Changes in sleep problems across attention-deficit/hyperactivity disorder treatment: Findings from the multimodal treatment of attention-deficit/hyperactivity disorder study

Emily J. Ricketts, Alexandra Sturm, Dana L. McMakin, Joseph McGuire, Patricia Z. Tan, Fallon B. Smalberg, James T. McCracken, Christopher S. Colwell, John Piacentini

Research output: Contribution to journalArticle

Abstract

Objective: Stimulant medication and behavior therapy are efficacious for youth with attention-deficit/hyperactivity disorder (ADHD). However, research suggests that stimulants may start and/or worsen sleep problems for youth. Further, the impact of behavior therapy for ADHD on sleep is unknown. This study examined the frequency of sleep problems and effects of stimulant medication, behavior therapy, and their combination on sleep problems in youth with ADHD. This study also explored the influence of dimensional baseline ratings of ADHD symptom subtype and psychiatric comorbidity on sleep outcomes. Methods: Participants were 576 children (aged 7-9 years) with ADHD-Combined type from the Multimodal Treatment of ADHD study that compared methylphenidate, behavior therapy, and their combination to community care. Before treatment, parents completed the Child Behavior Checklist used to derive a total sleep problems score. Parents also completed ratings of oppositionality and ADHD symptom severity, whereas youth completed ratings of depression and anxiety. These ratings were readministered after treatment. Results: General linear mixed-effects models were used to assess change in total sleep problems across treatment. The combined group exhibited a statistically significant reduction in total sleep problems (z =-5.81, p < 0.001). Reductions in total sleep problems in methylphenidate (z =-3.11, p = 0.05), behavior therapy (z =-2.99, p = 0.08), or community care (z =-1.59, p > 0.99) did not reach statistical significance. Change in psychiatric symptoms did not significantly moderate change in total sleep problems by treatment assignment. Greater baseline oppositional defiant disorder severity predicted less reduction in total sleep problems, χ2(1) = 3.86, p < 0.05. Conclusions: Findings suggest that combination of methylphenidate and behavior therapy is efficacious for reducing parent-reported sleep problems in young children with ADHD-Combined type relative to community care. However, potential ameliorative effects of monotherapy treatments (i.e., methylphenidate, behavior therapy) should be examined. Future replication is needed to confirm findings.

Original languageEnglish (US)
Pages (from-to)690-698
Number of pages9
JournalJournal of Child and Adolescent Psychopharmacology
Volume28
Issue number10
DOIs
StatePublished - Dec 1 2018

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Combined Modality Therapy
Attention Deficit Disorder with Hyperactivity
Sleep
Behavior Therapy
Methylphenidate
Therapeutics
Psychiatry
Parents
Attention Deficit and Disruptive Behavior Disorders
Child Behavior
Checklist
Comorbidity
Anxiety
Depression

Keywords

  • attention-deficit/hyperactivity disorder
  • behavior therapy
  • oppositional defiance
  • sleep
  • stimulant medication

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Psychiatry and Mental health
  • Pharmacology (medical)

Cite this

Changes in sleep problems across attention-deficit/hyperactivity disorder treatment : Findings from the multimodal treatment of attention-deficit/hyperactivity disorder study. / Ricketts, Emily J.; Sturm, Alexandra; McMakin, Dana L.; McGuire, Joseph; Tan, Patricia Z.; Smalberg, Fallon B.; McCracken, James T.; Colwell, Christopher S.; Piacentini, John.

In: Journal of Child and Adolescent Psychopharmacology, Vol. 28, No. 10, 01.12.2018, p. 690-698.

Research output: Contribution to journalArticle

Ricketts, Emily J. ; Sturm, Alexandra ; McMakin, Dana L. ; McGuire, Joseph ; Tan, Patricia Z. ; Smalberg, Fallon B. ; McCracken, James T. ; Colwell, Christopher S. ; Piacentini, John. / Changes in sleep problems across attention-deficit/hyperactivity disorder treatment : Findings from the multimodal treatment of attention-deficit/hyperactivity disorder study. In: Journal of Child and Adolescent Psychopharmacology. 2018 ; Vol. 28, No. 10. pp. 690-698.
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