Are ADHD and poor sleep linked?
Q: I recently read that sleep problems can be related to ADHD. Should we be looking into sleep therapy for our son, who has an ADHD diagnosis?
A: Sleep deprivation can sometimes be confused with attention-deficit/hyperactivity disorder in children. But ADHD on its own can also cause sleep problems, which can intensify existing ADHD symptoms.
That’s why — during a child’s initial evaluation of ADHD — many contributing or alternative health conditions are considered before a diagnosis is made.
A clinician may ask if the child’s ADHD symptoms are seen in many different situations versus just “acting out” at certain times with certain people. Or if the child has been tested for learning issues, such as dyslexia, for example. Or if the child’s vision and hearing are normal to allow a child to be able to follow directions in the classroom. Or if a child’s sleep needs aren’t being met.
This last concern is quite interesting because children whose sleep needs are unmet often display poor focus, poor attention, hyperactivity, impulsiveness, emotional lability and other difficult behaviors, all signs of ADHD.
There are many factors that may lead to sleep needs being unmet for children, such as sleep-environmental concerns, mental or physical conditions or lifestyle/scheduling issues.
When it’s time for sleep, a child’s bedroom should be quiet and dim/dark with no electronics, such as cell phones or tablets, as these may both delay sleep with use and disrupt sleep due to the blue light that is emitted.
Mental health issues such as anxiety or depression can also prevent children from falling asleep or cause them to wake up early.
Kids affected by scheduling issues include those without regular sleep routines, who are over-scheduled with activities or homework until late at night or those who don’t get enough scheduled exercise during the day to sleep soundly at night.
Physical conditions such as restless leg syndrome or snoring due to large tonsils or adenoids can disrupt sleep quality, too.
The most challenging issue is that children who truly do have ADHD also have difficulty getting organized enough to get to sleep on time and also may be taking medications with a side effect of sleep disturbance.
If your child has ADHD or is in the process of evaluation for ADHD, achieving quality sleep is a key component in arriving at a successful outcome. In the end, sleep inadequacy may be the full explanation for ADHD-like symptoms, a contributor to confirmed ADHD symptoms or a side effect of ADHD itself.
Ask your child’s clinician about next steps. For some it may be a sleep study or a sleep specialist evaluation or an ENT (ear, nose and throat) evaluation, for others it may be a mental health assessment or for others it may be more rigor around schedules or the bedroom environment.
Dr. Gigi Chawla is a board-certified pediatrician and the senior medical director of primary care at Children’s Hospitals and Clinics of Minnesota. Send your questions to firstname.lastname@example.org.