BAKGRUND: Healthy sleep practices for children should be promoted as an essential part of a healthy lifestyle, with important implications for the entire family. Unhealthy sleep patterns and sleep-related problems disrupt everyday life and functioning. Sleep problems are common among children, especially those with attention deficit hyperactivity disorder (ADHD). Weighted blankets are one type of non-pharmacological intervention that has been used in health-care settings, such as occupational therapy practice. However, evidence is scarce and knowledge is lacking concerning the effects of weighted blankets on sleep and their potential benefits. Given the challenges children with ADHD face in sleep problems and emotional and behavioural regulation, weighted blankets could be a particular relevant intervention. The SLEEP project was thus designed to increase current evidence and knowledge about the use of weighted blankets as a sleep intervention for children with ADHD. 

AIM: The overall aim of this thesis was to investigate the impact of weighted blankets on the sleep health of children with ADHD and sleep problems.

METHODS: A crossover randomised controlled trial (Study I) was conducted that included 94 children with ADHD, 6-14 years old. Children were randomly assigned to four weeks of a weighted blanket or four weeks of a lighter control blanket, followed by the other intervention. Data was collected with actigraphy (primary outcome), child- and parent-questionnaires and a daily sleep diary. The efficacy of weighted blankets was analysed with a paired t-test. An experimental longitudinal study (Study II) was carried out that involved the same 94 children, who were followed for 16 weeks. Weighted blanket-adherent vs non-adherent children were compared based on sample characteristics and changed sleep outcomes. The data collected at baseline, at 4 weeks, 8 weeks and at 16-week follow-up were analysed with mixed effect models. Weighted blanket-adherent children were further examined longitudinally (Study III) and compared from baseline to the 16-week follow-up. Parents’ ratings of children’s sleep problems were analysed using paired t-test and McNemar’s test. Furthermore, a qualitative study (Study IV) was performed in which a purposive sample of 26 children participated in individual interviews. A qualitative content analysis was performed to analyse the data.

RESULTS: In Study I, weighted blankets were found to be more efficacious than the lighter control blankets, according to objectively measured sleep (increased total sleep time, increased sleep efficiency and decreased wake after sleep onset). Older children, 11-14 years old, and children with an inattentive ADHD subtype slept longer and more effectively with the weighted blanket. In Study II, weighted blanket-adherent children showed improvement, with fewer sleep problems, compared to non-adherent children. Weighted blanket-adherent children also showed a stable total sleep time compared to non-adherent children, who displayed a decrease in their total sleep time during the 16-week sleep intervention. This association was shown for the older children aged 11-14, but not for the younger children aged 6-10. Furthermore, in Study III, the parents of the Weighted blanket-adherent children reported fewer episodes of night wakings, sleep onset delay, sleep duration difficulties and daytime sleepiness. Bedtime resistance and daytime sleepiness were considered the most problematic domains at baseline, and these also showed the greatest change, according to parents’ experiences of children’s problematic sleep. In Study IV, children described that using WBs requires a commitment, improves emotional regulation, changes sleeping patterns and promotes everyday participation.

CONCLUSION: The overall results of this thesis indicate that children with ADHD and sleep problems benefit from using weighted blankets. Weighted blankets could thus be an efficient sleep intervention and an important complement to standard treatment for children with ADHD and sleep problems. More research is needed to establish the effectiveness of weighted blankets in different subgroups and settings.