ADHD & sleep
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Mandy Gurney
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Former Director of the Sleep Clinic at the NHS St Charles hospital in London and Director of Millpond Sleep clinic. She also works as an NHS Sleep educator to health professionals across the UK.
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Child Sleep

ADHD & sleep

Essential Parent is passionate about helping primary school kids sleep better. Kids sleeping better means: Better focus and concentration in class = better results. A lower risk of ADHD misdiagnosis. A lower risk of obesity.
In Short
Scientists have found:

Sleep deprivation leads to poor concentration, bad moods, inability to focus, fidgeting, reduced IQ.

The symptoms of sleep deprivation are really similar to the symptoms of ADHD.

There's also a link between poor sleep and obesity.

Parents and teachers can avoid all of these issues by getting kids to sleep better.

Essential Parent have put together this super simple, 3 step course to show you how.

“This course changed the way we all sleep in our house! I learnt that I had many misconceptions about sleep and the practical tips and advice for bedtime routines are now with us for life! This is great for kids and adults”. Alice – Mum.
The link between sleep and obesity

The link between sleep and obesity is very straightforward. If children are sleep deprived, they tend to overeat to compensate and there is a higher change they will end up overweight or obese.

The links between sleep, behaviour and ADHD

The links between sleep, behaviour and ADHD are more complicated. We’ll go through them here.

A bit of background on ADHD

The numbers of children being diagnosed with ADHD – and the subsequent numbers of drug prescriptions – are rising alarmingly quickly, particularly in the USA.

According to the American Psychiatric Association, about 5 percent of American children do really suffer from Attention Deficit Hyperactivity Disorder (ADHD). However the diagnosis is given to some 15 percent of American children (up to 30% of boys in the Southern states), many of whom are then placed on powerful drugs with lifelong consequences.

This means around two thirds of the children diagnosed with ADHD do not actually suffer from the disorder, and shouldn’t be given stimulant drugs. These children suffer from simpler things, with similar symptoms that can be resolved without medication.

ADHD itself is not an epidemic—ADHD misdiagnosis is an epidemic…
Alan Schwarz – Pulitzer prize-winning author of ADHD Nation

Kids afraid laying in bed and pulling the quilt on their heads

What are the most common misdiagnoses of ADHD?

Three of the most common reasons for misdiagnosis are that children:

  • Aren’t sleeping well.
  • Are young for their class.
  • Have swollen tonsils or adenoids.

What are the symptoms of real ADHD?

Symptoms of ADHD include having:

  • Trouble concentrating.
  • Difficulty paying attention.
  • Trouble staying organised.
  • Difficulty remembering details.

Many children display these symptoms – particularly boys – but around 95% of them don’t have ADHD.

Why might a doctor diagnose ADHD and prescribe medication if it’s not needed?

ADHD medication might be prescribed quickly to children, rather than other possible avenues being explored, because:

  • It’s a potentially quick “solution”.
  • It might be easier for the doctors – hard-pressed for time, and appointment times short – than exploring longer term options of sleep, nutrition and other behavioural concerns.
  • Lots of parents want a quick solution too.
  • There is a lot of money being made by pharamaceutical companies with ADHD medication. These companies fund a lot of the research on ADHD which encourages Doctors and parents to try medication.

Would it hurt my child to try the medication?

If your child is one of the 5% who genuinely has ADHD, the medications can help – especially if taken in conjunction with behavioural therapy.

If your child doesn’t have ADHD (and remember, around 95% of children probably won’t), the drugs might cause long term problems worse than the original symptoms.

This is because potential side effects of the drugs include:

  • Insomnia.
  • Hallucinations.

How do doctors & specialists diagnose ADHD?

There’s no “diagnosis” – such as a blood test or CAT scan – so no-one really knows.

Instead, there’s a questionnaire (one standard example is called “The Conners Test” after the Doctor who created it) used to “diagnose” ADHD but it seems to lean towards over-diagnosis, at least in the USA.

Real diagnosis should take several visits to doctors and specialists. Discussions should be had with parents, teachers and specialists – and all other possibilities should be explored and ruled out first. This can take months.

A diagnosis which takes one appointment is not a thorough or responsible diagnosis.

So how can I actually test if my child really has ADHD?
  1. First ask your Doctor/ GP/ Paediatrician to check your child’s tonsils and adenoids. Swollen tonsils or adenoids can lead to poor quality sleep – which can create the same type of symptoms as ADHD.
  2. Is your child young for their class? Children in the same year at school can be nearly a year apart in age. At primary school age, this can be a huge gap in development and behaviour. Fidgety kids who can’t concentrate as well as their peers might just be a year younger!
  3. Is your child getting enough quality sleep?

You can consider questions 1 and 2 on your own, with your Doctor and Teachers. We will now help you with question 3.

Cute little kid sleeping

The Essential Parent 3 step course to helping kids sleep better
Step 1 – Create a target

The first question is – How much quality sleep should your child be having for their age group? That’s your target.

This table shows the average amount recommended for each age group – then the range as to what’s OK from time to time – then what’s not OK.

Source – US National Sleep Institute

Pre-schoolers (3-5 years)

Average – 10-13 hours

Normal range – 8-14 hours

Not OK – less than 8, more than 14 hours

School (6-13 years)

Average – 9-11 hours

Normal range – 7-12 hours

Not OK – less than 7, more than 12 hours

In summary:
So let’s say you have a 7 year old child. Your target becomes around 9-11 hours. If they sleep 7-8 hours, or up to 12 sometimes, that’s OK. If they are sleeping less than 7, or more than 12, that’s not OK.

Step 2 – Understand sleep hormones

There are two steps to improving a child’s sleep. The first is understanding how their sleep and stress hormones work. The second is using that understanding to create a bedtime routine.

We’ll look at understanding sleep hormones first. The Essential Parent sleep expert, Mandy Gurney, explains how they work in this video.

In summary:

  • Melatonin is the hormone which triggers sleep. It needs to be as high as possible at bedtime.
  • Cortisol is a stress hormone, which wakes you in the morning. It needs to be as low as possible at bedtime.
  • During the night, melatonin levels slowly decrease, and cortisol levels slowly increase.

When they cross over, you wake up.

Step 3 – Putting it all together – the bedtime routine

Once you have your target in terms of the number of hours you want your child to be sleeping, here’s how you encourage them to reach it.

Bedtime routines for children need to be all about increasing melatonin and reducing cortisol.

  1. Tryptophan rich foods like turkey and porridge can help to promote melatonin production and sleepiness.
  2. Avoid sugar, caffeine or fizzy, sugary drinks.
  3. A magnesium supplement can help children (and adults) relax before bedtime.
  4. A sleep routine is then really a series of gentle sleep cues that you and your child follow every night, in the same order. Your child will soon start to recognise that they’re preparing for bedtime and sleep, and will wind down accordingly so that by the time they’re in bed they’ll be feeling relaxed and ready to nod off.
  5. Don’t make the routine too long. It should only take about 30 minutes from beginning to end. Otherwise, your child will lose track and get confused and bored. Keep it calm and quiet.
  6. Remove all screens such as TV, smartphones and tablets for at least an hour before your child’s bedtime. Otherwise her brain will think it’s recognising daylight and trigger the hormone, cortisol, which will keep her awake.
  7. The sleep hormone, melatonin, is triggered by darkness so minimise light – especially the artificial light emitted by screens.
  8. When we were living in caves – we went to sleep when it became dark and cool. Dark and cool trigger melatonin – so you need to think like a caveman to help your child sleep!
  9. Your child’s bath should be nice and warm – not too hot – and last just five minutes. A long hot bath raises the body temperature and reduces melatonin. Remember that’s the hormone which promotes sleepiness, so it needs to be raised as high as possible at night-time – and that’s best done by keeping things dark and cool. If you want to have a longer, warmer play bath, have it earlier in the day for fun.
  10. Get your child to dry off quickly and head straight into her bedroom. Quietly put on pyjamas and pop into bed.
  11. Sing a lullaby, or read a story.
  12. Give her a kiss, a cuddle, say good night and pop her down to sleep.
For further information from Essential Parent on whether your child really has ADHD, please click here.

What is Essential Parent?

Essentialparent.com is a website created by a team formerly from the BBC Science Department. Working alongside some of the world’s top medical experts (see below) we create online courses, including videos, articles, webinars, and consultations, on everything you need to know on:

  • Conception
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  • Teenagers

Essential Parent was launched in 2011, and all our baby care courses are officially supported by:

The Royal College of Paediatrics and Child Health

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We follow expert advice from:
  • UNICEF UK Baby Friendly Initiative
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  • Paediatricians
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  • Midwives
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  • Teachers
  • and many more.

Essential Parent’s work is used by:
  • The Royal College of Paediatrics and Child Health to help train junior paediatricians around the world;
  • NCT teachers to give their antenatal classes in the UK;
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  • Midwives;
  • Barnardo’s children’s centres;
  • Local authority children’s centres; and
  • Over 100 maternity hospitals in the UK.
Mandy Gurney

We hope you enjoyed the videos and advice from Mandy Gurney, Essential Parent’s sleep expert and the Director of Millpond Sleep Clinic.

Mandy started her training as a general nurse and it was during that time that she decided to train as a midwife and health visitor.

Whilst being a health visitor she gave birth to her son, who’s now 23. He had all sorts of sleep problems. He came as a little bundle of joy with reflux, asthma and food allergies. He cried a lot during the day and at night too, and consequently it was a difficult time for her.

She went back to work and thought she had all the right people she needed to help her – GP’s, psychologists, and so on. But she found she wasn’t able to get the help she needed. This led her to think there must be so many other parents in a far worse situation that she was. So she eventually set up a sleep clinic at St Charles NHS Hospital in London which ran for about five years.

She then set up Millpond about 11 years ago with a colleague that she was working within the NHS. She acts as an advisor to the NHS on sleep issues.

Note
Do you need more help?

If you are a health professional or a parent, who needs more guidance on helping babies and children to sleep better, we suggest getting in touch with Mandy Gurney direct at www.millpondsleepclinic.com or 020 8444 0040. Mandy gives the NHS evidence-based, expert advice, and she is our recommendation for you too.
Any questions?

Get in touch on hello@essentialparent.com

Further reading:

Adams, SK, and TS Kisler. “Sleep quality as a mediator between technology-related sleep quality, depression and anxiety.” Cyberpsychol Behav Soc Netw. 2013; 16(1): 25-30.

Aronen, A et al. “Sleep and Psychiatric Symptoms in School-Age Children.” Journal of the American Academy of Child and Adolescent Psychiatry. April 2000, 39(4): 502-508.

Centers for Disease Control and Prevention. “Increasing prevalence of parent-reported attention-deficit/ hyperactivity disorder among children – United States, 2003-2007.” Morbidity and Mortality Weekly Report, 2010; 59 (44): 1439-43.

Cooper, WO et al. “ADHD drugs and serious cardiovascular events in children and young adults.” N Engl J Med. 2011; 365(20): 1896-904.

Elder, TE. “The importance of relative standards in ADHD diagnoses: evidence based on exact birth dates.” J Health Econ. 2010; 29(5): 641-56.

Hale, L, and S Guan. “Screen time and sleep among school-aged children and adolescents: a systematic literature review.” Sleep Med Rev. 2015; 21: 50-18.

Mayes, R et al. “ADHD and the rise in stimulant use among children.” Harv Rev Psychiatry. 2008; 16(3): 151-66.

Mosholder, AD et al. “Hallucinations and other psychotic symptoms associated with the use of attention-deficit/ hyperactivity disorder drugs in children.” Pediatrics. 2009; 123(2): 611-16.

National Institute for Clinical Excellence. “Attention Deficit Hyperactivity Disorder: Diagnosis and Management of ADHD in Children, Young People and Adults.” NICE Clinical Guidelines. 2008: 72:6.

Sleator, EK, and RK Ullmann. “Can the physician diagnose hyperactivity in the office?” Pediatrics. 1981; 67(1):13-17.

Swanson, JM et al. “Effects of stimulant medication on growth rates across 3 years in the MTA follow up.” J Am Acad Child Adolesc Psychiatry. 2007; 46(8): 1015-27.

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DISCLAIMER
This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Essential Parent has used all reasonable care in compiling the information from leading experts and institutions but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details click here.