The effects of a randomised-controlled group sleep improvement intervention on sleep and behavioural problems in adolescents

Introduction: As a consequence of developmental changes many adolescents have inadequate sleep. Adolescents who experience both sleep disturbance and anxiety may be at-risk for developing subsequent behavioural problems, yet intervention studies are lacking. The current study examined the efficacy of a 7-week cognitive-behavioural and mindfulness-based group sleep intervention for improving sleep and behavioural problems in at-risk adolescents using a randomised controlled design. Specifically, it investigated the extent to which intervention-related sleep improvements were associated with improvements in behavioural problems. The study also examined whether gender modified these relationships. Methods: Adolescents (12–16 years old; n = 118, 59.3% female) with elevated levels of sleep disturbance and anxiety were randomised to a sleep (treatment) intervention (n = 59) or a study skills (active control) intervention (n = 59). Assessments of subjective sleep and daytime functioning (Pittsburgh Sleep Quality Index; Paediatric Daytime Sleepiness Scale), objective sleep (actigraphy), and behavioural problems (Child Behavior Checklist–Youth Self-Report, four subscales) were conducted pre- and post- intervention. Moderated mediation analyses were performed, including an examination of the role of gender. Results: Analyses of covariance procedures showed that adolescents in the sleep intervention showed greater improvement in sleep (sleep quality, sleep onset latency and daytime sleepiness), compared to adolescents in the control intervention, with small to medium effect sizes. Males who completed the sleep intervention showed greater improvement in social problems, with a small effect size. Moderated mediation analyses revealed that, compared to the control, the sleep intervention decreased social and attention problems in males (but not females), which led to improvements in subjective and objective sleep. Conclusion: This study demonstrates the efficacy of a cognitive-behavioral and mindfulness-based group sleep intervention in improving sleep and daytime functioning in at-risk adolescents. The results support the relationship between behavioural problems and sleep, particularly in males. Future sleep interventions could target behavioural problems in adolescent males to maximise sleep improvement.