As a home care therapist, I got a lot of questions from parents who were concerned about specific problems. Questions regarding behaviors were most frequent. Parents now are much more informed about pediatric disorders than they used to be. It seems that more and more children are being diagnosed with autism, Asperger’s, ADHD,ODD and sensory processing disorder. So when a child starts to exhibit symptoms that could fit any of these categories, parents start to worry. Usually the parents become alarmed and assume the worst. What is interesting to note, however, is that many times the cause of the behaviors has nothing to do with any of these disorders. It may be the result of a sleep disorder.

Poor sleep patterns, inconsistent bedtimes and the inability of the baby or child to get to sleep on their own can result in behaviors that mimic ADHD or other disorders.

Additionally, sleep problems create stress for the household. A crying, sleepless baby can keep other family members from getting a good night’s rest. They can strain a mother and father’s relationship and affect interactions among family members. Lack of sleep at night creates a kind of chain-reaction of daytime behaviors. When children don’t get enough sleep, it can manifest in hyperactivity, crankiness, combativeness, inattention and poor compliance. These symptoms are also characteristic of ADHD. If the child is school age, and exhibits these behaviors, they are very often misdiagnosed. What’s more is that children with ADHD often have a hard time falling asleep and/or tend to sleep less than their peers in general. This often leads parents and teachers to suspect that ADHD is the culprit.

The situation also becomes complicated because of a parent’s efforts to help the child to sleep.

 It is natural to attend to a child who won’t sleep. The parent will soothe the sleepless child by rocking them, giving them a bottle or something to drink, keeping them company until they fall asleep or taking them into their own bed, or other seemingly helpful strategy. This, of course, ends up promoting the sleeplessness because the baby or child becomes dependent on the interaction, and gets distressed when it is stopped. Alternatively, the parent continues the pattern and ends up sleep deprived and irritable. Many times sleeplessness or interrupted sleep patterns reflect emotional issues of a parent or parents, or can be attributed to psychological problems related to separation anxiety or temperament.

Things are not always as they seem, as the saying goes. It is often very hard to discern whether the sleep problems are related to a disorder such as ADHD or if they are a consequence of developmental issues, or if they are perpetuated by well intentioned but ill-advised bedtime routines.

 It is essential that a baby or child learn to soothe themself to sleep, and to be able to return to sleep unassisted if they awaken during the night.

There are some strategies you can try in order to establish a consistent bedtime routine for your child. I recommend that a parent try these tips before they seek professional help. Of course, change does not happen overnight, so you need to devote some time before deciding outside help is necessary. It is also important for a baby or toddler to get the appropriate number of hours sleep. Too little total sleep time can result in behavior problems as well.

1. Set a specific time for bedtime. If the issue is not sleeping long enough, start working toward a good bedtime by backing up the time gradually. You can start by getting the child to bed fifteen minutes earlier, then thirty minutes earlier, and so on until you reach your goal.

2. Prepare your child verbally by giving them advance notice of bedtime. If you have a baby who has sleep issues, put them in the crib ahead of “lights out” with a few toys in the crib.

3. Do not allow a toddler or child to be involved in a stimulating activity immediately prior to bedtime. TV, high energy play and video games are arousing and can delay a child’s “sleepiness”

4. Spend the time right before bedtime in a calming routine. You can give a baby or a young child a warm bath and then read to them after they get in bed. Focus on activities that are calming and comforting to the child.

5. Be firm when you say goodnight. You can leave a nightlight on, or keep the door ajar if it reassures the child.

6. If the baby or child starts crying, avoid going in to check on them. Giving them attention can actually cause them to cry more when you leave. If an older child gets out of bed, take them back to bed without talking to them. They are seeking interaction, so you need to make it as minimal as possible. Keep in mind that if they are fed, toileted, bathed and not thirsty, then they are probably testing you.

I also want to mention that there are some natural sleep aids which can help get your child (not baby) to extend their sleep patterns by helping them to get drowsy. As a matter of fact, I used Melatonin with my son with good success. He typically would sleep for only about eight hours. I managed to back up his sleep time gradually from ten p.m to about 8:30 p.m. Now that his system is accustomed to falling asleep at an earlier time, he now falls asleep naturally.

A good nights sleep is important to everyone, but it is essential for a developing baby or child.

Irregular sleep patterns and inadequate sleep can result in behavior problems that mimic more serious disorders.  If sleep is the issue, the behavior problems will resolve. While it is not easy to establish new sleep habits, it is important to take the necessary steps to do so. If after making a concerted effort you don’t see an improvement, then it is a good idea to consult a professional. Most sleep problems can be resolved with the above strategies. However, there are some babies and children who have what is considered a complex sleep disorder. These children cannot self soothe and self-regulate. Developmental issues, emotional problems or medical problems may contribute to the sleep disorder and indicate the need to consult with a psychologist or child development specialist.