Journal of Pediatric Perspectives

Current Issue

By Issue

By Author

By Subject

Author Index

Keyword Index

About Journal

Aims and Scope

Editorial Board

Publication Ethics

Indexing and Abstracting

Related Links

FAQ

Peer Review Process

News

Effectiveness of Combining Medication and Lifestyle Modification with Iranian Traditional Medicine Measures Compared to Medication Alone on the Sleep Quality of Children with Attention-Deficit Hyperactivity Disorder

Document Type : original article

Authors

1 Ph.D Candidate in Health Psychology, Department of Health Psychology, Faculty of Medicine, Najafabad Branch, Islamic Azad University, Najafabad, Iran.

2 Associate professor, Department of Psychology, Najafabad Branch, Islamic Azad University, Najafabad, Iran.

3 Department. of. Psychology, Payame Noor University, Tehran, Iran.

4 Associate Professor, Department of Psychology of Children with Special Needs, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran.

5 Assistant professor, Department of Persian Medicine, School of Medicine Cancer Prevention Research Center. Isfahan University of Medical Sciences, Iran.

6 Assistant Professor, Department of Psychology, Najafabad Branch, Islamic Azad University, Najafabad, Iran.

Abstract

Background: The current study aims to compare the effects of medication and lifestyle changes with medication alone on the quality of sleep in children with attention deficit hyperactivity disorder.
Method: The study uses a mixed-methods approach to design a treatment for children with ADHD. It employs inductive thematic analysis to identifiy problems, and create a lifestyle modification package. The package is reviewed and approved by a panel of experts. The study evaluates the effects of two interventions on children with ADHD and sleep problems using a quasi-experimental design. The population consists of 7-11-year-olds from the Felavarjan region, diagnosed with ADHD and experiencing sleep issues. The study involves a combination of drug therapy and lifestyle modification, drug therapy alone, or no intervention.
Results: The findings show that, when compared to the control group, there is a significant difference in sleep quality between the experimental groups that received medication and lifestyle adjustment and those that received medication alone (P<0.05). Children's sleep quality was significantly enhanced by the combination of medicine and lifestyle change, which proved to be more effective than medication alone.
Conclusion: Lifestyle change combined with medication were found to be more effective in improving sleep quality in children with attention deficit hyperactivity disorder compared to medication alone. Based on the findings of the present study, lifestyle modification is suggested as a complementary approach to pharmacotherapy for reducing problems and improving sleep quality in children with attention deficit hyperactivity disorder.

Keywords

References
  1. Barkley RA. Taking charge of ADHD: The complete, authoritative guide for parents. Guilford Publications; 2020 May 4.
  2. Bandyopadhyay Prasanta S, Forster Malcolm R, Oxford E, Barkow Jerome H, Leda C, John T, et al. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders: Dsm-5, Washington, DC, American Psychiatric Publishing, 2013. Ananth Mahesh, In defense of an evolutionary concept of health nature, norms, and human biology, Aldershot, England, Ashgate. Philosophy. 2014;39(6):683-724.
  3. Sibley MH, Mitchell JT, Becker SP. Method of adult diagnosis influences estimated persistence of childhood ADHD: a systematic review of longitudinal studies. The Lancet Psychiatry. 2016 Dec 1;3(12):1157-65.
  4. Hassanzadeh S, Amraei K, Samadzadeh S. A meta-analysis of Attention Deficit/Hyperactivity Disorder prevalence in Iran. Empowering Exceptional Children. 2019 Jun 22;10(2):165-77.
  5. Abd El-Hay M, Badawy A, El Sawy H. Sleep characteristics in Egyptian children with attention deficit-Hyperactivity Disorder. Current Psychiatry. 2010 Jul;17(3):1-6.
  6. Bondopadhyay U, Diaz-Orueta U, Coogan AN. A systematic review of sleep and circadian rhythms in children with attention deficit hyperactivity disorder. Journal of Attention Disorders. 2022 Jan;26(2):149-224.
  7. Lucas I, Mulraney M, Sciberras E. Sleep problems and daytime sleepiness in children with ADHD: Associations with social, emotional, and behavioral functioning at school, a cross-sectional study. Behavioral sleep medicine. 2019 Jul 4.
  8. Martin CA, Papadopoulos N, Chellew T, Rinehart NJ, Sciberras E. Associations between parenting stress, parent mental health and child sleep problems for children with ADHD and ASD: Systematic review. Research in developmental disabilities. 2019 Oct 1;93:103463.
  9. Becker SP. ADHD and sleep: recent advances and future directions. Current opinion in psychology. 2020 Aug 1;34:50-6.
  10. Quach J, Hiscock H, Wake M. Sleep problems and mental health in primary school new entrants: Cross‐sectional community‐based study. Journal of paediatrics and child health. 2012 Dec;48(12):1076-81.
  11. Craig SG, Weiss MD, Hudec KL, Gibbins C. The functional impact of sleep disorders in children with ADHD. Journal of attention Disorders. 2020 Feb;24(4):499-508.
  12. Langberg JM, Molitor SJ, Oddo LE, Eadeh HM, Dvorsky MR, Becker SP. Prevalence, patterns, and predictors of sleep problems and daytime sleepiness in young adolescents with ADHD. Journal of attention disorders. 2020 Feb;24(4):509-23.
  13. Eyuboglu M, Eyuboglu D. Behavioural sleep problems in previously untreated children with attention deficit hyperactivity disorder. Psychiatry and Clinical Psychopharmacology. 2018 Jan 2;28(1):19-24.
  14. Yoon SY, Jain U, Shapiro C. Sleep in attention-deficit/hyperactivity disorder in children and adults: past, present, and future. Sleep medicine reviews. 2012 Aug 1;16(4):371-88.
  15. Matricciani L, Blunden S, Rigney G, Williams MT, Olds TS. Children's sleep needs: is there sufficient evidence to recommend optimal sleep for children?. Sleep. 2013 Apr 1;36(4):527-34.
  16. Cortese S, Faraone SV, Konofal E, Lecendreux M. Sleep in children with attention-deficit/hyperactivity disorder: meta-analysis of subjective and objective studies. Journal of the American Academy of Child & Adolescent Psychiatry. 2009 Sep 1;48(9):894-908.
  17. Owens JA. Sleep disorders and attention-deficit/hyperactivity disorder. Current psychiatry reports. 2008 Oct;10(5):439-44.
  18. Goodday A, Corkum P, Smith IM. Parental acceptance of treatments for insomnia in children with attention-deficit/hyperactivity disorder, autistic spectrum disorder, and their typically developing peers. Children's Health Care. 2014 Jan 2;43(1):54-71.
  19. Krinzinger H, Hall CL, Groom MJ, Ansari MT, Banaschewski T, Buitelaar JK, et al. Neurological and psychiatric adverse effects of long-term methylphenidate treatment in ADHD: A map of the current evidence. Neuroscience & Biobehavioral Reviews. 2019 Dec 1;107:945-68.
  20. Brown TE. Attention-deficit disorders and comorbidities in children, adolescents, and adults; 2000.
  21. Cortese S, Fusetto Veronesi G, Gabellone A, Margari A, Marzulli L, Matera E, et al. The management of sleep disturbances in children with attention-deficit/hyperactivity disorder (ADHD): an update of the literature. Expert Review of Neurotherapeutics. 2024 May 13:1-2.
  22. Shrestha M, Lautenschleger J, Soares N. Non-pharmacologic management of attention-deficit/hyperactivity disorder in children and adolescents: a review. Translational pediatrics. 2020 Feb;9(Suppl 1):S114.
  23. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative research in psychology. 2006 Jan 1;3(2):77-101.
  24. Sheykhzadeh M, Bani-Asad R. Thematic Analysis: Concepts, Approaches, and Applications. Tehran: Logos.[In Persian]. 2020.
  25. Lawshe CH. A quantitative approach to content validity, Personal Psychology, 28 (4), 563-575 [Internet]. 1975
  26. Hyrkäs K, Appelqvist-Schmidlechner K, Oksa L. Validating an instrument for clinical supervision using an expert panel. International Journal of nursing studies. 2003 Aug 1;40(6):619-25.
  27. Cohen L, Manion L, Morrison K. Research methods in education. routledge; 2002 Sep 11.
  28. Schuck S, Porter MM, Carlson C, Hartman CA, Sergeant JA, Clevenger W, et al. Categorical and Dimensional Definitions and Evaluations of Symptoms of ADHD: History of the SNAP and the SWAN Rating Scales James M. Swanson University of California, Irvine and Florida International University. International Journal. 2012 Apr;10(1).
  29. Zhou JB, Guo LT, Chen Y. Reliability and validity of the Chinese version of Swanson, Nolan, and PelhamVersion IV Rating Scale-Parent Form for attention-deficit/hyperactivity disorder. Chinese Ment Heal J. 2013;27:424-8.
  30. Momeniyan V, Nazifee M, Talepasand S. The Diagnostic Accuracy of Parent Rating Scales in Discriminating Children with and Without Attention-Deficit/Hyperactivity Disorder. Middle Eastern Journal of Disability Studies. 2020;10(0):231-.(Persian)
  31. Owens JA, Spirito A, McGuinn M. Children’s Sleep Habits Questionnaire (CSHQ).2000;23(8):1043-52.
  32. shoghi M, khanjari S, Farmani F, Hoseini F. Sleep habits in children aged 6 to 11 years. Iranian Nursing Journal. 2005;18(41):131-8.(in persion)
  33. Najafi M, Attari A, Marasi MR, Moein Y. A comparison of sleep status among 3-7 year-old children involved in masturbation with a control group in Isfahan. Journal of Isfahan Medical School. 2012 Feb 20;29(169):2605-12.
  34. Hood M, Baumann O. Could Nature Contribute to the Management of ADHD in Children? A Systematic Review. International Journal of Environmental Research and Public Health. 2024 Jun;21(6):736.
  35. Barrable A, Booth D, Adams D, Beauchamp G. Enhancing nature connection and positive affect in children through mindful engagement with natural environments. International journal of environmental research and public health. 2021 Apr 30;18(9):4785.
  36. de Vries S, Verheij R. Residential green space associated with the use of attention deficit hyperactivity disorder medication among Dutch children. Frontiers in Psychology. 2022 Sep 2;13:948942.
  37. Sardar MA, Yousefi M, Mohammadi MR, Sayyah M. Study of the relationship between the prevalence of sports injuries and athlete’s temperament from the perspective of Iranian traditional medicine in. Journal of Islamic and Iranian Traditional Medicine. 2016 Sep 10;7(2):201-6.
  38. Rasoli A, Zadeh MN, Shams A. Effect of Aerobic Activity with Low and Moderate Intensity on Executive Functions and Selective Attention in Children with Attention-Deficit/Hyperactivity Disorder (ADHD). Motor Behavior. 2022 Jun 22;14(48):63-82.
  39. Abedi A, Kazemi F, Shooshtari M, Golshani Monazzah F. The effect of aerobic exercises on the visual and auditory attention of pre-school boys with ADHD in Isfahan in 2009–2010. Psychology of Exceptional Individuals. 2012 Oct 26;2(7):133-52.
  40. Sabzevari H. Effect of rhythmic exercises with music on anxiety, depression and hyperactivity/attention deficits disorder in primary school children. Razi Journal of Medical Sciences. 2020 Jan 10;26(11):43-52.
  41. Silva LA, Doyenart R, Henrique Salvan P, Rodrigues W, Felipe Lopes J, Gomes K, et al. Swimming training improves mental health parameters, cognition and motor coordination in children with Attention Deficit Hyperactivity Disorder. International journal of environmental health research. 2020 Sep 2;30(5):584-92.
  42. Hattabi S, Bouallegue M, Jelleli H, Hammami N, Yahya HB, Bouden A. Effectiveness of a Recreational Swimming Program on Cognitive Functions of School-Children with Attention Deficit Hyperactivity Disorder (ADHD). Transylvanian Review. 2019;27(37).
  43. Salehian MH, Golabchi M. The Effectiveness of Swimming Training on Reducing Coping Behaviors, Cognitive Problems and Inattention of Elementary School Hyperactive Girls. International Journal of Pediatrics. 2021 Nov 1;9(11):14896-906.
  44. Ibn-sina AH. Al-Ghanun fi Al-teb. Lebanon: Al-Elmi Lel-Matbuat. 2005.
  45. Khorasani A, Hussain SM. Kholase al-hekmat. Correction by professor Nazim. Tehran. First print. 2005;1.
  46. Dadmehr M, Akhtari E, Haqiqi M. The effect of music on the improvement of sleep quality: a report from the viewpoint of Jorjani. Neurological Sciences. 2023 May;44(5):1787-9.
  47. Naseri M, Jafari F, Alizadeh M. The principles of health care and sanitation in traditional medicine of Iran. Journal of Islamic and Iranian Traditional Medicine. 2010 Jun 10;1(1):39-44.
  48. Blasco-Fontecilla H, Moyano-Ramírez E, Méndez-González O, Rodrigo-Yanguas M, Martin-Moratinos M, Bella-Fernández M. Effectivity of saffron extract (Saffr’Activ) on treatment for children and adolescents with attention deficit/hyperactivity disorder (ADHD): a clinical effectivity study. Nutrients. 2022 Sep 28;14(19):4046.
  49. Baziar S, Aqamolaei A, Khadem E, Mortazavi SH, Naderi S, Sahebolzamani E, et al. Crocus sativus L. versus methylphenidate in treatment of children with attention-deficit/hyperactivity disorder: A randomized, double-blind pilot study. Journal of child and adolescent psychopharmacology. 2019 Apr 1;29(3):205-12.
  50. Ibn-e-Sina AA. Al-Qānūn fī al-Tibb (Canon of Medicine). Beirut: Dare Ehyae al-Torathe al-Arabi. 2005;17.
  51. Chashti MA. Exir-e-Azam. Research Institute for Islamic and Complementary Medicine, Tehran University of Medical Sciences, Tehran. 2004:271-2.
  52. MH AK. Kholassat Al-Hekmah (the principal’s of traditional Iranian medicine). Qom: Esmaeilian. 2006;1385:94-114.
  53. Golsorkhi H, Kamalinejad M, Dadmehr M. The Useful Diet and Medicinal Plants for ADHD from the Viewpoint of Traditional Persian Medicine. International Journal of Pediatrics. 2022 Mar 1;10(3):15547-51.
  54. Motaharifard MS, Jafari Z, Paknejad MS, Oveidzadeh L, Karimi M. Prevention and treatment of constipation in children from the perspective of Iranian traditional medicine. Journal of integrative medicine. 2016 Nov 1;14(6):429-35.
  55. Jorjani L. Zakhireh kharazmshahi. Bonyade Farhang Iran, Tehean. 1992:101-74.
  56. Nimrouzi M, Sadeghpour O, Imanieh MH, Shams-Ardekani M, Zarshenas MM, Salehi A, et al. Remedies for children constipation in medieval Persia. Journal of evidence-based complementary & alternative medicine. 2014 Apr;19(2):137-43.
  57. Ahmadieh A. Raze darman. Mohammed Ali Ilmi; 1950.
  58. Kiluk BD, Weden S, Culotta VP. Sport participation and anxiety in children with ADHD. Journal of attention disorders. 2009 May;12(6):499-506.
  59. Naderi F, Heidarie A, Bouron L, Asgari P. The efficacy of play therapy on ADHD, anxiety and social maturity in 8 to 12 years aged clientele children of Ahwaz metropolitan counseling clinics. 2010;10(3):189-95.
  60. Dane S, Welcome MO. A case study: Effects of foot reflexotherapy on ADHD symptoms and enuresis nocturia in a child with ADHD and enuresis nocturia. Complementary Therapies in Clinical Practice. 2018 Nov 1;33:139-41..
  61. Asadi Z, Shakibaei F, Mazaheri M, Jafari-Mianaei S. The effect of foot massage by mother on the severity of attention-deficit hyperactivity disorder symptoms in children aged 6–12. Iranian Journal of Nursing and Midwifery Research. 2020 May 1;25(3):189-94.
  62. Subagya AN, Hartini S, Nurjannah I. Effect of foot reflexology on behavioral and emotional problems in preschool children. Enfermería Clínica. 2021 Nov 1;31:471-7.
  63. Faber Taylor A, Kuo FE. Children with attention deficits concentrate better after walk in the park. Journal of attention disorders. 2009 Mar;12(5):402-9.
  64. Damasceno MM, Mazzarino JM, Figueiredo A. How Nature Affects The Behavior of ADHD Children: A Case Study in Northeastern Brazil. Ambiente & Sociedade. 2022 Jul 15;25:e00311.
  65. Faber Taylor A, Kuo FE. Could exposure to everyday green spaces help treat ADHD? Evidence from children's play settings. Applied Psychology: Health and Well‐Being. 2011 Nov;3(3):281-303.
  66. Thygesen M, Engemann K, Holst GJ, Hansen B, Geels C, Brandt J, et al. The association between residential green space in childhood and development of attention deficit hyperactivity disorder: a population-based cohort study. Environmental health perspectives. 2020 Dec 22;128(12):127011.
  67. Arabi M, Saberi A, Mirhosseini M. The Effect of balance exercises on the sustained attention in boys 7-10 years with attention deficit/hyperactivity disorder (ADHD) in Kerman. Journal of Sports Psychology. 2021 Sep 23;13(2):103-15.
  68. Mollazadeh M, Gharayagh Zandi H, Rostamizadeh M. Effectiveness of yoga exercise training in visual and auditory attention in boys with attention deficit hyperactivity disorder. Razi J Med Sci. 2018 Nov 10;25(8):52-61.
  69. Eskandarnejad M, Rezaei F, Mobayen F. Effect of a Course of Basketball Training Program on ADHD Children’s Sustained Attention. Motor Behavior. 2016 Oct 22;8(25):139-52.
  70. saber Z, kowsari N, Alimohammadi N. The effect of gymnastics on symptoms of attention deficit/hyperactivity disorder in 5-6 year old children in Shiraz city. Studies in physical education and sports science. 2016;4(1):158-64.(Persian)
  71. Chen SC, Yu BY, Suen LK, Yu J, Ho FY, Yang JJ, et al. Massage therapy for the treatment of attention deficit/hyperactivity disorder (ADHD) in children and adolescents: a systematic review and meta-analysis. Complementary therapies in medicine. 2019 Feb 1;42:389-99.
  72. Soltani SS, Minaei MB, Evangelism M, Karimi F, Nazim I. Correction of sleep and wakefulness in different ages and geographical regions. Iranian Traditional Medicine. 2012;3:265.
  73. Cheong MJ, Kim S, Kim JS, Lee H, Lyu YS, Lee YR, et al. A systematic literature review and meta-analysis of the clinical effects of aroma inhalation therapy on sleep problems. Medicine. 2021 Mar 5;100(9):e24652.
  74. Zafari Z, Shokri S, Hasanvand A, Ahmadipour S, Anbari K. The Relationship Between Attention Deficit Hyperactivity Disorder and Functional Constipation in Patients Referred to Pediatric Gastrointestinal Clinic of the Hospitals of Khorramabad City, Iran. Crescent Journal of Medical & Biological Sciences. 2021 Jul 1;8(3).
  75. McKeown C, Hisle-Gorman E, Eide M, Gorman GH, Nylund CM. Association of constipation and fecal incontinence with attention-deficit/hyperactivity disorder. Pediatrics. 2013 Nov 1;132(5):e1210-5.
  76. Nimrouzi M, Zarshenas MM. Functional constipation in children: non-pharmacological approach. J Integr Med. 2015 Mar 1;13(2):69-71.
  77. Latifi SA, Haji Rahimian Tasuji MH, Rajabnejad MR, Asadi MH, Mahmoodi SA. Role of Aaraze Nafsani in Health and Illness. Complementary Medicine Journal. 2022 Mar 10;11(4):304-15..
  78. Chevalaria C. Managing symptoms of attention deficit hyperactivity disorder (ADHD) with massage therapy in children and adolescents: a bibliographic review (Bachelor's thesis, Salut-UVic).2022.
  79. Panahifar S, Nouriani JM. The Effectiveness of Narrative therapy on Behavioral Maladaptation and Psychological Health of Children with ADHD in Kerman. 2021;8(1):56-64.
  80. Vélez-Galarraga R, Guillen-Grima F, Crespo-Eguílaz N, Sánchez-Carpintero R. Prevalence of sleep disorders and their relationship with core symptoms of inattention and hyperactivity in children with attention-deficit/hyperactivity disorder. European journal of paediatric neurology. 2016 Nov 1;20(6):925-37.
  81. Kidwell KM, Van Dyk TR, Lundahl A, Nelson TD. Stimulant medications and sleep for youth with ADHD: a meta-analysis. Pediatrics. 2015 Dec 1;136(6):1144-53.
  82. Morash-Conway J, Gendron M, Corkum P. The role of sleep quality and quantity in moderating the effectiveness of medication in the treatment of children with ADHD. ADHD Attention Deficit and Hyperactivity Disorders. 2017 Mar;9:31-8.
  83. Becker SP, Froehlich TE, Epstein JN. Effects of methylphenidate on sleep functioning in children with attention-deficit/hyperactivity disorder. Journal of Developmental & Behavioral Pediatrics. 2016 Jun 1;37(5):395-404.
  84. Hoebert M, Van Der Heijden KB, Van Geijlswijk IM, Smits MG. Long‐term follow‐up of melatonin treatment in children with ADHD and chronic sleep onset insomnia. Journal of pineal research. 2009 Aug;47(1):1-7.
  85. Abdelgadir IS, Gordon MA, Akobeng AK. Melatonin for the management of sleep problems in children with neurodevelopmental disorders: a systematic review and meta-analysis. Archives of disease in childhood. 2018 Dec 1;103(12):1155-62.
  86. Ramtekkar UP. DSM-5 changes in attention deficit hyperactivity disorder and autism spectrum disorder: implications for comorbid sleep issues. Children. 2017 Jul 27;4(8):62.
  87. Villagomez A, Ramtekkar U. Iron, magnesium, vitamin D, and zinc deficiencies in children presenting with symptoms of attention-deficit/hyperactivity disorder. Children. 2014 Sep 29;1(3):261-79.
  88. Stone MR, Stevens D, Faulkner GE. Maintaining recommended sleep throughout the week is associated with increased physical activity in children. Preventive medicine. 2013 Feb 1;56(2):112-7.
  89. Tandon PS, Sasser T, Gonzalez ES, Whitlock KB, Christakis DA, Stein MA. Physical activity, screen time, and sleep in children with ADHD. Journal of Physical Activity and Health. 2019 Jun 1;16(6):416-22.
  90. Liu HL, Sun F, Tse CY. Examining the Impact of Physical Activity on Sleep Quality in Children With ADHD. Journal of Attention Disorders. 2023 Aug;27(10):1099-106.
  91. Qiu H, Liang X. Change in sleep latency as a mediator of the effect of physical activity intervention on executive functions among children with ADHD: A secondary analysis from a randomized controlled trial. Journal of Autism and Developmental Disorders. 2024 Aug;54(8):3069-77.
  92. Atkinson G, Davenne D. Relationships between sleep, physical activity and human health. Physiology & behavior. 2007 Feb 28;90(2-3):229-35.
  93. Garcia S, Gunstad J. Sleep and physical activity as modifiable risk factors in age-associated cognitive decline. Sleep and Biological Rhythms. 2016 Jan;14:3-11.
Journal of Pediatric Perspectives
Volume 13, Issue 1
January 2025
Pages 19219-19241
Files
Share
How to cite
Statistics