BED TIME. Does reading these two words give you nightmares as a parent of a child with ADHD? Apparently it is VERY common for children with ADHD (and adults with ADHD too) to resist bed time. It is a nightly challenge for us in our household.
When thinking about ADHD and sleep, it might be helpful to think what I call the 4 stages of sleep:

• Bed time
• Falling asleep
• Staying asleep
• Waking up

Bed time for children with ADHD is challenging because, well, they often just don’t want to stop. However, once in bed, many children and adults with ADHD have trouble falling asleep, staying asleep and then, once asleep, waking up. According to research, prior to puberty 10-15% of children with ADHD have trouble getting to sleep. This is 2x the rate found in children and adolescents who do not have ADHD. The number of individuals with ADHD experiencing trouble getting to sleep dramatically increases with age (oh joy – another thing to look forward to!):

• 50% of children with ADHD have difficulty falling asleep almost every night by age 12 ½
• By age 30, more than 70% of adults with ADHD report that they spend more than 1 hour trying to fall asleep at night

Yikes!! [These figures were found in the February/March 2004 issue of Additude in an article written by William Dobson M.D. entitled, “ADHD Sleep Advice – End Bedtime Battles”.]

Fortunately for us, our son does not have trouble sleeping once we actually get him settled down into bed. It is bed time, itself, that is our challenge right now. So what helps us with bed time?

• Routine, routine, routine – routine is our best friend. We are probably our own worst enemy because on the weekends, we do not stick to the routine but a routine associated with bed time and a routine on the time itself have helped tremendously.
• One on one time with parents – our son still loves to cuddle with mom and dad. Nothing calms him down faster than when we lay down with him and cuddle. We chat quietly about our day and have a few quiet laughs, hugs and kisses. I don’t know if it is the sense of security, the routine or the cuddling that calms him down but it works for us.

Other suggestions for bed time settling down and falling asleep include:

• Turning off the TV and shutting down video games about an hour before bed time. TV and video stimulate all childrens’ nervous systems – imagine what it does to the nervous system of a child with ADHD.
• Avoiding caffeine before bed time. Not only is caffeine a stimulant but it is also a diuretic. Nothing worse than trying to sleep when you really need to pee!
• Having milk and ice cream. Dairy foods contain an amino acid that converts the active ingredients in milk to melatonin and serotonin. Both melatonin and serotonin help the body fall asleep.
• Practicing deep breathing. Practice releasing the tensions, energy and worries from the day and preparing for sleep through deep breathing.
• Taking Melatonin.
• Taking a bedtime medication prescribed by your doctor.
• Using sensory products such as weighted blankets or special tents that give a sense of security.
• Playing nature sound CDs, meditation CDs, white noise or calming music.
• Drinking “Organic Nighty Night” tea (we have actually used this) or other types of soothing teas.
• De-cluttering the child’s room to limit distractions.
• Taking a warm bathes or shower.
• Using lavender in the child’s room to calm.
• Making sure the child has plenty of exercise throughout the day.
• Behavior therapy.

Hopefully within this list you will find some ideas to help you and your child to find a bed time routine which results in a smooth transition from an awake state to an asleep state! (Is there such a thing as a smooth transition with a child with ADHD?)

Trouble with staying asleep is a whole other issue. I would examine food and exercise habits but also consult a doctor to make sure other conditions like sleep apnea or restless leg syndrome are not impeding a good night’s rest.

I tend to believe that having trouble waking up is probably correlated to the earlier phases of sleep like having trouble falling asleep or staying asleep. We definitely have trouble waking our son up some mornings but it is usually when he is tired. He needs more sleep towards the end of the week versus the beginning of the week because he works so hard at school and at home with homework. We give him a hot shower every morning and wrap him in warm towels when he gets out of the shower (wouldn’t it be nice if we all could have warm towels in the morning) and that helps him in waking up!

In the academic world, the correlation between ADHD and sleep disorders is one which needs to be further explored. What is known is that sleep problems are rampant in people who have ADHD. However, the big unanswered question is whether sleep problems are secondary to having ADHD or whether sleep disorders are another cause of ADHD. Right now, there is no answer. What is known is that the proper amount of sleep is important for anyone. Children with ADHD, however, need their sleep even more because the lack of sleep can make a life that is challenging even more so.

I hope this article is helpful in giving you some ideas to try in establishing a way to help your child transition more peacefully from being awake to being asleep.

As always, take care …. Until next time.
Karen

The outbursts, the tantrums, the eruptions … day in and day out. It is so stressful. Is it ODD? What is it? Should I be concerned?

The answer to the “should I be concerned question” is both yes and no. Yes, because any child needs to be taught how to handle situations and frustrations with a healthy response. No, because if you look at the problem through the lens of ADHD, it is another symptom of the disorder.

Believe me, I often stress over the angry outbursts and tantrums. They raise my stress level and there are days that they make me exhausted beyond belief. I have found, however, that a shift in my mental framework towards the angry outbursts help. Let me explain.

I thoroughly believe at this point that ADHD is a neurological disorder that impacts the executive functioning within the frontal lobe of the brain. I have written on numerous occasions that this can manifest itself in many different ways. Most associated with ADHD is either hyperactivity or inattention. Both are forms of behavior regulation. Hyperactivity is the inability to control or limit one’s activity and inattention is the inability to maintain attention when there is no interest in an activity or the activity is too challenging (i.e. too frustrating).

So why have I consistently put anger in a different category?

I have even done research into ODD, being concerned that his anger is an indication of ODD. (About 1/3^rd of kids with ADHD do develop some form of ODD) Well, duh, it dawned on me that really anger or lack of handling anger is just another form of regulation. It is emotional regulation versus behavioral regulation but it is really just another form of regulation.

So I have another one of those enlightened moments that seems so stupid after the fact. Gee why did I not realize that anger is just another regulation/management issue that is so challenging for someone with ADHD?

I have noticed that when our son spends more time watching TV or playing video games that he seems to be an angrier child. Exercise is important for any child but can be the difference between a reasonable child and a tantrum child for someone with ADHD. I even say to my son, “Wow, you have watched too much TV/played too many video games – you are angry boy. “ This helps him to identify what is going on and helps him to stop and think.

We still need to teach our son how to handle situations that make him upset or frustrated. It helps me, though, to think of it as a situation that needs to be managed (exercise and fresh air) and taught and not as a discipline problem.

I hope this approach helps you too.

Until next time …. Take care.