In a recent randomized, controlled trial done by researchers in Australia, children with ADHD were treated with behavioral steps to reduce insomnia, or given usual treatment by a pediatrician. At 3 and 6 months, children in the treatment arm showed fewer symptoms of ADHD, better working memory, behavior and quality of life compared to children in the control arm of the study. The treatments did not cure the ADHD, but they did reduce the symptoms and impact of ADHD on the child's life.
What kind of treatments were they? Well, to start with, parents were given information about how sleep works in children and about techniques that help neurotypical children fall asleep easily. These techniques include:
having a set wake and sleep time
having a soothing bedtime routine (such as snack, brush teeth, pajamas, read a story, go to bed)
keeping the bedroom media free
no caffeine after 3 pm
The families were also given specialized instructions depending on what kind of sleep problem the child had.
Limit setting sleep disorder. This occurs when the parents are unable to get the child to comply with a set bedtime. The child may employ stalling techniques, including tantrums, asking questions, saying they have to go to the bathroom, and many other creative alternatives. Behavioral treatment involves not giving in, and basically ignoring any protests and sending the child gently back to bed. Also, it is important to note that giving in (for weekends, special events, etc) when still in the learning phase will make things more difficult for everyone.
Delayed sleep phase. This occurs when a child's biological clock is set for a longer than 24 hour day, so that their body does not produce the hormones needed for sleep until later and later every night. Behavioral treatment for this disorder includes keeping the child awake until later than they normally would fall asleep at first, to accustom them to falling asleep quickly, while waking them at a set time in the morning, then gradually moving their bedtime earlier. Delayed sleep phase can also be successfully treated with bright light therapy and melatonin.
Anxiety related sleep disorder. Children with this problem have trouble sleeping because of excessive worry at bedtime. Behavioral treatment for this problem involves learning relaxation techniques and visualization (i.e. imagining a relaxing place).
Better sleep helps people with ADHD. This study shows that sometimes treatments that do not involve medication can be effective in helping improve sleep in individuals with ADHD. However, some people with ADHD do have other, more serious or more difficult to treat sleep disorders. If the above steps are not working for your child, it is important to consult with a medical professional to determine if one of these sleep disorders is present. Some of the disorders are described in my article ADHD and Sleep Disorders.
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