Sleep can be tricky enough with neurotypical children – for both the parent and the child. For neurodiverse children with ADHD, sleep can become a nightly battle where sleep takes on an entirely different form. Delayed sleep onset, difficulty staying asleep and reduced sleep quality can be a result. As a Specialist Sleep Practitioner, I work with families around the world with infants and young children, however, I also support families who have children with a diagnosis of ASC and ADHD or who are on the pathway to a diagnosis.
ADHD or ADD as it is also referred to is a neurodevelopmental condition ‘characterized by a persistent pattern of inattention and/or hyperactivity/impulsivity that interferes with functioning or development’. In the UK, ADHD affects about 3-5% of children and 2% of adults. That number, I’m sure, is not accurate as there are so many children – and adults – who go undiagnosed. Individuals with ADHD often have co-morbidities such as depression, anxiety, OCD, ODD, learning difficulties, fine and gross motor skills, and tic disorders.
As if life wasn’t tricky enough for children with ADHD, sleep concerns are prevalent. Around 25% of these children experience mild difficulties and approximately 50 % experience moderate to severe difficulties with sleep, including sleep onset latency and shorter sleeping duration.
Sleep difficulties can exacerbate the core symptoms of hyperactivity, impulsivity and inattentiveness and can impact co-morbid conditions such as anxiety and low mood. Not being able to quiet the mind enough to relax and fall asleep is a major contributor to night time difficulties and distractibility and restlessness can also increase at bedtime. It’s a vicious cycle, isn’t it?
The way a child presents with ADHD can also contribute to different types of sleep problems; children with combined hyperactive-impulsive and inattentive ADHD experience both poor sleep quality and a delay in sleep onset. Additionally, ADHD medication can impact sleep as the nature of stimulant medication can make falling asleep harder.
Sensory differences can affect sleep for a variety of reasons. Sometimes the routine leading up to bedtime is dysregulating, which will impact the child: water can overstimulate, or their olfactory system can be overwhelmed by bath gel or clean laundry. Sometimes the child is so overstimulated from the day that settling to sleep can be challenging.
For neurotypical and neurodiverse children, there are common factors that affect their sleep. Some of these include:
- Use of technology in bedroom
- Lack of activity during the day
- Lack of or illogical bedtime routine
- Falling asleep with settling cues/wrong location
And the above list doesn’t include other sleep conditions such as parasomnias, obstructive sleep apnoea and restless leg syndrome.
Children with ADHD and ASC can also have lower levels of melatonin, one of our sleep hormones, which helps us feel sleepy. Melatonin is a soporific and is helpful in regulating or correcting our circadian rhythm and supporting sleep propensity.
Phew! It’s overwhelming, isn’t it? It’s as if the deck is stacked against these neurodiverse children, and on top of the struggles these children face in the day, night offers no respite.
So the question is, what can we do?
In addition to practicing good sleep hygiene, there are small ‘easy’ changes that we can introduce into each day to support healthy sleep. Some of these may be:
Reduce exposure to blue light as it can have a negative impact on settling time. Aim for 60 minutes screen free time before bed – a minimum of 30 minutes.
If not already using white noise, introducing it to the sleeping environment can help mask environmental noise. Studies have shown it to reduce sleep onset latency and it has also been shown to be beneficial for those who find it difficult to switch off, as well as those who struggle with anxiety.
Cut down on caffeine and sugar. Caffeine blocks a chemical in the brain called Adenosine. This is a neurotransmitter that makes us feel tired, so avoid caffeine from about lunchtime and certainly no later than 3:00pm. Sugar can cause rapid fluctuations in glucose levels which can increase adrenaline levels and make it difficult to settle.
Get active. Physical activity can help promote better sleep; the fitter you are, the better you sleep. Exercise increases sleep pressure or sleep drive.
Consume foods rich in tryptophan. Certain foods contain an essential amino acid called tryptophan which helps the body produce melatonin. Some foods rich in tryptophan are chicken, turkey, rice, bananas, oats, cheese, bread, milk (which contains the highest amount of tryptophan), and honey.
Bedtime routine: a bedtime routine should be consistent, logical and should link preparation for bed with going to bed (for example, putting on pyjamas in the bedroom and not downstairs in the living room). A routine should be followed before each sleeping period (for naps, you would use an abbreviated routine that lasts about 10 or 15 minutes) and should last between 30 to 45 minutes (a little longer for older children).
On top of these changes, a healthy dose of understanding mixed with a dollop of patience, support and humour, and topped off with a warm hug can help make bedtimes just that little bit easier for everyone.
Kate Himsworth, Founder and Chief Sleep Officer of www.katehimsworth.com, has worked with families worldwide for over 30 years, supporting children up to 16 years of age. Kate is a mother of four boys and is passionate about supporting women and their families during birth as a Doula, as well as in the years that follow by providing specialist sleep support. As an Advanced Paediatric Sleep Practitioner, Kate’s practice includes managing sleep complexities that accompany ADHD and ASC as well as neurotypical children.