ADD or sleep deprivation?

[velvetpage]

http://www.sciencefriday.com/program/archives/200804115

The link is to a radio program about the connections between sleep deprivation and various behavioural disorders, including ADHD. I have no problem believing that there's a connection, and that in some cases, it's a causal connection; that is, the lack of sleep is causing the symptoms that are diagnosed as ADHD. I have at least one student right now who is not diagnosed ADHD, but definitely exhibits many of the behaviours associated with it. The student has access to three different video game systems in his bedroom, and plays them until all hours of the night. I know this because he comes to school the next day boasting about how late he stayed up. I'd be surprised if he's getting five hours of sleep a night on average, and according to standard pediatric wisdom, he needs about double that. Meanwhile, he's a smart kid who should be getting B's and instead is getting C's and D's. Furthermore, I've never known an ADHD student who slept well.

Now, for my questions: I would like to see a study done on a wide variety of kids, some of them with ADHD diagnoses already in place, to find out if the sleep deprivation is causal or not; I'd like to know if there may be times when ADHD is causing the sleep deprivation rather than the other way around, and how much of that is due to environmental factors (such as the presence of video games or TVs in a child's bedroom.) I know plenty of parents - indeed, I am one - who have trouble getting their kids into a sleep pattern that would fit the bill for "enough sleep," according to prevailing wisdom: that is, eleven to twelve hours for a child under five, ten to eleven hours for a child five to nine, and nine to ten hours from then until the late teens, when most kids will start to settle into an adult sleep pattern of seven to eight hours a night. Is establishing a sleep pattern early in life essential to our children's long-term mental and physical health? At what point do we seek medical help to get them to sleep more - assuming they're exhibiting symptoms of sleep deprivation?

I predict that this series of studies will revolutionize not just the treatment of ADHD and other chronic childhood disorders, but also parenting books. Until now, a lot of sleep problems have been met with: "Give it time, and it will likely sort itself out. If you're not willing to wait it out, try this." I'm wondering if that advice is going to change to: "If your child doesn't have a good sleep pattern by X date in their development, they are at substantially increased risk for X, Y, and Z disorders. Here are some suggestions that parents REALLY NEED TO FOLLOW to prevent that." (For the record, this research has been building up over the last five or ten years, which is not very long in medical terms; a lot of it has been driven by adults diagnosed with ADHD as children, who come in for sleep studies. When a sleep disorder is diagnosed, the adults often find that their ADHD symptoms clear up.)

Thanks catsarah for the link.

Comments

[melstra.livejournal.com]

Very interesting! I'll have to listen to the podcast sometime soon (I *love* Science Friday, btw-- they always have excellent topics. I catch it a lot when I'm on the way home from school).

I have a student this semester who is ADHD and recently has been falling asleep through most of class. I contacted his parents about it and they've said it's happening in his other classes too-- he is having trouble sleeping at home, major insomnia. The doctor said he thought it was depression, but the kid insists he's not depressed. I wonder if there are studies connecting depression with sleep and ADHD too? Probably.

I just know it would be great for about 75% of my kids to get at least 2 hours more sleep a night. Starting school at 7.30 doesn't help matters!

[velvetpage.livejournal.com]

There are half a dozen studies out there suggesting that high schools should start at ten and end at five to take optimal advantage of teens' natural sleep cycles. As another who starts fairly early, I can see the benefit of this.

[kisekileia.livejournal.com]

Yeah, I think it's completely ridiculous that high schools start so early. I can't imagine why anyone would think it was a good idea for teenagers to start school at 7:30; 8:15/8:30 at the school I went to was bad enough.

[integritysinger.livejournal.com]

lol I have an ADD student that falls asleep in my biology class but not because of his meds... because he smokes pot at lunch before he comes to my class! lol

Dad's in denial of course. And mom's an absentee.

[kisekileia.livejournal.com]

Oh, joy. I think pot in ADHD people is something that can go either way--long-term use by anyone can cause some ADHD-type symptoms along with lack of motivation, but conversely, it can help a great deal with hyperfocus. (Don't ask me how I know this :P.) Smoking so much at lunch that one falls asleep in class afterwards is not exactly constructive, though.

[integritysinger.livejournal.com]

Smoking so much at lunch that one falls asleep in class afterwards is not exactly constructive, though hmmm...maybe because it results in him failing? lol

[kisekileia.livejournal.com]

Right. ;)

[merlyn4401.livejournal.com]

Very interesting, and completely believable. I wonder how many perants would be better tasked to address their child's sleep habits rather than food dyes or HFCS? I've been lucky - my kids are all awesome sleepers, and I made it a priority of the first order to get them into good sleep habits from day 1. Well, maybe more like week 4. But you get the idea. :) Jamie, my ADHD (without the H) gets a solid 10-11 hours of sleep a night and always has. And he sleeps HARD. I think in his case it's easy to eliminate sleep problems from the potential causitive factors of ADD.

[kisekileia.livejournal.com]

This sounds really interesting, but I never listen to podcasts because my auditory processing sucks, I read so much faster than people can talk, and my attention wavers. Listening to anything I can read is a waste of time for me. (Same with listening to anything where I can't read it or write it down, actually; I just don't retain it well.) Is there a written/transcribed version of this, or of the study in question?

I think the causation factor is probably often ADHD--> sleep problem. That poor kid probably gets tired out long before he actually goes to bed, but is too hyperfocused on the video games to stop playing, at least if he's anything like me. (As you might recall, my hyperfocus is worse than my inattention, and Adderall ended up doing more harm than good because it increased my hyperfocus and did not increase my control over what I focused on. I stayed hyperfocused on my computer for 32 hours. I felt like a meth addict.)

It could go partly the other way too, though; I know my sleep problems got worse (staying up very late into the night, often no stable sleep/wake cycle) when I started university, which was also when my ADHD started giving me more trouble. The state of affairs in high school wasn't tenable, though; I was chronically sleep-deprived, and I think that contributed to my university burnout. Like the ADHD kids you've known, I was never a good sleeper. I can't remember a time when I really had a "healthy" sleep cycle.

It definitely seems plausible to me that ADHD and sleep problems go together, whichever way the causation factor goes (and it could be both). I worry about parents trying to treat those sleep problems with harsher behavioural interventions, though, the way some less enlightened ones do with ADHD kids' other problems. Even watching (through LJ) you with Claire, I can't help thinking that these sleep problems aren't under the kids' or parents' control and that they're basically medical problems that we don't yet know how to treat. I hope people can soon figure out how to treat those problems in a therapeutic context, not in a way that's punitive to anyone (not saying you're being punitive to Claire, just that sleep problems are often considered a discipline issue).

[danaeris.livejournal.com]

Hi! Just wondering: if the adderall simply made your hyperfocus worse, what have you been able to do to ameliorate it?

[kisekileia.livejournal.com]

I've tried to learn to recognize triggers: hunger, tiredness, and stress all make my hyperfocus worse. If I can avoid combining those with being on the computer, that helps things a bit.

[hendrikboom.livejournal.com]

My psychologist told me that obsessive-compulsive behaviour is often misdiagnosed as attention-deficit disorder. Yet another complication for the studies.

[velvetpage.livejournal.com]

Well, OCD, ODD, ADHD, and Tourrette's all have very high correlation rates, so it's not uncommon to see kids with more than one diagnosis. In fact, ADHD and Torrette's occur in the general population between 7% and 3% respectively, but the co-morbidity rate is around 25% - that is, one quarter of people with ADHD have Tourrette's too, and vice-versa. I don't have the numbers in front of me for the others, but it's often not a misdiagnosis - it's a partial diagnosis or co-diagnosis.

[kisekileia.livejournal.com]

There's also overlap between ADHD and Asperger's, and Asperger's perseveration resembles both ADHD hyperfocus and OCD compulsiveness. I'm sure there are many people for whom two or three of those come into play. I was diagnosed OCD before anything else, but I'm crazily distractible when I'm not hyperfocused, so it definitely looks like I've got ADHD (inattentive).

[integritysinger.livejournal.com]

hmm. I think my kids would debunk your theory. I have them on a very strict sleep schedule (10 hrs/ night) AND they get night time sleep aids. Helps little to control and/or inhibit their ADHD.

[velvetpage.livejournal.com]

Yeah, I figured it wouldn't explain all of it - I would be very surprised if there weren't at least a few people whose ADHD causes sleep deprivation (in the absence of sleep aids) rather than the other way around. I do think, though, that before a diagnosis of ADHD is made, doctors should add a sleep questionnaire to the standard questionnaires, and try dealing with sleep issues before prescribing medication for ADHD.

[(Anonymous)]

I agree and I think a good pediatrician will ask those questions. Ours did. That's how the kids ended up on sleep meds. He said that as far as he was concerned, he didn't think it made sense to prescribe an ADHD med WITHOUT also prescribing a sleep aid. He even went as far as to say that some kids only need the sleep aids to treat their ADHD but never made the conclusion that sleep aids reduced the number of ADHD diagnoses altogether and/or that sleep deprivation is misdiagnosed as ADHD.

That said, i definitely can't imagine having a child up late. I need a break, thank you. Besides, by 10:30 I'm nodding off. And NO TVs or GAME SYSTEMS or COMPUTERS in my kids' rooms. period. out of the question.

My daughter's sleep aid (non spectral child) is Clonidine which is actually a blood pressure med. Her ADHD med is Concerta which wears off around 4 pm (just in time for homework... yay.)

My son's sleep aid (spectral) is Melatonin, the hormone that induces seratonin (the sleep hormone). He's NOT on ADHD meds because he has paradoxical effects to so many things and because he's such a lightweight (only 47 lbs and 7 years old!)

[integritysinger.livejournal.com]

sorry, that was me. forgot to login.

and reading through that, geez, sometimes I feel like a freakin' pharmacist dolin' out my kids' meds. My son is on five different things and Jess is on three and I'm on two (thyroid disease) and my hubby, (also ADD ironically, because the kids' aren't biologically related) is on two. Only the three year old is unmedicated!