Sleep and anxiety: key to ADHD treatment

One of Australia’s leading researchers on Attention Deficit Hyperactivity Disorder (ADHD), Dr Emma Sciberras, has shown that interventions targeting sleep and anxiety can improve the quality of life for children with ADHD - and their future prospects.

With symptoms such as inattention, impulsivity, and hyperactivity, the condition affects nearly 300,000 young people in Australia, and at least 63 million worldwide. Compared with their healthy peers, these children are at increased risk of academic underachievement, drop out from school, risk taking behaviours, and psychiatric difficulties.

A clinical psychologist, Dr Sciberras has just received her third National Health and Medical Research Council (NHMRC) grant as lead investigator in four years to continue her ground-breaking work. Her main research in this area began in 2009 with testing the feasibility of establishing Australia’s first community-based ADHD cohort study.

Gaining international attention in the “British Medical Journal” in January 2015, the intervention she has contributed to, in collaboration with Associate Professor Harriet Hiscock from the Murdoch Childrens Research Institute, has the potential to make a difference to children with ADHD around the world. The intervention focusses on strategies such as implementing better bedtime routines, reducing caffeine intake and reducing use of electronic media.

“Through giving children with ADHD a better night’s sleep, we have discovered that we can improve their classroom behaviour, daily functioning, working memory, and their parents’ mental health, which may improve their long-term prospects,” Dr Sciberras said.

“ADHD is an intriguing condition, particularly because of the variety of symptoms experienced. Many children with ADHD experience problems with sleep and anxiety, which seem to make daily functioning more difficult.”

Her team is currently developing an extension to the original sleep intervention designed for primary school aged children, for adolescents with ADHD. As a first step, they are currently surveying adolescents with and without ADHD to better understand their sleep patterns.

In relation to anxiety, children with ADHD are also at greater risk of anxiety disorders, which could impinge on their ability to cope with school and socialisation at important times of their development, also potentially affecting their long-term quality of life.

“Cognitive behaviour therapy can help children to develop better coping skills,” explained Dr Sciberras. “We try to make these activities engaging, visual and fun, so the children are supported, in small steps, to face their fears. Our pilot project showed very good results, with a marked reduction in inattention.”

“Medication often works well to treat the core symptoms of inattention and hyperactivity, but we have shown that improving sleep and anxiety can further improve outcomes,” she added.

“It is also important to share good messages about ADHD, and emphasise that a good proportion of kids with ADHD are doing pretty well.”

Dr Sciberras received a four-year NHMRC Early Career Fellowship in 2012, followed by an $850,000 NHMRC Project Grant last year and she has just received a four-year NHMRC Career Development Fellowship.

These grants are supporting a suite of five large cohort and intervention studies, including a longitudinal study of 500 Victorian children, around half of whom have ADHD. Now 10, the children received their first assessment at seven and are being assessed every 18 months as they transition to adolescence.

Dr Sciberras joined Deakin’s Centre for Social and Early Emotional Development (SEED) and the Deakin Child Study Centre last year from the Murdoch Childrens Research Institute (MCRI). She currently leads a team of 20 researchers and students on ADHD-related research. She continues to be affiliated with MCRI as an Honorary Research Fellow.

“By focusing on trajectories, as well as modifiable risk and protective factors, this research will result in significant advances in intervention for ADHD, addressing critical questions of when to intervene, with whom, and how,” she said.