REVIEW OF: Kamara D et al, J Pediatr Psychol 2025;50(7):633–657

STUDY TYPE: Systematic review and meta-analysis of RCTs

Sleep problems are the rule, not the exception, for children with ADHD, autism, epilepsy, and chronic medical illness. This meta-analysis asks a practical question: Do behavioral sleep interventions actually work in these kids?

Researchers reviewed 15 RCTs involving nearly 1,400 children ages 0–18 with neurodevelopmental or medical conditions (n = 1,374; 78% male; 71% White). Interventions included CBT-based approaches, other behavioral approaches (eg, extinction, chronotherapy, faded bedtime), parent training, and sleep hygiene education. Outcomes focused on sleep quality, bedtime behaviors, and sleep duration, with both short-term and follow-up data.

These nonpharmacologic interventions led to meaningful improvements in subjective sleep outcomes. Sleep satisfaction and perceived sleep quality improved moderately after treatment and remained better at follow-up. Bedtime resistance improved, though gains faded over time.

Sleep duration told a more mixed story. Objective measures like actigraphy showed little change, but parent-reported sleep duration increased at follow-up. There was also a small, short-term reduction in ADHD symptoms, which did not persist.

No studies reported adverse effects, but the overall study quality was only modest, with risk of bias common across trials.

CARLAT TAKE
This is another reminder to avoid jumping to medication. Nonpharmacologic sleep interventions are worth trying even when a child has ADHD, autism, or a chronic medical condition, and the risk is essentially zero. Be upfront with families: The goal of individualized care is fewer bedtime battles and better sleep by parent report, although they are unlikely to see a real change in total sleep hours. If progress fades, revisiting the approach is reasonable.