Teens, Sleep, and ADHD

ADHD is one of the most commonly diagnosed developmental disorders in children and teenagers.

The latest data from the Centers for Disease Control (CDC), based on the 2016 National Survey on Children’s Health (NSCH), show the following prevalence of ADHD in children age 2-17 in 2016:

  • 9.4% have received an ADHD diagnosis – that’s about 6.1 million kids. By age, that breaks down like this:
    • 2-5: 0.6%, around 388,000 kids
    • 6-11: 3.8%, around 2.4 million kids
    • 12-17: 5.1%, around 3.3 million kids

That’s a lot of kids with a significant behavioral diagnosis. However, there is good news in those numbers. They’ve dropped since the last large-scale survey was published in 2012, after an upward trend in diagnosis that lasted over a decade. The following numbers are not an exact comparison, because they include a slightly different age group – kids age 4-17 rather than 2-17 – but they are certainly valid for our discussion.

Here’s the trend that seems to have just reversed course:

  • 2003: 7.8% of kids age 4-17 received an ADHD diagnosis
  • 2007: 9.5% of kids age 4-17 received an ADHD diagnosis
  • 2011: 11% of kids age 4-17 received an ADHD diagnosis

Lower overall numbers is a good thing. There’s still a significant gap between the kids with a diagnosis and kids receiving treatment, though.

Experts call this a treatment gap.

The ADHD Treatment Gap

Treatment for ADHD typically involves a combination of therapy and medication. These statistics describe the size of the treatment gap in broad terms, and with regards to each type of treatment.

In 2016, among kids age 12-17 with an ADHD diagnosis:

  • 77% received treatment of some kind
  • 30% received medication only
  • 15% received behavioral treatment only
  • 32% received medication and behavioral treatment

That leaves 23% of kids – close to 1.5 million – with a diagnosis, but without professional help. This treatment gap is larger than the one identified in 2011, when 17.5% of kids – around one million – with an ADHD diagnosis did not receive treatment.

We don’t know whether the parents of the million plus kids with a diagnosis but without official treatment are taking an alternative approach to their kids’ ADHD. They may well be. Many parents make lifestyle adjustments, such as changes in diet and exercise patterns, instead of choosing medication or therapy.

Those parents – in fact, all parents of kids with an ADHD diagnosis – might be interested in a recent study performed by researchers from the University of Cincinnati. Presented at the annual Conference on Experimental Biology held by the American Physiological Society, the researcher discovered something important: more sleep can help teens with ADHD control their emotions, focus on tasks, and make plans. In short, sleeping longer can improve the overall efficiency of the executive function system in the teenage brain, which is often compromised in kids with ADHD.

How Much More Sleep?

In the study, researchers recruited adolescents with ADHD to participate in two sleep studies that lasted one week each. During the first week, researchers allowed the teens to sleep for six and a half hours per night. They called this the sleep restriction (SR) group. During the second week, they increased sleep time to nine and a half hours per night. They called this the sleep extension (SE) group. After each week, the teens took a test designed to assess their executive function. The test, called the Behavior Rating of Executive Function Second Edition (BRIEF2), measured performance in working memory, emotional control, inhibition, and planning/organization.

Here’s what they found in each area:

  • Working memory: The SR group showed significant deficits compared to the SE group.
  • Emotional control: The SR group showed significant deficits compared to the SE group.
  • Inhibition (i.e. impulse control): The SR group showed significant deficits compared to the SE group.
  • Planning/Organization: The SR group showed significant deficits compared to the SE group.

Therefore, the answer to the question “How Much More Sleep?” is straightforward: in the context of this study, an additional three hours made a difference.

In the words of the research team:

“This study provides the first evidence for shortened sleep duration as a causal contributor to worsened executive functioning in adolescents with ADHD. Increased sleep may significantly impact academic, social, and emotional functioning in adolescents with ADHD, and sleep may be an important target for future intervention.”

Practical Help for Teens With ADHD

The data indicates more sleep helps teens with ADHD. This is great news for parents, because although it may be difficult to get kids to go to bed earlier, it’s not impossible. It will also reassure parents who choose not to give their teenagers medication. Please understand this is not an anti-ADHD medication post. Not by any stretch of the imagination: for some children and teens, medication can be the difference between participating in a full day of school and struggling every moment to stay focused on the task at hand. What this study offers all parents of teens with ADHD, regardless of the treatment approach– medication, therapy, both, or neither – is another tool to help their teenager reach their full potential and live life on their own terms, rather than those dictated by their diagnosis.