Q. My child has Attention Deficit Hyperactivity Disorder (ADHD) and it’s been hard for him to get to sleep. What can we do?
A: Sleep problems may affect up to half of children and adolescents with attention deficit hyperactivity disorder. Typical problems include resisting getting into bed and difficulty falling asleep.
Poor sleep can cause attention problems in all children. But poor sleep can affect attention even more in those with ADHD. And it also works the other way; ADHD may be the reason for disrupted sleep. The two problems may have common biological roots.
In children with ADHD, brain circuits that control attention and sleep may function poorly. Another potential culprit is an unsteady circadian rhythm. This is the biological rhythm that makes us tired at night and more awake in the morning.
Symptoms such as hyperactivity and an inability to settle down may contribute to bedtime resistance. Likewise, poor sleep at night can make behavior worse during the day.
People with ADHD frequently also have anxiety, depression, learning disorders, conduct disorders, sleep-disordered breathing, or restless leg syndrome. All of these can cause sleep problems.
The drugs used to treat ADHD can interfere with sleep. Most drugs for ADHD are stimulants. But in children and teens, stimulants generally have an opposite effect of calming them down.
It’s usually best for children and teens to take stimulants early in the day. Sometimes, mood or behaviors get worse as the stimulant drug wears off. Those children may require a lower dose, a time-release formula, or a non-stimulant drug.
In most cases, the approach to sleep problems in children with ADHD will be similar to the approach with any child. Here are some tips:
• If medications are part of the treatment, adjust them to minimize any bad effect on sleep.
• Try to stick to a regular sleep/wake schedule.
• If possible, avoid caffeine after noon. That includes coffee, tea, some soft drinks, chocolate drinks and candy.
• Keep the bedroom free of distractions, like TV or video games.
• Get a therapist’s help for managing worries that may be interfering with sleep.
• Promote exercise during the day, but calm activities in the hours before bedtime.
• Above all, exercise patience. It’s harder to develop good sleep habits if sleep becomes a struggle. The goal is to help your child acquire one of the most important skills – knowing how to get a good night’s sleep. That could provide a lifetime of benefits.
Dr. Michael Craig Miller is an assistant professor of psychiatry at Harvard Medical School and an associate physician at Beth Israel Deaconess Medical Center, Boston, Mass.