SLEEP: Sleep intervention with weighted blankets for children with ADHD and sleep problems

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental condition in children that involves difficulty concentrating, hyperactivity and impulsivity to varying degrees depending on the subtype of diagnosis.

The symptoms can negatively affect the child's well-being, school attendance and relationships. Approximately 25–85% of children with ADHD also experience sleep problems such as difficulty falling asleep, restlessness and nighttime awakenings. Sleep deprivation risks worsening existing symptoms of ADHD and can thus negatively affect quality of life.

The research project SLEEP was initiated and designed in collaboration with Region Halland based on the need to increase knowledge about children with ADHD and sleep problems in relation to non-pharmacological (weighted blanket) and pharmacological (melatonin) treatment options as well as in relation to well-being and function in daily life. The prescription of melatonin has increased significantly in Sweden in recent years. Melatonin is considered safe and effective for treating sleep problems in children, but can cause side effects such as headache, nausea and fatigue. Knowledge about the long-term effects is insufficient. Research shows that parents often prefer non-pharmacological treatment over pharmacological treatment. There are various non-pharmacological treatments for sleep problems in children, of which sleep hygiene, behavioural therapy and weighted blankets are the most common. However, the Medical Technology Product Council in Sweden has recommended that the regions do not prescribe weighted blankets due to a lack of evidence.

The research project SLEEP aims to contribute to a better understanding of relevant and valid methods for evaluating health-related outcomes, sleep, and cost-effectiveness of sleep interventions in children with ADHD and sleep problems. The project is being carried out in two phases described below and includes systematic meta-analysis, randomized controlled trial, qualitative studies, longitudinal studies, cross-sectional studies, mixed methods study, validation study, cohort study and implementation study.

Phase 1 – Evaluation of sleep and health-related and symptom-related outcome measures after a sleep intervention with weighted blankets (2018–2025)

The aim was to evaluate a sleep intervention with a weighted blanket for children with ADHD and sleep problems and to investigate and evaluate sleep and health- and symptom-related outcome measures and experiences of using a weighted blanket.

The sleep intervention was evaluated through a randomized controlled trial where sleep was measured objectively by sleep actigraphy. The results showed that weighted blanket treatment:

Increased sleep time and sleep efficiency
Reduced nighttime awakenings and perceived sleep problems
Was particularly effective for children 11–14 years of age with attention deficit
Did not affect the time to fall asleep

A longitudinal study showed that:

Both children and parents reported reduced sleep problems after 16 weeks for children who used the weighted blanket

A mixed methods study that examined parents' health after the children underwent the sleep intervention with a weighted blanket showed that when the children slept better:

The parents' health also improved
The parents felt more rested, calm and hopeful
The parents experienced a better balance in family life
The parents managed everyday life better

Qualitative studies where interviews with a sample of both children and parents was performed showed that the children:

Adapted the use of the weighted blanket to their needs
Felt calm and secure
Improved their sleep habits and created new sleep routines
Experienced a better balance between activity and rest

The parents described that:

The children had satisfactory sleep, improved sleep onset, sleep continuity and established new sleep routines
The children's general well-being improved, with increased relaxation and reduced anxiety
The children coped better with everyday life, with improved balance in life, better family functioning and increased participation in school and leisure activities

Phase 2 – Implementation and effectiveness of a sleep intervention with weighted blankets (2025–2030)

The aim is to compare differences over time between a non-pharmacological sleep intervention using a weighted blanket and standard treatment with melatonin for sleep problems in children with ADHD, focusing on health and lifestyle factors as well as symptom burden. Additionally, the study aims to identify facilitators and barriers to implementing the intervention in routine clinical practice and assess its health economic outcomes.

It is crucial to explore the introduction of a sleep intervention using weighted blankets as a first-line treatment for children with ADHD and sleep problems, as well as the long-term effects of using weighted blankets versus melatonin on both the children and their families. Additionally, understanding the facilitators and barriers influencing implementation in clinical practice is essential.