It’s back to school time and that means parents are grappling with getting their children on a regular sleep routine. But for parents with children who have been diagnosed with ADHD, that’s no small task.

As many as 70% of children with ADHD experience problems with sleep. The issues include bedtime anxiety or resistance, insomnia and delayed sleep – meaning their sleep cycle has shifted and they aren’t tired at bedtime. 

Kristin Mock, MD, is a family practice physician at OSF HealthCare who specializes in ADHD and pediatric sleep issues. She sees patients whose behaviors are often linked to ADHD; but they could also be a result of a lack of sleep.

Unlike adults who have excessive sleepiness and fatigue, Dr. Mock says children with ADHD tend to have more behavioral issues such as acting out or temper tantrums. They have difficulties with behavior and focus and concentration, and they tend to get fidgety.

So that begs the question – is the issue ADHD or a sleep problem or a combination of both?

“If your child has ADHD, there is a high likelihood they have comorbid sleep dysfunction and mental health dysfunction,” says Dr. Mock. “We need to treat the whole of the child and make sure that we've looked at all of those reasons that people can have concentration deficits and treat all of that to give them the best potential.”

Dr. Mock adds that not getting enough sleep can cause or make ADHD symptoms worse. And that means improving a child’s sleep issues can help reduce symptoms.

“So, when the brain is tired, it tries to find ways to get it to stay awake. It will go from one task to the next. It will jump from here to there. It will stutter and sometimes forget things,” she says. “Children will get very fidgety to keep their brain awake. So, while your brain is trying to just get through to the next time it gets to sleep, it makes you not as effective.”

Dr. Mock says the most common referral to her clinic comes from teachers who inform parents that their child lacks focus in the classroom. “Then it's our job to figure out why,” she says.  “What’s really going on? Are they tired, do they have learning disabilities or do they learn differently?”

Mock says parents can help by discouraging any use of electronics once your child has gone to bed. That means there is no iPhone, iPad or TV in their bedroom and no texting, social media or video games, which will not go over well with many teens. Starting this behavioral change at younger ages makes this change easier. 

She also recommends encouraging children to go to bed and wake up at the same time every day. Most children require eight to 10 hours of sleep every night. Dr. Mock adds children need two weeks to gradually get back into a good sleep routine now that school has started.

It's also important to get a handle on your child’s medication. Some ADHD stimulants can make sleep worse so talk to your child’s care team about how they are affecting your child’s sleep. Dr. Mock adds that if your child snores, medical providers need to do more. Dr. Mock says their doctor should make a detailed sleep history or maybe make a referral to a sleep specialist.

“Parents need to pay attention to their children's sleep,” Dr. Mock says. “Physicians may not realize that the child is not sleeping well. And so, parents need to be able to tell their doctor, 'Hey, I'm concerned about the way my child is sleeping, or my child is snoring. Can we do more?'"

For more information on sleep disorders, visit OSF HealthCare. 

 

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Mental health care starts with a first step, but that first step can be intimidating. Maybe you don’t want to let others know what you’re dealing with, or you’ve heard about friends having poor experiences while seeing a mental health provider.

Susan Hanson, DSW, LCPC, a psychotherapist at OSF HealthCare, is debunking misconceptions about therapy so you can feel comfortable and get the most out of your care.

• Myth: Seeing a therapist is scary.
  
  Fact: “People quickly learn it’s a safe place to talk about trials, tribulations and conflicts. It’s a very warm and inviting place,” Hanson says. She adds that even group therapy shouldn’t be intimidating. Group work can help build empathy and a sense of belonging. When you see others going through the same issues, you can often feel less alone.
   
• Myth: My private health information is at risk of becoming public.
  
  Fact: Hanson says this comes up often with her patients. They don’t want to talk about certain things with friends and family, but they’re also wary of talking with a provider. Hanson reassures that all health care providers abide by confidentiality and use software that keeps your information secure and private. She says the only reasons a provider must breach that confidentiality is if the person is a danger to harm themself or others or if there is evidence of child endangerment.
   
• Myth: I’ll be back to normal after just a few sessions.
  
  Fact: It’s usually not a quick fix, Hanson says. Therapy is something you need to buy into and stick with. Success is often seen after awareness, acceptance and internal structural changes in terms of emotional regulation and setting healthy boundaries.
  
  “Some people can come in and have a quick fix. Maybe they’re nervous about moving. Or they have test-taking anxiety, and we can work through skills for that,” Hanson says. “But many other people have more complex trauma that might take longer to work through.”
   
• Myth: Medication will fix me, and therapy is an easy way to get it.
  
  Fact: Hanson stresses that mental health care providers are not medication dispensaries, nor will medication alone likely heal you.
  
  “Sometimes medication is appropriate if there’s a biological basis [an issue innate within someone’s body, in other words], complex trauma or a diagnosis like ADHD or major depression. The medication can help enhance the talk therapy,” Hanson explains. She adds that a therapist can put a timeline on things. If, for example, anxiety symptoms aren’t improving after a few sessions, the provider could look into medications that could help.
   

• Myth: I’ll see my therapist then go back to normal life.

  Fact: Hanson says you have to put what you learn at therapy into practice. Common activities outside of a session include journaling, meditation, grounding exercises and finding a trusted person who you can go to if, for example, you’re having an anxiety attack. Some of Hanson’s patients have also benefitted from emotional support animals, she says.
  
  “Reframing thoughts around a certain situation can be a good goal. Learn positive word choices. Rewrite the story around a situation,” Hanson says. Reducing anxiety is another big goal she’s seen with patients.
  
  “Therapy is not a straight road. I like to see it like a dance. Two steps forward, one step back,” Hanson adds. “I also tell my clients that this bridge will take you halfway there. The rest, you walk alone. There’s only so much any one person can do for another person. We need to learn how to develop some of the skills outside of a therapy session.”

Learn more

Read more about mental and behavioral health care on the OSF HealthCare website. Mental health care at OSF includes providers like Hanson on the local level and the to-be-built Meadowview Behavioral Hospital in Peoria, Illinois, for people who need a higher level of care.

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From misconceptions about symptoms to stereotypes about drugs like Adderall, there’s a lot to parse out when getting treatment for attention-deficit/hyperactivity disorder (ADHD), a neurodevelopmental disorder that affects attention, impulse control and activity levels. ADHD is seen in all ages and can overlap with other issues like depression and anxiety.

“ADHD is different from lack of interest or just not paying attention. It includes emotional dysregulation, chronic impatience, restlessness and constant fidgeting. There’s difficulty managing, planning and organizing things,” says Maghav Sharma, MD, an OSF HealthCare psychiatrist. “That leads to difficulties at home or work. It can cause relationship difficulties or difficulties with bosses. Maybe the person is not completing work on time or are impatient with the result of the work.

“We see symptoms of hyperactivity mostly in kids. They’ll run around their classroom. It’s a common reason why teachers and parents send their students to the doctor to get ADHD treatment,” Dr. Sharma adds. “In adults, that anxiousness and restlessness is not outwardly projected. It’s more inside. A person can feel overwhelmed. They are fidgety, restless or on edge.”

All this is why it’s important to get a treatment plan tailored to your needs. Seeing someone like Dr. Sharma would be a good first step. He says therapy can teach skills, like how to plan and be organized, that can help cope with everyday ADHD issues and, at the same time, help if there are other issues present, like depression. For example, if ADHD is causing you to procrastinate on work projects, you could feel anxious about getting in trouble or sad about missed opportunities to move up the corporate ladder.

“We do quite often see people with symptoms of depression or anxiety, but they have underlying ADHD as well,” Dr. Sharma says. “It’s hard to tell sometimes which symptoms are related to anxiety and which are related to ADHD. So we tend to treat the conditions together. Treatment for anxiety and depression can sometimes alleviate the symptoms of ADHD.”

ADHD treatment “never should be just medication,” Dr. Sharma says. But if ADHD is making daily life difficult, medication can be paired “thoughtfully” with other treatment, he says. Stimulants like Adderall and Vyvanse are often starting options for adults. For kids, health care providers might try methylphenidate (Ritalin is a common brand name). A provider could change your medication if side effects are a problem. They could try a non-stimulant like clonidine or guanfacine.

Lifestyle changes also play a big role in ADHD management, Dr. Sharma says. Sticking to a routine – everything from when you sleep to when you leave for work – can help. Exercise, staying hydrated, eating a healthy diet and getting outside to pursue hobbies or be around others can also help your mood.

Learn more about keeping your mind healthy on the OSF HealthCare website.

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Click here for more stories on mental health care on the OSF Newsroom.

Lavender Zarraga, APRN, a behavioral health provider at OSF HealthCare, says it’s not uncommon for her patients to ask for a medication that isn’t the right fit.

The culprit? She says symptoms of common mental health issues like depression, attention deficit hyperactivity disorder (ADHD) and bipolar disorder can overlap. So, it’s important to stay in contact with your provider to make sure you’re on the best treatment plan.

On depression mimicking ADHD: “You have changed executive functioning. You can’t decide. You feel dull. You can’t concentrate,” Zarraga says. “You have a hard time learning new things. You can’t remember things or forget things easily. Attention and concentration are low. You think ‘Why am I processing everything so slow?.’”

Zarraga adds that she’s seen people with depression take prescribed medicine and feel better, but then residual symptoms that mimic ADHD creep in. And, she says, ADHD can seem like bipolar disorder.

“If you start somebody on an antidepressant and they have an underlying bipolar disorder that they have not been diagnosed with, that can trigger mood symptoms. It could potentially trigger mania [a high energy period where high-risk behaviors can occur],” Zarraga says.

It’s a lot to sort out, and it may make the person feel like they have a whole new set of problems.

“Talk to a provider. See what’s going on,” Zarraga says to people in that situation, noting that kids should not have to carry these issues into adulthood.

“There’s a lot of talking involved,” she adds. “Let’s start from the beginning. Let’s go back to your childhood. How were you doing then? And we relate that to how you are now.”

From there, Zarraga says treatment could include more counseling or different medication. She says medicine for children is more straightforward. But for adults, a provider will make sure the pill isn’t impacting the rest of the person’s body.

There are also science-backed written tests that can help diagnose someone with ADHD. Questions along the lines of: Can you sit still in class? Does your mind wander all the time?

And a word for caregivers, friends and family members: watch for symptoms of these disorders in your loved ones and have a conversation, if needed. Don’t ignore things, Zarraga says.

“There’s nothing wrong with just talking about it. It’s not going to hurt anybody to discuss it,” she says, noting that society is now more accepting of mental health issues.

Signs to watch for in your close companion: irritability, aggression, anxiety and trouble sleeping. If you or someone you know needs to talk to a professional quickly, the national suicide and crisis lifeline is 9-8-8. And the OSF HealthCare website lists other resources.

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If you spend time on social media, chances are you’ve seen an ad asking, “Do you have ADHD?”

The ads lead to a self-diagnosing quiz and often provides viewers with misconceptions about attention deficit hyperactivity disorder (ADHD), before they ever see a medical provider.

That’s where Kyle Boerke, PsyD, director of Behavioral Health Outpatient Services for OSF HealthCare, hopes to provide clarity.

ADHD starts in childhood, not in adulthood

“Are adults being diagnosed with ADHD? Absolutely, yes. Is it that they are developing ADHD in adulthood, that’s a no. We know enough about the research, that in order to receive a diagnosis of ADHD, we have to have symptoms starting in childhood. Somewhere near 7 years of age,” Dr. Boerke says.

If you’re having symptoms as an adult that appear to be ADHD, such as lack of focus, inability to sit still, fidgeting, or excessive talking, but you didn’t have these symptoms as a child, Dr. Boerke says you may be experiencing something else.

“We see depression leads to difficulty with concentration,” Dr. Boerke says. “Something inside of them will ring true (if they have ADHD), like if they always struggled with paying attention to their teacher in elementary school.”

What to do about an ADHD diagnosis?

 “The easy answer is, we need to seek treatment from a professional,” Dr. Boerke says. “If you have thoughts that you’ve had ADHD symptoms for a long time and you take one of those online quizzes, that’s fine, that can be a starting point.” But he stresses, “I wouldn’t take that quiz and all of a sudden say ‘I have ADHD.’ A great place to start is with your primary care physician.”

Dr. Boerke adds that there’s no official test for ADHD. It’s a whole set of symptoms that include how it’s impacting your daily functioning and for how long.

There are three types of ADHD

1: Predominantly Inattentive

“They’re not going to be jumping all over the place, moving from activity to activity,” Dr. Boerke says. “It’s just going to be some hard times focusing, concentrating or finishing a task because your mind gets switched over to a different task all of a sudden.”

2: Predominantly Impulsive/Hyperactive

“These are the kids that just can’t sit still. They’re up out of their seats in the classroom, and this is really where ADHD in children to adults’ changes,” Dr. Boerke explains. “As we age, we do a better job managing the motoric end of things. It’s not uncommon to see kids have a hard time sitting still, it’s more uncommon to see somebody in a business meeting get up and walk around the room.”

3: Combined Presentation

Dr. Boerke describes the third type this way: “You have inattention, plus you have hyperactivity and impulsivity,” Dr. Boerke says.

Do I need to take medicine if I have ADHD?

Dr. Boerke says medicine alone isn’t the answer.

“The analogy I’ll use is Bear Grylls from Man vs. Wild. He’s an adventurer on a TV show where he goes out into the wild and he has to survive for a number of days,” Dr. Boerke says. “I liken ADHD to being on a Bear Grylls survivor show. He can do it. ADHD management without medication is like Bear gets dropped in the middle of the Florida Everglades and he has to trudge through the swamps, battle the alligators, get past the snakes and manage to get out. Can he do it? Yes, he does. Is it easy? It sure isn’t.”

Dr. Boerke says ADHD medication is as if Bear Grylls was in the Florida Everglades and producers drop him a rescue boat.

“But the reality is, he still has to get himself into the airboat. He has to start it, steer it, and do the work. It’s just easier to do the work,” Dr. Boerke adds. “Medication is not the fix. It can help, but if you don’t change your lifestyle, put in some organizational tools and do the things necessary, we’re still not going to get better and you’re going to rely on the medication.”

If you’re an adult and think you have ADHD, Dr. Boerke says seeking medical attention by a professional is the best first step. Then, your medical provider will help map out a plan moving forward. This can include ADHD medication and working to keep a strict routine to help you manage any ADHD symptoms.

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