And last October, the American Academy of Pediatrics amended their ADHD treatment guidelines, thus allowing doctors to prescribe drugs to preschoolers believed to have ADHD. Says Dennis Rosen, associate medical director of the pediatric sleep center at Boston Children's Hospital and assistant professor of pediatrics at Harvard Medical School: "If taken later in the day, [these medications] can cause difficulty settling at night. They can often suppress hunger as well, resulting in 'rebound feasting' which delays going to sleep." But for some children, says Smith, "these medications may improve their quality of sleep by reducing nocturnal activity and consolidating sleep." Smith advises those parents who notice sleep problems to discuss with the prescribing physician such options as "adjusting the dosage, when the child should take the med, and other medication or behavioral [treatment] options."
The American Psychological Association states that 69 percent of children experience some sort of sleep problem a few nights or more a week. The effect of insufficient sleep in children can be profound. As studies have demonstrated, behavioral issues like trouble focusing and concentrating and mood disturbances can be common. Poor sleep can also compromise a child's immune system—making him more susceptible to infection—and is associated with a higher incidence of being overweight and obese.
How can parents tell if their child is sleep-deprived? It's not that difficult to spot if you know what you're looking for, says Rosen. "Younger children will often fall asleep anywhere, anytime—in the middle of their toys in the living room or on the high chair while eating their cornflakes—when they need to recharge with sleep. Older children can fall asleep in school or revert to napping after not having needed to for a while, or when it is no longer developmentally necessary." Some experts say that children usually outgrow the need for a nap around ages 3 and 4, but the necessary amount of sleep for a child is individual and does vary.
To ensure that a child gets a good night's sleep, Smith suggests that parents focus on promoting good "sleep hygiene." This includes providing an environment that is conducive to sleep like a quiet, dark room with a comfortable bed, and having a consistent bedtime routine. Offer opportunities for physical activity throughout the day—though not too close to bedtime, cautions Smith—as this can help to regulate sleep. And says Rosen, avoid bright light and exposure to televisions and computers in the last two hours before bedtime. "Stimulation from the content makes it harder [for the brain] to settle. And bright light exposure from screens can delay the internal circadian clock by sending a signal to the brain that it is still daytime and therefore too early to go to sleep."
If a child is still showing symptoms of sleep deprivation despite getting what is believed to be enough rest, there could be an underlying problem. Take note of any excessive movements, which could be an indication of periodic limb movement disorder. And observe your child's breathing. Snoring, gasping, choking, and periods of not breathing can each be a sign of obstructive sleep apnea. Discuss all this with a pediatrician, says Smith, as children and adolescents should feel refreshed after a night's sleep.
Sleep is vital for the growth and development of all children, and in light of current research, parents of children with ADHD should pay especially close attention. A solution for their child could be less Adderall and more zzzs.