Improving Sleep and Daytime Functioning Among Children Diagnosed With Attention Deficit Hyperactivity Disorder (ADHD)

Parents, researchers, and clinicians have long suspected that inadequate sleep in many
children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) can exacerbate
symptoms of hyperactivity and inattentiveness, leading to further cognitive and behavioral
disruptions. Extant sleep studies report that upwards of 50% of children diagnosed with
ADHD display behaviors associated with chronic sleep disruption (in comparison to
non-diagnosed youth). Although studies have attempted to alleviate sleep difficulties, most
intervention studies have used only one treatment modality. This study will incorporate a
systematic, multi-method treatment intervention protocol that will combine behavioral and
pharmacologic strategies aimed to improve sleep functioning among children with ADHD.

The specific aims of this study are to (a) examine the effects of a structured sleep
behavioral/pharmacologic intervention protocol on improved sleep onset and efficiency, and
(b) examine how such improvements may alleviate daytime neuropsychological (i.e., response
time) and behavioral deficits associated with ADHD. The study will take place at the ADHD
Clinic. Twelve children (ages 6-12), following confirmed diagnosis of ADHD and who meet all
criteria for evaluation, and who have signed parent/child consent/assent, will be randomly
assigned to a treatment or intervention group (6 in each group, with participants matched on
age). Children in the treatment group will receive the sleep intervention protocol, while
those in the control group will receive all of the sleep, activity, and daytime assessments
on the same schedule as the treatment group, but they will not receive any of the treatment
methods.

The study will occur in four separate phases. Phase one will consist of an intake session
at the ADHD Clinic to determine eligibility for the study. Phase two will immediately
follow (for eligible participants) and will consist of a one-week baseline to gather sleep,
neuropsychological functioning and daytime behavior data. Sleep functioning will be
measured using both subjective (i.e., parent sleep logs) and objective measures (i.e.,
actigraphy), while response time will be assessed using a device that measures continuous
reaction-time performance. Attention and other ADHD-related behaviors will be collected
using parent- and teacher rating scales during baseline. Phase three, which will last 4
weeks, consists of parents of each child in the treatment group coming to the Clinic to
learn a specific sequence of interventions, first beginning with behavioral methods,
followed by melatonin (if necessary) to improve sleep functioning (80% above baseline).
Parents of children in the control group will not come to the Clinic during phase three, but
will be contacted for a brief phone interview once per week. They will be asked questions
pertaining to any changes in sleep and daytime behaviors. Finally, Phase 4 consists of
having all parents return to the ADHD Clinic, where measures administered at the end of
Baseline will be repeated. A repeated measure ANOVA using group status (control vs.
treatment) across two time points (baseline, post-sleep intervention) will assess changes in
sleep and daytime functioning over time. Although a group-by-time interaction will indicate
treatment efficacy, this is a small pilot study; the small number of participants in each
group likely precludes the power to determine this statistically. Instead, effect sizes and
subjective measures will be used to describe and justify, if appropriate, an expansion of
this study for a subsequent grant application.