Tag: adhd

Understanding and Treating Teen Sleep Problems

Do your kids have to get up too early because school starts too early?
Do your kids have to get up too early because school starts too early?

Parents often ask for help getting their kids to fall sleep and then stay asleep all night.

At least they do when they are little.

Teens often have trouble sleeping too though, but parents often don’t recognize these sleep problems and might not think to ask for help. They do likely see some of the issues that can be caused by a poor night’s sleep though, which can include irritability, sadness, a poor attention span, and hyperactivity, etc.

Why Teens Don’t Sleep Well

From being over-scheduled and having to get up early for school to staying up late on a screen, there are many reasons why your teen might not be sleeping well.

There are also many different types of sleep problems.

To understand what is causing your child’s sleep problems, ask yourself these questions and share the answers with your pediatrician:

  • Does your teen sleep at least 8 1/2 to 9 1/2 hours each night?
  • Does your teen have trouble falling asleep or does he just wake up a lot in the middle of the night? Or does your teen seem to sleep enough, but is still always tired?
  • Does your teen snore loudly at night – a sign of obstructive sleep apnea?
  • Is your teen taking any medications that could cause insomnia, such as for ADHD (stimulant) or allergies (decongestant)?
  • Does your teen have poorly controlled allergies, asthma (late night coughing), eczema (frequent itching keeping him awake), or reflux?
  • Is your teen drinking any caffeine in the afternoon or evening?
  • Do you think that your teen is depressed or has anxiety, either of which could cause problems sleeping?
  • Have you noticed any symptoms of restless leg syndrome, including a strong urge to move his legs when he is sitting or lying down?
  • Does your teen have too much homework and is staying up late trying to get it all done?
  • What does your teen do just before going to sleep?
  • Does your teen fall asleep easier when he goes to bed much later than his typical bedtime or does he still have trouble falling asleep?
  • Are your teen’s sleep problems new?

And perhaps most importantly, what is your teen’s daily sleep schedule like? What time does he go to sleep and wake up, including weekends, and does he typically take a nap?

Treatments for Teen Sleep Problems

In addition to treating any underlining medical issues that might be causing your teen to have trouble sleeping, it will likely help if your teen learns about sleep hygiene and:

  • goes to bed and wakes up at about the same time each day, instead of trying to catch up on “lost sleep” on the weekends
  • keeps his room bright in the morning (let in the sunshine) and dark at night
  • avoids taking naps, or at least naps that are longer than about 30 to 45 minutes
  • avoids caffeine
  • is physically active for at least one hour each day
  • doesn’t eat a lot just before going to bed
  • turns off all screens (phone, TV, computer, video games, etc.) about 30 minutes before going to sleep
  • doesn’t get in bed until he is actually ready to go to sleep, which means not watching TV, reading, or doing anything else on his bed
  • gets out of bed if he doesn’t fall asleep after 10 to 15 minutes and reads a few pages of a book, before trying to go to sleep again

Did that work?

If you teen is still having sleep problems, encourage them to try some basic relaxation techniques, such as progressive muscle relaxation, guided imagery, and deep breathing or abdominal breathing. You do them at bedtime and again if you wake up in the middle of the night.

I especially like the idea of guided imagery for teens, as they can focus on something they like to do, whether it is building a sandcastle on the beach, or going horseback riding, surfing, hiking, or playing baseball, etc. They should focus on the details of the story they make up, coming back to it if their mind wanders, and hopefully they fall asleep as they get caught up in it.

With the deep breathing technique, they slowly breath in through their nose and out through their mouth. They can hold their breath for a few seconds or breath into their abdomen too (abdominal breathing).

Progressive muscle relaxation is another technique that might help your child relax at bedtime. They simply tense and then relax each muscle group of their body, one at a time, starting with their toes and working their way up. If they make it up to their forehead and aren’t asleep, then they should work their way down, perhaps doing 3 to 5 repetitions for each muscle group,  or try another technique.

And be sure to talk to your pediatrician if your teen continues to struggle with sleep problems.

What To Know About Teen Sleep Problems

Although teen sleep problems are common, they can cause serious daytime issues for your teenager, which makes it important to learn about good sleep hygiene and that help is available from your pediatrician.

For More Information on Teen Sleep Problems

Treating Hard to Control ADHD

ADHD is often much harder to treat than many people imagine.

It isn’t always just a matter of writing a script for Adderall or Ritalin and then have kids who had been failing suddenly jump to the ‘A’ Honor Roll.

ADHD Treatments

Whether your child’s ADHD symptoms include problems with inattention, hyperactivity and impulsivity, or both, the treatments are the same:

  • Stimulants – Adderall vs Ritalin based
  • Non-Stimulants – Intuniv (extended release guanfacine), Kapvay (extended release clonidine), Strattera
  • Behavior Management Therapy

Although often underused, it is recommended that behavior therapy be the first treatment for younger, preschool children with ADHD. Both medication and behavior therapy are typically recommended for older children with ADHD.

ADHD Medications

Surprisingly, there is really no one best ADHD medicine. Those that aren’t yet generic (in bold) are going to be much more expensive than the others.

  • Short Acting Stimulants – Adderall, Focalin, Methylin (chewable), ProCentra (liquid), Ritalin
  • Intermediate Acting Stimulants – Dexedrine, Ritalin SR, Methylin ER
  • Long Acting Stimulants – Adderall XR, Adzenys XR-ODT, Concerta (Methylphenidate ER), Daytrana (patch), Focalin XR, Metadate CD, Metadate ER, Quillichew ER (chewable), Quillivant XR (liquid), Ritalin LA, Vyvanse
  • Non-Stimulants – Intuniv, Kapvay, Strattera

In general, stimulants are thought to work better than non-stimulants, but again, there isn’t one stimulant that is consistently better than another.

Treating Hard to Control ADHD

What do you do when your child’s ADHD treatments aren’t working?

While it is important to “initiate an evaluation for ADHD for any child 4 through 18 years of age who presents with academic or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity,” it is important to remember that not all kids with academic or behavioral problems have ADHD.

So the first thing you should do is confirm that your child really does have ADHD. Is it possible that your child was misdiagnosed and doesn’t have ADHD at all? Or could your child have ADHD and another co-morbid condition, including “emotional or behavioral (eg, anxiety, depressive, oppositional defiant, and conduct disorders), developmental (eg, learning and language disorders or other neurodevelopmental disorders), and physical (eg, tics, sleep apnea) conditions.”

Next, ask yourself these questions and discuss the answers with your pediatrician:

  • Is your child taking his medicine?
  • Does your child need behavior management therapy?
  • Are you not getting your child’s ADHD medicine because of how expensive it is? Ask your pediatrician about a lower cost generic ADHD medicine.
  • Has there been a sudden worsening of previously well controlled ADHD, which might indicate a problem with bullying, social changes at home, abuse, or depression, etc.?
  • Are you relying on restrictive diets or other alternative treatments for ADHD that have been proven to not usually work?
  • Does your child need a different dosage of his current stimulant, either a higher or lower dose?
  • Is your child’s medication wearing off too soon?
  • Does your child’s medication take too long to work?
  • Does your child need to switch to a different stimulant or to a stimulant with a different delivery method?
  • Does your child need to switch from a long-acting stimulant to a short-acting stimulant?
  • Does your child need to switch to a non-stimulant, keeping in mind that these are often used in combination with a stimulant and not by themselves.
  • Do you need to adjust your expectations for what kind of control you can get from even maximal treatment?
  • Does your pre-teen or teen with ADHD not want to take his medication anymore?
  • Are side effects keeping your child from taking his ADHD medicine everyday?
  • Does your child need 504 plan accommodations at school and/or an IEP?

And perhaps most importantly, what is making your child’s ADHD hard to control? Is he just still having some ADHD symptoms or are those lingering ADHD symptoms causing an impairment? If they aren’t causing an impairment, such as poor grades, problems with friends, or getting in trouble at school, etc., then your child’s ADHD may be under better control than you think.

What To Know About Treating Hard to Control ADHD

ADHD can sometimes be hard to control and require more than just a quick prescription for Ritalin or Adderall, including adding behavior therapy, careful monitoring, and special accommodations at school.

More Information About Treating Hard to Control ADHD