4-min read
If your child with ADHD won't sleep, you are not alone, and it is not a sign you are failing as a parent. Sleep problems show up far more often in children and teens with ADHD than in their peers. Research also points to brief behavioural changes that were linked to real, lasting improvements.
When your child with ADHD won't sleep, what's going on?
Sleep trouble is common alongside ADHD, and large studies show how common. In a population-based study of 9007 older teens in Norway, aged 16 to 19, insomnia was reported by 28.7% of those with ADHD who were in contact with mental health services, compared with 16.7% in a general reference group (Hysing et al., 2020). That same study found formally diagnosed sleep disorders were very rare, only 0.6% of teens connected with services, which suggests sleep problems in this group often go unnamed rather than being absent.
Body clock timing may play a part too. Another population study of 9338 Norwegian teens aged 16 to 19 looked at delayed sleep phase, a pattern where sleep naturally shifts later. About 3.3% fit that pattern, and those teens reported more inattention and more hyperactivity and impulsivity than peers, with inattention showing the strongest link (odds ratio 2.11; Sivertsen et al., 2014).
For you as a parent, the takeaway is that trouble sleeping is a known part of the picture for many young people with ADHD, not a sign you are doing something wrong. These two studies were done in older adolescents, not younger children, and both were snapshots in time. So they can show that ADHD symptoms and sleep problems travel together, but they cannot tell you which came first or that one caused the other.
Has anything been shown to help children sleep better?
Yes, at least in trials of behavioural changes, though the evidence has real limits. In a randomised controlled trial of 244 children with ADHD aged 5 to 13 (average age about 10) in Victoria, Australia, families received a brief two-session behavioural sleep programme covering sleep hygiene and standardised behavioural strategies. Twelve months later, children in the programme were less likely to have a moderate or severe sleep problem by parent report, 28.4% compared with 46.5% in usual care (adjusted odds ratio 0.4; 95% CI 0.2 to 0.9; p = 0.03; Sciberras et al., 2019). Parents also reported small improvements in ADHD symptoms, quality of life, daily functioning and behaviour.
Two things temper that. The 12-month benefits showed up in parent reports but not in teacher reports, which the authors say raises the possibility of bias. And the benefits were less sustained for children who were not taking ADHD medication and for children whose parent had clinical depression (Sciberras et al., 2019).
A separate small pilot tested a six-session behavioural sleep programme in 14 adolescents with ADHD aged 13 to 17. Poor sleep dropped sharply, with the share classed as poor sleepers falling from 71.4% before to 21.4% right after (Becker et al., 2021). But this was a single group with no comparison group, and the authors say a proper controlled trial is still needed before anyone draws firm conclusions.
Try this today: For one week, jot down the time your child actually falls asleep and wakes up, so you have a simple record to share if you decide to raise sleep with your child's clinician.
What the research still can't tell you
Honesty here matters. Much of what we know rests on parents reporting their own child's sleep rather than objective measurement. In the 12-month trial above, sleep was not measured with actigraphy, a wristband that tracks movement, and the clearest benefits were the ones parents reported themselves (Sciberras et al., 2019). Parent report is meaningful, since you live with it, but it is not the same as an independent measure.
Sample size and study type limit things too. The adolescent pilot included just 14 young people and had no control group (Becker et al., 2021). A larger Australian trial protocol was published to test a brief sleep programme delivered in everyday clinics, but it reported no results, because a protocol only describes the plan (Sciberras et al., 2017). The two large Norwegian studies were snapshots, so they cannot say whether sleep problems cause ADHD symptoms, ADHD symptoms drive sleep problems, or something else links them (Hysing et al., 2020; Sivertsen et al., 2014).
None of this is a reason to give up. It is a reason to hold any single claim loosely, to watch how your own child responds over time, and to bring a clinician in rather than deciding alone. The studies point one way: sleep in ADHD is common enough to take seriously, and worth revisiting more than once.
Sources
- Sciberras E, Mulraney M, Heussler H, et al.. Does a brief, behavioural intervention, delivered by paediatricians or psychologists improve sleep problems for children with ADHD? Protocol for a cluster-randomised, translational trial. BMJ Open (2017). doi:10.1136/bmjopen-2016-014158
- Sciberras E, Mulraney M, Mensah F, et al.. Sustained impact of a sleep intervention and moderators of treatment outcome for children with ADHD: a randomised controlled trial. Psychological Medicine (2019). doi:10.1017/s0033291718004063
- Becker S, Duraccio K, Sidol C, et al.. Impact of a Behavioral Sleep Intervention in Adolescents With ADHD: Feasibility, Acceptability, and Preliminary Effectiveness From a Pilot Open Trial. Journal of Attention Disorders (2021). doi:10.1177/10870547211056965
- Mari Hysing, Ove Heradstveit, Allison G. Harvey, et al.. Sleep problems among adolescents within child and adolescent mental health services. An epidemiological study with registry linkage. European Child & Adolescent Psychiatry (2020). doi:10.1007/s00787-020-01676-4
- Sivertsen B, Harvey A, Pallesen S, et al.. Mental health problems in adolescents with delayed sleep phase: results from a large population‐based study in N orway. Journal of Sleep Research (2014). doi:10.1111/jsr.12254
[!note] Founder review required before publishing. Every claim above descends from a digest approved in KB Tab 3.