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


A total of 161 patients met inclusion criteria and were invited to participate. Of those patients, 53 enrolled and completed the innovation; 49 caregivers of identified patients declined participation in the study. (Table 1 provides a summary of the reasons for declination.) More than half of the patients identified for study were eliminated because of attrition or medication changes. Four patients were referred for polysomnography because of concerns regarding obstructive sleep apnea. (Table 2 provides a summary the sample and patient disposition.) Of the 53 patients, 30 scored 41 or less on the CSHQ. The remaining 23 scored 42 or greater on the CSHQ and received the sleep hygiene intervention. Baseline characteristics for the intervention group are provided in Table 3. The numbers of male and female study participants were nearly equal. Most received methylphenidate medication, and 61% (n = 14) used Medicaid as their primary insurance. Primary comorbid diagnoses for the intervention group included anxiety, oppositional defiant disorder, learning disability, and mood disorder. Nearly half of the children in the intervention group reported multiple "home" settings for sleep. The mean daily screen time duration for the intervention group was 3 hours; most did not have a television in their bedroom. (Table 4 provides a summary of the data listed above).

The baseline mean CSHQ score ± standard deviation was 50.13 ± 7.16. The post-CSHQ score decreased to a mean ± standard deviation of 43.74 ± 6.49 after the 6-week intervention. The decreased CSHQ score indicated a significant improvement in sleep quality after implementation of the sleep hygiene routine and a large effect size (p < .001; Cohen d = .928). The mean ± standard deviation Parent Vanderbilt score on Questions 1 through 9 was 11.39 ± 7.75 at baseline and 7.52 ± 8.41 after the intervention. The initial mean ± standard deviation Parent Vanderbilt score on Questions 10 through 18 was 9.30 ± 9.08 at baseline and 6.39 ± 8.51 after the intervention. The Parent Vanderbilt scores decreased appreciably after implementation of the 6-week sleep hygiene routine, indicating a significant decrease in ADHD behaviors (Questions 1–9: p < .001, Cohen d = .473; Questions 10–18: p = .004, Cohen d = .329). Table 5 and Table 6 summarize statistical calculations. All caregivers (N = 53) completed the Patient Satisfaction Likert Survey; 87% of the responses were positive.