Cognitive and Behavioral Effects of Sleep Restriction in Adolescents With ADHD
Condition: Attention Deficit Hyperactivity Disorder
MeSH terms: Attention Deficit Disorder with Hyperactivity
Study type: Interventional

Summary: 
      Adolescents with attention-deficit/hyperactivity disorder (ADHD) obtain less sleep than their
      typically developing peers. Observational studies indicate that inadequate sleep is
      correlated with impairment in adolescents with ADHD, but it remains unknown if sleep is
      causally related to impairment. This study will use an experimental sleep restriction and
      extension protocol to evaluate sleep as a contributor to clinically significant impairment
      and possible target for intervention in adolescents with ADHD.
    

Detailed description: 
      Teens with attention-deficit/hyperactivity disorder (ADHD) obtain less sleep than their
      peers, with up to 75% of youth with ADHD obtaining insufficient sleep. This is noteworthy
      since insufficient sleep is associated with a multitude of negative outcomes in typically
      developing teens, including academic underachievement, emotion dysregulation, and mental
      health problems - all outcomes that occur at higher rates among teens with ADHD. Our pilot
      work demonstrates that insufficient sleep is correlated with depression, behavior problems,
      and academic impairment in teens with ADHD specifically and insufficient sleep is clearly
      associated with greater attentional problems in typical teens. However, no experimental study
      has examined whether sleep duration is causally linked to attentional, behavioral, emotional,
      and academic impairments in teens diagnosed with ADHD. If sleep problems contribute to
      functional impairments in teens with ADHD, then they represent an overlooked treatment
      target. Experimental studies provide the strongest test of causality, and studies using
      at-home sleep restriction protocols in teens without ADHD show a causal link between
      shortened sleep duration and impairment. However, administering an at-home sleep restriction
      protocol may be especially challenging for teens with ADHD due to their difficulties with
      organizing bedtime and wake activities, as well as differences from healthy teens in
      biological circadian preference. Thus, a critical first step in examining sleep as causally
      related to impairment in teens with ADHD is documenting the feasibility of using an at-home
      sleep restriction protocol with this population. This study will (1) evaluate the feasibility
      of using an at-home sleep restriction protocol in teens with ADHD, and (2) collect
      preliminary data examining whether shortened sleep duration is causally linked to
      attentional, behavioral, emotional, and academic impairment in teens with ADHD. These goals
      will be accomplished by recruiting 54 teens with ADHD who will undergo a three-week sleep
      manipulation protocol. Specifically, a cross-over design will be used that includes a week of
      typical sleep followed by weeks of sleep restriction or sleep extension. Sleep functioning
      will be assessed during these three weeks with daily sleep diary and objective sleep
      measurement (i.e., actigraphy). After each sleep condition, teens and their parents will
      complete subjective and objective measures of attention, behavior, mood, and academics.
      Findings from this study will allow us to identify and address barriers to administering an
      at-home sleep restriction and extension protocol to teens with ADHD and pursue larger-scale
      experimental research examining sleep problems as causally linked to impairment. This
      research is clinically significant since teens with ADHD frequently experience a range of
      impairments that extend well into adulthood. If short sleep duration contributes to
      functional impairments in teens with ADHD, then sleep represents a modifiable and overlooked
      treatment target.
    

Intervention name(s): Healthy Sleep Duration; Shortened Sleep Duration
Intervention type(s): Behavioral; Behavioral
Intervention description(s): This study examines healthy sleep duration as related to improved functioning in adolescents with ADHD. Adolescent participants will be instructed to go to bed at a time such that they are able to obtain 9 hours of nightly sleep (9.5 hours in bed, leaving up to ½ hour to fall asleep). Researchers will work with the adolescent and their family to problem-solve how to accomplish this sleep duration goal.; This study examines shortened sleep duration as related to poorer functioning in adolescents with ADHD. Adolescent participants will be instructed to go to bed at a time such that they are in bed for 6.5 hours per night. Researchers will work with the adolescent and their family to problem-solve how to accomplish this sleep duration goal.
Intervention MeSH terms: Oxymetazoline
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Basic Science
Keywords: ADHD; Sleep; Attention; Adolescence