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Sleep Problems and ADHD
After reviewing a study on the association between sleep difficulties and ADHD in the last issue of ADHD RESEARCH UPDATE, I became curious about prior research in this area. Recall that the study indicated that a significant percentage of children with ADHD had some form of sleep difficulty, and suggested that treating their sleep problem could also be an effective treatment for their ADHD symptoms.
It is important to note that a study like this merely establishes that a correlation may exist between sleep difficulties and ADHD, and documenting this correlation does not mean that sleep problems cause ADHD. It is just as likely that ADHD causes the sleep difficulties or that some other factor contributes both to the child’s ADHD symptoms and to their sleep difficulties.
What I was interested in learning is whether any research has been done where treating the sleep difficulties of a child with ADHD was found to reduce their ADHD symptoms. I was surprised to find only two published case studies on this issue. The first was as far back as 1976 and appeared in the Journal of Behavior Therapy and Experimental Psychiatry. In this report, the insomnia of a 7 year old boy with ADHD was treated via behavioral therapy. The treatment was successful in eliminating the boy’s insomnia and it was reported that significant reductions in hyperactivity were also obtained. These reductions were sustained over a 6 month period. The only other study I found appeared in the Journal of Pediatric Psychology (1991, Vol. 16). This was another case study in which behavioral interventions were used to treat insomnia in a 10 year old girl. Successful treatment of the girl’s insomnia led to better peer interactions, and increased academic productivity at school. These gains were maintained over a 4 month follow up period.
Obviously, 2 case studies are not nearly sufficient to establish the efficacy of any form of treatment, and it is surprising to me that more research has not been conducted on this provocative topic. Until such work is done, no definitive statements about the efficacy of treating sleep difficulties as a treatment for ADHD can be made. Even so, work in this area highlights the importance of considering the role that sleep problems may play in a child’s behavioral difficulties. This is an area that most mental health and medical professionals don’t routinely inquire about, and it may be an important factor for at least some children with ADHD. Thus, even though the nature of sleep difficulties in children with ADHD is not yet clearly established, behavioral treatment of these difficulties may provide symptom relief for some children, and improve their relationships with peers and family members. If your child seems to have consistent difficulty getting a good nights sleep, this may be very important to take a careful look at.
Note: This article originally appeared in Attention Research Update, an online newsletter written by Dr. David Rabiner, a Duke University psychologist and former member of CHADD's Professional Advisory Board. You can learn more about Attention Research Update and sign up for a free subscription at www.helpforadd.com.