Treating Insomnia in Children with ADHD

Insomnia commonly complicates the clinical presentation and treatment in children with ADHD.

Stimulant therapy may provide significant relief for daytime attention and hyperactivity symptoms. However, stimulants do not appear to help with comorbid insomnia. In fact, stimulant therapy may cause more problems with insomnia in ADHD.

Behavioral treatments are known to be effective in children without ADHD. Now we have a recently published study showing the effectiveness of behavioral treatment of insomnia in children with ADHD.

Harriet Hiscock and colleagues from Australia conducted a randomized controlled trial of behavioral treatment in 244 children with ADHD between 5 and 12 years of age.

The primary elements of the behavioral intervention included:

• Two direct consultations with a psychologist or pediatrician
• One phone follow up consultation
• Education on sleep, sleep cycles and sleep cues
• Sleep hygiene instruction, i.e. set sleep time, limit caffeine after 3 pm

A novel element in this study was to not limit outcome measures to sleep variables but also to look for changes in ADHD symptoms. The authors were able to identify the following key findings in their study:

• Intervention children had fewer sleep problems at 3 and 6 months
• Intervention children also had greater improvement in ADHD symptoms
• Improved sleep appeared to mediate up to 50% of improvement in ADHD symptoms
• Actigraphy (sleep monitoring device) showed 10 minutes longer sleep per night in the intervention group
• Teachers were also able to identify improvement in the children with the sleep intervention

Another important finding was the relatively small number needed to treat for significant benefit in this study: four. This suggests a strong therapeutic effect that deserves consideration for the general childhood ADHD population.

This is an important study with significant implications for treatment and further research. This is re-enforced by lack of safe and effective drug treatment for insomnia in children.

Readers with more interest in this study can access the free full-text manuscript by clicking on the PMID link below.

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Hiscock H, Sciberras E, Mensah F, Gerner B, Efron D, Khano S, & Oberklaid F (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 (Clinical research ed.), 350 PMID: 25646809