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 < 0.001; sleeping pills [k = 7]: −0.10 [-0.41, 0.22], 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 < 0.001) and sleep onset latency (overall [k = 12]: −0.41 [-0.67, −0.14], p < 0.01; sleeping pills [k = 3]: −0.68 [-1.08, −0.27], p < 0.01; ADHD drug [k = 1]: −0.39 [-0.96, 0.18], 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.