Up to 73% of children with ADHD struggle with chronic insomnia, yet the NHS typically offers only melatonin rather than behavioural sleep support. This project will develop and test a digital, parent-guided sleep intervention for children aged 6–12 with ADHD, comparing its cost-effectiveness against standard care in a randomised trial involving 334 families. The problem is that face-to-face behavioural sleep interventions work but are too resource-intensive for the NHS. Meanwhile, melatonin is often prescribed as a one-size-fits-all solution, and clinicians rarely receive training in sleep management for ADHD. The researchers will also create an ADHD-specific sleep screening questionnaire and e-learning tools for clinicians, co-produced with parents and professionals. If the digital intervention proves cost-effective, it could be rapidly rolled out to an estimated 110,000 UK children with ADHD and chronic insomnia. This would offer families a practical, scalable alternative to medication, potentially improving children’s sleep, behaviour, and parental well-being without adding strain on NHS resources. The screening tools and clinician training could also shift how sleep problems in ADHD are routinely identified and managed.
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Research question: Is a novel digital parent-guided behavioural intervention for chronic insomnia in children with Attention-Deficit/Hyperactivity Disorder (ADHD) significantly more cost-effective than treatment-as-usual (TAU) to improve sleep and relevant outcomes (e.g., child behaviour and parental well-being)? Background: ADHD affects about 3-6% of UK children, of whom up to 73% have sleep problems, increasing the burden of the disorder. In the UK, the commonest sleep problem in ADHD - chronic insomnia - is inadequately managed. Professionals rarely receive training in sleep and often prescribe melatonin as a one-size-fits all approach. Face-to-face behavioural sleep interventions are effective to manage insomnia in children with ADHD but their implementation is challenging in a resource-limited NHS. Aims and objectives: to appraise the evidence on the efficacy/effectiveness of behavioural sleep interventions in children (work package, WP1, months 0-12); to develop A) an adapted sleep screening questionnaire for children with ADHD and B) e-learning for clinicians on sleep problems in ADHD (WP2 months 0-18); to develop a novel digital behavioural intervention for chronic insomnia in children with ADHD (WP3, months 6-30); to test the cost-effectiveness of the digital behavioural intervention versus TAU in a randomised controlled trial (RCT) with a 9-month internal pilot (WP4, months 24-66). Methods: WP1: We will synthesise the evidence on non-pharmacological interventions for chronic insomnia in children through an umbrella review. WP2: Parents of 300 children with ADHD, aged 6-12y, will complete the Omnibus Sleep Questionnaire and the ADHD Swanson Nolan & Pelham Scale. An ADHD-specific sleep questionnaire will be generated, removing items with significant overlap between the questionnaires. Validity will be assessed using actigraphy in 150 children and test re-test reliability assessed. Supportive clinician e-learning tools will be co-produced with users within a Health E-Learning and Media centre. WP3: The novel digital parent-guided behavioural intervention will be developed with parents and carers, informed by WP1, using the Person-Based Approach and behavioural analysis, supported by Mindtech expertise (https://www.mindtech.org.uk/). WP4: Children with ADHD and chronic insomnia aged 6-12y and their families (n=334) will be recruited to a multicentre RCT from NHS clinics, foster care services, and parent support networks, sampling for under-represented populations. Children will be randomised 1:1 to digital intervention or TAU. The primary outcome - sleep onset latency, based on parent-completed sleep diaries- will be measured 3 and 6-months post-randomisation. Secondary outcomes will include ADHD symptom severity, behavioural and emotional functioning, neurocognitive variables, quality of life, and parental sleep and well-being. A within-trial cost-effectiveness analysis will be extended to model long-term costs and quality adjusted life years for the digital intervention versus TAU. WP5: Process evaluation will measure engagement with WP2 outputs and the digital intervention. Public and patient involvement will inform the development, conduct, evaluation, and dissemination of the programme. Anticipated impact and dissemination: Stakeholder involvement (e.g., professional bodies, parent support groups, local authorities, NHS commissioners and providers) will ensure rapid implementation of WP2 outputs - sleep questionnaire (host - https://www.acamh.org/) and clinician e-learning (host - https://www.nottingham.ac.uk/helm/home.aspx). A cost-effective digital intervention would be rapidly available at scale to 110,000 UK children.
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