In continuation of the discussion of the frustration in diagnosing a child with ADHD, I'd like to comment on the topic of sleepiness. Studies show that close to half of children with ADHD also have problems with sleep. A curious observation repeatedly made when observing how children behave when they haven't slept well is that kids tend to act in ways that are opposite of the ways adults act when they are tired. Specifically, when kids are sleepy and are trying to stay awake, they tend to have poor attention and act in hyperactive ways. If symptoms of ADHD include inattention and hyperactivity and sleepy kids act the same way, how do you tell if a kid is sleepy, has ADHD, or both?
The short answer is: slowly, methodically, and with great difficulty. The truth is since ADHD and sleep disorders in children manifest themselves in the same way, it takes a lot of careful assessment to figure out what is going on. A detailed understanding of your child's sleep patterns can provide essential information. Sleep diaries are helpful in this endeavor. Tracking bedtimes, arousals in the middle of the night, wake-up times, and lengths of naps can give valuable information to a pediatrician or psychiatrist. Other important considerations are bedtime behavior and hygiene. Kids have more demands on their 'free time' than ever before. Homework, sports, and other activities can take up a lot of time, and just like some busy adults, busy kids do a lot of high-stimulation activity right before bed. Playing exciting video games and vigorous exercise before bed can have a lot to do with difficulty falling asleep.
There are also some differences between how children and adults sleep that you should consider. Kids tend to take longer to fall asleep than adults and also aren't able to ignore potentially disturbing activities in their environment. Kids have a harder time sleeping through noise and slight discomforts in their sleeping arrangements (like the temperature of the room or how lumpy their beds feel to them).
Stressful family dynamics and interactions between parents and children can also have a substantial effect on sleep. In fact, these can have the most profound effects on sleep. Stress can lead to problems falling asleep, nightmares, and frequent arousals at night. Of course, it takes a trained clinician to tease through the symptoms a child may have and determine the source of the problem. If your child has some of the symptoms we discussed here, talk to your physician to determine if the source of your child's problem is sleep or ADHD.