The effect of protocolled cognitive behavioural therapy for insomnia (CBT-I) on sleep, vigilance, working memory and aggressive behaviour.

Sleeping problems in adolescents have received little attention, even though
several studies show that the prevalence of these problems in adolescents is
high. Moreover, the prevalence in adolescents with psychiatric problems is even
higher: up to 60-80% of adolescents with ADHD or autism suffer from sleeping
problems. Poor sleep is related to impairment of cognitive and psychological
functioning and behavioural problems. Therefore, it is important to pay more
attention to the treatment of sleeping problems, especially in adolescents with
both (complex) psychiatric and sleeping problems.

In this study, the objective is to examine the effect of protocolled cognitive
behavioural therapy for insomnia (CBT-I) in adolescents with complex
psychiatric problems and sleeping problems (problems falling asleep, staying
asleep and/or waking up too early) on their vigilance, working memory,
aggressive behaviour and self-reported sleep efficiency.

A stepped wedge trial design is used including 31 adolescents admitted at The
Catamaran, a hospital for youth forensic psychiatry and orthopsychiatry. In
order to collect data, all adolescents will report their sleep on a sleep
calendar during a week. Sixteen adolescents with sleeping problems will enrol
into the intervention and form the experimental group. They will receive
treatment with CBT-I, while computerized tests targeting vigilance and working
memory and a behavioural questionnaire will be used to evaluate the effect of
treatment. The other adolescents, without sleeping problems, form the control
group. They will only report their sleep once more on a sleep calendar during a
week in the last week (week 17) of the study.

Adolescents in the experimental group will receive, in four clusters of four, a
weekly, protocolled, CBT-I session with a total duration of six weeks. Every
four adolescents will be individually treated but they will start at the same
moment with their treatment. Every morning, the adolescents fill out a sleep
calendar about their night*s sleep. Every three weeks and in total six times,
vigilance and working memory will be measured with computerized tasks. Every
six months, the adolescents in the experimental group and their key worker
(*zaakwaarnemer*) complete a behavioural questionnaire as part of care as usual
during their admission at The Catamaran. The score on aggressive behaviour
before and after treatment will be used in this study.

No health risks are involved in participating in this study. The assumption is
that the adolescents in the experimental group will directly benefit from
participation because their sleeping problems will decrease. The main burden is
their investment in time. The total burden is approximately three hours for
each participant in the experimental group and 14 minutes for the participants
in the control group in the time period of 17 weeks.