Most studies on sleep and ADHD rely on questionnaires. Parents tick boxes. Researchers count numbers. The data is useful, but it misses the full picture. A 2024 qualitative study published in Behavioral Sleep Medicine took a different approach. Instead of questionnaires, the researchers sat down and talked to parents.
The study, titled “Tell Me More About Your Child’s Sleep”: A Qualitative Investigation Of Sleep Problems In Children With ADHD, was conducted by Bondopadhyay, McGrath and Coogan at Maynooth University and the ADMIRE ADHD service at Linn Dara Child and Adolescent Mental Health Services in Dublin, Ireland. They interviewed 26 parents of pre-adolescent children with ADHD and used thematic analysis to identify patterns in what parents described. What came out of those conversations offers sleep consultants a richer, more detailed view of what bedtime actually looks like in these families.
Who was in the study
The 26 children ranged in age from 6 to 12 years, with a mean age of 9.8 years. Seventy-seven percent were boys. In 88% of cases the mother was the parent interviewed. Sixty-nine percent of the children had siblings. Seventy-three percent were on ADHD medication, 30% were on both ADHD medication and melatonin, and one child was on melatonin only.
Several children had co-occurring conditions: 19% had Autism Spectrum Disorder, 7% had OCD, 7% had a history of sleep apnoea, and individual children had epilepsy or migraine.
Parents were recruited from ADHD Ireland (a charity organization) and from the ADMIRE ADHD clinical service. Interviews were conducted by the first author via Zoom. The transcripts were analyzed using Reflexive Thematic Analysis.
Three themes came out of the interviews
The analysis produced three main themes: Children’s Sleep Difficulties, Impacts of Children’s Sleep Problems, and Improving Children’s Sleep.
Falling asleep was the biggest problem. Difficulty initiating sleep appeared in 17 out of 26 transcripts. This was the most reported issue. Parents described a pattern of children getting in and out of bed, coming downstairs to talk, asking for drinks, wanting to share thoughts. One parent of an eight-year-old boy described it: the child kept getting out of bed saying “I have something to tell you” or “I need a drink.” The parent noted that the child seemed afraid of missing out on things happening in the household.
Sleep maintenance problems, by comparison, were not identified as a separate subtheme. For these children, the difficulty was getting to sleep, not staying asleep.
Emotions made it harder to fall asleep, and not being able to fall asleep made emotions worse. Emotional distress affecting sleep appeared in 8 out of 26 transcripts. Parents described a problematic feedback loop: unresolved emotions from the day made it difficult for the child to settle, and the frustration of not being able to fall asleep added more distress on top. One parent said that 90% of the difficulty was anxiety, and that staring at the ceiling unable to sleep was their child’s norm.
The researchers noted that this feedback loop between sleep onset problems and emotional distress has not been widely reported in the existing literature. It is a finding with direct implications for how sleep consultants approach bedtime difficulties in children with ADHD.
Children woke early no matter how late they fell asleep. Early waking appeared in 6 out of 26 transcripts. Parents reported that a late bedtime did not lead to later morning wake-up. The children woke at the same time regardless, full of energy and ready to engage with the household. Combined with delayed sleep onset, this resulted in shortened total sleep.
The ripple effects of poor sleep
Seventeen out of 26 transcripts reflected the impact of poor sleep on the child and family.
Parents perceived shorter sleep as being directly linked to emotional and behavioral outbursts during the day. They reported that when the child got catch-up sleep, emotional regulation improved. One parent of a seven-year-old boy described how without sleep the child “wasn’t functioning” and would “explode basically, screaming, shouting, kicking the walls.”
The children’s sleep problems also affected parents’ own sleep and evening schedules. Eight parents described how they had to spend extra time with the child at bedtime, which cut into their own evening. Checking on the child during the night further disrupted parental sleep. One mother of an eleven-year-old girl said that sleep was “something that we’re constantly talking about, it affects our lives every day.”
A striking finding: in 6 out of 26 cases, the child’s sleep problems were the initial concern that led the family to seek assessment, which then resulted in the ADHD diagnosis. Five of those six children had co-occurring conditions. The researchers suggest that sleep problems may be an early-presenting symptom that parents can identify more readily than other ADHD symptoms, and that this makes sleep assessment an important part of clinical encounters.
What parents did to help
This was the most widely endorsed theme: 24 out of 26 parents described steps they took to improve their child’s sleep.
Bedtime routines appeared in 20 out of 26 transcripts. Parents described using consistent evening routines, restricting screen time before bed, avoiding certain foods and drinks such as carbonated beverages, and ensuring the child got physical exercise during the day. One parent emphasized: “We do the same thing every night.”
Emotional wind-down appeared in only 7 out of 26 transcripts. Parents described avoiding situations that might upset the child before bed, providing reassurance with their presence, and talking through unsettled feelings. One parent of a ten-year-old girl explained that the child’s sleep was “mostly affected by things that have happened and overthinking,” and that when the child felt she had a chance to “get those thoughts out,” sleep came more easily.
The researchers pointed out that only 7 out of 26 parents mentioned this emotional preparation for sleep. They identified this as a gap in psychoeducation. They suggested that there is potential for a positive cycle: better sleep leads to better emotional self-regulation, which then supports better sleep.
Bedroom features appeared in 10 out of 26 transcripts. Parents described using specific items such as play dough, stuffed toys or a familiar blanket at bedtime. They reported adjusting bedroom temperature, lighting, and sounds. One parent said temperature was “the biggest factor” for their child’s sleep. Another used relaxing music to help the child wind down.
Medication effects appeared in 12 out of 26 transcripts. Parents perceived psychostimulant medication (methylphenidate) as increasing the time it took for their child to fall asleep. One parent described the child as “overstimulated” with dilated eyes, running around the house at night after a dose increase. Melatonin, on the other hand, was perceived as helpful. One parent reported that without melatonin the child would stay awake until one-thirty in the morning.
How sleep consultants can use this
This study gives sleep consultants something that quantitative research does not: the actual texture of bedtime in families of children with ADHD. Several findings from the paper carry specific practical weight.
The feedback loop between emotions and sleep onset deserves close attention. When a child with ADHD cannot fall asleep and becomes upset about it, the upset itself pushes sleep further away. The researchers noted that this feedback loop has not been widely reported in the existing literature. Sleep consultants who work with these families can help parents recognize this cycle.
The gap in emotional wind-down is an opportunity. Only 7 out of 26 parents described actively addressing their child’s emotional state before bed. The researchers flagged this as a potential target for psychoeducation. Sleep consultants are well positioned to fill that gap by helping parents learn to calm their child’s emotions before bed, through conversation, reassurance or calming activities, as the parents in this study described doing.
The finding that children’s sleep problems led to ADHD assessment in nearly a quarter of the families speaks to the role that sleep difficulties can play as an early warning sign. Sleep consultants may be among the first professionals to hear about these problems. Knowing that persistent sleep difficulties in a child can sometimes signal an underlying neurodevelopmental condition helps consultants make appropriate referrals.
The study also serves as a reminder that sleep problems in children with ADHD are a household issue. The researchers themselves suggest that sleep should be examined as a “whole-household issue” in future ADHD studies. Parents’ own sleep and evening time were affected. The emotional weight of managing a child’s sleep difficulty night after night was clear in these interviews.
Limitations
This was a qualitative study with 26 parent-child dyads from Ireland. The sample had a male bias (77%), which may reflect the higher rate of ADHD diagnoses in boys. The study relied on parental report and did not directly assess children’s experiences. Limited clinical information was available about the children’s ADHD subtype or severity. The findings apply to pre-adolescent children and may not extend to teenagers. ADHD diagnosis was parent-reported and not confirmed through clinical interview for all participants.
Bondopadhyay, U., McGrath, J., & Coogan, A. N. (2024). “Tell Me More About Your Child’s Sleep”: A Qualitative Investigation Of Sleep Problems In Children With ADHD. Behavioral Sleep Medicine, 22(3), 298–307. https://doi.org/10.1080/15402002.2023.2253947