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Sleep Care

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A.D.H.D. and Sleep

Does your child have trouble sitting still in class and staying focused? Difficulty controlling his or her emotions and behavior? While some may attribute such challenges to normal behavior at that age, for a few children, they are signs of something more significant: Attention Deficit/Hyperactivity Disorder (ADHD).

According to the National Institute of Mental Health, it’s estimated that 3% to 5% of children have ADHD, although those figures rise to 8% to 10% in school-age children. ADHD is also sometimes referred to as Attention Deficit Disorder (ADD), although ADD is more common in young adults than children.

While the exact cause of ADHD is unknown, research has shown several factors that might impact its development. Heredity appears to play a role, since ADHD tends to run in families. Imbalances in neurotransmitters—chemicals that regulate various functions in the brain—may also be a factor. Studies with children who have ADHD have found that the areas of their brain responsible for controlling attention are less active than in normal children, suggesting a possible structural cause. Complications during pregnancy—such as those due to poor nutrition, infections, or cigarette and alcohol abuse—can lead to ADHD since they affect the baby’s brain development

A Hyperactive Tired State

When adults with ADD are tired, they become sluggish. Children with ADHD, however, tend to become more energetic and active. It would be reasonable to conclude this would make it harder for them to fall asleep. Surprisingly, this does not appear to be the case. In a 2004 study investigating sleep disturbances in children with ADHD, those with ADHD generally fell asleep as quickly as those without ADHD. Children with ADHD also slept for the same length of time throughout the night. Despite these similarities, children with ADHD were significantly sleepier during the following day. One explanation offered by the study authors was that children with ADHD had higher rates of various sleep disorders when compared to the normal control group. For example, 50% of the children with ADHD had some form of sleep disordered breathing, compared with only 22% for the control group. While none of the children in the normal group had periodic limb movement disorder (PLMD) during the night, 15% of those with ADHD did.

The primary characteristic of a person’s ADHD may make a difference in how their condition affects their sleep. A 2007 questionnaire/survey study with several thousand college freshmen in Taiwan found that if a person’s ADHD was associated primarily with inattention as the main symptom, they required a significantly longer sleep time in order to maintain normal daytime functioning.

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In contrast, people with ADHD primarily associated with hyperactivity or impulsivity did not show that difference when compared to the normal group’s responses.

A Variety of Treatment Approaches

A common starting point for treating ADHD is stimulant medication, such as Ritalin. Stimulant medications are effective for approximately 80% of individuals who take them. Unfortunately, several side effects—notably insomnia—are common with the medications. Because of this, a variety of other approaches are usually considered as well.

Children with ADHD often benefit from a special education plan: namely, a highly structured environment and use of routines to help regulate behavior. This can also be beneficial for developing regular bedtimes and good sleep hygiene to promote better sleep. Social skills training can help children develop new behaviors, such as sharing and taking turns, to help them participate in group activities in a more appropriate manner.

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Because a lack of control over emotions and frustrations often accompanies ADHD, counseling for both the child and the family can be beneficial to learn healthy ways to communicate.

Since sleep disorders often accompany ADHD, sometimes treating the sleep disorder can improve the ADHD symptoms. For example, a 2007 study evaluating obstructive sleep apnea (OSA) and ADHD found that surgical treatment of mild OSA in children led to such an improvement in symptoms that stimulant medication was not necessary to use on a long-term basis to control the children’s ADHD.

 

 

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