ADHD, Sleep Problem
Conditions
Keywords
Cognitive Behaviour Therapy, Psychological Intervention
Brief summary
Cognitive Behavioral Therapy (CBT) is treatment of choice for insomnia (CBT-i). Many patients in psychiatric care have sleep problems including insomnia, but are rarely given the choice to participate in CBT to improve their sleep. Patients with ADHD is a patient group with high levels of sleep difficulties. Sleep problems in this patient group can be both more general such as insomnia, but can also be related to the ADHD itself and to the use of ADHD medication. In a previous pilot study, the investigators developed a version of CBT-i that would target sleep problems in this population. The basis was CBT-i, but with more emphasis on sleep promoting behaviors specific to ADHD (e.g. appropriate timing of ADHD-medication), techniques that would also alleviate sleep phase problems, (e.g. the systematic use of light and darkness), and techniques to target more general sleep disturbing habits (e.g. not winding down before bed time), that are also common in patients with ADHD. This treatment was well tolerated and gave moderate effects on insomnia severity in the pilot study. In a naturalistic randomized controlled trial, the investigators now evaluate the effects of this psychological treatment on sleep and symptoms of ADHD in patients at the ADHD-clinics, Northern Stockholm Psychiatry, Sweden.
Interventions
BEHAVIORALAdjusted CBT-i for ADHD
This is a version of CBT for insomnia (CBT-i) developed during the pilot phase of this Project. Traditional CBT-i is adjusted for use in the adult ADHD population. This behavioral intervention adresses not only traditional aspects of insomnia, but also sleep phase problems and other aspects of sleep specifically relevant to the ADHD-population. Treatment is given as 10 weekly group sessions with telephone calls from the therapist between sessions to increase adherence and adress individual patient needs.
OTHERTreatment as Usual
Usual care at the ADHD-clinic. This mostly entails managing pharmacological treatment for ADHD, comorbid psychiatric problems and/or sleep problems. The clinic also provides different group treatments, for instance mindfulness groups and groups for developing behavioral strategies for managing ADHD symptoms, and individual therapy.
Sponsors
Department of ADHD, Northern Stockholm Psychiatry
Karolinska Institutet
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Being a patient at the ADHD-clinics Northern Stockholm Psychiatry * Experiencing sleep problems (subjective report)
Exclusion criteria
* None
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Insomnia Severity Index | Changes from base-line to 10 weeks and 3 months | 7-item, self-rated questionnaire measuring change in insomnia severity. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Actigraphy | Continuously from treatment start (week 1) to the last week of treatment (week 10) | An actigraph is placed on the participant's arm for one week. It measures participants' activity in the form of movements. It can be used for acquiring data on sleep and daytime activity, including calculated sleep latency, total sleep time, sleep efficiency, wake after sleep onset, variability in sleep timing and daytime activity. |
| Sleep diary | Changes from base-line to 10 weeks and 3 months | Daily self-ratings on a number of sleep parameters, resulting in several measures including sleep latency, wake after sleep onset, total sleep time, sleep efficiency, subjective sleep quality and variability in sleep timing |
Other
| Measure | Time frame | Description |
|---|---|---|
| Dysfunctional Beliefs and Attitudes about Sleep | Changes from base-line to 10 weeks and 3 months | 10-items self-rating questionnaire measuring sleep related cognitions. |
| Sleep Problems Acceptance Questionnaire | Changes from base-line to 10 weeks and 3 months | 8-items self-rating questionnaire measuring acceptance of sleep problems. |
| Sleep habits and behaviors | Changes from base-line to 10 weeks and 3 months | Self-rating questionnaire regarding the use of sleep promoting behaviors. The questionnaire was constructed for the current project and consists of two parts. The first part includes 16 statements such as Last week I got out of bed within 15 minutes of waking up to be answered by number of days the last week this was true (i.e. from 0 to 7). The other part is to be answered on a 6-point Likert scale from Not at all true to Entirely true, with 7 statements like I get out of bed the same time every morning. |
| Brunnsviken brief quality of life scale | Changes from base-line to 10 weeks and 3 months | 12-items self-rating questionnaire measuring quality of life. |
| Adult ADHD Self-Report Scale | Changes from base-line to 10 weeks and 3 months | 18-items self-report questionnaire measuring ADHD-symptoms. |
Countries
Sweden
Outcome results
None listed