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ADHD in Children Health Center

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Kids' Poor Bedtime Habits May Bring ADHD Misdiagnosis

Study Suggests That No Set Bedtime, Bed Sharing Linked to Behavior Problems

Bedtime, Sleep, and 'Faux ADHD' continued...

Pressman says he's looking at this issue in ongoing studies. Giving troubled kids a firm bedtime and getting them to sleep alone, he says, has dramatic and rapid effects on their daytime behavior.

"We have noticed beyond a shadow of a doubt that these behaviors change dramatically, within five days to a week -- not a long time," Pressman says.

Pressman emphasizes that a focus on bedtime issues is not a treatment for kids who truly have ADHD. But he says many kids with behavior problems are wrongly diagnosed with ADHD. Adesman agrees.

"Not every child with attention issues or restlessness has ADHD," he says. "There can be a multitude of other problems, one of which could be a sleep disorder."

Adesman notes that the relationships between ADHD, sleep, and behavior are complex. He says there's likely no single answer to the questions raised by the Pressman study. However, he notes that altering a family's bedtime rituals likely affects overall parenting style.

"Perhaps parents who are more willing to give in to a child's sleep-behavioral problems may be more prone to have children with manipulative behavior and aggression," Adesman suggests. "And parents who have trouble setting limits on daytime behavior are also more likely to have difficulties with nighttime behavior."

Setting a Bedtime

So how can parents start getting their children to have a consistent bedtime?

Pressman says the underlying idea is that bedtime is a clear expectation of what occurs -- a rule, not a command.

"Nobody likes to be told what to do," he says. "But if the amusement park opens at 10, you can argue about it but it won't change. It is not imposed on anyone, it is just there."

Implementing such a rule requires a meeting of the whole family, because every family member has to be on board.

Pressman says there are five key points:

  • It must be clear. "There must be very little room for negotiation," Pressman says. "The child does have an opportunity to discuss, but there is no real negotiation."
  • It has to be doable.
  • It has to be time specific. "Saying 'You have to go to bed between 8 and 9 is not clear," Pressman says.
  • It has to be enforceable. Until bedtime becomes routine, parents have to be at home to enforce the new rule. Leaving it to a babysitter won't work.
  • 100% consistency for two weeks. Over the first two weeks of the new bedtime rule, there can be no exceptions. Later on, a child can stay up late to go to the ball game, but not at first.

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