Dyssomnias in children with ADHD : behavioural family interventions.

Sleep disturbances are extremely common among children with Attention Deficit Hyperactivity Disorder (ADHD) and are reported to occur more frequently than in typically developing children. These sleep problems are likely to be highly stressful for family members and may have adverse effects on the well-being of both the child and parents. Unfortunately, there is a paucity of research investigating the development and efficacy of behavioural management strategies to treat the sleep disturbances of children with ADHD. This study used a multiple baseline design across participants to examine the effects of individualized behavioural family interventions in treating the inappropriate bedtime behaviour and sleep disturbances presented by four children (aged 5-11 years) diagnosed with ADHD. Assessment data suggested that sleep disturbances were reinforced and maintained by parental attention. The behavioural strategies implemented to treat the sleep problems were comprised of standard extinction procedures involving differential reinforcement of inappropriate and appropriate behaviours, positive reinforcement programmes, a structured positive bedtime routine and a response cost procedure. Results showed that the multiple sleep problems presented by these four children, including bedtime disturbances, sleep onset delay, night wakings, bedtime non-adherence and co-sleeping, were reduced as a function of their respective individual behavioural interventions. Sleep and behavioural improvements were mostly maintained at 3 months follow-up. Generalized positive effects on the child's daytime behaviour, changes in parental mood, increased parental sleep and increased confidence in parenting skills were also reported following completion of the sleep intervention programmes. These findings indicate that behavioural management strategies are an effective method to alleviate and/or eliminate sleep disturbances experienced by children with ADHD. Implications for the assessment and treatment of sleep disturbances in this special needs paediatric population are discussed as well as recommendations for current clinical practice and future research