The influence of existing interventions on sleep of youth with attention-deficit/hyperactivity disorder: A meta-analysis of randomized controlled trials

Sleep problems are commonly observed among children and adolescents with attention-deficit/hyperactivity disorders (ADHD). We completed a literature search by 2025-6-9 on EBSCOhost, PubMed, Web of Science, and Scopus to quantify the effects of any existing interventions on sleep outcomes among children/adolescents with ADHD. From a pool of 4081 studies, 40 randomized controlled trials (RCTs; 75% with low-risk-of-bias, 4361 participants and 65.2% attended interventions) were eligible for a pairwise meta-analysis (PWMA). Of these, 28 RCTs were included in a Bayesian network meta-analysis (NMA). Results were yielded from both mean change and post-test measurement of the outcomes if available. In PWMA (moderate-to-high certainty), the examined interventions had small and significant effects on sleep disturbance (standardized mean difference SMD by mean change 95% CI: overall k=29: -0.30 -0.42, -0.17, p 0.05; ADHD drugs k=6: -0.25 -0.52, 0.01, p >0.05; behavioral sleep BS interventions k=10: -0.48 -0.70, -0.27, p 0.05; BS interventions k=5: -0.36 -0.88, 0.16, p >0.05). The examined interventions did not have significant effects on sleep efficacy, sleep duration, latency to persistent sleep or daytime sleepiness. Results of NMA showed that sleeping pills had the best performance in shortening SOL, while BS interventions may be the best choice for reducing sleep disturbance. However, more rigorous evidence is warranted. This review indicates that a multi-component and tailored-designed intervention represents important personalized strategies for improving sleep in youths with ADHD. Practice points • Sleep problems are prevalent in children and/or adolescents with ADHD. • Existing interventions for children and/or adolescents with ADHD, which were assessed by randomized controlled trials and screened for eligibility of inclusion, were quantified based on the sleep outcomes of participants in this meta-analysis. • Pairwise meta-analyses indicated that existing interventions were likely to reduce sleep disturbance and sleep onset latency, but were unlikely to change sleep efficacy, sleep duration, latency to persistent sleep, or daytime sleepiness. • Network meta-analysis estimated that sleeping pills and behavioral sleep intervention would achieve the best performance on reducing sleep onset latency and sleep disturbance, respectively. Research agenda • Future studies should explore the effect of different types interventions on sleep of children and/or adolescents with ADHD according to their clinical situation (e.g., age, sex, subtypes of ADHD, comorbidity, intellectual quality, and familial socio-economic status). • Future studies should investigate whether there is additive or synergetic effect of combining different types of interventions on the quality of sleep of children and/or adolescents with ADHD. • Future studies should develop an effective strategy or algorithms to design a tailored/personalized sleep intervention for young individuals with ADHD.