ADHD and Sleep
Could More Sleep Help ADHD?
Q. We think our son may have ADHD. One of his teachers mentioned that if he does, getting enough sleep is crucial. We’ve never been able to keep a bedtime schedule in our home that well. He is 7 and goes to bed around 10 p.m. He doesn’t seem to settle down before then. Any advice?
A: Your question opens up two large areas of concern in today’s society. The first is the role of sleep in children’s lives and the second is ADHD.
Let’s start with Attention Deficit Hyperactive Disorder (ADHD). “Attention Deficit” refers to an inability to consistently pay attention to what the child deems as boring material (much of schoolwork, for example). Attention can nearly always be paid to interesting material (video games and TV, for example). This inattention presents to the outsider as easy distractibility, procrastinating, poor organization, forgetfulness and starting but not finishing tasks. “Hyperactivity” is just what is says. To the outsider it presents as overactivity to the point that the child cannot sit or be still, is constantly fidgeting, is overtalkative, interruptive and does things just too fast to the point of making mistakes or having accidents.
Severe conditions need help. Mild conditions might benefit from help. It is likely some children who are not ADD/ADHD are diagnosed as such as the medicine can help anybody focus and be more energetic (just as caffeine can) and there are parents who push for “help” for their children to compete better even without strong traits of ADD.
The second issue is sleep. American society is sleep deprived from top to bottom. We try to squeeze so much into each day because we either have to or want to. We are a far too stimulated society for children, I believe. Because parents work so long and frequently want to squeeze in some time for their own relief and recreation, children are first subjected to the loss of time to be with their parents. With TV, video games, computers and the Internet there is little time left at night to let down and relax.
Sleep is a necessary thing. Ten hours for children and eight hours for teens are needed. Achieving those sleep times is a rarity, I believe. Lack of sleep can look very much like ADHD as described above with added irritability and oppositional behavior. There are experts who believe ADHD might be a sleep disorder.
If what I have just said is true, then the treatment should be making every effort to see that children get adequate sleep each night. That means that parents have to have consistent routines for sleep (such as baths, reading, music, no exciting TV or videos, no caffeine, etc.). That means some things in our busy lives might need to be given up to accomplish these goals. If problems are severe, then a counselor could help. If done properly, medicines are rarely necessary. Unfortunately, I use sleep medicines a lot with ADHD children. Most of the parents of these medicated children will say they are doing the best they can.
But, what I would add is the best they can under the circumstances we have come to live under in 21st-century America. Appropriate sleep alone should lead to greater focus, less irritability, more cooperation and more energy. Mild ADHD can sometimes be dealt with using this approach alone. Severe ADHD will require medication for optimal results.
As always, there are no easy answers. However, your son’s teacher brings up a very valid point. Good luck to your family!
Gerald Taylor, M.D., is a psychiatrist with Moses Cone Behavioral Health System Psychiatric Associates. Please submit your questions to “Is My Kid OK?” by e-mailing firstname.lastname@example.org.