Impact of a behavioural sleep intervention on symptoms and sleep in children with attention deficit hyperactivity disorder, and parental mental health: randomised controlled trial

BMJ, 20 January 2015

Objective:  To examine whether behavioural strategies designed to improve children’s sleep problems could also improve the symptoms, behaviour, daily functioning, and working memory of children with attention deficit hyperactivity disorder (ADHD) and the mental health of their parents.

Design: Randomised controlled trial.

Intervention:  Sleep hygiene practices and standardised behavioural strategies delivered by trained psychologists or trainee paediatricians during two fortnightly consultations and a follow-up telephone call. Children in the control group received usual clinical care.

Main outcome measures: At three and six months after randomisation: severity of ADHD symptoms (parent and teacher ADHD rating scale IV—primary outcome), sleep problems (parent reported severity, children’s sleep habits questionnaire, actigraphy), behaviour (strengths and difficulties questionnaire), quality of life (pediatric quality of life inventory 4.0), daily functioning (daily parent rating of evening and morning behavior), working memory (working memory test battery for children, six months only), and parent mental health (depression anxiety stress scales).

Results:  Intervention compared with control families reported a greater decrease in ADHD symptoms at three and six months (adjusted mean difference for change in symptom severity −2.9, 95% confidence interval −5.5 to −0.3, P=0.03, effect size −0.3, and −3.7, −6.1 to −1.2, P=0.004, effect size −0.4, respectively). Compared with control children, intervention children had fewer moderate-severe sleep problems at three months (56% v 30%; adjusted odds ratio 0.30, 95% confidence interval 0.16 to 0.59; P<0.001) and six months (46% v 34%; 0.58, 0.32 to 1.0; P=0.07). At three months this equated to a reduction in absolute risk of 25.7% (95% confidence interval 14.1% to 37.3%) and an estimated number needed to treat of 3.9. At six months the number needed to treat was 7.8. Approximately a half to one third of the beneficial effect of the intervention on ADHD symptoms was mediated through improved sleep, at three and six months, respectively. Intervention families reported greater improvements in all other child and family outcomes except parental mental health. Teachers reported improved behaviour of the children at three and six months. Working memory (backwards digit recall) was higher in the intervention children compared with control children at six months. Daily sleep duration measured by actigraphy tended to be higher in the intervention children at three months (mean difference 10.9 minutes, 95% confidence interval −19.0 to 40.8 minutes, effect size 0.2) and six months (9.9 minutes, −16.3 to 36.1 minutes, effect size 0.3); however, this measure was only completed by a subset of children (n=54 at three months and n=37 at six months).

Conclusions:  A brief behavioural sleep intervention modestly improves the severity of ADHD symptoms in a community sample of children with ADHD, most of whom were taking stimulant medications. The intervention also improved the children’s sleep, behaviour, quality of life, and functioning, with most benefits sustained to six months post-intervention. The intervention may be suitable for use in primary and secondary care.

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Measuring child development at age 2 to 2.5 years

Department of Health, 6 January 2015

This factsheet explains how the ASQ-3 tool will be used to collect data for a public health outcome measure of child development at age 2.

The factsheet is for health visiting providers and others involved in the roll-out of the ASQ-3™ tool, and provides information about:

  • what the tool is
  • how it will be used
  • why it was chosen
  • accessing the tool
  • training for using the tool
  • data collection arrangements

Click here for further information and to download the factsheet.

Traumatic childhood experiences associated with chronic health problems, study finds

BMJ, 9 December 2014

Children who have had one or more traumatic experiences in childhood have higher rates of chronic disease than those who have not had such experiences, even after adjusting for factors such as race, ethnicity, and household income, a US study has found…

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Fifth of millennium babies ‘obese’ by age of 11

BBC News, 27 November 2014

One in five children born at the start of the millennium was obese by the age of 11, according to a major study.  The Millennium Cohort Study, which follows 13,000 children born in the UK, showed a sudden surge in obesity between the ages of seven and 11…

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Parents who refuse vitamin K for newborns are also likely to refuse vaccinations, Canadian study finds

The British Medical Journal, 21 August 2014

Parents who declined vitamin K prophylaxis for their newborns were more likely to have had their child at home, to have had the child delivered by a midwife, and subsequently to decline to have their children vaccinated, a Canadian study has found…

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