(C-010) Effectiveness of non-pharmacological interventions for insomnia in children and young adolescents with attention deficient hyperactivity disorder (ADHD): A systematic review and meta-analysis.

Background: Attention deficient hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder characterised by impulsivity and hyperactivity symptoms. The prevalence of sleep disturbances in children and young adolescents with ADHD is 40-80%, with linked effects on psychosocial quality of life and daily function.

Objectives: To synthesis evidence of the effect of behavioural interventions in improving sleep amongst children and young adults with ADHD.

Methods:

Design: systematic review and meta-analysis
Setting: seven electronic databases (MEDLINE, PsycINFO, CINAHL Complete, EMBASE, Web of Science, ClinicalTrials.gov and Current Controlled Trials) were searched in accordance with the preferred reporting items for systematic review, from inception to December 2024. Exposure: children and young adolescent (5-15-years of age) who met criteria and confirmed a diagnosis attention-deficit hyperactivity disorder (ADHD) and diagnosis of sleep-disorder or average score on a validated sleep disturbance scale indicating sleep issues at baseline. Studies of behavioural interventions targeting sleep compared with concurrent control that reported relevant sleep outcome measures were eligible. Main outcomes: the primary outcome was a mean difference in total sleep duration, secondary outcomes included sleep latency and sleep efficiency. Statistical analysis: the summary measure of treatment effect for both primary and secondary outcomes was the between groups difference in sleep outcomes, expressed as mean difference (MD). Random-effects models were used in all meta-analyses. Statistical heterogeneity was assessed using the I2 test, which described the percentage of variability among effect estimates beyond that expected by chance.

Results: Eight studies met the inclusion criteria and were included. There were significant differences between behavioural intervention and comparison control for overall sleep time (26.61 minutes, 95%CI 5.21, 47.11, P=0.01), sleep latency (-15.21 minutes, 95% CI-28.74, -4.88, P=0.003) and sleep efficiency (4.69%, 95% CI 0.79, 11.31, P=0.03). Bias risk was low across a number of important factors (randomisation, allocation concealment and reporting), with few studies with unclear results due to poor reporting.

Conclusions: High quality randomised controlled trials that assesses non-pharmacological interventions for insomnia in children and adolescents with ADHD are very scant. This study provide the synthesis of evidence for the effectiveness of behavioural interventions for managing sleep disturbances in children and adolescent with ADHD.