Dr. Alan Greene on Sleep Deprivation and ADD/ADHD
Is there a link between sleep deprivation and ADD or ADHD?
Can sleep deprivation play a role in behavior disorders such as ADD and ADHD?
Until recently, the effects of partial sleep deprivation have been seriously underestimated. We know, based on common sense, that inadequate sleep makes kids more moody, more impulsive, and less able to concentrate. We've known for more than 20 years that sleep deprivation makes it difficult to learn (Journal of Experimental Psychology, March 1975).
Recent research has verified that chronic poor sleep results in daytime tiredness, difficulties with focused attention, low threshold to express negative emotion (irritability and easy frustration), and difficulty modulating impulses and emotions (Seminars in Pediatric Neurology, March 1996). These are the same symptoms that can earn kids the diagnosis of attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD).
ADD/ADHD is a real and important problem in its own right, but recent research in sleep laboratories has shown that some -- perhaps a great many -- kids are mislabeled with ADD/ADHD when the real problem is chronic partial sleep deprivation.
When children are identified with the symptoms of ADD/ADHD, often no one thinks to explore the child's sleeping habits and whether they might be responsible for the symptoms. (People also forget to consider childhood depression as a possible cause for these symptoms -- but that is another story.)
Sometimes it is obvious to parents that their children are not sleeping well -- but not always.
Any child who snores may not be getting adequate sleep. Obstructive sleep apnea is a common medical condition that is now being identified in more and more children. The peak age for this is 2 to 5 years, but it can occur at any age. Not all kids who snore have sleep apnea. Classically, those with sleep apnea snore quite loudly for a bit, then are silent, then snort briefly, move about, and resume snoring. If snoring is accompanied by nighttime breathing difficulty and pauses in breathing, then it may well be sleep apnea. This should be brought to the attention of your pediatrician. You might want to make a cassette tape of your child's sleep noises to bring with you.
Children with sleep apnea do not get sound sleep. They may also get suboptimal oxygen to the brain at night. Obstructive sleep apnea can have a serious negative impact on a child's intellect and behavior. The common symptoms of sleep apnea are difficulty paying attention during the day, decreased academic performance, oppositional behavior, and restlessness. Not all kids with sleep apnea snore. Even when they do, sleep apnea is often overlooked. Instead the child is diagnosed with a behavioral disorder -- most commonly ADD (Journal of Clinical Child Psychology, September 1997).
Children with sleepwalking, restless leg syndrome, narcolepsy, insomnia, or other sleep problems may also be misdiagnosed with ADD (Neurology, January 1996).
When parents of children with ADD are interviewed, they usually identify their kids as poor or restless sleepers (Journal of Pediatric Psychology, June 1997). Kids who have been diagnosed with ADD do wake up more often at night than their peers (Pediatrics, December 1987). Poor sleep is a common feature of ADD -- a problem that can be made worse by the use of stimulant medications such as Ritalin or Dexedrine.
In an individual child, it can be very difficult to tease apart whether interrupted sleep is the cause or the result of ADD. The good news is that even when ADD is the correct diagnosis, addressing the sleep issues can dramatically improve the behavior of the child (Journal of Pediatric Psychology, April 1991).
If your child has ADD symptoms or other behavior problems, he or she should be carefully assessed for sleep problems. If sleep disturbances are present, addressing these is important whether or not they are the root cause.
If your child is not getting sound, uninterrupted sleep, discuss this with your pediatrician. You may also want to contact the National Sleep Foundation at 202-347-3471 or the American Academy of Sleep Medicine at 507-287-6006 for information or referrals. There are now more than 3,000 Sleep Disorders Centers that can provide help. Another great resource is Helping Your Child Sleep Through the Night, by Joanne Cuthbertson and Susie Schevill.
As parents, we all know what it feels like to be grumpy, contrary, and "not at our best" from lack of sleep. If our kids often feel this way, we owe it to them to find solutions to this problem.
The information on this Web site is designed for educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your pediatrician or family doctor. Please consult a doctor with any questions or concerns you might have regarding your or your child's condition.