A trouble to pay attention, memory loss, poor control on impulses - all these behaviours are parts of ADHD. But, something far simpler can trigger their onset. It’s sleeping less than the required length and quality needed. The trouble folds double when you learn about ADHD and sleep-related challenges. They help each other grow and prosper and it’s hard differentiating. This often results in misdiagnosis with ADHD. The symptoms might just arise if the subject is not sleeping enough. There are interesting reports from parents who found ADHD symptoms diminish or disappear in their children once sleep-related problems were taken care of. Or, did these children really suffered from ADHD? The Senior Director, David Anderson of the ADHD and Behavior Disorders Center, Child Mind Institute expresses a different view. As he stated, children do not undergo sleep disorders, normally. Therefore, so many kids couldn’t have been wrongly diagnosed. It’s like both ADHD and sleep disorder affected the child. There are, though, a few children with severe sleep problems, enough to be misdiagnosed as ADHD. This is something to take into account when evaluating ADHD symptoms. But it is also proven that sleeping not enough worsen ADHD symptoms besides bringing it up. Hence, sleep issue reductions must be helpful in reducing symptoms. A careful evaluation; therefore, must always consider alternate explanations for ADHD symptoms. This must be done before running a diagnosis. A good assessment is all about considering a number of other issues matching ADHD that must be ruled out first. Sleep issues aside, there could surface similar symptoms due to psychosis type depression and anxiety, also trauma. But these are no factors to cause sleeplessness in a child. To identify the source, we should focus on symptoms like distractibility, inattention and hyperactivity. To know if sleep disturbance is occurring, you must also know about anxiety. Anxiety often results from sleep deprivation. There also appear other symptoms. Night terrors, sleep apnea and asthma are most common; these further affects breathing. A sound sleep is hampered. Thankfully, sleep disorders occur only in few. Thus, we may also rule out a few of the associated medical conditions, considered bit more serious than others. Their presence might prove things differently after initial psychiatric evaluations. For not enough of sleep starts impacting a child's behaviour far before it turns out into a full-blown disorder. If you see there is trouble with falling and staying asleep or waking-up; screaming/in a panic/coughing in sleep; a heavy/laboured/paused breathing pattern; strange noises made while sleeping; falling asleep during daytime, irritability and loss of focus, you might have just detected a sleep disorder! There are guidelines on how long, how much and how a kid must sleep as he/she ages, yet every child is different in his/her need. Sleeping lesser than typical; therefore, does not always indicate instantly that something must be wrong. Instead, it should initiate further investigation(s). Signs of ADHD are detected in approximately 6-10% of the population. The signs usually become apparent by early childhood. Signs include: Trouble with focusing on activities for long that doesn’t seem interesting or rewarding. Trouble with listening to directions and following them. Trouble with staying seated. Restless movement. Excess energy. Interruptive behaviour. Blurting out. Can be easily distracted. Difficulty in organizing. Poor memory. Tendency of losing things. Impatience. As Dr. Anderson further explained, these are common among kids, to a certain extent. Assessing ADHD in a child, it is the intensity of such behaviours that are sought for. Only a higher than normal (compared to other kids in that age group) count is considered. It’s also seen if that behaviour is impairing the child by any means or is causing him difficulty across varied settings. These fix the criteria to tell if ADHD is present in a child. In case there are both, it’s hard to tell which one came up first. ADHD commonly gives children a much-higher energy level, which might prevent them from actually going to sleep. This translates into sleeping less every night. Or, it might be the ADHD medication. It causes some to sleep less until the effects wear off before they try to fall asleep. So, the deduction follows: Less sleep => an unidentifiable sleep disorder=> no treatment => ADHD symptoms worsening further. Comparatively fewer children may show ADHD along with undiagnosed sleep issues. Their diagnosis for ADHD was not wrong, but sleep disorder treatments alone could lessen their ADHD symptoms. When you see a child under a stimulant medication has trouble getting sleep, you may ask the doctor for dosage reduction. Or, try adjusting the medication’s timing so that it's not active during bedtime. If there are no discernible medical issues found to be the cause, visiting the sleep-specialist, paediatric psychologist or a general child specialist may help you create a behavioural plan to get the child his/her required hours of quality sleep. Implementing consistent bedtime routines require limiting before-bed screen times, so it must be included with other behavioural-change strategies. These will help improve overall sleep hygiene. Same is advised in case of sleep apnea and other similar medical issues. Treating sleep disturbances successfully leads to decreased ADHD symptoms; ADHD diagnosis must be done if the former measure bears little or no fruit.