Could Childhood ADHD Be a Sleep Disorder?

Over the past several decades, U.S. parents and teachers have reported epidemic levels of children with trouble focusing, impulsive behavior and so much energy that they are bouncing off walls. Educators, policymakers and scientists have referred to ADHD, as a national crisis and have spent billions of dollars looking into its cause.

They’ve looked at genetics, brain development, exposure to toxic substances like lead, the push for early academics, and many other factors. But now a growing number of researchers are asking what if the answer to at least some cases of ADHD is due to the fact that many kids today simply aren’t getting the sleep they need, leading to challenging behaviors that mimic ADHD?

Several studies in the past have identified links between ADHD and problems with the length, timing and quality of sleep. There seems to be growing evidence that some children have been diagnosed with ADHD when, in fact, they suffer from insufficient sleep, insomnia, breathing issues or other sleep disorders.

But now research, presented recently at  European College of Neuropsychopharmacology Conference in Paris takes this a step further and suggests that ADHD itself may be a sleep disorder. The latest data on this topic examined people’s natural cycle of sleeping and waking and showed that study subjects with ADHD had levels of the hormone melatonin that rose 1.5 hours later in the night than those without ADHD. As a result, they fell asleep later and got less sleep overall, with consequences for other body processes. When the day and night rhythm is disturbed, explained researcher Sandra Kooij of the Vrije Universiteit Medical Centre in Amsterdam, so are temperature, movement and the timing of meals. Each change can lead to inattentiveness and challenging behavior.

Karen Bonuck, a professor of family and social medicine at Albert Einstein College of Medicine in New York, during her work for the National Institutes of Health, found that a large number of preschool children were going to sleep at 11 p.m. or later but had to be up before 8 a.m. to go to school. They were getting far less sleep than the American Academy of Pediatrics recommends for children of that age. “Challenging behavior is a huge problem in the classrooms on a national level, and the symptoms of lack of sleep can look a lot like the symptoms of ADHD,” she said in discussing her findings.

While tantalizing linkages between sleep disorders and ADHD are becoming more evident, most clinicians will probably not be ready to accept that ADHD itself is a sleep disorder. William E. Pelham, a longtime ADHD specialist who directs the Center for Children and Families at Florida International University, represents this viewpoint when he says, “Sleep is an issue for anything where you are trying to measure attention. But I don’t believe it accounts for the vast majority of ADHD in the United States.”