Study: Early Childhood Sleep Problems Linked to Later ADHD Diagnosis

March 14, 2023

Early childhood sleep problems, including irregular sleep routines, short nighttime sleep duration, and frequent night awakenings, correlate with subsequent ADHD diagnoses, according to research published in the Journal of Child Psychology and Psychiatry. ¹

Researchers conducted an observational review of the Avon Longitudinal Study of Parents and Children (a U.K. birth cohort study), which included 7,769 10-year-old children (49.6% girls; 50.4% boys). Participants’ parents assessed their children’s sleep habits at age 3.5, answering questions such as ‘Does your child have regular sleep routines?’ ‘How long does your child sleep during the day?’ and ‘How often during the night does your child usually wake?’ Researchers calculated nighttime sleep durations from questions asking what time (to the nearest minute) the child ‘normally’ went to sleep in the evening and woke up in the morning. Findings showed that short nighttime sleep durations, frequently waking up in the middle of the night, and irregular sleep routines increased the toddler’s risk of receiving an ADHD diagnosis at age 10. (Researchers used the Development and Wellbeing Assessment to identify children with ADHD.)

Prior studies have identified sleep disturbances as a common comorbid condition with ADHD ² and found that 70% to 85% of children with ADHD experience sleep problems.³ However, researchers said this is the first longitudinal study that “specifically investigated the prospective association between inflammation, sleep, and ADHD.”

“These results highlight the potential of future preventative interventions in ADHD, with the novel target of sleep and inflammation,” they said.

Sleep Problems Comorbid with ADHD

The study’s findings mirror those of a recent ADDitude poll, which found that 66% of participants noticed sleep problems in their children with ADHD at age 3 or younger.

“As an infant, my daughter was a horrible sleeper,” said a reader from Colorado. “She almost never napped for more than 20 to 30 minutes. She woke up several times throughout the night until she was 18 months old. She’s 7 now and still has trouble falling asleep without melatonin. Even with melatonin, she’ll wake up after a couple of hours.”

Said another respondent, “Our son has fought sleep since infancy. He has always tried to stay awake as long as possible. He often has disrupted sleep and does not want to return to sleep, even at midnight.”

“She would wake up every two hours and then be ready to party for two hours,” said a panelist from Maryland. “It was absolutely exhausting. At age 1, she finally started to sleep more consistently but continued to wake up very early (before 5 a.m.).”

Sleep Problems in Early Childhood

Reader panelists indicated the following early childhood sleep problems in their children who were later diagnosed with ADHD:

• Shorter nighttime sleep due to difficulty falling asleep: 71.63%
• Frequent waking during the night: 60.58%
• Shorter nighttime sleep due to waking up very early: 44.71%
• Inconsistent bedtime routine: 25.96%

Sleep problems persisted for some panelists’ children as they aged. “Both of my kids took forever to fall asleep,” said a panelist from Wisconsin. “By the time my son started daycare at four months old, I could not get him to nap. One of us still lies with our kids at night; we usually fall asleep and spend the night in their beds. They are now ages 8 and 5 (both have ASD along with ADHD), and there is no end in sight.”

“My child seemed to need less sleep from the beginning,” said another parent. “As an infant, she often woke up in the middle of the night and was wide awake for quite some time. She took very short naps and gave up napping very early on. As she got older, we had to put an alarm on her door because she would go out in the garage during the winter or climb on kitchen counters looking for candy in the middle of the night.”

ADHD Sleep Solutions

Creative thinking, natural supplements, and medication helped some ADDitude readers’ children get to sleep. “There were a lot of ‘midnight snack’ escapades and much wandering around the house,” said a panelist from Georgia. “We made an approved snack drawer for her and gave her a flashlight, books, coloring books, etc., so she could do what she needed and stay in her room.”

A Michigan panelist said, “We were militant about sleep hygiene, diet, screens, etc., and it did not make a difference. Even lots of exercise wasn’t the answer. We finally had to use clonidine. It was like a miracle. My now 13-year-old is off clonidine with a ‘normal’ sleep routine.”

“My child began having difficulty falling asleep at six months,” a panelist from Virginia said. “Melatonin is a staple in our household. Just like you know, if you forgot your child’s ADHD medication on a Saturday morning, you also know when they haven’t had their melatonin!”

A North Carolina parent turned her son’s insomnia into a positive. “My oldest had a terrible time going to sleep,” she said. “Early on, I found ‘go to sleep’ meant nothing, so switched to ‘Lie down and be still and quiet;’ that was something he could do (even if it didn’t lead to immediate sleep). I read to him at length at night — and through middle school. It became a close sharing time and a chance to read some really good books.”

Sources

¹Morales-Muñoz, I., Upthegrove, R., Lawrence, K., et al. (2023). The Role of Inflammation in the Prospective Associations Between Early Childhood Sleep Problems and ADHD at 10 years: Findings from a UK Birth Cohort Study. J Child Psychol Psychiatry. https://doi.org/10.1111/jcpp.13755

²Bondopadhyay, U., Diaz-Orueta, U., and Coogan, A.N. (2022). A Systematic Review of Sleep and Circadian Rhythms in Children with Attention Deficit Hyperactivity Disorder. Journal of Attention Disorders. https://doi.org/10.1177/1087054720978556

³Yürümez, E., and Kılıç, B.G. (2013). Relationship Between Sleep Problems and Quality of Life in Children with ADHD. Journal of Attention Disorders. https://doi.org/10.1177/1087054713479666

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