Childhood ADHD has become much more common. At the same time, children have been getting less and less sleep now compared to even 20 years ago. How a child develops ADHD is not exactly clear, but there is evidence suggesting that a lack of sleep could be related to it. If the two are related, it’s possible many ADHD symptoms could be improved through simple changes in sleep.
What is ADHD?
ADHD or attention-deficit hyperactivity disorder can be broken down into 3 subtypes:
- A combination of both
A child with ADHD will show these traits at inappropriate times and in different settings. The inattentive type is the most common, making up between 39% and 49% of all ADHD diagnoses.
ADHD often comes with difficulties in school or social situations, and related but separate psychiatric conditions may occur, such as oppositional defiant disorder, conduct disorder, anxiety, depression, obsessive-compulsive disorder (OCD), tic disorder, autism spectrum disorders, substance abuse, and delinquent behaviours (Willcut, 2012).
ADHD is the most commonly diagnosed childhood psychiatric disorder, affecting around 5.3% of children worldwide (Polanczyk, de Lima, Horta, Biederman, & Rohde, 2007).
Lack of Sleep Could Be an Explanation for Increased ADHD Diagnoses
A lack of sleep has similar symptoms to ADHD. Sleep deprivation weakens a child’s cognition, usually presenting itself as problems with attention. Research shows that limiting the sleep of healthy students leads to more comments from their teacher about trying to keep their attention (Fallone, Acebo, Seifer, & Carskadon, 2005). Other problems from not enough sleep could be with working memory, problem-solving, or emotional responsiveness. Because of these behaviours, inattention due to a lack of sleep could lead to a diagnosis of ADHD.
On a larger scale, the rising rate of ADHD might be explained by the lower amounts of sleep children are getting these days. Today’s technology is constantly stimulating kids, making it difficult for them to fall asleep at night and get quality sleep.
US research shows that about 96% of Americans under 30 use a technological device in the bedroom in the last hour before going to sleep, and 42.4% of US children aged six to ten have a television in their bedroom (Calamaro, Yang, Ratcliffe, & Chasens, 2012).
Pre-bedtime electronic use is common in many countries.
Check out another interesting and related article from the UK’s Daily Mail on the use of mobile devices at night and the effect it’s having on children. http://www.dailymail.co.uk/health/article-2577824/Why-NEVER-mobile-bedroom.html
Is There a Definite Relationship Between ADHD and Lack of Sleep?
Low sleep increases both inattention and hyperactivity. Surprisingly, hyperactive behaviour is most likely a way for a child to battle fatigue and stay alert. Once again, this shows how sleep deprivation can lead to an ADHD diagnosis.
But, the relationship is two-sided, because the symptoms of ADHD often make sleeping more difficult. Many parents report children with ADHD having sleep problems. Sleep-related breathing disorders like snoring and periodic limb movement disorders can develop from hyperactive behaviour during the day. But, in turn, treating the sleep disorders can then reduce the daytime ADHD symptoms.
It is hard to know where the cycle of symptoms begins. Lack of sleep seems to boost ADHD symptoms, and those symptoms (and the required drugs) make sleeping harder. It is unclear whether it’s the daytime or nighttime symptoms that shape the child’s behaviour. Most likely, it is a mixture of both.
Look to Sleep
However, there is some evidence suggesting that sleep problems actually do come before ADHD. There are several studies showing how sleep problems can accurately predict the development of ADHD for a child in the future, one even starting with infants and predicting five years ahead (Thunstrom, 2002).
Also, it is significant that ADHD symptoms can be reduced by treating sleep problems. For example, having a tonsillectomy helps with breathing when asleep, thereby improving sleep quality and reducing daytime ADHD behaviours.
Based on these findings, sleep is probably a good place to look first to prevent and calm ADHD symptoms.
What to Do If You Suspect ADHD?
It is good to start with sleep. The 5-item test BEARS (B-Bedtime issues, E-Excessive daytime sleepiness, A-Awakenings during the night, R-Regularity and duration of sleep, S-Snoring), which is used in primary care, is a useful tool to consider your child’s sleep. The BEARS test can be found by clicking here.
To get better sleep, make behavioural changes that bring more structure to your child’s sleep schedule. These changes could be having a regular bedtime or avoiding coffee/energy drinks before bed. Also, good sleep hygiene practice has been shown to reduce ADHD symptoms and improve overall health and behaviour.
Perhaps most importantly is a child’s use of electronics in the evening. It is recommended not to use electronic devices at least one hour before bed, especially interactive ones like video games. Also, if snoring is a problem, consider options with your paediatrician like a tonsillectomy or mouth/breathing exercises.
Taking these above steps will likely help a child’s inattentive or hyperactive behaviour during the day.
Every child needs healthy sleep, usually around 8 hours worth. So before looking into ADHD medication, perhaps try the simpler cure!
Calamaro, C.J., Yang, K., Ratcliffe, S., & Chasens, E.R. (2012). Wired at a young age: the
effect of caffeine and technology on sleep duration and body mass index in school-aged children. J Pediatr Health Care, 26(4), 276-282. doi: 10.1016/j.pedhc.2010.12.002
Fallone, G., Acebo, C., Seifer, R., & Carskadon, M.A. (2005). Experimental restriction of sleep
opportunity in children: effects on teacher ratings. Sleep, 28(12), 1561-1567.
Polanczyk, G.V., de Lima, M.S., Horta, B.L., Biederman, J., & Rhode, L.A. (2007). The
worldwide prevalence of ADHD: a systematic review and metaregression analysis. American Journal of Psychiatry, 164(942-948).
Thunstrom, M. (2002). Severe sleep problems in infancy associated with subsequent
development of attention-deficit/hyperactivity disorder at 5.5 years of age. Acta Paediatr, 91(5), 584-592.
Willcut, E.G. (2012). The prevalence of DSM-IV Attention-Deficit/Hyperactivity Disorder: A
meta-analytic review. Neurotherapeutics, 9(490-499).