An Intervention to Promote Sleep and Reduce ADHD Symptoms

Katherine H. Peppers, DNP, CPNP, CPMHS, RN; Shelly Eisbach, PhD, RN, PMHNP; Sarah Atkins, MD, MPH; James M. Poole, MD, FAAP; Anne Derouin, DNP, CPNP, RN


J Pediatr Health Care. 2016;30(6):e43-e48. 

In This Article

Abstract and Introduction


Objective: To determine the effect of a sleep hygiene education module and prescriptive sleep routine for children ages 5 through 11 years with attention deficit hyperactivity disorder (ADHD).

Methods: The 20-week pilot project used a pre–/posttest design to assess sleep and ADHD symptoms. The Child Sleep Habits Questionnaire (CHSQ) and Vanderbilt Assessment Scale–Parent Form survey were provided to assess sleep and ADHD behaviors of participants at baseline and 6 weeks after implementation of the sleep hygiene routine. Fifty-three children participated in the project. Of these, 23 scored 42 or greater on the CHSQ, indicating a sleep disorder, and received the intervention.

Results: The CHSQ and Vanderbilt scores indicated a significant improvement in sleep quality and reduction in ADHD symptoms after implementation of the sleep hygiene routine (CHSQ: p < .001, d = .928; Vanderbilt Questions 1–9: p < .001, d = .473; Vanderbilt Questions 10–18: p = .004; d = .329).

Conclusion: A provider-instructed sleep hygiene routine in children with ADHD improves sleep quality and reduces ADHD symptoms.


Attention deficit hyperactivity disorder (ADHD) is a complex neurobehavioral disorder characterized by inattention, hyperactivity, impulsivity, emotional dysregulation, and impaired learning (American Psychiatric Association, 2013). It is the most common mental health disorder among children and adolescents in the United States, affecting 6.4 million youth (11%) annually (Centers for Disease Control and Prevention, 2014). Symptoms of ADHD are often persistent and age inappropriate, and they affect multiple domains of a child's life. Children and adolescents with ADHD are at increased risk for academic failure, mental illness comorbidity, low self-esteem, risk-taking behaviors, and delinquency (Sonuga-Barke et al., 2013). Sixty percent of affected children and adolescents will have lifelong ADHD (Centers for Disease Control and Prevention, 2014).

Sleep is foundational to a child's physical, mental, and social growth and development (Mindell et al., 2011). The prevalence of sleep disorders is 25% to 40% among healthy children but increases to 70% to 90% among those with mental health issues, such as ADHD (Mindell, Meltzer, Carskadon, & Chervin, 2009). Disordered sleep is associated with reduced cognitive function, inattention, problematic behavior, progressive psychopathology, and attenuated emotional regulation (Matricciani, Olds, & Petkov, 2012). These behaviors often mirror the symptoms of ADHD; therefore, it is imperative to assess sleep before diagnosing ADHD (Cortese et al., 2013).