(PS11-A14) A Pilot Study of a Cognitive-behavioral Sleep Intervention Specifically for Adolescents with ADHD and Sleep Problems: A Qualitative and Quantitative Evaluation

Introduction: Up to 72% of adolescents experience sleep problems, e.g. insomnia, daytime sleepiness and nonrestorative sleep, which are causally related to increased ADHD symptom impairment, oppositional, depressive symptomatology and functional impairments. Therefore, reducing sleep problems in adolescents with ADHD is an important intervention target. However, to date there are no specific sleep-focused cognitive behavioral treatments for adolescents with ADHD, although the ADHD related problems (difficulty organization, resisting immediate temptations, delay aversion, motivational difficulties) may urge the need for an ADHD specific sleep intervention. This study describes a qualitative and quantitative evaluation of a pilot study examining a cognitive behavioral sleep intervention for adolescents with ADHD, the satisfaction of participants and how they perceived the intervention and assessment procedures.

Methodology: The intervention consists of seven individually tailored sessions with the adolescent and two parental sessions. The main focus is on improving sleep hygiene in adolescents with ADHD, whilst also targeting planning and organizational difficulties related to sleep-problems, and integrating motivational interviewing throughout the manual. In the pilot study eight adolescents with ADHD and sleep problems followed the intervention and evaluated it both qualitatively (focus groups) and quantitatively (questionnaires, sleep diaries and actigraphs). The focus group data were analyzed using thematic analysis.

Results: A preliminary thematic analysis of the focus group data showed that adolescents valued that the treatment was individual/adaptable and at their own pace, while parents mentioned less feelings of incapability. One point of improvement mentioned by both was more practical tips and tricks. Reliable Change Indexes showed that all adolescents improved in at least one aspect of sleep hygiene practices. Sleep diary data and actigraph data were difficult to interpret due to non-compliance and COVID-19 measures in Belgium. Lastly, adolescents gave valuable feedback on how to improve the intervention, e.g. more structure, and the study protocol, e.g. compliance with sleep diaries and actigraphs.

Conclusion: This study supports preliminary evidence of an ADHD specific sleep-focused intervention for adolescents with ADHD. It also highlights the need for hearing the voices of adolescents and parents in designing and adapting interventions, and assessment procedures for larger scale randomized controlled trials.