Lack of Sleep and ADHD?
I saw a message from a mama on another holistic sleep account where she relayed that sleep training messaging has really been getting to her lately, particularly that a popular ST account shared that there is a connection between “poor quality” baby sleep and development of ADHD. So I had to dive in, because my bullshit meter was on fire.
First off, I did not see this specific messaging and I do not know which sleep training account it came from. But I can imagine that this ideology has been floating around for a while now. So I took myself to Google Scholar to dig out some research articles and see what I could find.
There is actually quite a bit of research on this topic, the most recent of which was published in 2019. As is the case with any research on babies and children, there are many confounding variables due to ethical limitations (duh). This particular study (citation will be at the end) looked at children at 3 months, 8 months, and 24 months and then at those same children at age 5. Here is a summary of their results taken directly from the paper:
“Sleep duration at the age of 3, 8, and 24 months was associated with inattentiveness at 5 years of age. Moreover, parent-reported sleep problems at the age of 24 months were related to both inattentive and hyperactive symptoms at the age of 5 years. Finally, at the age of 5 years, parent-reported sleep problems and night awakenings were associated with concurrent symptoms of inattention and hyperactivity.”
I have many issues with this, but I’ll try to list them briefly because no one wants to read my entire novel of criticism.
1. In the methods, they mention that they ruled out babies with chronic illness or disability, but did not mention any control for a HUGE confounding variable, which would be sleep disordered breathing (like sleep apnea). Or whether or not the baby had a tongue tie, whether or not they had a feeding allergy, reflux, “cholic”, etc. ALL of which are known to be huge red flags when it comes to sleep issues in babies and young children. And, spoiler, if not resolved, can present as ADHD symptoms in young children. In other words, unresolved medical problems can create symptomology that mimics an attention disorder, but they are NOT the same. Also, this confounding variable being ignored could lead parents to believe that a baby with normal nocturnal wakes is at risk for this disorder, which is not the case.
2. Again in the methods, all of the sleep measurements were self-reported by the parents using questionnaires (takes me back to what I said before about the general limitations of all sleep research on babies). These measurements were scored in several ways, but the majority were qualitative, other than one tool (which was quantitative: # of night wakings), and therefore are extremely subjective. This is not a flaw, per say, just something to note when applying research and data to your unique family.
3. The main result here is the presence of symptoms of inattentiveness or hyperactivity at the age of 5. They used an 18-item scale of ADHD symptoms that is cohesive with the DSM-IV, as well as a 25-question behavioral screening questionnaire. And yet, in all of this, they did not once mention any of these children having an actual DIAGNOSIS of ADHD.
4. AND THIS IS A BIG ONE GUYS- if they did not control for sleep disruptors (like disordered breathing that I mentioned above), the symptoms of hyperactivity or inattentiveness could be caused by difficulty sleeping due to breathing problems, or diet, or whatever it is, and NOT because the child is predisposed to a later diagnosis of ADHD.
AND IN THAT SAME VEIN- are we naïve enough to think that 5 year olds are capable of attentiveness and sitting still for great lengths of time? Of course there are ranges of “normal” here and I’m not saying to ignore warning signs, but I really think so much of this is an issue of US expecting babies and children to show levels of independence and competence before it is developmentally appropriate for them to do so. Both in sleep as babies and young toddlers, and then later when they are school-age. So much of their neurological functioning is still being built, scaffolded, and connected.
For anyone to use data like this to suggest that a baby not sleeping through the night puts them at risk for an ADHD diagnosis later in life is not just incorrect, but it is disingenuous and ethically shaky. To use this type of research to market sleep training to parents could potentially cause a different medical issue to be overlooked. For example, if a family is concerned that “under sleeping” is a risk for ADHD, they may be inclined or pressured to “teach that child” who is having a lot of wakings to sleep independently. And it is in this scenario where something underlying could be missed or ignored. In which case, symptoms that mimic ADHD certainly could present later in life. Only by then, the true root cause might not be discovered and that child might be misdiagnosed, or worse, medicated unnecessarily.
All of that to say, it is biologically normal for babies to wake at night. If they are waking with extreme frequency, that is a red flag for something deeper going on and it should absolutely be investigated. But there is no logical reason to worry that your healthy baby is chronically sleep deprived to the point of developing a neurological disorder.
Article Citation:
Huhdanpää H, Morales-Muñoz I, Aronen ET, et al. Sleep Difficulties in Infancy Are Associated with Symptoms of Inattention and Hyperactivity at the Age of 5 Years: A Longitudinal Study. J Dev Behav Pediatr. 2019;40(6):432-440.
My cute little man who definitely doesn’t sit still for long, but who is perfectly healthy, happy, smart, balanced, and doing exactly what he should be doing- PLAYING.
