Alison Pritchard, Ph.D., on bedtime routines for kids with ADHD

Structure is the first step toward better sleep for children with ADHD, according to Alison Pritchard, Ph.D., a child clinical psychologist and co-director of the Center for Neuropsychological and Psychological Assessment at Kennedy Krieger Institute in Baltimore. “I think number one is just having a schedule and sticking to it is really helpful,” she said. “As in many areas of life for kids with ADHD, having a bit more structure can be helpful.”

For children who have trouble falling asleep, a bedtime routine done “the same way, at the same time, every night” can make a substantial difference in sleep onset, she said.

She also recommends removing phones, TVs and video games from the bedroom because they are too tempting. “Most of us adults have a hard time getting off our phones when it’s time to go to bed at night,” Pritchard said. “So, kids can’t be expected to do that for themselves.”

For children who wake at night and have difficulty falling back asleep, Pritchard suggests working with a counselor or therapist. For some, the problem is tied to fear of the dark and wanting a parent nearby at bedtime. If the parent leaves once the child is asleep, the child may have trouble settling after waking and finding the parent gone. Therapists can help families “break some of those associations or habits that aren’t serving them particularly well,” she said.

Pritchard said interest in sleep has grown over the last decade, with new treatments emerging rapidly. She sees two routes to greater symptom improvement, better treatments and better matching each child with the treatment that fits them best. “I do think that we’re getting better in both of those arenas,” she said.

Pritchard was lead author of a survey study in the Journal of Attention Disorders of 100 caregivers of youth with ADHD. Caregivers said they wanted treatment to shorten a child’s time to fall asleep by 30 minutes, while the best current treatments average approximately 20 minutes.