Today, we’re re-exploring a topic that we’ve touched on before: the connection between ADHD and sleep disorders. You might be wondering why, as a parent of a baby or a young toddler, you should even bother thinking about diagnoses like ADHD. But as we pointed out in a past article,
Rates of ADHD diagnoses are on the rise; the percentage of American children diagnosed with the disorder has risen 66% in the last 10 years. That is significant, readers! There’s also evidence to suggest that the sleep issues your baby or toddler might have now could lead to a greater risk for ADHD.
In today’s article, we’ll take a look at one family’s story of how a sleep disorder proved to cause far more serious problems than they could’ve imagined.
The Graham Family’s Story
Recently, the Vancouver Sun spotlighted the Graham family. The article focuses broadly on how sleep disorders in children are often misdiagnosed as ADHD; it focuses specifically on the experience of 6 year old Emmy Graham.
Her parents explain that Emmy was always a restless, active child (even in the womb!) But that restlessness caused sleep issues immediately after Emmy’s birth:
As an infant, Emmy would sleep only eight hours a day — in fits and starts, never in a stretch. There were no naps after the age of one and maybe six or eight hours of restless sleep a day. Toddlers are supposed to spend about half of every 24 hours asleep.
Without that much-needed rest, Emmy threw daily tantrums and screaming fits. Her development stalled; even at age five she couldn’t hold a pencil. She was diagnosed with a developmental co-ordination disorder, attention deficit hyperactivity disorder (ADHD), attachment disorder and anxiety.
“Her brain wasn’t sleeping enough to lay down the motor pathways for co-ordination,” says Kirsten [Emily's mother]. “None of the pieces can come together for kids if they’re not sleeping.
That’s absolutely true — babies and toddlers require adequate amounts of sleep each day in order to grow and develop properly. We’ve written before about how prolonged lack of sleep for a baby or toddler can lead to developmental and behavior problems, and even depression.
The Grahams struggled with Emmy’s various diagnoses for years, trying to sort out why Emmy wouldn’t sleep, and trying to manage her symptoms. It was a heartbreaking time for parents Kristen and Rob. Emmy’s symptoms grew worse, to the point where she wouldn’t allow her parents to comfort her, or even to touch her. Some of Emmy’s psychiatrists went so far as to make the Grahams feel they were to blame for Emmy’s issues:
…child psychiatrists told Kirsten that her lack of attachment to her child was the problem.
“I remember time and time again in the psychologist’s office saying, ‘but she came this way.’
“I won’t discount that there was a problem in our relationship, but it starts to grow out of having a child that won’t look at you, won’t touch you, (whom) you can’t comfort … I was desperate as a mother that I couldn’t care for her,” Kirsten says.
“In hindsight, it’s obvious that a child that won’t look at you and won’t be comforted is in physical distress,” says Rob.
For the Grahams, ADHD Was the Symptom, but RLS Was the Cause
It wasn’t until they met Dr. Osman Ipsiroglu that the Grahams got the answer they so desperately needed. Whereas other doctors and experts had been focused on Emmy’s symptoms, and had been diagnosing those, Dr. Ipsiroglu was able to uncover the root cause of Emmy’s problems:
Finally, a year ago, Osman Ipsiroglu, a Vancouver pediatrician with expertise in sleep problems, diagnosed Emmy with restless leg syndrome, a common condition for adults, but rarely recognized in children.
Instead, it and other under-recognized sleep disorders are lumped into the growing number of ADHD cases in B.C. [British Columbia], he say, adding that pediatricians and child psychologists should rule out sleep disorders before making an ADHD diagnosis.
Emmy’s experience is common, according to Dr. Ipsiroglu. He says a number of children who are diagnosed with ADHD actually have sleep disorders:
“We believe that there is a tremendous overlap with ADHD … If you don’t sleep well, you will have some behavioural issues the next day. You will be grumpy, you will be less tolerant, possibly, and this is what happens with the kids. If they have chronic sleep deprivation, they may have an ADHD-like presentation.”
ADHD Misdiagnosis Is Common and Understandable, but It Can Be Dangerous
The Graham family and Dr. Ipsiroglu recognize that it can be hard to distinguish between normal bedtime-resistance and true sleep disorders, and that currently, the medical community isn’t equipped to properly diagnose sleep disorders in children:
Untangling the difference between run-of-the-mill ‘I don’t want to go to bed’ pushback from a three-year-old and a child with a serious medical issue is not easy, Ipsiroglu admits.
He suggests an individualized approach to each child, something that’s effectively impossible right now in B.C. because there aren’t enough health professionals who know what they’re looking for.
“There simply isn’t the training at the medical level to recognize it,” says Kirsten.
Still, it’s important for parents and medical professionals to realize that misdiagnosing a sleep disorder like RLS, and applying an ADHD diagnosis instead, can create big problems:
A misdiagnosis isn’t benign. If typical stimulant medications for ADHD are prescribed, the itching, crawling, creeping feelings of restless leg syndrome are amplified.
How To Avoid an ADHD Misdiagnosis
Let’s be clear — we’re not saying that every ADHD diagnosis can be traced to a sleep disorder. Not at all. As Dr. Merrill Wise, a pediatric neurologist and sleep medicine specialist, puts it,
“No one is saying that ADHD does not exist, but there’s a strong feeling now that we need to rule out sleep issues first.”
So, what can we do, as parents, to prevent a misdiagnosis like Emmy Graham’s? First, we can educate ourselves on what sleep disorders are, and what they look like. Common sleep disorders for children include:
- Bruxism (teeth grinding)
- Sleep apnea (loud snoring, long pauses between breathing during sleep)
- Restless Leg Syndrome (an overwhelming desire to move and kick legs during sleep)
- Frequent night waking
- Sensory processing issues (oversensitivity to feel of the blankets or sheets, to light or sound, etc.)
- Difficulty relaxing and falling asleep at bedtime
As parents, we can also seek medical help when we think it’s necessary. If you suspect your child has a sleep disorder like sleep apnea or Restless Leg Syndrome, seek out appropriate medical treatment. Surgery to remove tonsils and adenoids can help with apnea, and there are several types of medications that can alleviate RLS.
Finally, one of the best things we can do as parents is to tackle our children’s sleep issues head-on. True sleep disorders often require medical intervention, but plenty of other children suffer from sleep issues that can be solved with some basic sleep training.
If your baby just won’t sleep through the night, or if your toddler is consistently getting less sleep than necessary, don’t ignore those problems. Whether you tackle sleep training on your own, or whether you seek out help, the main thing is to do it. Work to lay a good foundation of healthy sleep habits for your child now, and it just may prevent bigger problems down the road.
Good News for the Grahams
The Grahams wish someone had caught Emmy’s RLS sooner, of course. But now that Emmy’s on medication to treat her problem, it appears she’s doing much better:
Kirsten Graham says her daughter climbed onto her lap and relaxed her usually rigid frame for the first time at age 5½, after starting the medication.
“The earthquake in my body has stopped,” she told her mother then.
Does your family have experience with sleep disorders or ADHD? Share your story with us. Remember, it’s as valuable to our readers as any expert’s opinion!
If you’re looking for ways to to get your baby or toddler into a healthy sleeping routine, please be sure to pick up your FREE copy of 5 (tear-free) Ways to Help Your Child Sleep Through the Night, our e-Book with tear-free tips to help your baby sleep better. For those persistent nighttime struggles, check out The 3-Step System to Help Your Baby Sleep (babies) or The 5-Step System to Better Toddler Sleep (toddlers). Using a unique approach and practical tools for success, our e-books help you and your baby sleep through the night and nap better. For those looking for a more customized solution for your unique situation with support along the way, please consider one-on-one baby and toddler sleep consultations, where you will receive a Personalized Sleep Plan™ you can feel good about! Sometimes it’s not that you can’t make a plan. Sometimes you’re just too tired to.