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


Study participants receiving sleep hygiene interventions had a significant reduction in ADHD symptoms and a significant improvement in sleep quality. The results substantiate the benefits of assessing sleep and instructing parents on clinical guideline-based behavior interventions incorporated into a sleep hygiene routine. The intervention was cost effective, conducive to a busy clinical setting, and easily tailored for use in pediatric primary care. The project showed the ease of assessing and treating sleep difficulties among children with ADHD and established documentation of interventions in the electronic medical record, to facilitate sharing with treatment team members and caregivers. The associated cost of assessing and treating sleep difficulties equated to provider and staff time; provider time totaled an additional 10 minutes/visit, and staff time totaled an additional 5 minutes/visit. Standardized sleep assessment and the provision of the prescriptive sleep hygiene routine occurred during routine office visits.

Strengths of the study included careful exclusion criteria for patients with medication changes, pharmaceutical and alternative sleep aids, and symptoms of obstructive sleep apnea. Additional strengths were modeling implementation of the clinical practice guideline, embedding the sleep hygiene routine in the electronic medical record, instructing a patient-specific sleep hygiene routine, and use of a brief standardized video. Each of the features shows the ease of replication of this project in other pediatric clinics. Although the overall sample size was acceptable (N = 53), convenience sampling was used to obtain the participants, and the innovation group had only 23 participants, limiting the generalizability.

We were surprised by the significant number of caregivers who declined to participate in this intervention. Most parents/caregivers who declined cited lack of time or their inability to implement the sleep hygiene routine in their home. As providers, we need to acknowledge how time requested for study participation, whether real or perceived by families, affects their willingness to participate in a collaboratively developed, individualized treatment plan. As the sleep hygiene innovation evolves in our clinical settings, we will consider providing sleep assessment surveys via electronic mail or before the follow-up visit, to decrease in-office time requirements and improve participation. We will also offer the sleep intervention to all children with ADHD who score 42 or greater on the CHSQ in an effort to improve sleep hygiene and reduce the effects of disordered sleep.