2-week study during an ADHD Summer Treatment Program (STP). Sleep was measured with actigraphy. Behavior was assessed using STP clinical data and daily parent and counselor ratings of ADHD symptoms, oppositional defiant disorder behaviors, and emotion regulation (e.g., difficulty regulating emotional disposition and controlling emotions). We hypothesized that healthier night's sleep measured by actigraphy (i.e., sleep efficiency and total sleep time [TST]) would relate to less ADHD symptoms, less emotional dysregulation, and better academic performance the next day. Additionally, we hypothesized that less ADHD symptoms, less emotional dysregulation, and greater academic performance would relate to healthier sleep that night. Results Higher nightly sleep efficiency was related to improved parent-ratings of ADHD the next day (R 2 = 0.04, p = 0.04) and improved parent-ratings of ADHD during the day lead to higher sleep efficiency that night (R 2 = 0.002, p = 0.02). Higher rates of daily assignment completion were related to higher sleep efficiency at night (R 2 = 0.035, p = 0.03). TST was not related to any behavioral outcomes. Conclusion Sleep efficiency may be more relevant than TST to behavioral performance the next day. Additionally, a bidirectional relationship exists between sleep efficiency and parent ratings of ADHD. Findings highlight the importance of assessing for manifestations of poor sleep efficiency, waking minutes, and wakings after sleep onset when diagnosing and treating ADHD.
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Affiliation(s)
- Craig A. Sidol
- Division of Behavioral Medicine and Clinical PsychologyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PsychologyUniversity of CincinnatiCincinnatiOhioUSA
| | - Stephen P. Becker
- Division of Behavioral Medicine and Clinical PsychologyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - James L. Peugh
- Division of Behavioral Medicine and Clinical PsychologyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - James D. Lynch
- Department of PsychologyUniversity of CincinnatiCincinnatiOhioUSA
| | - Heather A. Ciesielski
- Division of Behavioral Medicine and Clinical PsychologyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Allison K. Zoromski
- Division of Behavioral Medicine and Clinical PsychologyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Jeffery N. Epstein
- Division of Behavioral Medicine and Clinical PsychologyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PsychologyUniversity of CincinnatiCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
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Keuppens L, Marten F, Baeyens D, Boyer B, Danckaerts M, van der Oord S. Sleep IntervEntion as Symptom Treatment for ADHD (SIESTA)-Blended CBT sleep intervention to improve sleep, ADHD symptoms and related problems in adolescents with ADHD: Protocol for a randomised controlled trial. BMJ Open 2023; 13:e065355. [PMID: 37055205 PMCID: PMC10106018 DOI: 10.1136/bmjopen-2022-065355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
INTRODUCTION Adolescents with attention deficit hyperactivity disorder (ADHD) experience a more disrupted sleep and more sleep problems compared with typically developing adolescents. This is particularly concerning, because disrupted sleep is related to worsened clinical, neurocognitive and functional outcomes and leads to increased ADHD symptom impairment. Due to the specific difficulties adolescents with ADHD experience, a tailored sleep treatment is needed. Therefore, our lab developed a cognitive behavioural treatment-Sleep IntervEntion as Sympom Treatment for ADHD (SIESTA)-that integrates sleep training with motivational interviewing, and planning/organisational skills training with the aim of improving sleep problems in adolescents with ADHD. METHODS AND ANALYSIS A randomised, controlled, investigator-blinded monocentre trial is used to test whether SIESTA in combination with treatment as usual (TAU) for ADHD results in greater improvement in sleep problems than TAU only. Adolescents (aged 13-17 years) with ADHD and sleep problems are included. They complete measurements before treatment (pre-test), approximately 7 weeks after the pre-test (post-test), and approximately 3 months after the post-test (follow-up). The assessment includes questionnaires filled out by adolescents, parents and teachers. Additionally, sleep is assessed by actigraphy and sleep diaries at all time-points. Primary outcomes include objectively and subjectively measured sleep architecture (specified as total sleep time, sleep onset latency, sleep efficiency and number of awakenings), subjectively measured sleep problems and sleep hygiene. Secondary outcomes include ADHD symptoms, comorbidities and functional outcomes. To analyse the data, a linear mixed effects model will be used with an intent-to-treat approach. ETHICS AND DISSEMINATION The study activities, informed consent and assent forms have been approved by the Ethical Committee Research UZ/KU Leuven (study ID S64197). If proven effective, the intervention will be implemented throughout Flanders. Therefore, an advisory board consisting of societal partners in healthcare is appointed at the start of the project, giving advice throughout the project and assistance with implementation afterwards. TRIAL REGISTRATION NUMBER NCT04723719.
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Affiliation(s)
| | | | - Dieter Baeyens
- Parenting and Special Education, KU Leuven, Leuven, Belgium
| | - Bianca Boyer
- Developmental and Educational Psychology, University of Leiden, Leiden, The Netherlands
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Servot S, St-Amand A, Rousseau M, Simard V, Touchette E. Sleep ecology, objective sleep characteristics and behavior problems in preschoolers referred to child protection services: An exploratory study. CHILD ABUSE & NEGLECT 2023; 138:106075. [PMID: 36764173 DOI: 10.1016/j.chiabu.2023.106075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/19/2023] [Accepted: 01/29/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Exposure to environmental risk factors increases the negative impact maltreatment has on children's development. Sleep ecology (i.e., sleep hygiene and home sleeping conditions) can be one of these factors. Poor sleep hygiene and suboptimal home sleeping conditions can alter sleep characteristics, which in turn, may lead to behavior problems (BPs), highly prevalent in maltreated preschoolers. OBJECTIVES Describe sleep ecology in maltreated preschoolers and explore associations between their sleep ecology, objective sleep characteristics and BPs. METHOD Parents (n = 22) completed the Children's Sleep Hygiene Scale (CSHS), and a sleep environment questionnaire to document sleep ecology. Children wore an actigraph to record objective sleep characteristics. Parents completed the Behavioral Assessment Scale for Children (BASC-2) to assess children's BPs. Descriptive and correlational analyses were performed. RESULTS Most of the parents (90.5 %) reported adequate sleep hygiene. However, 20 parents (95.2 %) reported suboptimal home sleeping conditions. Better physiological and overall sleep hygiene were related to earlier sleep onset. Better emotional sleep hygiene was associated with shorter nighttime awakenings and better sleep efficiency. Later sleep onset was associated with lower anxiety, and longer 24-hour sleep duration with higher somatization. Better physiological sleep hygiene was associated with less depression, and better emotional sleep hygiene with less hyperactivity. CONCLUSION This study showed that sleep hygiene could be associated with maltreated preschoolers' sleep characteristics and BPs, and that their home sleeping conditions may be of concern. Associations between sleep ecology, objective sleep characteristics and BPs deserve to be better understood, and further explored.
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Affiliation(s)
- Sabrina Servot
- Department of Psychoeducation, Université du Québec à Trois-Rivières, Québec, Canada; Centre de recherche universitaire sur les jeunes et les familles, Québec, Canada
| | - Annick St-Amand
- Department of Psychoeducation, Université du Québec à Trois-Rivières, Québec, Canada; Centre de recherche universitaire sur les jeunes et les familles, Québec, Canada
| | - Michel Rousseau
- Department of Psychoeducation, Université du Québec à Trois-Rivières, Québec, Canada; Centre de recherche universitaire sur les jeunes et les familles, Québec, Canada
| | - Valérie Simard
- Department of Psychology, Université de Sherbrooke, Québec, Canada; Centre de recherche Charles-Le Moyne, Longueuil, Canada; Sainte-Justine University Hospital Research Center, Montréal, Canada
| | - Evelyne Touchette
- Department of Psychoeducation, Université du Québec à Trois-Rivières, Québec, Canada; Centre de recherche universitaire sur les jeunes et les familles, Québec, Canada; Research Unit on Children's Psychosocial Maladjustment, Québec, Canada.
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The Origins of the Dark—Hyperactivity and Negative Peer Relationships, an Objectively Lower Sleep Efficiency, and a Longer Sleep Onset Latency at Age Five Were Associated with Callous-Unemotional Traits and Low Empathy at Age 14. J Clin Med 2023; 12:jcm12062248. [PMID: 36983253 PMCID: PMC10053498 DOI: 10.3390/jcm12062248] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/28/2023] [Accepted: 02/14/2023] [Indexed: 03/17/2023] Open
Abstract
Background: Within the spectrum of emotional competencies, callous-unemotional traits are socially discouraged, while empathy is considered a socially much more accepted emotional trait. This holds particularly true for adolescents, who are still building up their social and emotional competencies. The aims of the present study were two-fold: First, longitudinally, to identify traits of behavioral problems and objective sleep dimensions at the age of 5 years to predict callous-unemotional traits and empathy at the age of 14 years. Second, cross-sectionally, to associate callous-unemotional traits and empathy with current insomnia, stress, and mental toughness. Methods: Preschoolers at the age of 5 years were contacted nine years later at the age of 14 years. At 5 years, parents rated their children’s behavior (Strength and Difficulties Questionnaire, SDQ); in parallel, children underwent a one-night sleep-EEG assessment. At the age of 14 years, adolescents completed a series of questionnaires covering callous-unemotional traits, insomnia, empathy, stress, and mental toughness. Results: A total of 77 adolescents (38.1% females) took part in the present study. Longitudinally, higher scores for hyperactivity at age 5 significantly predicted higher callous-unemotional traits at age 14. A higher score for negative peer relationships at age 5 significantly predicted lower scores for cognitive empathy at age 14. Further, objective sleep-EEG measures showed that a higher sleep efficiency and a shorter sleep latency was associated with lower scores for callousness. Cross-sectionally, higher scores for callous-unemotional traits were associated with higher insomnia and stress, while lower insomnia was associated with higher empathy. Mental toughness was unrelated to callous-unemotional traits and empathy. Conclusions: It appears that hyperactivity traits and negative peer relationships and more unfavorable objective sleep patterns at 5 years predicted socially discouraged callous-unemotional traits and low empathy during adolescence. Further, cross-sectionally at the age of 14, callous-unemotional traits, subjective poor sleep, and higher stress were associated.
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Ribeiro WS, Grande AJ, Hoffmann MS, Ziebold C, McDaid D, Fry A, Peixoto C, Miranda C, King D, Tomasi CD, Faustino C, Leone S, Moraes S, Schäfer AA, Alves V, Rosa MI, Evans-Lacko S. A systematic review of evidence-based interventions for child and adolescent mental health problems in low- and middle-income countries. Compr Psychiatry 2023; 121:152358. [PMID: 36508775 DOI: 10.1016/j.comppsych.2022.152358] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 11/15/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Treatments for mental health problems in childhood and adolescence have advanced in the last 15 years. Despite advances in research, most of the evidence on effective interventions comes from high-income countries, while evidence is scarce in low- and middle-income countries (LMICs), where 90% of world's children and adolescents live. The aim of this review was to identify evidence-based interventions tested in LMICs to treat or prevent child and adolescent mental health problems. METHODS We conducted a systematic review of seven major electronic databases, from January 2007 to July 2019. We included randomised or non-randomised clinical trials that evaluated interventions for children or adolescents aged 6 to 18 years living in LMICs and who had, or were at risk of developing, one or more mental health problems. Results were grouped according to the studied conditions. Due to the heterogeneity of conditions, interventions and outcomes, we performed a narrative synthesis. The review was registered at PROSPERO under the number CRD42019129376. FINDINGS Of 127,466 references found through our search strategy, 107 studies were included in narrative synthesis after the eligibility verification processes. Nineteen different conditions and nine types of interventions were addressed by studies included in the review. Over 1/3 of studied interventions were superior to comparators, with psychoeducation and psychotherapy having the highest proportion of positive results. One-third of studies were classified as presenting low risk of bias. INTERPRETATION This review shows that different interventions have been effective in LMICs and have the potential to close the mental health care gap among children and adolescents in low-resource settings.
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Affiliation(s)
- Wagner Silva Ribeiro
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom.
| | | | | | - Carolina Ziebold
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | - David McDaid
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | - Andra Fry
- Library, London School of Economics and Political Science, London, United Kingdom
| | - Clayton Peixoto
- Universidade Estadual de Mato Grosso do Sul, Campo Grande, Brazil
| | | | - Derek King
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | | | | | - Sandra Leone
- Universidade Federal de Mato Grosso do Sul, Campo Grande, Brazil
| | | | | | | | - Maria Ines Rosa
- Universidade do Extremo Sul de Santa Catarina, Criciúma, Brazil
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
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13
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Malkani MK, Pestell CF, Sheridan AMC, Crichton AJ, Horsburgh GC, Bucks RS. Behavioral Sleep Interventions for Children With ADHD: A Systematic Review and Meta-Analysis. J Atten Disord 2022; 26:1805-1821. [PMID: 35758199 DOI: 10.1177/10870547221106239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate intervention characteristics and components within behavioral sleep interventions in school-aged children with ADHD and examine evidence related to effectiveness. METHOD A systematic review was conducted using PsycINFO, Embase, MEDLINE, PubMed, and OpenGray. The subsequent meta-analysis used sleep outcomes to produce comparable effect sizes (Hedges' g) and compare intervention effects between randomized controlled trials and pre-post studies. RESULTS Eleven articles satisfied the inclusion criteria (562 children, across all groups, aged 5-14 years, M = 8.71). Studies reported improvements in sleep although there was marked heterogeneity between studies and limited use of objective sleep measures within them. On average, intervention groups improved more than control groups in the five randomized controlled trials (-0.46, 95% CI = [-0.58, -0.35], k = 4). CONCLUSION The findings support the use of behavioral sleep interventions for school-aged children with ADHD. Findings suggest that brief, individualized intervention may be more effective than standardized.
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14
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Sadeghi‐Bahmani D, Brand S. Sleep patterns, sluggish cognitive tempo, and daytime sleepiness - a commentary on Fredrick et al. (2022). J Child Psychol Psychiatry 2022; 63:1668-1670. [PMID: 36065720 PMCID: PMC9826332 DOI: 10.1111/jcpp.13693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2022] [Indexed: 01/11/2023]
Abstract
Fredrick et al. (Journal of Child Psychology and Psychiatry, 2022) showed in their cross-sectional and observational study that higher Sluggish Cognitive Tempo (SCT) traits were associated with more impaired subjective and objective sleep parameters. Importantly, data were gathered from adolescents and their parents, thus, enhancing the validity of the findings. In addition, the observed pattern of associations was unrelated to ADHD traits, age, sex, medication, or pubertal development. In the present commentary, we acknowledge the scientific value and practical and clinical implications of these findings. For future studies, we propose seven research avenues, which might help to further clarify the neurophysiological, psychological, and behavioral associations between SCT traits and sleep patterns.
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Affiliation(s)
| | - Serge Brand
- Center for Affective, Stress and Sleep Disorders (ZASS), Psychiatric Clinics (UPK)University of BaselBaselSwitzerland,Division of Sport Science and Psychosocial Health, Department of Sport, Exercise, and HealthUniversity of BaselBaselSwitzerland,Sleep Disorders Research CenterKermanshah University of Medical SciencesKermanshahIran,Substance Abuse Prevention Research CenterKermanshah University of Medical SciencesKermanshahIran,Department of Psychiatry, School of MedicineTehran University of Medical SciencesTehranIran
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15
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Harris U, Svedberg P, Aili K, Nygren JM, Larsson I. Parents' Experiences of Direct and Indirect Implications of Sleep Quality on the Health of Children with ADHD: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15099. [PMID: 36429815 PMCID: PMC9690148 DOI: 10.3390/ijerph192215099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/28/2022] [Accepted: 11/13/2022] [Indexed: 06/16/2023]
Abstract
Sleep problems represent a significant challenge for children with ADHD. However, lack of knowledge about how sleep affects children with ADHD in terms of their health and everyday life prevents the development and implementation of interventions to promote sleep. The aim of this study was to explore parents' experiences of direct and indirect implications of sleep quality on the health of children with ADHD. The study used an abductive qualitative design, with Tengland's two-dimensional theory of health as a deductive analysis framework. Semi-structured interviews were conducted with 21 parents of children aged 6-13 with ADHD and sleep problems. The parents experienced that sleep influenced their children's abilities to control emotional behaviour related to ADHD and to manage everyday life. Sleep also had an impact on the children's well-being, in relation to both vitality and self-esteem. In conclusion, the results show important direct and indirect implications of sleep quality on the health of children with ADHD. This implies a need for greater focus on sleep, to target both abilities and well-being in promoting health among children with ADHD.
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Affiliation(s)
- Ulrika Harris
- Blekinge Centre of Competence, SE-371 81 Karlskrona, Sweden
- Department of Health and Care, School of Health and Welfare, Halmstad University, SE-301 18 Halmstad, Sweden
| | - Petra Svedberg
- Department of Health and Care, School of Health and Welfare, Halmstad University, SE-301 18 Halmstad, Sweden
| | - Katarina Aili
- Department of Health and Sport, School of Health and Welfare, Halmstad University, SE-301 18 Halmstad, Sweden
| | - Jens M. Nygren
- Department of Health and Care, School of Health and Welfare, Halmstad University, SE-301 18 Halmstad, Sweden
| | - Ingrid Larsson
- Department of Health and Care, School of Health and Welfare, Halmstad University, SE-301 18 Halmstad, Sweden
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16
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Li X, Shea KSC, Chiu WV, Lau FLF, Wong CKD, Yu WMM, Li AM, Wing YK, Lai YCK, Li SX. The associations of insomnia symptoms with daytime behavior and cognitive functioning in children with attention deficit hyperactivity disorder. J Clin Sleep Med 2022; 18:2029-2039. [PMID: 35638119 PMCID: PMC9340593 DOI: 10.5664/jcsm.10060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The current study aimed to examine the association of insomnia symptoms with daytime behavior and cognitive functioning in children with attention deficit hyperactivity disorder (ADHD). METHODS Thirty-six children with ADHD and insomnia symptoms, 27 children with ADHD without insomnia symptoms and 21 age-matched healthy controls were recruited in this study (age range: 6-12 years, 70% male). They were assessed by parent-report questionnaires on insomnia symptoms (Children's Sleep Habit Questionnaire) and ADHD symptoms (Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Scale, SWAN), and completed a battery of cognitive tests including Continuous Performance Test (CPT) for sustained attention, Letter-digit test for processing speed, Digit Span forward test and N-back task for working memory, Tower of London (TOL) test for planning skills and Bergs Card Sorting Test (BCST) for set-shifting ability. RESULTS Children with ADHD and insomnia symptoms had the highest scores on SWAN total, and inattention and hyperactivity subscales, followed by children with ADHD without insomnia and healthy controls (all ps < 0.05). After controlling for potential confounders, children with ADHD and insomnia symptoms showed poorer performance on CPT and Letter-digit test as compared to children with ADHD without insomnia and healthy controls (all ps < 0.05). CONCLUSIONS Insomnia symptoms are associated with more severe ADHD symptoms and cognitive impairments in children with ADHD, especially deficits on sustained attention and processing speed. Future longitudinal studies are needed to explore the long-term impacts of insomnia symptoms and the effects of sleep-focused intervention on cognitive functioning in children with ADHD.
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Affiliation(s)
- Xiao Li
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong SAR
| | | | - Waiyan Vivian Chiu
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong SAR
| | - Fanny Lok Fan Lau
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong SAR
| | - Ching Kwong Dino Wong
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong SAR
| | - Wai Man Mandy Yu
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Albert Martin Li
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Yee Ching Kelly Lai
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Shirley Xin Li
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong SAR.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR
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17
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Guo C, Assumpcao L, Hu Z. Efficacy of Non-pharmacological Treatments on Emotional Symptoms of Children and Adults with Attention-Deficit/Hyperactivity Disorder: A Meta-Analysis. J Atten Disord 2022; 26:508-524. [PMID: 33759605 DOI: 10.1177/10870547211001953] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The present meta-analysis aimed to evaluate the efficacy of various non-pharmacological interventions on comorbid emotional symptoms such as depression, anxiety, and emotional dysregulation (ED) in children and adults with ADHD. METHOD Forty-four randomized controlled trials (23 studies with ADHD children and 21 studies with ADHD adults) were included. Risk of bias, heterogeneity assessment, and subgroup analyses were conducted. RESULTS We found that therapies targeting the relationship between children and others (i.e., parent-training [on ED and depression] and social skills training [on ED]) were efficacious in the treatment of emotional symptoms in children with ADHD at post-intervention. As for adults with ADHD, cognitive behavioral therapy was found to be effective for the improvement of emotional symptoms at both post-intervention and follow-up. CONCLUSION Our findings demonstrate that the efficacy of non-pharmacological interventions varies substantially across children and adults with ADHD. These results provide important implications for the selection of non-pharmacological interventions for children with ADHD.
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Affiliation(s)
- Chao Guo
- The Affiliated Hospital of Hangzhou Normal University, Hangzhou, P.R. China.,Institute of Psychological Science, Hangzhou Normal University, P.R. China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, P.R. China
| | - Leonardo Assumpcao
- The Affiliated Hospital of Hangzhou Normal University, Hangzhou, P.R. China.,Institute of Psychological Science, Hangzhou Normal University, P.R. China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, P.R. China
| | - Zhiguo Hu
- The Affiliated Hospital of Hangzhou Normal University, Hangzhou, P.R. China.,Institute of Psychological Science, Hangzhou Normal University, P.R. China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, P.R. China
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18
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McWilliams S, Zhou T, Stockler S, Elbe D, Ipsiroglu OS. Sleep as an outcome measure in ADHD randomized controlled trials: a scoping review. Sleep Med Rev 2022; 63:101613. [DOI: 10.1016/j.smrv.2022.101613] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/31/2022] [Accepted: 02/14/2022] [Indexed: 12/30/2022]
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19
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Bondopadhyay U, Diaz-Orueta U, Coogan AN. A Systematic Review of Sleep and Circadian Rhythms in Children with Attention Deficit Hyperactivity Disorder. J Atten Disord 2022; 26:149-224. [PMID: 33402013 DOI: 10.1177/1087054720978556] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Children and adults with ADHD often report sleep disturbances that may form part of the etiology and/or symptomatology of ADHD. We review the evidence for sleep changes in children with ADHD. METHODS Systematic review with narrative synthesis assessing sleep and circadian function in children aged 5 to 13 years old with a diagnosis of ADHD. RESULTS 148 studies were included for review, incorporating data from 42,353 children. We found that sleep disturbances in ADHD are common and that they may worsen behavioral outcomes; moreover, sleep interventions may improve ADHD symptoms, and pharmacotherapy for ADHD may impact sleep. CONCLUSION Sleep disturbance may represent a clinically important feature of ADHD in children, which might be therapeutically targeted in a useful way. There are a number of important gaps in the literature. We set out a manifesto for future research in the area of sleep, circadian rhythms, and ADHD.
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Affiliation(s)
- Upasana Bondopadhyay
- Department of Psychology, Maynooth University, National University of Ireland, Maynooth
| | - Unai Diaz-Orueta
- Department of Psychology, Maynooth University, National University of Ireland, Maynooth
| | - Andrew N Coogan
- Department of Psychology, Maynooth University, National University of Ireland, Maynooth
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20
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Sciberras E. Sleep in Individuals with ADHD: Prevalence, Impacts, Causes, and Treatments. Curr Top Behav Neurosci 2022; 57:199-220. [PMID: 35419765 DOI: 10.1007/7854_2022_336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Sleep problems are common in children and adolescents with ADHD. This chapter covers the basics of sleep and the prevalence and types of sleep problems experienced by children and adolescents with ADHD. The impacts of sleep problems on the day-to-day lives of children with ADHD and their families are covered including impacts on child daily functioning and cognition, as well as family well-being. There is no one cause of sleep problems in children with ADHD with both biological and environmental factors implicated. There are a small number of randomized controlled trials that support the efficacy of treating sleep problems in children with ADHD using behavioral strategies. A small number of studies also have found improvements in sleep onset delay in children with ADHD following treatment with melatonin. Little is known about how to best support adolescents and adults with ADHD with sleep, although a small emerging literature largely in adults with ADHD suggests that bright light therapies could potentially be helpful given the extent of circadian involvement in the sleep problems experienced by individuals with ADHD. This chapter ends with consideration of future research directions largely related to approaches to supporting individuals with ADHD and sleep difficulties.
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Affiliation(s)
- Emma Sciberras
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, VIC, Australia.
- Health Services, Murdoch Children's Research Institute, Parkville, VIC, Australia.
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
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21
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Mayes SD, Puzino K, DiGiovanni C, Calhoun SL. Cross-Sectional Age Analysis of Sleep Problems in 2 to 17 Year Olds with ADHD Combined, ADHD Inattentive, or Autism. J Clin Psychol Med Settings 2021; 29:239-248. [PMID: 34213724 DOI: 10.1007/s10880-021-09799-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 12/01/2022]
Abstract
Sleep problems are common in autism and ADHD. No study has compared sleep problems by age in 2 to 17 year olds with autism versus ADHD-Combined versus ADHD-Inattentive type. Mothers rated 1415 youth with autism and 1041 with ADHD on 10 Pediatric Behavior Scale sleep items. Nighttime sleep problems were most severe in autism, followed by ADHD-Combined, and then ADHD-Inattentive. Difficulty falling asleep, restless during sleep, and waking during the night were the most common problems. Adolescents slept more at night than other age groups, and youth who slept more at night were sleepier during the day. Sleep problems declined with age, but correlations were small. In adolescence, 63% with autism, 53% with ADHD-Combined, and 57% with ADHD-Inattentive had difficulty falling asleep. Given that the majority of children in all age groups had one or more sleep problem, developmentally appropriate interventions are needed to address sleep difficulties and limit their adverse effects.
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Affiliation(s)
- Susan D Mayes
- Department of Psychiatry H073, Penn State College of Medicine, 500 University Dr., Hershey, PA, 17033, USA.
| | - Kristina Puzino
- Department of Psychiatry H073, Penn State College of Medicine, 500 University Dr., Hershey, PA, 17033, USA
| | - Craig DiGiovanni
- Department of Psychiatry H073, Penn State College of Medicine, 500 University Dr., Hershey, PA, 17033, USA
| | - Susan L Calhoun
- Department of Psychiatry H073, Penn State College of Medicine, 500 University Dr., Hershey, PA, 17033, USA
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22
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Sciberras E, Mulraney M, Hayes N, Rinehart N, Schuster T, Mudiyanselage SB, Hiscock H. A brief clinician training program to manage sleep problems in ADHD: what works and what do clinicians and parents think? Sleep Med 2021; 89:185-192. [PMID: 34001454 DOI: 10.1016/j.sleep.2021.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE/BACKGROUND Brief behavioural sleep interventions have been shown to be effective in treating sleep problems in children with ADHD. Little research, however, has focused on the translational aspects of these programs from the consumer perspective. This study aimed to explore clinician and parent views of a brief training program in managing sleep problems in children with ADHD. PARTICIPANTS Fifty-nine community-based clinicians (32 paediatricians, 27 psychologists) were trained to deliver a brief behavioural sleep intervention as part of the Sleeping Sound with ADHD translational trial; 183 families were allocated to receive the sleep intervention and 115 provided follow-up data. METHODS Clinicians reported on competency, confidence and perceived barriers pre- and post-training. Parents reported on usefulness of the program and frequency of sleep strategy use at 3 months post-randomisation. Parent-report of severity of the child sleep problem was also measured at 3 and 6 months post-randomisation. RESULTS Clinicians' feelings of competency and confidence in managing sleep difficulties increased from pre-to post-training, while perceptions of barriers decreased. Parent-reported usefulness of the program and frequency of sleep use varied by program domain and sleep strategy. Increased parent-reported use of sleep strategies was associated with improved sleep at 3 and 6 months post-randomisation. CONCLUSIONS A brief sleep training program leads to improvements in clinician confidence and competence in managing sleep problems in children with ADHD and positive parent perspectives. The findings highlight the potential for the Sleeping Sound with ADHD program to be optimized to better help parents in their implementation of sleep strategies.
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Affiliation(s)
- Emma Sciberras
- School of Psychology, Deakin University, Geelong, Victoria, Australia; Health Services, Centre for Community Child Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia.
| | - Melissa Mulraney
- Department of Paediatrics, University of Melbourne, Victoria, Australia; Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Institute for Social Neuroscience, ISN Innovations, Ivanhoe, Australia
| | - Nicole Hayes
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Nicole Rinehart
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Tibor Schuster
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | | | - Harriet Hiscock
- Health Services, Centre for Community Child Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia; Health Services Research Unit, The Royal Children's Hospital, Parkville, Victoria, Australia
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23
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Phillips NL, Moore T, Teng A, Brookes N, Palermo TM, Lah S. Behavioral interventions for sleep disturbances in children with neurological and neurodevelopmental disorders: a systematic review and meta-analysis of randomized controlled trials. Sleep 2021; 43:5804209. [PMID: 32163581 DOI: 10.1093/sleep/zsaa040] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/25/2020] [Indexed: 01/06/2023] Open
Abstract
STUDY OBJECTIVES Sleep disturbances are common and associated with negative functional and health consequences in children with neurological and neurodevelopmental disorders (NNDDs) and represent an important potential target for behavioral interventions. This systematic review examined the efficacy of behavioral sleep interventions (BSIs) for children with NNDDs and comorbid sleep disturbances. METHODS A systematic search of MEDLINE, EMBASE, PsychINFO, and CENTRAL was conducted in April 2019. Randomized controlled trials (RCTs) of BSI for children with NNDDS were included. Meta-analysis and GRADE quality ratings were performed on sleep and secondary functional outcomes (cognition, academics, and behavior). RESULTS Nine RCTs were identified (n = 690; Mage = 8.39 ± 2.64years; 71.11% male). The quality of the evidence was predominantly rated as moderate. Posttreatment improvements in sleep were found on self-reported sleep disturbances (total sleep disturbance [standardized mean difference, i.e. SMD = 0.89], night wakings [SMD = 0.52], bedtime resistance [SMD = 0.53], parasomnias [SMD = 0.34], sleep anxiety [SMD = 0.50]) and self-reported sleep patterns (sleep duration [SMD = 0.30], sleep onset duration [SMD = 0.75]) and (2) objectively measured actigraphic sleep patterns (total sleep time [MD = 18.09 min; SMD = 0.32], sleep onset latency [MD = 11.96 min; SMD = 0.41]). Improvements in sleep (self-reported, not actigraphy) were maintained at follow-up, but few studies conducted follow-up assessments resulting in low-quality evidence. Reduction in total behavioral problems (SMD = 0.48) posttreatment and attention/hyperactivity (SMD = 0.28) at follow-up was found. Changes in cognition and academic skills were not examined in any studies. CONCLUSIONS BSIs improve sleep, at least in the short term, in children with NNDDs. Benefits may extend to functional improvements in behavior. More rigorous RCTs involving placebo controls, blinded outcome assessment, longer follow-up durations, and assessment of functional outcomes are required.
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Affiliation(s)
- Natalie L Phillips
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Teleri Moore
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Arthur Teng
- Department of Sleep Medicine, Sydney Children's Hospital (Randwick), Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Naomi Brookes
- Brain Injury Rehabilitation Program, Sydney Children's Hospital (Randwick), Sydney, New South Wales, Australia
| | - Tonya M Palermo
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA.,Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA
| | - Suncica Lah
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
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24
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Amizadeh M, Shamsadini A, Motamed S, Zeinadini Meimand N. Epidemiology of Sleep Disturbances Among Primary School Students in Kerman, Iran, in 2019. SOCIAL WORK IN PUBLIC HEALTH 2021; 36:311-316. [PMID: 33487142 DOI: 10.1080/19371918.2021.1873886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Primary sleep disturbances are common in both children and adults and can lead to cognitive problems and educational and psychological disorders. In this study, we evaluated the epidemiology of sleep disturbances among children in Kerman, Iran, in 2019. This cross-sectional study was done in 2019 with 561 children in elementary schools of Kerman, Iran. Data were collected by a Pittsburgh Sleep Quality Index (PSQI) questionnaire that was filled out by parents and analyzed statistically. A total of 561children with a mean age of 9.54 ± 1.55 years were enrolled. The ratio of boys to girls was 1.01 and consistent across age groups. The prevalence of sleep disturbances in this population study was 26.7% (150 patients); 51.3% of them were girls. Sleep disturbances were associated with mothers' lower education level and parents' higher job positions (P < .05). This study showed the relatively high prevalence of sleep disturbances among children in this region. It can be reduced by a program such as sleep training or by promoting the level of parents' education. We recommend some educational programs and preschool screening to evaluate sleep disturbances and educating the parents to increase their responsiveness.
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Affiliation(s)
- Maryam Amizadeh
- Department of Otorhinolaryngology, Kerman University of Medical Sciences, Kerman, Iran
| | - Ayeh Shamsadini
- Department of Otorhinolaryngology, Kerman University of Medical Sciences, Kerman, Iran
| | - Soheil Motamed
- Department of Otorhinolaryngology, Kerman University of Medical Sciences, Kerman, Iran
- Student research committee, Kerman University of Medical Sciences, Kerman, Iran
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25
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Halstead EJ, Jones A, Esposito G, Dimitriou D. The Moderating Role of Parental Sleep Knowledge on Children with Developmental Disabilities and Their Parents' Sleep. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020746. [PMID: 33467212 PMCID: PMC7830639 DOI: 10.3390/ijerph18020746] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Children with intellectual and developmental difficulties often experience sleep problems, which in turn may impact parental sleep patterns. This study explored the role of parental sleep knowledge as a moderator on the relationship between child sleep and parental sleep impairment. METHODS 582 parents or caregivers (92.6% mothers) of children with different developmental disabilities (Age M = 9.34, 29.5% females) such as Down's syndrome, participated in an online survey. Multiple regression analysis was conducted. RESULTS Parental sleep knowledge of child sleep was a moderating variable in the relationship between child sleep nocturnal duration and parental sleep impairment. Although overall, sleep knowledge was high in this sample, two specific knowledge gaps were identified namely child sleep duration requirements, and the recognition of signs of a well-rested child. CONCLUSION This study has provided evidence that increased parental sleep knowledge can positively impact both child and parental sleep outcomes.
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Affiliation(s)
- Elizabeth J. Halstead
- Sleep Education and Research Laboratory (SERL), UCL Institute of Education, London WC1H 0AA, UK; (E.J.H.); (A.J.)
| | - Alexandra Jones
- Sleep Education and Research Laboratory (SERL), UCL Institute of Education, London WC1H 0AA, UK; (E.J.H.); (A.J.)
| | - Gianluca Esposito
- Social and Affective Neuroscience Lab, Psychology Program-SSS, Nanyang Technological University, Singapore 639818, Singapore;
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Affiliative Behaviour and Physiology Lab, Department of Psychology and Cognitive Science, University of Trento, 38068 Trento, Italy
| | - Dagmara Dimitriou
- Sleep Education and Research Laboratory (SERL), UCL Institute of Education, London WC1H 0AA, UK; (E.J.H.); (A.J.)
- Correspondence:
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Lunsford-Avery JR, Bidopia T, Jackson L, Sloan JS. Behavioral Treatment of Insomnia and Sleep Disturbances in School-Aged Children and Adolescents. Child Adolesc Psychiatr Clin N Am 2021; 30:101-116. [PMID: 33223055 PMCID: PMC7687719 DOI: 10.1016/j.chc.2020.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Insomnia and related sleep disturbances are prevalent among youth and are associated with adverse consequences, including poorer psychiatric functioning. Behavioral sleep interventions, ranging from brief educational interventions to behavioral therapies (cognitive behavior therapy-insomnia), are associated with positive outcomes for pediatric sleep health. In addition, sleep interventions may improve psychiatric health for children and adolescents with neurodevelopmental and internalizing disorders. Additional research is necessary to clarify the efficacy of these interventions over the long-term and across demographic groups; however, evidence suggests incorporating behavioral sleep strategies may prove beneficial to pediatric patients with sleep disturbances and related psychiatric complaints.
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The Role of the Circadian System in Attention Deficit Hyperactivity Disorder. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1344:113-127. [PMID: 34773229 DOI: 10.1007/978-3-030-81147-1_7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental condition characterised by the core symptoms of inattention, impulsivity and hyperactivity. Similar to many other neuropsychiatric conditions, ADHD is associated with very high levels of sleep disturbance. However, it is not clear whether such sleep disturbances are precursors to, or symptoms of, ADHD. Neither is it clear through which mechanisms sleep and ADHD are linked. One possible link is via modulation of circadian rhythms. In this chapter we overview the evidence that ADHD is associated with alterations in circadian processes, manifesting as later chronotype and delayed sleep phase in ADHD, and examine some mechanisms that may lead to such changes. We also interrogate how the circadian clock may be a substrate for therapeutic intervention in ADHD (chronotherapy) and highlight important new questions to be addressed to move the field forward.
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Martin CA, Papadopoulos N, Rinehart N, Sciberras E. Associations Between Child Sleep Problems and Maternal Mental Health in Children with ADHD. Behav Sleep Med 2021; 19:12-25. [PMID: 31760782 DOI: 10.1080/15402002.2019.1696346] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objective/Background: Children with attention-deficit/hyperactivity disorder (ADHD) experience more sleep problems than typically developing children. In addition, higher rates of depression are experienced by mothers of children with ADHD compared to mothers of children without ADHD. This study aimed to determine whether particular sleep problems in children with ADHD are associated with specific maternal mental health difficulties. Participants: Female caregivers of 379 children with ADHD (5-13 years) participated. The child's ADHD diagnosis was reconfirmed during recruitment by caregivers completing the ADHD Rating Scale-IV. Method: Caregivers reported on their mental health using the Depression Anxiety Stress Scale and their child's sleep using the Children's Sleep Habits Questionnaire. Unadjusted and adjusted regression analyzes were undertaken. Results: In the adjusted analyzes, there were small significant associations between most aspects of child sleep (i.e. Bedtime Resistance, Night Waking, Parasomnias, Sleep Duration, Daytime Sleepiness and Total Sleep Problems) and maternal Anxiety and Stress, with the exception of Sleep-Onset Delay. Bedtime Resistance, Sleep Duration, Daytime Sleepiness and Total Sleep Problems also had small significant associations with maternal Depression. Sleep Anxiety had a small significant association with maternal Anxiety only. Conclusions: This study demonstrates important connections between many child sleep problems and particular aspects of maternal mental health, suggesting adaptations to behavioral sleep interventions for children and mental health interventions for parents to take a family approach may be beneficial. Future research should consider the longitudinal associations between child sleep and parent mental health in an effort to inform future intervention approaches.
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Affiliation(s)
| | - Nicole Papadopoulos
- Deakin Child Study Centre, School of Psychology, Deakin University , Geelong, VIC, Australia
| | - Nicole Rinehart
- Deakin Child Study Centre, School of Psychology, Deakin University , Geelong, VIC, Australia
| | - Emma Sciberras
- School of Psychology, Deakin University , Geelong, VIC, Australia.,Health Services, Murdoch Children's Research Institute , Parkville, VIC, Australia.,Department of Pediatrics, The University of Melbourne , Parkville, VIC, Australia
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Becker SP, Tamm L, Epstein JN, Beebe DW. Impact of sleep restriction on affective functioning in adolescents with attention-deficit/hyperactivity disorder. J Child Psychol Psychiatry 2020; 61:1160-1168. [PMID: 32157691 PMCID: PMC7483709 DOI: 10.1111/jcpp.13235] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/11/2019] [Accepted: 02/18/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Shortened sleep and affective disturbances are both prevalent in adolescents with attention-deficit/hyperactivity disorder (ADHD), yet the causal link between these domains has not been examined. This study investigated whether shortened sleep duration is causally linked to affective functioning in adolescents with ADHD. METHODS Participants were 48 adolescents (75% male) aged 14-17 years with ADHD who successfully completed a three-week sleep protocol using an experimental crossover design. The protocol included a phase stabilization week, followed, in randomized counterbalanced order, by one week of sleep restriction (6.5 hr in bed) and one week of sleep extension (9.5 hr in bed). Sleep was monitored with objective actigraphy, and all participants included in this study obtained ≥1 hr actigraphy-measured sleep duration during extension compared to restriction. Parents and adolescents provided daily ratings of positive and negative affect during the extension and restriction conditions. Ratings of affect, internalizing symptoms, and emotion regulation were collected at laboratory visits conducted at the end of each week. RESULTS Both parents and adolescents reported greater depressive symptoms and lower positive affect during restriction compared to extension. Parents also reported greater negative affect and emotion dysregulation among adolescents during sleep restriction than extension. No effects were found for parent- or adolescent-reported anxiety symptoms or for adolescent-reported emotion regulation or negative affect. CONCLUSIONS Findings from this study provide the first evidence that shortened sleep duration is a causal contributor to the affect and mood disturbances frequently experienced by adolescents with ADHD, particularly as observed by parents. Targeting sleep may be important to reduce affective disturbances in adolescents with ADHD.
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Affiliation(s)
- Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Leanne Tamm
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jeffery N Epstein
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Dean W Beebe
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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30
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Little K, Raiker J, Coxe S, Campez M, Jusko M, Smith J, Gnagy E, Greiner A, Villodas M, Coles E, Pelham WE. A Preliminary Evaluation of the Utility of Sluggish Cognitive Tempo Symptoms in Predicting Behavioral Treatment Response in Children with Behavioral Difficulties. Psychol Rep 2020; 124:2063-2091. [PMID: 32921265 DOI: 10.1177/0033294120957239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Interest in symptoms of sluggish cognitive tempo (SCT) has led to a number of studies evaluating how these symptoms respond to treatment commonly utilized in youths with symptoms of ADHD. No study to date, however, has examined the extent to which symptoms of SCT predict behavioral treatment response in youths across multiple domains of functioning. The current preliminary investigation integrates a number of methodological (e.g., direct observations) and analytic (e.g., Poisson regression) refinements to evaluate the extent to which symptoms of SCT predict treatment responses across multiple domains including behavioral (e.g., interruptions, rule violations), social (e.g., social skills, negative verbalizations), and severe behavioral difficulties (e.g., intentional aggression) above and beyond other demographic characteristics (e.g., symptom severity, Full Scale Intelligence Quotient [FSIQ]). A relatively small sample of 37 children, aged six to 12 years (M = 8.03, SD = 1.83, 35 males: 2 females) attending an eight week multi-component intensive behavioral treatment program for youths with behavioral difficulties participated in the current study. Baseline parental perceptions of SCT were collected prior to the initiation of treatment. Results from this preliminary investigation revealed that pre-treatment SCT symptoms only predicted a less robust treatment response to time out which was associated also with parent's perceptions of underlying working memory problems. Results revealed also that pre-treatment SCT symptoms failed to predict paraprofessional counselor's and teacher's improvement ratings of both rule following and social skills following treatment. Notably, other potential predictors (e.g., symptom severity, FSIQ) also largely failed to predict behavioral treatment response.
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Affiliation(s)
- Kelcey Little
- Center for Children and Families, Florida International University, Miami, FL, USA
| | - Joseph Raiker
- Center for Children and Families, Florida International University, Miami, FL, USA
| | - Stefany Coxe
- Center for Children and Families, Florida International University, Miami, FL, USA
| | - Mileini Campez
- Center for Children and Families, Florida International University, Miami, FL, USA
| | - Morgan Jusko
- Center for Children and Families, Florida International University, Miami, FL, USA
| | - Jessica Smith
- Center for Children and Families, Florida International University, Miami, FL, USA
| | - Elizabeth Gnagy
- Center for Children and Families, Florida International University, Miami, FL, USA
| | - Andrew Greiner
- Center for Children and Families, Florida International University, Miami, FL, USA
| | - Miguel Villodas
- Center for Children and Families, Florida International University, Miami, FL, USA
| | - Erika Coles
- Center for Children and Families, Florida International University, Miami, FL, USA
| | - William E Pelham
- Center for Children and Families, Florida International University, Miami, FL, USA
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The effect of behavioral parent training on sleep problems of school-age children with ADHD: A parallel randomized controlled trial. Arch Psychiatr Nurs 2020; 34:261-267. [PMID: 32828358 DOI: 10.1016/j.apnu.2020.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/24/2020] [Accepted: 04/09/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The aim of this study was to examine the effect of behavioral parental training (BPT) on sleep problems in children diagnosed with ADHD. METHODS This parallel randomized controlled trial was conducted in a psychiatric clinic in an urban area of Iran. Participants of this study were 58 school-age children who were diagnosed with ADHD, were receiving methylphenidate and had at least one problem in sleeping. They were randomly assigned into BPT or control groups. Participants' parents in the BPT group underwent a 5-week behavioral intervention program. Data were collected at baseline, immediately after the intervention, and two months after the intervention. Data were analyzed using Chi-square, Fisher's exact test, independent sample t-test, and repeated measure ANOVA test via the SPSS software. RESULTS Children in the intervention group experienced a significant improvement in total sleep scores two months after the intervention compared to the control group (p = 0.03). Also, the findings showed a significant decline in total sleep problems in the intervention group compared to the control group over time (p = 0.01). CONCLUSION The results suggest that BPT could be an effective method in improving sleep problems of school-age children diagnosed with ADHD undergoing methylphenidate treatment.
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Abstract
Objective: This study compared the quality of friendships (same- and other-sex) in adolescents with and without ADHD, across age and gender. Method: A community sample of 115 participants (61 ADHD, 54 Comparison), ages 13 to 18, completed a questionnaire assessing perceived levels of social support and negative interactions experienced in their friendships. Results: Ratings of friendship social support diminished across age in youth with ADHD, but increased in typically developing youth. Adolescents with and without ADHD, however, did not differ on ratings of negative interactions experienced in their friendships. Compared with males, females rated their friendships to be more supportive, irrespective of ADHD status. Adolescents with and without ADHD rated their same-sex friendships to be simultaneously more supportive and more conflictual than their other-sex friendships. Conclusion: Assessments of adolescents with ADHD should include a careful examination of their social functioning with particular attention devoted to the quality of their friendships.
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Nikles J, Mitchell GK, de Miranda Araújo R, Harris T, Heussler HS, Punja S, Vohra S, Senior HEJ. A systematic review of the effectiveness of sleep hygiene in children with ADHD. PSYCHOL HEALTH MED 2020; 25:497-518. [DOI: 10.1080/13548506.2020.1732431] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jane Nikles
- UQCCR - Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Geoffrey Keith Mitchell
- Discipline of General Practice, School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | | | - Thomas Harris
- UQCCR - Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Helen S. Heussler
- Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, Australia
- Mater Research Institute, The University of Queensland, Brisbane, Australia
| | - Salima Punja
- Department of Pediatrics, Medicine, and Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Sunita Vohra
- Department of Pediatrics, Medicine, and Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
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Schwerdtle B, Kübler A, Schlarb A. External Validity of the Multicomponent Group Treatment KiSS for School-Aged Children With Insomnia. Behav Sleep Med 2020; 18:147-162. [PMID: 30482055 DOI: 10.1080/15402002.2018.1546706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Insomnia is common in school-aged children and often associated with other mental disorders. Here, we investigated the effectiveness and acceptance of the KiSS program in an "all-comer" pediatric insomnia clinic. Participants/Methods: Forty-five families (children: 5-10 years, 57.8% female) were randomly assigned to the multicomponent six-session KiSS treatment (CBT-I, hypnotherapy, and imaginations) or a wait-list control group. A sleep diary was recorded before intervention or waiting time, immediately after, as well as 3, 6, and 12 months postintervention (primary outcome: sleep efficiency, SE; sleep-onset latency, SOL). Results: Sleep improved significantly after the KiSS intervention. Three to 12 months after the intervention, only 1.75% of treated children still met the diagnostic criteria for insomnia. SE improved to 96%, and both SOL (reduced to 23 min) and total sleep time were normalized. All improvements were stable for at least one year after the intervention. KiSS was well accepted (0% dropout during intervention) and well tolerated. Conclusions: Treatment with the multimodal sleep training KiSS leads to positive changes in the sleep of children with insomnia, including a subset of children that presented with comorbid mental disorders. With only three sessions for parents and three sessions for children, the treatment can be readily implemented as a stand-alone treatment or be combined with other interventions. Dismantling studies and studies with an active control group are ongoing.
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Affiliation(s)
| | - Andrea Kübler
- Institute of Psychology, University of Würzburg, Würzburg, Germany
| | - Angelika Schlarb
- Department of Psychology, University of Bielefeld, Bielefeld, Germany
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35
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Martin CA, Hiscock H, Rinehart N, Heussler HS, Hyde C, Fuller-Tyszkiewicz M, McGillivray J, Austin DW, Chalmers A, Sciberras E. Associations Between Sleep Hygiene and Sleep Problems in Adolescents With ADHD: A Cross-Sectional Study. J Atten Disord 2020. [PMID: 29542374 DOI: 10.1177/1087054718762513] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To determine whether self-reported sleep hygiene practices are associated with self- and parent-reported behavioral sleep problems in adolescents with ADHD. Method: Participants included 79 adolescents with ADHD (13-17 years) and their parents. Adolescents were asked to report on their sleep hygiene (Adolescent Sleep Hygiene Scale) and sleep (Adolescent Sleep Wake Scale). Parents also reported on their adolescent's sleep (Sleep Disturbance Scale for Children). Results: Poorer sleep hygiene was associated with higher total self-reported behavioral sleep problems and most self-reported sleep problems: falling asleep, reinitiating sleep, and returning to wakefulness. The association was also apparent for total parent-reported behavioral sleep problems, problems with initiating and maintaining sleep, and excessive somnolence. Conclusion: This study demonstrates small-to-moderate relationships between poor sleep hygiene practices and sleep problems in adolescents with ADHD, by both self- and parent-report.
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Affiliation(s)
| | - Harriet Hiscock
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,The Royal Children's Hospital, Parkville, Victoria, Australia.,University of Melbourne, Parkville, Victoria, Australia
| | | | - Helen S Heussler
- The University of Queensland, South Brisbane, Queensland, Australia
| | | | | | | | | | | | - Emma Sciberras
- Deakin University, Geelong, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,University of Melbourne, Parkville, Victoria, Australia
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36
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Sciberras E, Mulraney M, Mensah F, Oberklaid F, Efron D, Hiscock H. Sustained impact of a sleep intervention and moderators of treatment outcome for children with ADHD: a randomised controlled trial. Psychol Med 2020; 50:210-219. [PMID: 30654852 DOI: 10.1017/s0033291718004063] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND We aim to (1) determine whether a behavioural sleep intervention for children with attention-deficit/hyperactivity disorder (ADHD) leads to sustained benefits; and (2) examine the factors associated with treatment response. METHODS This study was a randomised controlled trial of 244 children (5-13 years) with ADHD from Victoria, Australia. All participants had a moderate/severe sleep problem that met American Academy of Sleep Medicine criteria for an eligible sleep disorder by parent report. The two-session intervention covered sleep hygiene and standardised behavioural strategies. The control group received usual care. Parent- and teacher-reported outcomes at 12 months included sleep, ADHD severity, quality of life, daily functioning, behaviour, and parent mental health. Adjusted mixed effects regression analyses examined 12 month outcomes. Interaction analyses were used to determine moderators of intervention outcomes over time. The trial was registered with ISRCTN, http://www.controlled-trials.com (ISRCTN68819261). RESULTS Intervention children were less likely to have a moderate/severe sleep problem by parent report at 12 months compared to usual care children (28.4% v. 46.5%, p = 0.03). Children in the intervention group fared better than the usual care group in terms of parent-reported ADHD symptoms (Cohen's d: -0.3, p < 0.001), quality of life (d: 0.4, p < 0.001), daily functioning (d: -0.5, p < 0.001), and behaviour (d: -0.3, p = 0.005) 12 months later. The benefits of the intervention over time in terms of sleep were less for children not taking ADHD medication and children with parents experiencing depression. CONCLUSIONS A behavioural sleep intervention for ADHD is associated with small sustained improvements in child wellbeing. Children who are not taking ADHD medication or have parents with depression may require follow-up booster sleep sessions.
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Affiliation(s)
- E Sciberras
- School of Psychology, Deakin University, Geelong, VIC, Australia
- Murdoch Childrens Research Institute, Parkville, VIC, Australia
- The Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - M Mulraney
- Murdoch Childrens Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - F Mensah
- Murdoch Childrens Research Institute, Parkville, VIC, Australia
- The Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - F Oberklaid
- Murdoch Childrens Research Institute, Parkville, VIC, Australia
- The Royal Children's Hospital, Parkville, VIC, Australia
| | - D Efron
- Murdoch Childrens Research Institute, Parkville, VIC, Australia
- The Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - H Hiscock
- Murdoch Childrens Research Institute, Parkville, VIC, Australia
- The Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
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Lah S, Phillips NL, Palermo TM, Bartlett D, Epps A, Teng A, Brookes N, Parry L, Naismith SL. A feasibility and acceptability study of cognitive behavioural treatment for insomnia in adolescents with traumatic brain injury: A-B with follow up design, randomized baseline, and replication across participants. Neuropsychol Rehabil 2019; 31:345-368. [PMID: 31752595 DOI: 10.1080/09602011.2019.1693404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Difficulties falling asleep or staying asleep (symptoms of insomnia) are common following paediatric traumatic brain injury (TBI). Yet, interventions to treat insomnia in this population have not yet been reported. This single-case series examined the feasibility and acceptability of cognitive behavioral treatment for insomnia (CBT-I) for adolescents (n = 5, aged 11-13 years) with TBI, and explored changes in sleep and fatigue post-treatment. Adolescents were randomly assigned to two conditions: a 7- or 14-days baseline, followed by 4 weeks of manualised CBT-I delivered individually. To assess feasibility and acceptability we compared recruitment and retention rates, and questionnaire scores to a-priori set criteria. We explored treatment efficacy and functional gains in sleep and fatigue from baseline to follow-up using structured visual analysis of time-series graphs, and reliable change indices or changes in clinical classification. Feasibility and acceptability indicators met a-priori criteria, but therapists noticed limited adolescent engagement in sessions. Clinically significant improvements were found in sleep, in 3 out of 4 cases, and fatigue, in all cases. Our study provides preliminary evidence that CBT-I is feasible for insomnia treatment in adolescents with TBI and provides directions for development of future treatment studies.
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Affiliation(s)
- Suncica Lah
- School of Psychology, University of Sydney, Sydney, Australia
| | | | - Tonya M Palermo
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Delwyn Bartlett
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Adrienne Epps
- Brain Injury Rehabilitation, Sydney Children's Hospital, Randwick, Australia
| | - Arthur Teng
- Department of Sleep Medicine, Sydney Children's Hospital, Randwick, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Naomi Brookes
- Brain Injury Rehabilitation, Sydney Children's Hospital, Randwick, Australia
| | - Louise Parry
- Brain Injury Rehabilitation, Sydney Children's Hospital, Randwick, Australia
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38
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Hiscock H, Mulraney M, Heussler H, Rinehart N, Schuster T, Grobler AC, Gold L, Bohingamu Mudiyanselage S, Hayes N, Sciberras E. 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; 60:1230-1241. [PMID: 31184382 DOI: 10.1111/jcpp.13083] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2019] [Indexed: 01/05/2023]
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.
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Affiliation(s)
- Harriet Hiscock
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, VIC, Australia.,Health Services, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Melissa Mulraney
- Health Services, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Helen Heussler
- Mater Research Institute, University of Queensland, Brisbane, QLD, Australia
| | - Nicole Rinehart
- Deakin Child Study Centre, School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Tibor Schuster
- Clinical Epidemiology and Biostatistics Unit and Melbourne Children's Trials Centre, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Anneke C Grobler
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.,Clinical Epidemiology and Biostatistics Unit and Melbourne Children's Trials Centre, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Lisa Gold
- School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | | | - Nicole Hayes
- Mater Research Institute, University of Queensland, Brisbane, QLD, Australia
| | - Emma Sciberras
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.,Deakin Child Study Centre, School of Psychology, Deakin University, Geelong, VIC, Australia
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39
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ADHD and sleep: recent advances and future directions. Curr Opin Psychol 2019; 34:50-56. [PMID: 31629217 DOI: 10.1016/j.copsyc.2019.09.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/19/2019] [Accepted: 09/06/2019] [Indexed: 12/17/2022]
Abstract
Individuals with attention-deficit/hyperactivity disorder (ADHD) frequently have sleep disturbances, daytime sleepiness, and/or circadian rhythm abnormalities. This article reviews recent advancements and key future directions: examining group differences across the life span, advancing a developmental psychopathology perspective, moving from correlation to causation, conceptualizing ADHD as a 24-hour disorder, understanding sleep in relation to other health behaviors, and evaluating sleep in interventions for individuals with ADHD. This is an exciting time in the empirical study and clinical care of sleep disturbances and circadian rhythm alterations in individuals with ADHD. As research continues to advance, studies are increasingly using large samples and longitudinal/experimental research designs to test hypotheses that will ultimately allow for a more robust and sophisticated understanding of sleep and ADHD.
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40
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San Mauro Martin I, Sanz Rojo S, Garicano Vilar E, González Cosano L, Conty de la Campa R, Blumenfeld Olivares JA. Lifestyle factors, diet and attention-deficit/hyperactivity disorder in Spanish children - an observational study. Nutr Neurosci 2019; 24:614-623. [PMID: 31479410 DOI: 10.1080/1028415x.2019.1660486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background: The aetiology of Attention Deficit Hyperactivity Disorder (ADHD) continues to be debated, although several contributing factors have been acknowledged.Objective: Assess the association between weight, birth attributes, exercise and sleep habits, dietary intake and adherence to a Mediterranean diet, and impulsive behaviour on Spanish ADHD children. Establish whether specific food groups (not just adherence to the Mediterranean diet) associate with impulsive behaviour.Methods: This observational cross-sectional study included 57 ADHD children from Madrid (Spain). Demographic, clinical data, sleep, exercise and technology-use habits were obtained. Anthropometric measurements included height and weight. Adherence to the Mediterranean diet was assessed using the KIDMED test. Barratt Impulsivity Scale version-11c was used to assess impulsivity. Subjects were divided into three groups for analysis, according to their age (6-10 years, children; 11-13 years, pre-adolescents; 14-16 years, adolescents).Results: There were clear associations between those who had higher BIS scores and who slept less at weekends (49.4 ± 10.16 vs. 43.8 ± 12.51), who adhered poorly to the Mediterranean diet (49.9 ± 11.72 vs. 41.6 ± 16.52), who used internet and technological devices for >3 h/day (45.5 ± 13.6 vs. 44.7 ± 12.11), who were born with >2.5 kg (46.1 ± 11.61 vs. 42.9 ± 15.29), who were delivered by caesarean (45.1 ± 12.78 vs. 44.7 ± 12.5) and who were not breastfed (45.0 ± 13.38 vs. 44.8 ± 12.39). Subjects exercising more than 3 days a week also scored slightly higher (45.4±14.02 vs. 44.6±11.85) in the BIS.Conclusion: There is a need to follow up the link between ADHD and sleep onset difficulties, dietary patterns, technological habits, perinatal factors, breastfeeding and birth delivery mode.
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Lucas I, Mulraney M, Sciberras E. Sleep problems and daytime sleepiness in children with ADHD: Associations with social, emotional, and behavioral functioning at school, a cross-sectional study. Behav Sleep Med 2019; 17:411-422. [PMID: 28922019 DOI: 10.1080/15402002.2017.1376207] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Sleep problems and daytime sleepiness are common in children with attention-deficit hyperactivity disorder (ADHD) and are associated with poor parent-reported functional outcomes. However, the potential impact of sleep problems or daytime sleepiness on the school functioning of children with ADHD remains unknown. We aimed to determine if sleep problems and daytime sleepiness were associated with the social, emotional, and behavioral school-based functioning of children with ADHD and comorbid sleep problems. Methods: Children aged 5-13 years with ADHD and a moderate-severe sleep problem (confirmed using American Academy of Sleep Medicine diagnostic criteria) were recruited from 43 pediatric practices across Victoria and Queensland, Australia (N = 257). Parent-rated sleep problems were assessed using the Children's Sleep Habits Questionnaire (CSHQ) and teacher-rated daytime sleepiness using the Teacher's Daytime Sleepiness Questionnaire. Teacher-rated social, emotional, and behavioral school functioning was assessed using three scales (peer problems, emotional problems, and conduct problems) from the Strength and Difficulties Questionnaire. Data was analyzed using Pearson correlations and linear regression models. Results: Teacher-rated daytime sleepiness was associated with higher levels of emotional (β = 0.39; 95% CI = 0.25-0.52) and behavioral problems (β = 0.47; CI = 0.36-0.58) in adjusted models. While total sleep duration and parent-rated sleep problems were not associated with daytime sleepiness or school functioning, the CSHQ subscale night wakings was correlated with teacher-rated daytime sleepiness (r = 0.21; p < 0.01). Conclusions: Daytime sleepiness (possibly as an indicator of sleep quality) may be a better predictor of school functioning in children with ADHD who have concomitant sleep problems than total sleep duration or parent-rated sleep problems.
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Affiliation(s)
- Isabelle Lucas
- a Department of Pediatrics, The University of Melbourne , Parkville , Victoria , Australia
| | - Melissa Mulraney
- a Department of Pediatrics, The University of Melbourne , Parkville , Victoria , Australia.,b Community Health Services Research, Murdoch Childrens Research Institute , Parkville , Victoria , Australia
| | - Emma Sciberras
- a Department of Pediatrics, The University of Melbourne , Parkville , Victoria , Australia.,b Community Health Services Research, Murdoch Childrens Research Institute , Parkville , Victoria , Australia.,c Deakin Child Study Centre, School of Psychology, Deakin University , Geelong , Victoria , Australia
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The association between sleep and dual-task performance in preterm and full-term children: an exploratory study. Sleep Med 2019; 55:100-108. [PMID: 30772694 DOI: 10.1016/j.sleep.2018.11.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/15/2018] [Accepted: 11/17/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The present study explored associations between sleep and children's dual-task performance using cognitive-motor dual tasks (eg, walking and talking). Previous research with older adults indicated correlations between higher gait variability and unfavorable sleep continuity variables. Based on this research, as a first objective, we investigated similar correlations in a sample of children. Second, we explored correlations between dual-task performance and dimensions of sleep architecture. Third, we tested moderating effects of prematurity on these associations. METHODS In this study, 7-to 12-year-old children were tested in dual-task situations; of those, 39 were formerly preterm, and 59 were full-term born children. They were asked to walk and simultaneously perform different cognitive tasks. Gait was measured using an electronic walkway system. Sleep was measured using in-home sleep-electroencephalography. RESULTS After accounting for age and cognition, regression analyses revealed correlations between a higher number of awakenings after sleep onset and lower dual-task performance; concerning sleep architecture, analyses revealed correlations between a higher amount of rapid-eye-movement (REM) sleep and lower gait variability. Furthermore, associations between a higher amount of slow wave sleep (SWS) and children's higher cognitive performance were found. Moderation analyses indicated no effects of prematurity. CONCLUSIONS Our exploratory study suggests that a more disrupted sleep was related to children's poorer dual-task performance. Our findings support claims that REM sleep seems more related to performance in procedural tasks whereas SWS seems more related to performance in declarative tasks, suggesting that different sleep stages may support the processing of different performance types.
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Papadopoulos N, Sciberras E, Hiscock H, Mulraney M, McGillivray J, Rinehart N. The Efficacy of a Brief Behavioral Sleep Intervention in School-Aged Children With ADHD and Comorbid Autism Spectrum Disorder. J Atten Disord 2019; 23:341-350. [PMID: 25646022 DOI: 10.1177/1087054714568565] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Sleep problems are common in children with autism spectrum disorders (ASD) and ADHD and impact adversely on child and parent well-being. The study evaluated the efficacy of a brief behavioral sleep intervention in children with comorbid ADHD-ASD. METHOD A subsample of children with ADHD-ASD ( n = 61; 5-13 years; 89% male) participating in the Sleeping Sound With ADHD study were included in the current investigation. The subsample comprised of 28 children randomized to the sleep intervention group, while 33 were randomized to usual clinical care. The intervention consisted of two clinical consultations and a follow-up phone call covering sleep hygiene and standardized behavioral strategies. RESULTS Children with ADHD-ASD who received the intervention had large improvements in sleep problems and moderate improvements in child behavioral functioning 3 and 6 months post-randomization. CONCLUSION These findings suggest that a brief behavioral sleep intervention can improve sleep problems in children with ADHD-ASD.
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Affiliation(s)
| | - Emma Sciberras
- 2 Murdoch Children's Research Institute, Melbourne, Australia.,3 The Royal Children's Hospital, Melbourne, Australia.,4 University of Melbourne, Australia
| | - Harriet Hiscock
- 2 Murdoch Children's Research Institute, Melbourne, Australia.,3 The Royal Children's Hospital, Melbourne, Australia.,4 University of Melbourne, Australia
| | - Melissa Mulraney
- 2 Murdoch Children's Research Institute, Melbourne, Australia.,3 The Royal Children's Hospital, Melbourne, Australia
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Elphick HE, Lawson C, Ives A, Siddall S, Kingshott RN, Reynolds J, Dawson V, Hall L. Pilot study of an integrated model of sleep support for children: a before and after evaluation. BMJ Paediatr Open 2019; 3:e000551. [PMID: 31799451 PMCID: PMC6863653 DOI: 10.1136/bmjpo-2019-000551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/02/2019] [Accepted: 10/12/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Despite the success of behavioural sleep support interventions in the third sector, sleep support is not universally available for families in the UK. The aim of the study was to provide evidence of efficacy and to propose a delivery model for integrated sleep support for families of vulnerable children. DESIGN AND SETTING A sleep support intervention was carried out in Sheffield Local Authority evaluated using a preintervention and postintervention study design by Sheffield Children's National Health Service (NHS) Trust. PARTICIPANTS Fifty-six children aged 6-16 years with significant sleep problems were recruited; 39 completed the intervention and evaluation. INTERVENTIONS Basic sleep education and an individualised programme was delivered by a sleep practitioner. Follow-on telephone support was provided to empower the parent (and/or young person) to carry out the sleep programme at home. An integrated NHS and Local Authority delivery model was designed and implemented. RESULTS Parents' ratings of their child's ability to self-settle improved from 1.1/10 to 6.4/10 (p<0.05). Mean Warwick-Edinburgh Mental Well-being Scale scores improved significantly for parents/carers (MD 5.16, 95%CIs 2.62 to 7.69, p<0.05). Children who completed the intervention gained on average an extra 2.4 hours sleep a night. There was reduction in healthcare utilisation, illnesses and medication use. CONCLUSIONS The behavioural approach to sleep support for these vulnerable groups of children is highly effective. Follow-on individual support to empower parents is key to achieving success. Sleep support can be implemented in NHS and Local Authority services by integration into the existing workforce using a cross-agency model.
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Affiliation(s)
- Heather E Elphick
- Department of Respiratory and Sleep Medicine, Sheffield Children's Hospital, Sheffield, UK
| | | | - Ann Ives
- Sheffield City Council, Sheffield, UK
| | | | - Ruth N Kingshott
- Department of Respiratory and Sleep Medicine, Sheffield Children's Hospital, Sheffield, UK
| | - Janine Reynolds
- Department of Respiratory and Sleep Medicine, Sheffield Children's Hospital, Sheffield, UK
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45
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Ricketts EJ, Sturm A, McMakin DL, McGuire JF, Tan PZ, Smalberg FB, McCracken JT, Colwell CS, Piacentini J. Changes in Sleep Problems Across Attention-Deficit/Hyperactivity Disorder Treatment: Findings from the Multimodal Treatment of Attention-Deficit/Hyperactivity Disorder Study. J Child Adolesc Psychopharmacol 2018; 28:690-698. [PMID: 30388029 PMCID: PMC7364298 DOI: 10.1089/cap.2018.0038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective: Stimulant medication and behavior therapy are efficacious for youth with attention-deficit/hyperactivity disorder (ADHD). However, research suggests that stimulants may start and/or worsen sleep problems for youth. Further, the impact of behavior therapy for ADHD on sleep is unknown. This study examined the frequency of sleep problems and effects of stimulant medication, behavior therapy, and their combination on sleep problems in youth with ADHD. This study also explored the influence of dimensional baseline ratings of ADHD symptom subtype and psychiatric comorbidity on sleep outcomes. Methods: Participants were 576 children (aged 7-9 years) with ADHD-Combined type from the Multimodal Treatment of ADHD study that compared methylphenidate, behavior therapy, and their combination to community care. Before treatment, parents completed the Child Behavior Checklist used to derive a total sleep problems score. Parents also completed ratings of oppositionality and ADHD symptom severity, whereas youth completed ratings of depression and anxiety. These ratings were readministered after treatment. Results: General linear mixed-effects models were used to assess change in total sleep problems across treatment. The combined group exhibited a statistically significant reduction in total sleep problems (z = -5.81, p < 0.001). Reductions in total sleep problems in methylphenidate (z = -3.11, p = 0.05), behavior therapy (z = -2.99, p = 0.08), or community care (z = -1.59, p > 0.99) did not reach statistical significance. Change in psychiatric symptoms did not significantly moderate change in total sleep problems by treatment assignment. Greater baseline oppositional defiant disorder severity predicted less reduction in total sleep problems, χ2(1) = 3.86, p < 0.05. Conclusions: Findings suggest that combination of methylphenidate and behavior therapy is efficacious for reducing parent-reported sleep problems in young children with ADHD-Combined type relative to community care. However, potential ameliorative effects of monotherapy treatments (i.e., methylphenidate, behavior therapy) should be examined. Future replication is needed to confirm findings.
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Affiliation(s)
- Emily J. Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California.,Address correspondence to: Emily J. Ricketts, PhD, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 760 Westwood Plz, Los Angeles, CA 90024
| | - Alexandra Sturm
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Dana L. McMakin
- Department of Psychology, Florida International University, Miami, Florida.,Department of Neurology, Nicklaus Children's Hospital, Miami, Florida
| | - Joseph F. McGuire
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Patricia Z. Tan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Fallon B. Smalberg
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - James T. McCracken
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Christopher S. Colwell
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
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46
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Kidwell KM, McGinnis JC, Nguyen AV, Arcidiacono SJ, Nelson TD. A pilot study examining the effectiveness of brief sleep treatment to improve children’s emotional and behavioral functioning. CHILDRENS HEALTH CARE 2018. [DOI: 10.1080/02739615.2018.1540306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | | | | | - Timothy D. Nelson
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
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47
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Rigney G, Ali NS, Corkum PV, Brown CA, Constantin E, Godbout R, Hanlon-Dearman A, Ipsiroglu O, Reid GJ, Shea S, Smith IM, Van der Loos HFM, Weiss SK. A systematic review to explore the feasibility of a behavioural sleep intervention for insomnia in children with neurodevelopmental disorders: A transdiagnostic approach. Sleep Med Rev 2018; 41:244-254. [PMID: 29764710 DOI: 10.1016/j.smrv.2018.03.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/02/2018] [Accepted: 03/27/2018] [Indexed: 01/07/2023]
Abstract
Children with neurodevelopmental disorders (NDD) are at high risk for sleep problems, especially insomnia. It is currently not known whether behavioural sleep interventions developed for typically developing (TD) children are effective for children with NDD, and if interventions need to be modified for each diagnostic group. The aim of this systematic review was to identify and evaluate commonalities, trends in outcomes, and the methodological quality of parent-delivered behavioural sleep interventions for children with NDD, specifically Attention-Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), Cerebral Palsy, and Fetal Alcohol Spectrum Disorder. Nine databases were searched. A total of 40 studies met eligibility criteria. The majority of studies were conducted with ASD and ADHD populations. Common sleep problems were evident across the NDD populations. The most frequently reported included bedtime resistance, night-waking, early morning awakening, and co-sleeping. The most common interventions used were implementation of healthy sleep practices, reinforcement, graduated extinction, and faded bedtime. All studies reported at least one behavioural treatment component as effective. Commonalities across NDD populations, as well as the TD population, for both sleep problems reported and behavioural interventions implemented, suggest the feasibility of developing a transdiagnostic behavioural sleep intervention suitable for children with a range of NDD.
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48
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de Almondes KM, Leonardo MEM. Study Protocol of Sleep Education Tool for Children: Serious Game "Perfect Bedroom: Learn to Sleep Well". Front Psychol 2018; 9:1016. [PMID: 29997540 PMCID: PMC6028730 DOI: 10.3389/fpsyg.2018.01016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/31/2018] [Indexed: 12/19/2022] Open
Abstract
Promoting a healthy sleep is a big challenge and becomes a strategic priority in public health, due to the severe consequences on children's development and risk to psychiatric diseases. Interventions that promote healthy sleep, such as those that focus on the dissemination of behavioral and environmental recommendations of sleep hygiene with children, are presented as an alternative. Serious game design offers wide-reaching domains in health applications and is increasing in popularity, particularly with children and teens because of it's potential to engage and motivate players differently from other interventions. This study aims to evaluate effects of serious game on sleep hygiene recommendations "Perfect Bedroom: learn to sleep well," on sleep habits and sleep parameters of healthy children. This is an experimental, prospective and quantitative study. We will randomize children in experimental (n = 88) and no intervention groups (n = 88). The experiment has four stages (pre-intervention, intervention, post-intervention, and follow-up), which will count with participation of children and their parents/guardians. In the evaluation stages, the guardians will answer questionnaires and scales to assess sociodemographic and health data, sleep habits and sleep pattern of their child. The children themselves will answer the following: a scale to assess sleepiness levels, a questionnaire to evaluate the serious game and the game itself, will characterize their bedroom and the activities they perform before sleep, with strategies developed by researches. Intervention with experimental group conducted with the serious game "Perfect Bedroom" will happen twice a week, for 3 weeks in a row, resulting in six sessions of 50 min each. Inferential analysis will be conducted for comparisons between groups and intragroups to measure effect of intervention in primary outcomes (sleep habits) and secondary outcomes (sleep parameters). We expect that the intervention with this game can provide valuable evidence to a new approach in promoting healthy sleep habits, with applications in clinical, educational, and familiar settings, which could diminish future health issues and risk at psychiatric diseases, decreasing the social burden of treatments for these conditions in children.
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Affiliation(s)
- Katie Moraes de Almondes
- Department of Psychology and Postgraduate Program, Postgraduate Program in Psychobiology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Maria E M Leonardo
- Postgraduate Program in Psychology, Federal University of Rio Grande do Norte, Natal, Brazil
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49
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Inkelis SM, Thomas JD. Sleep in Infants and Children with Prenatal Alcohol Exposure. Alcohol Clin Exp Res 2018; 42:10.1111/acer.13803. [PMID: 29852534 PMCID: PMC6274610 DOI: 10.1111/acer.13803] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 05/22/2018] [Indexed: 01/12/2023]
Abstract
Prenatal exposure to alcohol can result in a range of neurobehavioral impairments and physical abnormalities. The term "fetal alcohol spectrum disorders (FASD)" encompasses the outcomes of prenatal alcohol exposure (PAE), the most severe of which is fetal alcohol syndrome. These effects have lifelong consequences, placing a significant burden on affected individuals, caregivers, and communities. Caregivers of affected children often report that their child has sleep problems, and many symptoms of sleep deprivation overlap with the cognitive and behavioral deficits characteristic of FASD. Alcohol-exposed infants and children demonstrate poor sleep quality based on measures of electroencephalography, actigraphy, and questionnaires. These sleep studies indicate a common theme of disrupted sleep pattern, more frequent awakenings, and reduced total sleep time. However, relatively little is known about circadian rhythm disruption and the neurobehavioral correlates of sleep disturbance in individuals with PAE. Furthermore, there is limited information available to healthcare providers about identification and treatment of sleep disorders in patients with FASD. This review consolidates the findings from studies of infant and pediatric sleep in this population, providing an overview of typical sleep characteristics, neurobehavioral correlates of sleep disruption, and potential avenues for intervention in the context of PAE.
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Affiliation(s)
- Sarah M Inkelis
- Center for Behavioral Teratology (SMI, JDT), San Diego State University, San Diego, California
| | - Jennifer D Thomas
- Center for Behavioral Teratology (SMI, JDT), San Diego State University, San Diego, California
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50
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Becker SP, Cusick CN, Sidol CA, Epstein JN, Tamm L. The impact of comorbid mental health symptoms and sex on sleep functioning in children with ADHD. Eur Child Adolesc Psychiatry 2018; 27:353-365. [PMID: 28983772 PMCID: PMC5854508 DOI: 10.1007/s00787-017-1055-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 09/21/2017] [Indexed: 12/28/2022]
Abstract
Children with attention-deficit/hyperactivity disorder (ADHD) display more sleep problems than their peers, but it remains unclear whether comorbid mental health symptoms [i.e., anxiety, depression, oppositional-defiant disorder (ODD)] are uniquely related to sleep functioning. It is also largely unknown whether boys and girls with ADHD differ in their sleep functioning. This study (1) examined whether boys or girls with ADHD differ in their sleep functioning, (2) evaluated comorbid symptoms as uniquely related to sleep functioning domains, and (3) explored whether sex moderated associations between comorbid symptoms and sleep. Participants were 181 children (ages 7-13; 69% male; 82% White) diagnosed with ADHD. Parents completed measures assessing their child's ADHD symptoms, comorbid symptoms, and sleep functioning. Girls had poorer sleep functioning than boys across most sleep functioning domains. Sixty percent of children met cutoff criteria for having sleep problems, though rates differed significantly between girls (75%) and boys (53%). No differences in rates of sleep problems were found between ADHD subtypes/presentations or between younger and older children. In path models including ADHD and comorbid symptom dimensions, anxiety symptoms were uniquely associated with increased bedtime resistance and sleep anxiety, ADHD hyperactive-impulsive symptoms were associated with more night wakings and more parasomnia behaviors, and ODD and depressive symptoms were associated with shorter sleep duration. Depression was also uniquely associated with increased daytime sleepiness and overall sleep problems. Sex did not moderate associations between comorbid symptoms and sleep problems. This study provides important preliminary evidence that girls with ADHD experience more sleep problems than boys with ADHD. Findings also demonstrate that the associations between comorbid symptoms and sleep functioning in children with ADHD vary based on both the specific symptoms and sleep domains examined.
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Affiliation(s)
- Stephen P. Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA,College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA,Address correspondence to Stephen Becker, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 10006, Cincinnati, Ohio 45229-3039; (513) 803-2066 (phone); (513) 803-0084 (fax);
| | - Caroline N. Cusick
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Craig A. Sidol
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jeffery N. Epstein
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA,College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA,Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Leanne Tamm
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA,College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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