An open trial tested the feasibility, acceptability, and preliminary effectiveness of a behavioral sleep intervention in adolescents with ADHD.
Method:
Fourteen adolescents (ages 13–17 years; 50% male) with ADHD and co-occurring sleep problems received the cognitive-behavioral-based Transdiagnostic Sleep and Circadian Intervention for Youth (TranS-C). Adolescent, parent, and teacher ratings, actigraphy, and daily sleep diaries were collected at pre-intervention, post-intervention, and 3-month follow-up.
Results:
Adolescents experienced moderate to large improvements in sleep, mental health symptoms, and daily life executive functioning from pre-treatment to post-treatment, and improvements were generally maintained at 3 months. Pre-intervention, 71.4% of adolescents were classified as poor sleepers and this was reduced to 21.4% and 28.6% at post-treatment and follow-up, respectively.
Conclusion:
This study provides strong preliminary evidence that TranS-C improves sleep and associated outcomes in adolescents with ADHD and co-occurring sleep problems. A randomized controlled trial is needed to rigorously test the efficacy of TranS-C in this population.
AchenbachT. M.RescorlaL. A. (2001). Manual for the ASEBA school-age forms and profiles. University of Vermont, Research Center for Children, Youth, and Families.
2.
AlfonsiV.PalmizioR.RubinoA.ScarpelliS.GorgoniM.D’AtriA.PazzagliaM.FerraraM.GiulianoS.De GennaroL. (2020). The association between school start time and sleep duration, sustained attention, and academic performance. Nature and Science of Sleep, 12, 1161–1172. https://doi.org/10.2147/NSS.S273875
3.
Arrona-PalaciosA.Díaz-MoralesJ. F. (2018). Morningness–eveningness is not associated with academic performance in the afternoon school shift: Preliminary findings. British Journal of Educational Psychology, 88(3), 480–498.
4.
ÅslundL.LekanderM.WicksellR. K.HenjeE.JernelövS. (2020). Cognitive-behavioral therapy for insomnia in adolescents with comorbid psychiatric disorders: A clinical pilot study. Clinical Child Psychology and Psychiatry, 25(4), 958–971. https://doi.org/10.1177/1359104520929376
5.
BarkleyR. A. (2012). Barkley deficits in executive functioning scale – children and adolescents (BDEFS-CA). Guilford.
6.
BarkleyR. A. (2015). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (4th ed.). Guilford.
7.
BeckerS. P. (2019). The triple threat of sleep, adolescence, and ADHD. In HiscockH.SciberrasE. (Eds.), Sleep and ADHD: An evidence-based guide to assessment and treatment (pp. 257–294). Elsevier/Academic Press.
8.
BeckerS. P.EpsteinJ. N.TammL.TilfordA. A.TischnerC. M.IsaacsonP. A.SimonJ. O.BeebeD. W. (2019). Shortened sleep duration causes sleepiness, inattention, and oppositionality in adolescents with attention-deficit/hyperactivity disorder: Findings from a crossover sleep restriction/extension study. Journal of the American Academy of Child and Adolescent Psychiatry, 58, 433–442. https://doi.org/10.1016/j.jaac.2018.09.439
9.
BeckerS. P.LangbergJ. M.EadehH. M.IsaacsonP. A.BourchteinE. (2019). Sleep and daytime sleepiness in adolescents with and without ADHD: Differences across ratings, daily diary, and actigraphy. Journal of Child Psychology and Psychiatry, 60(9), 1021–1031. https://doi.org/10.1111/jcpp.13061
10.
BeckerS. P.LangbergJ. M.EvansS. W. (2015). Sleep problems predict comorbid externalizing behaviors and depression in young adolescents with attention-deficit/hyperactivity disorder. European Child & Adolescent Psychiatry, 24(8), 897–907. https://doi.org/10.1007/s00787-014-0636-6
11.
BeckerS. P.SidolC. A.Van DykT. R.EpsteinJ. N.BeebeD. W. (2017). Intraindividual variability of sleep/wake patterns in relation to child and adolescent functioning: A systematic review. Sleep Medicine Reviews, 34, 94–121. https://doi.org/10.1016/j.smrv.2016.07.004
12.
BeckerS. P.TammL.EpsteinJ. N.BeebeD. W. (2020). Impact of sleep restriction on affective functioning in adolescents with attention-deficit/hyperactivity disorder. Journal of Child Psychology and Psychiatry, 61, 1160–1168. https://doi.org/10.1111/jcpp.13235
13.
BeebeD. W.FalloneG.GodiwalaN.FlaniganM.MartinD.SchaffnerL.AminR. (2008). Feasibility and behavioral effects of an at-home multi-night sleep restriction protocol for adolescents. Journal of Child Psychology and Psychiatry, 49(9), 915–923. https://doi.org/10.1111/j.1469-7610.2008.01885.x
14.
BeiB.ByrneM. L.IvensC.WaloszekJ.WoodsM. J.DudgeonP.MurrayG.NicholasC. L.TrinderJ.AllenN. B. (2013). Pilot study of a mindfulness-based, multi-component, in-school group sleep intervention in adolescent girls. Early Intervention in Psychiatry, 7(2), 213–220. https://doi.org/10.1111/j.1751-7893.2012.00382.x
15.
BlakeM.WaloszekJ. M.SchwartzO.RanitiM.SimmonsJ. G.BlakeL.MurrayG.DahlR. E.BootzinR.DudgeonP.TrinderJ.AllenN. B. (2016). The SENSE study: Post intervention effects of a randomized controlled trial of a cognitive-behavioral and mindfulness-based group sleep improvement intervention among at-risk adolescents. Journal of Consulting and Clinical Psychology, 84(12), 1039–1051. https://doi.org/10.1037/ccp0000142
16.
BlakeM. J.BlakeL. M.SchwartzO.RanitiM.WaloszekJ. M.MurrayG.SimmonsJ. G.LandauE.DahlR. E.McMakinD. L.DudgeonP.TrinderJ.AllenN. B. (2018). Who benefits from adolescent sleep interventions? Moderators of treatment efficacy in a randomized controlled trial of a cognitive-behavioral and mindfulness-based group sleep intervention for at-risk adolescents. Journal of Child Psychology and Psychiatry, 59(6), 637–649. https://doi.org/10.1111/jcpp.12842
17.
BlakeM. J.SheeberL. B.YoussefG. J.RanitiM. B.AllenN. B. (2017). Systematic review and meta-analysis of adolescent cognitive-behavioral sleep interventions. Clinical Child and Family Psychology Review, 20, 227–249. https://doi.org/10.1007/s10567-017-0234-5
18.
BourchteinE.LangbergJ. M.CusickC. N.BreauxR. P.SmithZ. R.BeckerS. P. (2019). Featured article: Technology use and sleep in adolescents with and without attention-deficit/hyperactivity disorder. Journal of Pediatric Psychology, 44(5), 517–526. https://doi.org/10.1093/jpepsy/jsy101
19.
BuysseD. J.ReynoldsC. F.3rdMonkT. HBermanS. RKupferD. J. (1989). The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193–213.
20.
CarneyC. E.BuysseD. J.Ancoli-IsraelS.EdingerJ. D.KrystalA. D.LichsteinK. L.MorinC. M. (2012). The consensus sleep diary: Standardizing prospective sleep self-monitoring. Sleep, 35, 287–302.
21.
CarskadonM. A.VieiraC.AceboC. (1993). Association between puberty and delayed phase preference. Sleep, 16(3), 258–262.
22.
ChorpitaB. F.MoffittC. E.GrayJ. (2005). Psychometric properties of the revised child anxiety and depression scale in a clinical sample. Behaviour Research and Therapy, 43(3), 309–322. https://doi.org/10.1016/j.brat.2004.02.004
23.
ClarkeG.McGlincheyE. L.HeinK.GullionC. M.DickersonJ. F.LeoM. C.HarveyA. G. (2015). Cognitive-behavioral treatment of insomnia and depression in adolescents: A pilot randomized trial. Behaviour Research and Therapy, 69, 111–118. https://doi.org/10.1016/j.brat.2015.04.009
24.
ConnersC. K. (2008). Conners-3. Multi-Health Systems.
25.
CorkumP.Lingley-PottieP.DavidsonF.McGrathP.ChambersC. T.MullaneJ.LaredoS.WoodfordK.WeissS. K. (2016). Better nights/better days-distance intervention for insomnia in school-aged children with/without ADHD: A randomized controlled trial. Journal of Pediatric Psychology, 41(6), 701–713. https://doi.org/10.1093/jpepsy/jsw031
26.
CorteseS.BrownT. E.CorkumP.GruberR.O’BrienL. M.SteinM.WeissM.OwensJ. (2013). Assessment and management of sleep problems in youths with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 52(8), 784–796. https://doi.org/10.1016/j.jaac.2013.06.001
27.
CrowleyS. J.WolfsonA. R.TarokhL.CarskadonM. A. (2018). An update on adolescent sleep: New evidence informing the perfect storm model. Journal of Adolescence, 67, 55–65. https://doi.org/10.1016/j.adolescence.2018.06.001
28.
CusickC. N.LangbergJ. M.BreauxR.GreenC. D.BeckerS. P. (2020). Caffeine use and associations with sleep in adolescents with and without ADHD. Journal of Pediatric Psychology, 45(6), 643–653.
29.
de BruinE. J.BögelsS. M.OortF. J.MeijerA. M. (2015). Efficacy of cognitive behavioral therapy for insomnia in adolescents: A randomized controlled trial with internet therapy, group therapy and a waiting list condition. Sleep, 38(12), 1913–1926. https://doi.org/10.5665/sleep.5240
30.
DevillyG. J.BorkovecT. D. (2000). Psychometric properties of the credibility/expectancy questionnaire. Journal of Behavior Therapy and Experimental Psychiatry, 31(2), 73–86. https://doi.org/10.1016/s0005-7916(00)00012-4
31.
Díaz-MoralesJ. F. (2015). Morningness–eveningness scale for children (MESC): Spanish normative data and factorial invariance according to sex and age. Personality and Individual Differences, 87, 116–120.
32.
DongL.DolsenM. R.MartinezA. J.NotsuH.HarveyA. G. (2020). A transdiagnostic sleep and circadian intervention for adolescents: Six-month follow-up of a randomized controlled trial. Journal of Child Psychology and Psychiatry, 61(6), 653–661. https://doi.org/10.1111/jcpp.13154
33.
DongL.GumportN. B.MartinezA. J.HarveyA. G. (2019). Is improving sleep and circadian problems in adolescence a pathway to improved health? A mediation analysis. Journal of Consulting and Clinical Psychology, 87(9), 757–771.
34.
DrakeC.NickelC.BurduvaliE.RothT.JeffersonC.PietroB. (2003). The pediatric daytime sleepiness scale (PDSS): Sleep habits and school outcomes in middle-school children. Sleep, 26(4), 455–458.
35.
EbesutaniC.BernsteinA.NakamuraB. J.ChorpitaB. F., The Research Network on Youth Mental Health, & WeiszJ. R. (2010). A psychometric analysis of the revised child anxiety and depression scale: Parent version in a clinical sample. Journal of Abnormal Child Psychology, 38(2), 249–260. https://doi.org/10.1007/s10802-009-9363-8
36.
FigueroaC. A.AguileraA. (2020). The need for a mental health technology revolution in the COVID-19 pandemic. Frontiers in Psychiatry, 11, 523. https://doi.org/10.3389/fpsyt.2020.00523
37.
GradisarM.DohntH.GardnerG.PaineS.StarkeyK.MenneA.SlaterA.WrightH.HudsonJ. L.WeaverE.TrenowdenS. (2011). A randomized controlled trial of cognitive-behavior therapy plus bright light therapy for adolescent delayed sleep phase disorder. Sleep, 34(12), 1671–1680. https://doi.org/10.5665/sleep.1432
38.
GradisarM.WolfsonA. R.HarveyA. G.HaleL.RosenbergR.CzeislerC. A. (2013). The sleep and technology use of Americans: Findings from the National Sleep Foundation’s 2011 sleep in America poll. Journal of Clinical Sleep Medicine, 9(12), 1291–1299. https://doi.org/10.5664/jcsm.3272
39.
GratzK. L.RoemerL. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54. https://doi.org/10.1023/B:Joba.0000007455.08539.94
40.
HarveyA. G. (2016). A transdiagnostic intervention for youth sleep and circadian problems. Cognitive and Behavioral Practice, 23(3), 341–355. https://doi.org/10.1016/j.cbpra.2015.06.001
41.
HarveyA. G.BuysseD. J. (2018). Treating sleep problems: A transdiagnostic approach. Guilford.
42.
HarveyA. G.HeinK.DolsenM. R.DongL.Rabe-HeskethS.GumportN. B.KanadyJ.WyattJ. K.HinshawS. P.SilkJ. S.SmithR. L.ThompsonM. A.ZannoneN.BlumD. J. (2018). Modifying the impact of eveningness chronotype (“night-owls”) in youth: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 57(10), 742–754. https://doi.org/10.1016/j.jaac.2018.04.020
43.
HarveyA. G.MurrayG.ChandlerR. A.SoehnerA. (2011). Sleep disturbance as transdiagnostic: Consideration of neurobiological mechanisms. Clinical Psychology Review, 31(2), 225–235.
44.
HirshkowitzM.WhitonK.AlbertS. M.AlessiC.BruniO.DonCarlosL.HazenN.HermanJ.KatzE. S.Kheirandish-GozalL.NeubauerD. N.O’DonnellA. E.OhayonM.PeeverJ.RawdingR.SachdevaR. C.SettersB.VitielloM. V.WareJ. C.Adams HillardP. J. (2015). National Sleep Foundation’s sleep time duration recommendations: Methodology and results summary. Sleep Health, 1(1), 40–43. https://doi.org/10.1016/j.sleh.2014.12.010
45.
HiscockH.MulraneyM.HeusslerH.RinehartN.SchusterT.GroblerA. C.GoldL.Bohingamu MudiyanselageS.HayesN.SciberrasE. (2019). Impact of a behavioral intervention, delivered by pediatricians or psychologists, on sleep problems in children with ADHD: A cluster-randomized, translational trial. Journal of Child Psychology and Psychiatry, 60, 1230–1241. https://doi.org/10.1111/jcpp.13083
46.
HiscockH.SciberrasE.MensahF.GernerB.EfronD.KhanoS.OberklaidF. (2015). Impact of a behavioural sleep intervention on symptoms and sleep in children with attention deficit hyperactivity disorder, and parental mental health: Randomised controlled trial. BMJ, 350, h68. https://doi.org/10.1136/bmj.h68
47.
KaufmanA. S.KaufmanN. L. (2004). Kaufman brief intelligence test (KBIT-2) (2nd ed.). Pearson.
48.
KaufmanJ.BirmaherB.AxelsonD.PerepletchikovaF.BrentD.RyanN. (2013). Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL2013, DSM-5). Western Psychiatric Institute and Yale University.
49.
LangbergJ. M.BreauxR. P.CusickC. N.GreenC. D.SmithZ. R.MolitorS. J.BeckerS. P. (2019). Intraindividual variability of sleep/wake patterns in adolescents with and without attention-deficit/hyperactivity disorder. Journal of Child Psychology and Psychiatry, 60(11), 1219–1229. https://doi.org/10.1111/jcpp.13082
50.
LangbergJ. M.DvorskyM. R.BeckerS. P.MolitorS. J. (2014). The impact of daytime sleepiness on the school performance of college students with attention deficit hyperactivity disorder (ADHD): A prospective longitudinal study. Journal of Sleep Research, 23(3), 318–325. https://doi.org/10.1111/jsr.12121
51.
LangbergJ. M.DvorskyM. R.MarshallS.EvansS. W. (2013). Clinical implications of daytime sleepiness for the academic performance of middle school-aged adolescents with attention deficit hyperactivity disorder. Journal of Sleep Research, 22(5), 542–548. https://doi.org/10.1111/jsr.12049
52.
LeBourgeoisM. K.GiannottiF.CortesiF.WolfsonA. R.HarshJ. (2005). The relationship between reported sleep quality and sleep hygiene in Italian and American adolescents. Pediatrics, 115(1 Suppl.), 257–265. https://doi.org/10.1542/peds.2004-0815H
53.
LoJ. C.LeeS. M.LeeX. K.SasmitaK.CheeN. I. Y. N.TandiJ.CherW. S.GooleyJ. J.CheeM. W. L. (2018). Sustained benefits of delaying school start time on adolescent sleep and well-being. Sleep, 41(6), zsy052. https://doi.org/10.1093/sleep/zsy052
54.
Lunsford-AveryJ. R.KrystalA. D.KollinsS. H. (2016). Sleep disturbances in adolescents with ADHD: A systematic review and framework for future research. Clinical Psychology Review, 50, 159–174.
55.
MorinC. M.VallièresA.IversH. (2007). Dysfunctional beliefs and attitudes about sleep (DBAS): Validation of a brief version (DBAS-16). Sleep, 30(11), 1547–1554.
56.
MulraneyM.SciberrasE.BeckerS. P. (2020). Sleep functioning in adolescents with ADHD. In BeckerS. P. (Ed.), ADHD in adolescents: Development, assessment, and treatment (pp. 204–227). Guilford.
57.
MuroA.Gomà-i-FreixanetM.AdanA. (2012). Circadian typology and sensation seeking in adolescents. Chronobiology International, 29(10), 1376–1382. https://doi.org/10.3109/07420528.2012.728665
58.
MyersE.StartupH.FreemanD. (2011). Cognitive behavioural treatment of insomnia in individuals with persistent persecutory delusions: A pilot trial. Journal of Behavior Therapy and Experimental Psychiatry, 42(3), 330–336.
59.
NakagawaS. (2004). A farewell to Bonferroni: The problems of low statistical power and publication bias. Behavioral Ecology, 15, 1044–1045. https://doi.org/10.1093/beheco/arh107
60.
OwensJ. A.Dearth-WesleyT.HermanA. N.OakesJ. M.WhitakerR. C. (2017). A quasi-experimental study of the impact of school start time changes on adolescents’ mood. Sleep Health, 3(6), 437–443.
61.
OwensJ. A.SpiritoA.McGuinnM. (2000). The children’s sleep habits questionnaire (CSHQ): Psychometric properties of a survey instrument for school-aged children. Sleep, 23(8), 1043–1051.
62.
SadehA.SharkeyK. M.CarskadonM. A. (1994). Activity-based sleep-wake identification: An empirical test of methodological issues. Sleep, 17(3), 201–207.
63.
SáezB.ServeraM.BeckerS. P.BurnsG. L. (2019). Optimal items for assessing sluggish cognitive tempo in children across mother, father, and teacher ratings. Journal of Clinical Child & Adolescent Psychology, 48(6), 825–839.
64.
SáezB.ServeraM.BurnsG. L.BeckerS. P. (2019). Advancing the multi-informant assessment of sluggish cognitive tempo: Child self-report in relation to parent and teacher ratings of SCT and impairment. Journal of Abnormal Child Psychology, 47(1), 35–46. https://doi.org/10.1007/s10802-018-0436-4
65.
SchlarbA. A.LiddleC. C.HautzingerM. (2011). JuSt – a multimodal program for treatment of insomnia in adolescents: A pilot study. Nature and Science of Sleep, 3, 13–20. https://doi.org/10.2147/NSS.S14493
66.
SciberrasE.MulraneyM.MensahF.OberklaidF.EfronD.HiscockH. (2020). Sustained impact of a sleep intervention and moderators of treatment outcome for children with ADHD: A randomised controlled trial. Psychological Medicine, 50(2), 210–219. https://doi.org/10.1017/S0033291718004063
67.
SciberrasE.SongJ. C.MulraneyM.SchusterT.HiscockH. (2017). Sleep problems in children with attention-deficit hyperactivity disorder: Associations with parenting style and sleep hygiene. European Child & Adolescent Psychiatry, 26(9), 1129–1139. https://doi.org/10.1007/s00787-017-1000-4
68.
SprichS. E.SafrenS. A.FinkelsteinD.RemmertJ. E.HammernessP. (2016). A randomized controlled trial of cognitive behavioral therapy for ADHD in medication-treated adolescents. Journal of Child Psychology and Psychiatry, 57(11), 1218–1226. https://doi.org/10.1111/jcpp.12549
69.
WalkerL. R.AbrahamA. A.TercyakK. P. (2010). Adolescent caffeine use, ADHD, and cigarette smoking. Children’s Health Care, 39(1), 73–90. https://doi.org/10.1080/02739610903455186
70.
WolraichM. L.LambertW.DoffingM. A.BickmanL.SimmonsT.WorleyK. (2003). Psychometric properties of the Vanderbilt ADHD diagnostic parent rating scale in a referred population. Journal of Pediatric Psychology, 28(8), 559–567. https://doi.org/10.1093/jpepsy/jsg046
71.
WosikJ.FudimM.CameronB.GelladZ. F.ChoA.PhinneyD.CurtisS.RomanM.PoonE. G.FerrantiJ.KatzJ. N.TchengJ. (2020). Telehealth transformation: COVID-19 and the rise of virtual care. Journal of the American Medical Informatics Association, 27(6), 957–962.
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