Trouble paying attention. Forgetfulness. Poor impulse control. These are behaviors commonly associated with ADHD, but they can also be signs of lack of sleep. And since many kids with ADHD are sleep-challenged, the two issues can at times be hard to tease apart.
Parents sometimes ask if a child might be misdiagnosed with ADHD when what’s causing his symptoms might really be a lack of sleep. And we hear anecdotes from parents of children whose ADHD symptoms diminished or disappeared when their sleep problems were solved. Does that mean they didn’t have ADHD in the first place?
Not getting enough sleep can cause or worsen ADHD symptoms. Hence solving sleep issues can help reduce symptoms.
Sleep disorders are rare in children, notes David Anderson, senior director of the ADHD and Behavior Disorders Center at the Child Mind Institute, so it is not likely that many kids have sleep disorders mistaken for ADHD, or both ADHD and a sleep disorder. But not getting enough sleep (even if your child doesn’t qualify for a sleep disorder) can cause or worsen ADHD symptoms. Hence solving sleep issues can help reduce symptoms.
A clinician doing a careful evaluation should always consider alternate explanations for ADHD symptoms before making an ADHD diagnosis, says Dr. Anderson. “As part of a good assessment for ADHD,” he says, “we want to rule out a number of other issues that could masquerade as ADHD symptoms.”
Besides sleep issues, other causes could include depression, trauma, and anxiety, all of which can present similar symptoms and, not incidentally, cause a child to be unable to sleep. Looking at symptoms like hyperactivity, distractibility and inattention in the context of all of a child’s symptoms is key to identifying the source.
Your child might have a sleep disturbance.
Lack of sleep can be the result of anxiety, including night terrors, or a medical condition like sleep apnea or asthma that affects breathing and makes it difficult to sleep soundly. Although only a small percentage of children are diagnosed with sleep disorders, ruling out a more serious medical condition is an important part of an initial psychiatric evaluation, notes Dr. Anderson. Things to look out for include:
- Trouble falling asleep
- Trouble staying asleep
- Trouble waking up in the morning
- Waking up screaming or in a panic
- Waking up coughing
- Labored breathing or pauses in breathing during sleep
- Strange noises during sleep
- Irritability
- Falling asleep in class
- Distractibility and difficulty paying attention
Though there are guidelines for how much sleep kids should be getting at every age, individual children vary in how much they need, so sleeping less than is typical is not an instant indication that something is wrong. However, less sleep than the average child of that age should be cause for further investigation. And lack of sleep can be impacting a child’s behavior even if it doesn’t reach the level of a full-blown disorder.
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