A journey to better sleep for adolescents with ADHD: Development and evaluation of an ADHD-adapted sleep intervention for adolescents with ADHD

Sleep is a vital natural process that is necessary for maintaining both physical and mental health as well as psychosocial and cognitive functioning. Compared to adolescents without ADHD, adolescents with ADHD experience more sleep problems. As sleep problems have been shown to be related to several negative outcomes, the need for a sleep intervention for this target group is apparent. Considering the specific challenges that adolescents with ADHD encounter, it is likely necessary to modify interventions towards this developmental phase and condition. Therefore, this dissertation aimed to provide insight in the sleep of adolescents with ADHD, with the broader goal of developing, evaluating, and testing the effectiveness of a sleep intervention to improve their sleep.

In Chapter 1, a theoretical overview is provided of sleep and sleep problems of adolescents with ADHD, existing sleep interventions, and their limitations regarding the specific needs of adolescents with ADHD. Building on this, Chapter 2, summarizes the findings of sleep research in adolescents with compared to without ADHD in a systematic review and meta-analysis. Findings show that adolescents with ADHD have significantly more subjectively measured disturbed sleep parameters and sleep problems compared to adolescents without ADHD.

Chapter 3 addresses a qualitative and quantitative evaluation of a sleep intervention adapted to the specific needs of adolescents with ADHD and sleep problems: Sleep IntervEntion as Symptom Treatment for ADHD - SIESTA. The pilot version of SIESTA was positively evaluated by adolescents and their caregivers, and was deemed effective in improving sleep hygiene. SIESTA and the research procedure was fine-tuned based on the information from focus groups with adolescents and caregivers who received SIESTA. The finalized protocol for a randomized controlled trial (RCT) to test the effectiveness of SIESTA is outlined in Chapter 4. Chapter 5 details the RCT, where 92 adolescents with ADHD and co-occurring sleep problems were randomly assigned to either receive SIESTA next to treatment as usual for ADHD (SIESTA+TAU) or TAU only. Results show that SIESTA+TAU was more effective than TAU only in improving sleep hygiene, reducing self-reported sleep problems, and depressive symptoms in adolescents with ADHD and co-occurring sleep problems in the short term, whilst in the longer term only an effect on sleep hygiene remained. Chapter 6 concludes the dissertation with a broad overview and discussion of the findings. Important theoretical and clinical implications are discussed and suggestions for future research are made.