School of Psychology, Deakin University, Geelong, VIC, Australia.
Murdoch Childrens Research Institute, Parkville, VIC, Australia.
Psychol Med. 2020 Jan;50(2):210-219. doi: 10.1017/S0033291718004063. Epub 2019 Jan 18.
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.
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).
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.
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.
我们旨在：（1）确定针对注意力缺陷多动障碍（ADHD）儿童的行为睡眠干预是否会带来持续的益处；（2）检查与治疗反应相关的因素。
这是一项针对来自澳大利亚维多利亚州的 244 名 ADHD 儿童（5-13 岁）的随机对照试验。所有参与者都有中度/重度睡眠问题，且根据父母报告，符合美国睡眠医学学会（AASM）的合格睡眠障碍标准。两阶段干预涵盖了睡眠卫生和标准化行为策略。对照组接受常规护理。12 个月时，家长和教师报告的结果包括睡眠、ADHD 严重程度、生活质量、日常功能、行为和家长心理健康。调整后的混合效应回归分析检查了 12 个月的结果。交互分析用于确定随时间变化的干预结果的调节剂。该试验在 ISRCTN 注册，网址为：http://www.controlled-trials.com（ISRCTN68819261）。
与常规护理儿童相比，干预组儿童在 12 个月时父母报告的中度/重度睡眠问题的可能性较小（28.4%比 46.5%，p=0.03）。与常规护理组相比，干预组儿童的家长报告的 ADHD 症状（Cohen's d：-0.3，p<0.001）、生活质量（d：0.4，p<0.001）、日常功能（d：-0.5，p<0.001）和行为（d：-0.3，p=0.005）在 12 个月后更好。随着时间的推移，对于未服用 ADHD 药物的儿童和父母患有抑郁症的儿童，干预在睡眠方面的益处较小。
针对 ADHD 的行为睡眠干预与儿童幸福感的持续小幅度改善相关。未服用 ADHD 药物或父母患有抑郁症的儿童可能需要后续的睡眠强化疗程。
