Comparing the Efficacy of Cognitive Behavior Therapy and Pharmacological Intervention of Clonidine for Improving Sleep Quality in Adolescents with ADHD and Insomnia

Comparing the Efficacy of Cognitive Behavior Therapy and Pharmacological Intervention of Clonidine for Improving Sleep Quality in Adolescents with ADHD and Insomnia Student Name University Course Professor Name Date Table of Contents Abstract……………………………………………………………………………………….3 Statement of the Problem……….….………….……………………………………………...4 Background Information……………………………………………………………………...4 Clinical Question………………………………………………………………………….….6 Purpose of the Study………………………………………………………………………….7 Summary………………………………………………………………………………….…..7 Literature Review….………………………………………………………………………….9 Search for Evidence ………………………………………………………………………….9 Search Terms ………………………………………………………………………………..12 Databases ……………………………………………………………………………………14 Revalence ……………………………………………………………………………………18 Summary …………………………………………………………………………………….19 Discussion………………………………………………………………………………….. 20 Conclusion………………………………………………………………………………….. 23 References …………………………………………………………………………………...26 Abstract The healthcare system has been evolving with the emergence of numerous psychiatric infections affecting many people around the world. Insomnia is such an illness that co-occurs with multiple mental health disorders, including attention-deficit/hyperactivity disorder. This paper aims to develop an effective treatment intervention and compares the pharmacological treatment of Clonidine and the therapy intervention of cognitive-behavioral therapy (CBT). Keywords: ADHD, adolescence, CBT, insomnia, clonidine Comparing the Efficacy of Cognitive Behavior Therapy and Pharmacological Intervention of Clonidine for Improving Sleep Quality in Adolescents with ADHD and Insomnia Chapter 1: Introduction Statement of the Problem This project addresses the problem of a lack of an effective treatment intervention to manage insomnia symptoms in adolescents experiencing attention-deficit/hyperactivity disorder (ADHD) as a comorbid illness. The establishment of an effective insomnia treatment among adolescents experiencing insomnia may help with improved ADHD treatment outcomes. ADHD adolescent patients’ symptoms range from inattention to hyperactive symptoms and are expected to escalate when the same adolescents experience insomnia. Parents of ADHD adolescents also suffer when they see their children fail to sleep, which reduces the quality of life ([QoL], Harris et al., 2022). Understanding the best intervention to help ADHD adolescents with insomnia could serve as an effective intervention to improve the QoL. Background Information According to Liu et al. (2020), ADHD has a prevalence rate of 7.2% worldwide among the youth, making it worth addressing and developing an effective treatment intervention to manage the symptoms. Adolescents are a group "vulnerable to irregular sleep patterns, insufficient sleep, sleep disturbance, nightmares, and daytime sleepiness” (Liu et al., 2020, p. 2). A systematic review was conducted to explore qualitative research focused on the life experiences of adolescents who have been diagnosed with ADHD. The results indicated that the psychological well-being, self-esteem, and identity of young individuals are adversely affected by interpersonal conflict, stigma, and invalidation (Eccleston et al., 2019). Adolescents experiencing both insomnia and ADHD along with life experiences as a teenager may intensify their symptoms. Treatment Interventions The cross-sectional study that addressed the relationship between sleep problems and ADHD fail to clarify the causal relationship between the two health conditions, making it challenging to develop an effective treatment intervention (Liu et al., 2020). This creates research that should be addressed. According to Barrett et al. (2013), various pharmacological treatments are used by pharmacists to manage insomnia symptoms among ADHD patients. There is a lack of sufficient information about the efficacy of pharmacological intervention in the management of insomnia among adolescents experiencing ADHD. Although insomnia is a common illness that co-occurs with ADHD, the insufficient information on how effective pharmacological interventions help patients cope with sleep problems and opens a need for research to ensure healthcare providers understand the treatments to offer to the patients to manage the insomnia symptoms. Barrett et al. (2013) estimated that 28% of ADHD patients are suffering from sleep disturbances, and approximately 48-73% of children reported experiencing sleeping problems during their childhood stages (p. 640). The study showed how previous studies put more focus on children being exposed to insomnia that co-occurs with ADHD without including adolescents as participants in past research. This exposes another research to ensure the issue around insomnia being a common comorbid illness among adolescents and that the effective treatments are well covered for improved QoL among these patients. Barrett et al. (2013) identified Clonidine as a relevant drug used by pharmacists to prescribe to ADHD patients to manage sleeping problems. The study considered by Barrett et al. (2013) on Clonidine usage in a study by Prince et al. (1996) showed the ineffectiveness of the pharmacological intervention to manage insomnia among ADHD adolescents since among the 62 children and adolescents considered as the participants of the study, 31% reported to experience adverse symptoms and 1.6% withdrew from the study as they developed depression (p.642). The use of Clonidine is questionable based on this Prince et al. (1996) study, but since it is still used to date, understanding its efficacy in the management of sleeping disturbances among adolescents experiencing ADHD is worth studying. Cognitive Behavior Therapy (CBT) Aslund et al. (2020) address how CBT is used as a therapeutic intervention to manage sleeping problems since it's used to manage psychiatric disorders’ symptoms. The study by Aslund et al. (2020) focuses on anxiety and major depressive disorder (MDD) as common psychiatric illnesses that are comorbid with insomnia since “in adolescents aged 7–15 years diagnosed with MDD, 77% of girls and 69% of boys report symptoms of sleep disturbances” (p.959). This puts ADHD aside as a significant psychiatric disorder that should be addressed when discussing how to manage it, as previous studies consider MDD and anxiety as the significant illnesses that patients are exposed to, insomnia being a comorbid illness (Aslund et al., 2020). Developing an effective treatment intervention to cope with sleeping problems among ADHD adolescents may be challenging as numerous gaps should be addressed. This study aims to fill these gaps with up-to-date information and evidence-based intervention to help ADHD adolescents have better and healthier lives by improving their QoL since sleeplessness leads to depression (Riemann et al., 2020). Adolescents with ADHD is a population for whom providers need a clearer understanding of: * how ADHD and insomnia are related in adolescents * what is an effective intervention to effectively treat symptoms occurring in adolescent ADHD and insomnia. Clinical Research Question Does CBT intervention offer a more effective intervention to manage insomnia among adolescents with ADHD than the use of Clonidine? The target population of adolescents aged between 13 and 18 to assess how the past research on management of sleep disturbances could enhance their academic achievement and improve QoL. This is because inattention is a significant symptom among ADHD patients and insomnia may enhance these symptoms which worsens the cooperation and participation of the students in classroom setting, leading to poor academic achievement. The use of CBT as a treatment intervention is significant since it is used in the management of sleep disturbances among persons experiencing psychiatric disorders. Clonidine is a pharmacological approach to managing sleep problems in patients. Purpose of the Study The purpose of this project is to compare the outcomes between CBT and Clonidine for the healthcare providers to have an effective intervention to use as an evidence-based practice to manage insomnia among adolescents with ADHD. Understanding the best intervention to use when managing insomnia among adolescents with ADHD will be essential to promote their QoL and improve academic performance. Summary This project aims to address the lack of effective treatment interventions for managing insomnia symptoms in adolescents with attention-deficit/hyperactivity disorder (ADHD). It emphasizes the potential impact of effective insomnia treatment on improving ADHD outcomes and enhancing the quality of life for both adolescents and their parents. The project discusses the prevalence of ADHD among youth and highlights adolescents' vulnerability to sleep disturbances. It identifies gaps in understanding the relationship between sleep problems and ADHD, particularly in adolescents, and explores pharmacological and cognitive-behavioral interventions for managing insomnia in this population. The clinical research question focuses on comparing the efficacy of cognitive behavior therapy (CBT) and Clonidine in managing insomnia among adolescents with ADHD, with outcomes including changes in sleep quality, ADHD symptoms, and academic performance. Review of the clinical literature targets adolescents aged 13 to 18 and aims to provide evidence-based practices for healthcare providers to improve the quality of life and academic performance of adolescents with ADHD experiencing insomnia. The following chapter provides a comprehensive overview of the methods employed in the literature review, including the search for evidence, utilization of databases, and meticulous assessment of source quality, ensuring a robust foundation for informed insights into treatment modalities for insomnia in adolescents with ADHD. Chapter 2: Literature Review In the pursuit of understanding the optimal treatment approach for adolescents with attention deficit/hyperactivity disorder (ADHD), this investigation examines the realms of cognitive behavioral therapy for insomnia and medical treatment with clonidine. The exploration encompasses a comprehensive analysis of diverse databases to gather evidence ranging from randomized controlled trials to longitudinal studies. The evaluation will not only consider the quantity of evidence but also scrutinize the evidential quality, emphasizing studies with robust methodologies and statistically significant outcomes. As presented by Aslund et al. (2020) and Liu et al. (2020), examining the potential impact of cognitive behavioral therapy and clonidine on sleep quality, ADHD symptom severity, and academic performance, this inquiry aims to provide a degree of understanding the comparative effectiveness of these treatments in addressing the complexed challenges faced by adolescents with ADHD. Search for Evidence In the clinical research, specific and evidential knowledge holds profound importance in shaping informed decision-making processes. For the research question on the comparative effectiveness of cognitive behavioral therapy for insomnia (CBT-I) and clonidine in adolescents with ADHD, acquiring precise and evidence-based information is essential. Rigorous examination of relevant studies, like in the qualitative study by Harris et al. (2022) and Aslund et al. (2020), will not only elucidate whether CBT-I leads to greater sleep quality, reduced ADHD symptoms, and improved academic performance compared to clonidine but also provide a solid foundation for decision-making in clinical practice and education. This evidential knowledge guides healthcare providers and educators in tailoring interventions that align with the specific needs of adolescents with ADHD. By understanding the nuanced impact of CBT-I and clonidine on sleep, ADHD symptoms, and academic performance, practitioners can make informed choices to optimize the care and education provided to this demographic, thereby enhancing overall outcomes and well-being. Population The evidential knowledge emphasizing the high prevalence of sleep disorders, particularly insomnia, among adolescents aged 13-18 with ADHD, as presented by Eccleston et al. (2019) and Liu et al. (2020) holds significant implications for enhancing the provision of quality care and education. Understanding that ADHD-related factors such as hyperactivity, impulsivity, and attention problems contribute to insomnia highlights the need for targeted interventions. Insomnia's detrimental impact on academic performance, social development, and overall quality of life underscores the urgency of addressing sleep-related challenges in adolescents with ADHD. Intervention In the quest for evidence regarding the effectiveness of cognitive behavioral therapy (CBT) as an intervention for insomnia in adolescents with ADHD, several studies from Becker et al. (2021), Liu et al. (2020), and Aslund et al. (2020) shed light on this topic. These studies primarily focused on interventions conducted by healthcare professionals, emphasizing the importance of tailored CBT techniques. Central to these interventions was the consistent use of sleep diaries, which served as invaluable tools for recording and monitoring sleep patterns, allowing for a comprehensive evaluation of progress over time. The interventions involved regular meetings with adolescents to identify and address any barriers hindering progress towards treatment goals. CBT’s directed strategies target cognitive element...