Top 10 reasons a child or teen is tired

I see many kids each month who complain of being too tired. Parents often fear the worse, such as low iron or even cancer. There are many things to consider, but there are a few very common reasons that could explain why a child or teen is tired. I’m also including some less common things that make kids feel tired, but are common worries of parents. Always remember that common is common. Serious causes of being tired will not happen with fatigue as the only complaint.

Here are 10 reasons a child or teen is tired:

1. Not enough exercise

top 10 reasons a child is always tiredStrenuous aerobic exercise helps our bodies get healthy, quality sleep. Better quality sleep improves our performance, both physical and mental.

If you lay around, you tend to feel more relaxed, lazy and tired. Getting up and moving can help.

Many kids sit all day at school, then come home to sit more doing homework, watching tv, or playing video games.

Limit time on screens, especially before bedtime. We need to encourage kids to get up and move, ideally outside.

Make it fun!

  • Take a walk to a park, then play
  • Play catch
  • Go on a bike ride
  • Swim
  • Join a sports team
  • Play frisbee
  • Golf
  • Go bowling
  • Dance
  • Try yoga — there are many online videos to get you started

Several of these ideas you can do with your kids. Make it a family goal to be active together! It models the healthy habits you want your kids to live.

2. Celiac disease

Celiac disease is an autoimmune disease in which people can’t eat gluten (a protein found in wheat, barley and rye) because it will damage their small intestine. This can lead to malnutrition and anemia (low red blood cell counts). Symptoms vary, but often include abdominal pain, diarrhea, constipation, fatigue and bloating. In kids it can affect puberty and growth. Celiac disease can run in families.

There are a lot of people who say they feel healthier when they avoid gluten for non-celiac gluten sensitivity. These people have symptoms that are found in celiac disease, such as abdominal pain, bloating, diarrhea, constipation, headaches, bone or joint pain, and chronic fatigue when they have gluten in their diet, but do not test positive for celiac disease. It is not clear what the etiology of this is, but removing gluten seems to improve symptoms.

It’s uncommon for kids to have fatigue as the only symptom of celiac disease, but if you are worried about their symptoms, schedule a visit with their physician to discuss it as a possibility.

A quick warning…

Do not remove gluten from their diet without talking to your doctor. Gluten in the diet is needed for testing, which is needed to confirm celiac disease.

Celiac disease is important to diagnose and treat due to chronic issues that can occur from long-term damage to the intestines. If a child doesn’t have a true diagnosis, it is more likely they will not remain compliant with the diet changes that are required.

3. Depression

We often think we would recognize a depressed child or teen. We picture them crying often or appearing sad, but this is not necessarily how they appear. Yes, they can cry and appear sad, but sometimes they don’t.

Depression doesn’t always look like you’d think.

Sometimes parents think their child is angry. Or parents are mad because a teen stops trying at school. The child might get into fights.

Common symptoms of depression:

  1. Sadness, crying and tears
  2. Losing interest in things they usually enjoy
  3. Appearing angry or irritable
  4. Boredom and apathy
  5. Isolation from friends and family
  6. Extreme sensitivity
  7. Headaches, stomach aches, and other ill type symptoms
  8. Low self-esteem or guilt
  9. Poor concentration
  10. Change in eating patterns – either more or less
  11. Low energy
  12. Falling grades
  13. Change in sleeping patterns – either more or less
  14. Self harm (cutting or other behaviors)
  15. Talks of suicidal thoughts or intent

If you think your child is depressed, please get professional help. Sadly, depression is a fairly common underlying reason for kids to be tired.

4. Thyroid problems

Thyroid problems are relatively common and can be present at birth or develop later in life.

Hypothyroidism occurs when the thyroid gland does not make enough thyroid hormone. About 5% of people over 12 years of age has hypothyroidism.

People with hypothyroidism might feel depressed, be tired, have poor focus, and become forgetful. They might gain weight or have slowed growth. They might feel colder than others or have constipation. Sometimes they’ll develop a swelling in their neck called a goiter.

Most of these are very common symptoms that are not specific to thyroid problems. Having some of them does not necessarily mean that there is a problem with the thyroid. If there are several of these symptoms, it’s relatively easy to screen for thyroid problems with a blood test.

Schedule an appointment to talk to your pediatrician if you’re concerned about a thyroid problem.

5. Too much sugar

Although the body needs sugar for energy, eating too much refined sugar can cause weight gain, chronic disease and sugar crashes. Excess weight can make it harder to exercise and sleep, both of which help us not feel tired.

Encourage kids to eat a healthy balance of fruits, vegetables, proteins, and complex carbohydrates.

Limit the juices, candies, and other high-sugar / low nutrition foods. I know this is easier said than done when kids beg and cry for candy. It’s even harder to limit when kids grab their own snacks.

Keep easy to eat healthy snacks available as much as possible. Don’t buy the junk. Kids will get plenty of it outside the home. If it’s not at home, they won’t grab it.

6. Caffeine

Most adults have grabbed a caffeinated beverage to help ward off fatigue, but caffeine can lead to poor sleep and more tiredness. It can become part of an unhealthy cycle.

Kids don’t need caffeine. If they do have it, it should be before noon. Caffeine can stay in your body for about 8 hours and keep you from sleeping.

Children under 10 years of age should not have caffeine due to jitteriness, irritability, and other side effects. It’s recommend that kids who are 10 – 12 should get no more than 85 mg per day. Teens should have 100 mg or less. Up to 400 mg of caffeine a day appears to be safe for most healthy adults.

Mixing caffeine with certain medicines or alcohol can increase its problems.

7. Anemia

Anemia is a low red blood cell count.

Our red blood cells bring oxygen to the cells of our body, and when the levels are low we can feel tired. Other symptoms are irritability and pale skin coloring. Often there are no symptoms with mild anemia.

There are many causes of anemia. Blood work can help to identify anemia and its causes. Treatment depends on the cause.

If you’re worried about anemia, schedule an appointment with your pediatrician. A history and exam will be needed to determine if labs are indicated.

8. Insomnia

It makes sense that if you don’t sleep enough, you’ll be tired. When people have insomnia, they do not sleep enough hours.

There are many causes of insomnia, but all can lead to insufficient sleep. Addressing the underlying cause is important.

  1. Anxiety and depression (see above)
  2. Screens (see below)
  3. Circadian rhythm changes
  4. Allergies or other causes of nasal congestion
  5. Pain
  6. Gastroesophageal reflux
  7. Restless leg syndrome
  8. Some medications and caffeine
  9. Exercise too late in the evening
  10. Nicotine (growing in popularity among kids due to vaping)

If your child is struggling to sleep, schedule an appointment to discuss potential reasons and treatments.

9. Sleep apnea

Sleep apnea happens when a person stops breathing during sleep. It’s usually caused by something blocking the upper airway. You might hear snoring followed by pauses in the breathing pattern, gasps, or choking sounds.

Because the airway is obstructed, oxygenation levels can fall briefly. This triggers the brain to wake up to open the airway. When this happens repeatedly throughout the night, sleep quality is affected. A person wakes feeling tired.

Enlarged tonsils or adenoids and obesity are common causes of sleep apnea. If you think your child has sleep apnea, talk to your child’s pediatrician.

10. Screen time

The light emitted from televisions, computers, tablets, and smart phones trick our brains into staying awake.

When kids are on a screen up until bedtime, their brain is not yet ready to go to sleep. This leads them to stay up too late, which makes them too tired the following day.

Dr. Craig Canapari discusses the problems with screens and sleep in Prevent Sleep Problems in Kids: Keep Technology Out of The Bedroom.

Not enough sleep is the common thread to many of these.

Not enough sleep is the #1 reason I find for kids being tired. They need more sleep.

Studies show that many of us just don’t sleep enough. It’s important for kids to get adequate amounts of sleep. If your child is tired and is not able to sleep sufficiently, talk to your pediatrician about ways to improve sleep and decrease fatigue.

 

Spring Forward: Help your kids ease into their new schedule

Bonus post! I’ve been scheduling posts on Tuesdays and Saturdays, but forgot about the clock change that’s happening next weekend. I wanted to post off schedule to give people a week to think about how they’ll adjust and Spring forward!

Spring forward and lose an hour of sleep

spring forward and lose an hour of sleepSpring is a wonderful time with warmer weather, flowers blooming, and more daylight hours to play outside.

Most of the US will move our clocks forward on March 11th.

This simply means an hour of lost sleep, right?

Not at all.

Especially if you have kids.

Or worse: teens.

Even adults can suffer, as the heart attack and accident rates rise at this time of year.

There are some things we can do to help ease the transition though.

If you have early risers

If your little ones wake too early consistently, this is a great time of year! Instead of them waking at 6 am, they’ll wake at 7.

This is great if you want them to sleep an extra hour in the morning.

Most kids

If your kids are used to waking up at the “correct” time, you’ll have to re-train them to go to bed and wake up an hour later.

The good news is the change happens over the weekend, so plan on waking kids up Sunday at the same time you always wake them, even if you have a lazy Sunday planned. Get them up and moving!

If your clocks don’t automatically reset, set them before everyone goes to bed for the new time. They will be going to bed at the old time, but they should be aware that when they wake it will be the new time. It will look like they’re going to bed an hour late.

If they go to bed at their usual time, they will be short an hour of sleep. Some kids might benefit from a little longer nap due to this, but don’t let them sleep so long that they won’t fall asleep on time Sunday night.

Do your normal activities at their normal times on Sunday so that Sunday night they’ll be ready for bed at their regular bedtime in the new time.

Teens and other kids who have a hard time getting up

Make a plan

Talk about a plan for waking earlier by Monday morning to see what your teen (or older child) thinks will work best for him or her.

Try to not dictate what they want to do. That just won’t work.

A defiant kid will just not listen.

Some kids might get anxious about the change if you push it too much – and anxiety is one of the biggest triggers for insomnia.

No one wants to be tired, and even teens will admit they want more sleep.

It’s not their fault that they stay up late and want to sleep in. It’s built into their circadian rhythm.

Spring Forward Plan suggestions

Slowly back it up over days

Go to bed 10-20 minutes earlier for several nights before the switch and get up a little earlier than normal each day.

It’s important that they get up a little earlier because that helps them reset their internal clock, even if they couldn’t fall asleep earlier.

So if they normally wake at 6:30 for school, get them up at 6:10, then 5:50, then 5:30 over a few days, so they will be ready for 6:30 on Monday morning.

Wake early for the weekend

Wake up an hour early on Saturday the weekend the clock changes. Or 30 minutes earlier on Saturday and the other 30 minutes Sunday.

This might help them readjust to the new time over the weekend and be able to go to bed a little earlier Saturday and Sunday nights, which helps with Monday morning.

Practice meditation

Each day this week they can use a mindfulness app to practice mindfulness. Then when it comes time to sleep, they can get into their mindfulness place and relax.

Belly breathing

Try belly breathing at bedtime.

It’s a great way to relax.

Even if they don’t fall asleep, their body is resting if they’re laying still and focusing on their breathing.

Make it dark

Sunlight and artificial lights keep us up.

Turn off the screens and some of the lights in your home a little early Saturday to help everyone start to feel tired.

Use room darkening shades if the sun is still shining. (This can be important in the summer months when the sun is out until 9pm and kids need to go to bed earlier.)

More things to consider

Be vigilant

Be extra vigilant on the roads Monday morning, since studies show a higher rate of traffic accidents.

Battery changes

Each clock change it’s recommended to change the batteries in your smoke alarms and carbon monoxide detectors.

Even if your alarms are hooked into your electric system, they need a battery backup in case the power goes out.

Not to mention they always seem to start beeping in the middle of the night if you don’t change them in time!



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Transitioning to The Big Kid Bed

Parents often try to keep the crib as long as possible to avoid the problem of their toddler/preschooler leaving the bed again and again at bedtime, but eventually they all need to take the plunge and get a big kid bed. How do you get a kid to stay in a bed?

Daycares do it

How do you know when your child's ready to move to the big kid bed?It always blows me away that daycares get 1 year olds to sleep on cots.

They stay there… how???

I suspect they are following what the older kids in the class are doing and they are never left alone. That makes it easier on many levels.  Parents don’t have that luxury at home when transitioning to the big kid bed.

When’s the right time?

Many parents are tempted to move their toddler to a bed before the child is really ready. Many experts advise continuing the crib until around 3 years of age.

Remember that the crib also is a place of security, so sleep problems can develop if kids are transitioned too soon.

Many kids that leave the crib before they can understand rules (around age 3) have a hard time staying in the bed.

Some kids are able to climb out of the crib, so parents think it’s safer to move to a bed. This is one solution, but you can also work on ways to keep your toddler in the crib.

Make sure the space is safe

Before you let kids sleep in a bed that they can easily get in and out of, make sure the room is safe.

This is a great time to check the smoke and carbon monoxide detectors. Change batteries when you change your clocks.

Furniture should be secured to walls so climbing kids won’t pull them down.

Don’t allow window cords to be reachable by kids. Too many kids get hurt from cords and window coverings.

Don’t put beds near windows.

Keep all medications and poisons out of your child’s room. This includes diaper rash cream and other “non-medicine” hazards.

If you have a bunk bed, be sure kids under 6 years of age don’t sleep on the top bunk. If your little ones won’t follow the rules, you should unbunk the beds.

Make sure kids can’t get out of their room without you hearing them. They could be at risk falling down the stairs or simply get into trouble helping themselves to junk food or extra tv time.

For more safety tips, check out Charlie’s House.

Build excitement

Parents can get the child excited about leaving the security of the crib by talking about the bed before it is used.

Have kids help pick out sheets or a pillow for the bed.

Remind them during the day how big they are when they ___ (fill in the blank with “use a spoon,” “pick up a toy,” etc). Warning:  This can backfire if they really are afraid of the bed and they do want to not be big, so they stop all the “big kid” behaviors.

Addressing fears

If kids are afraid of their new bed, lay together to read books at nap and bed time.

If you still have the crib available, ask if they want to sleep in the bed or the crib. Simply having the choice might empower them to want to stay in the bed.

Feel free to leave a light or night light on in the hall (or even in the room if they prefer).  Eventually they won’t need it, but it can really help if they want it!

Go through a routine of checking the closet (then closing the closet door), checking under the bed, and picking a favorite toy to be there while your child sleeps.

Use a comfort item. It’s amazing how much the power of suggestion that a stuffed toy will stay with them works!

Let them know you will check on them soon… and do, but wait a little longer each night until they are asleep when you check.

If your child has fears related to sleep, check out The Most Common Reasons Why Kids are Afraid to Sleep from AT Parenting’s Child Therapist & Author, Natasha Daniels.

Falling out

For kids who are prone to falling out of bed, decide what works best for that child.

Some parents put the mattress on the floor instead of on a bed frame, so if they roll off it’s no big deal.

Many parents use bed rails that keep kids in the bed.  Unfortunately if they roll hard enough, they can get trapped between the mattress and bed rail.  I know this from experience! My son would do that and it would FREAK him out. He usually went to sleep without much fuss, but after he would get stuck in the rails he was too scared to sleep. We finally just put the bed against one wall and moved everything away from the other side of the bed except a nice layer of pillows and blankets. When he fell out of bed (yes, most nights…) he landed on the pillow pile and kept sleeping.  Problem solved!

Pick a reasonable bedtime

Account for all the time it will take to do all the stall tactics when picking the bedtime.

If sleep time needs to be by 7:30, and you know they will resist brushing teeth, need to potty a 2nd time, get a drink, check the closet and under the bed, and read 3 books… get started in plenty of time to do all of that and still have them tucked in for the last time before 7:30.

Ironically as kids get more tired, they get more wired, so DO NOT allow this process to run too late! They will hit a 2nd wind and be up far too long.  We all know what kind of day tomorrow will be if they are up too late tonight… and it isn’t pretty!  Then they are overly tired for the routine the next night, which can lead to an earlier 2nd wind and more troubles!

Card trick

One trick I’ve learned that works well for older toddlers and preschoolers is the card trick.

They start each night with 3 cards.

Every time they leave their bed for another hug, a drink, to potty, etc, they surrender a card to you.

Once all 3 cards are gone, they can’t leave the bed any more.

If they have cards left over in the morning, they get a sticker for each card.

They can earn up to 3 stickers (or make it special to get an extra sticker if they have all 3 cards!)

When they reach a set number of stickers they earn a prize.

Supplies:

Cards

You can use cards from a regular deck, or you can make it even more fun by having your child make his own cards.

Sticker chart

I also suggest making a simple sticker reward chart, keeping in mind how difficult you think it will be to earn stickers and set a realistic goal for all the needed stickers to be earned within a week.

If they don’t earn the prize fast enough at the beginning they might lose interest (but it needs to be enough time that they earn it). You can make it more difficult over time, as their bedtime routine gets better.

For ideas of reward charts, check out this fantastic free site!

Simple prizes

Prizes shouldn’t break the bank.

You can find trinket toys inexpensively or even pick an “event” as a prize. Maybe your child has been wanting to go to a new park. Maybe they want to have an extra book read at bedtime.

The most important thing is that the child will want to earn the prize.

Playing the game

Go over the rules of the cards and stickers during the day several times so they know the rules before you start the system.

At bedtime minimize the talking and just let them figure it out when you ask for cards or refuse to let them have a 4th resistance tactic.

Remember that each day is new, so they start with 3 cards and you can talk up how much you know they can keep them all!

Praise all the good choices.

If they struggle with it, find positives to praise… “You kept your cards a little longer last night. I can tell you’re working on keeping them all night!”

When kids leave their bed

If kids end up in your bed in the middle of the night and you don’t want them there, you must firmly but without much discussion bring them back to their room.

Too much snuggling, talking, or other interactions will only reinforce them coming to you again.

And again.

Night after night they get to spend more time with you– that’s what they see every time you give them attention when you need to limit the interaction.

Attempt to get them to walk themselves, but if they refuse, carry them with outstretched arms facing away from you to decrease body contact.

Family bed

If you don’t mind them in your bed, be sure you’re ready for a long term commitment to a family bed. Once the habit’s started it will be harder to break until the child wants to sleep independently.

Sleep deprivation makes parents do things they never thought they would…  you just want to get sleep.

Yes, I’m one of those parents who succumbed to being tired and let a little one stay in my bed. I realized I was kicked and punched often throughout the night by my lovely little angel who was not a great bedfellow. She affected my quality of sleep for quite awhile. She wasn’t sleeping well either. We all needed to have our own space. Her nightly visits didn’t stop until we made a firm decision to stop the behavior.

Weaning from a family bed

When we decided we simply couldn’t do the family bed anymore, we tried several methods to get our daughter back to her room. Many of these are discussed by Dr. Craig Canapari’s At Long Last: Sleep Training Tools For the Exhausted Parent.

The thing that finally worked was a slow wean.

We made a bed on the floor of our bedroom and let her sleep there. We slowly moved that bed further from our bed, then into the hall, and finally into her room. Eventually she even made it to her own bed.

If problems continue

If all else fails, talk to your child’s doctor about sleep problems.

Some sleep problems are due to real medical conditions and these should be evaluated.

If sleep problems continue, loss of sleep can affect growth, learning, behavior, and more… don’t let it get to that point!


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Alternative Treatments for ADHD

I’ve covered why you should get your child evaluated for learning and behavior issues, who does the evaluations, and what the evaluation process involves in my previous posts. I’ve also covered specific diets and supplements. Today I want to talk about alternative treatments for ADHD. If parents aren’t ready to use medicines yet or if they want to supplement medications with additional treatments, there are many alternatives.

Natural treatments, psychological and occupational therapies, and complementary alternative therapy for the treatment of ADHD are available. Some of these are more effective than others.

Alternative Treatments

Nutritionalternative treatments for ADHD

Nutrition is very important for learning and behavior in all kids, not just those with a diagnosis of some sort. My next blog will be dedicated to more on components of nutrition and elimination diets, then the following blog will cover vitamins and supplements.

Behavioral Therapy

Behavioral therapy can be very effective to help manage the symptoms of ADHD. It is beneficial even for children who are medicated to help them learn to control behaviors over time.

Parent skills training provides parents with tools and techniques for managing their child’s behavior. Behavior therapy rewards appropriate behavior and discourages destructive behavior. This training has been shown to improve ADHD symptoms among children, but studies show it does not change academic performance when used alone.

Parent training teaches parents to interact differently with children to encourage desirable behavior. This is done by reinforcing good behavior and having set consequences for bad behavior.

There are several kinds of parent training that have been shown to be effective. These include Parent-Child Interaction Therapy (PCIT), Parent Management Training (PMT), Positive Parenting Program (Triple P).

Cognitive Behavioral Therapy (CBT) is a way to change thinking from negative to positive and focuses on finding solutions to current problems. It has been proven to be effective in the treatment of ADHD and other common issues, such as anxiety. CBT can help children learn techniques to control behaviors, screen thoughts before speaking, organize things, and more.

Initial treatment for ADHD in children under 5 years of age is behavioral therapy. Studies show that the best benefits for ADHD are a combination of medication and behavioral therapy for those over 5 years of age.

 

social skills group

Many kids with ADHD struggle socially. They tend to lag behind peers by a few years developmentally. Their impulsivity and inattention leads to poor behavior and trouble making good friends. They may also have trouble managing their emotions.

Joining a professionally run social skills group can help kids learn and practice important skills for interacting with others. Some school counselors can do this during school hours and many therapists offer groups outside of school.

School resources

Schools have various abilities in helping kids with unique needs. They can offer special seating (or standing desks), extra time for tests, fidget items, and other accommodations. To learn more about school resources, Understood.org has much needed information about what is available and what you can do to legally get accommodations with IEPs or 504Plans.

Exercise

Getting kids outside and moving has many benefits for all kids – including those with ADHD.

First, they are off all screens, which have been shown to increase aggressiveness and impulsivity.

Second, they are getting exercise. Studies show that when kids play outside their focus, attention, and behavior improve.

Exercise helps to elevate the same neurotransmitters that are increased with stimulant medications, which helps with executive functioning skills (sequencing, working memory, prioritizing, inhibiting, and sustaining attention).

Any exercise helps, but studies show the best are martial arts, ballet, ice skating, gymnastics, yoga, rock climbing, mountain biking, skateboarding, and whitewater paddling (I know not all of these are practical on a regular basis, but most are). These activities require sustaining attention, balance, timing, fine motor adjustments, sequencing, evaluating consequences, error correction, and inhibition.

Sleep

Sleep problems are common in many children, especially those with ADHD. Fixing the sleep cycle can have extreme benefits in learning and behavior.

Sometimes it’s as easy as getting a routine for sleep to ensure the proper number of hours for a child, but often they suffer from insomnia, nightmares, sleep apnea, restless leg, or other medical conditions that impair sleep time and/or quality.

Symptoms of chronic sleep deprivation in kids are hyperactivity, poor focus, and irritability. There are many kids who can have all of their ADHD symptoms relieved when they simply get better sleep. I see this in many teens who suddenly “develop ADHD”- only it’s really not ADHD at all. They are running on 4-5 hours of sleep a night. If your child has sleep troubles not improved with these Sleep Tips, talk to your child’s doctor.

Occupational Therapy and Sensory Training

There are many kids with ADHD who benefit from using techniques that occupational therapists use with sensory processing disorder (SPD). In some kids, SPD might be the real diagnosis causing symptoms of ADHD, but in others they may co-exist.

Treating SPD is usually fun for the kids, and there is no harm in doing their techniques even if a child doesn’t have the disorder.

Schools have started integrating these ideas into their classrooms as needed, such as having kids sit on stability balls or using tactile objects at their desks.

Therapy for SPD involves playing in ways that use sensory input (such as with sand or play doh, rolling down a hill, manipulating tactile objects, and more).

For a great list of ideas visit Sensory Integration Activities, but working with an occupational therapist is recommended.

Biofeedback and Neurofeedback

Biofeedback and neurofeedback are often not covered by insurance due to inconclusive evidence that they work. Children and adults with ADHD often have abnormal patterns of brain electrical activity on electroencephalographic (EEG) testing. EEG biofeedback is aimed at normalizing EEG activity by correcting the brain’s state of relative under-arousal and optimizing cognitive and behavioral functioning.

Neurofeedback trains kids to become more aware of their physiological responses and improve their executive functioning. Each neurofeedback session lasts 30-60 min and children usually need 10-20 sessions. Patients wear a cap that measures their brain activities, and it helps them train their brain to maintain focus during video games specific to this purpose.

The significance of most findings on neurofeedback and EEG biofeedback is limited by study design flaws that include small study sizes, heterogeneous populations, absence of a control group, inconsistent outcome measures, self-selection bias, and limited or no long-term follow-up. While this doesn’t mean they don’t work, I would like to see more studies showing their benefit. You might invest a lot of time and money only to find out it doesn’t work.

Working memory training

Working memory training has been shown in studies to help with symptoms of ADHD, though there are some conflicting studies out there.

Cogmed is the company that has studies showing benefit. It’s a computer program that kids play like a video game, but it reportedly trains their brain to remember things. Cogmed is intensive: 1 hour a day, 5 days a week for 5 weeks, but can be done at home. It can be expensive and is often not covered by insurance. About 70-80% of children show improvement immediately after the training, and of those who improved, 80% maintained the benefit over a 6 – 12 month window. Cogmed is designed to be used with medication, such as stimulants.

Herbs and other supplements

There are some studies supporting nutritional supplements or herbal medicines for ADHD, but many reported treatments have not been found effective. I will cover these in a separate blog.

ADHD Coaching

Just like anyone who needs help improving a skill, working with a coach with experience helping others in that area can be a big help.

Working with an ADHD coach can help many with certain aspects of their life. ADHD coaches can help with organization, motivate a person with ADHD to finish tasks, or help them learn techniques that makes them more effective at life skills.

Coaches do not do psychotherapy or counseling. This can be beneficial for people who are against therapy but need help to improve their skills.

It does not work if the parent makes the child go. The child must be motivated to make changes in his or her life and be willing to work on things, then coaching can be great.

Tips on finding an ADHD coach can be found on PsychCentral.

Mindfulness

I recommend mindfulness for many issues, especially anxiety (which often co-exists with ADHD). Mindfulness is thought to help with ADHD as well. It is a process of being focused on the present moment and is more fully explained on Understood.org’s Mindfulness page.

There are many free apps that can help kids (and adults) learn mindfulness.

No evidence exists for these treatments

There are many alternative treatments out there that do not have scientific proof that they help. Many parents try these treatment programs in hope that their child’s symptoms will go away.

In general, if it sounds too good to be true, it probably is.

Don’t be fooled into thinking “alternative” or “natural” treatments are without risk. There are always risks, including the lost time not being on a proven therapy, leading to a child falling further behind academically and suffering emotionally from symptoms related to ADHD.

“Train the brain” games 

There are claims that games designed to train the brain can improve memory, attention and other skills, but there is no research that supports this claim. Kids may get good at playing the game and seem to learn, but studies have found no improvements that generalize to their daily life or learning. For more, see what experts say about “train the brain games” for kids with ADHD.

Brain Balance has a center in our city, and I’ve seen more than a few parents who waste time and money on their program. I don’t know of any that noted significant and continued benefit. Although their website might look like there’s impressive evidence to use it, there really isn’t. Please see Science Based Medicine: Brain Balance for more information.

Caffeine

Caffeine is a stimulant but since it is available from grocery stores instead of pharmacies some parents feel more comfortable using it instead of a medication.

If you’re using it as a drug, it is a drug.

Whether it comes in a beverage or a pill, it is a chemical with properties that act like other drugs in our bodies.

Unfortunately studies don’t really support its use. It’s difficult to dose since it comes in so many forms, and most people develop a tolerance for it, requiring more and more, which can increase side effects.

For details, see Science Based Medicine: Caffeine for ADHD.

chiropractic medicine, Vision therapy, and Applied kinesiology

I have not been able to find any valid scientific studies for chiropractic medicine, vision training, and applied kinesiology for the treatment of ADHD.

Insurance usually does not cover these and they can be quite expensive. I do not recommend them.

Essential oils and aromatherapy

Essential oils are all the rage now. It seems they can cure everything if you do a quick online search. The problem is that research hasn’t shown that to be true. Dr. Chad Hayes does a good job of discussing what they are and why they aren’t recommended.

Remember…

There is no alternative medicine. There is only medicine that works and medicine that doesn’t work. ~ Richard Dawkins

If it stays alternative, that must say something. Once an alternative treatment is shown to work, it becomes a preferred treatment, no longer an alternative…

Things to consider when choosing treatment plans:

  • First, be sure your child is properly assessed to make the best diagnosis on which to base the treatment plan.
  • Natural isn’t necessarily safe. Evaluate all the risks and benefits known before making a decision. Even exercise (which is always recommended) comes with risks, such as injury and at times sleep problems due to scheduled activity times.
  • Talk with your doctor about any treatments you are doing with your child. Don’t forget to mention vitamins, supplements, herbs, brain training, therapies, etc.
  • Choosing one treatment doesn’t mean you are married to it. If response doesn’t prove to be beneficial, re-think your approach.
  • There is no cure for ADHD known at this time. If someone claims that they can cure your child, don’t buy into it.
  • Learn your costs. Does insurance cover it? Insurance companies often prefer certain treatments due to their cost and other factors. They also do not cover many treatments. Sometimes this is again due to cost, but other times it is because there is no evidence to show the treatment is effective. (Hint: This is a good clue to look at other treatments!)
  • Is the treatment something your child can do and is your family willing to put in the time? CBT is proven to help, but it doesn’t work if the child and parents don’t work on the techniques at home. Neurofeedback and Cogmed take many hours of treatment over weeks of time and are not guaranteed to work in all children.  Medications must be titrated to find the most effective dose that limits side effects. This requires frequent follow up with your doctor until the best dose is found.

Sources:

The ADDitude Guide to Alternative ADHD Treatment

WebMD: Attention Deficit and Hyperactivity Disorder: Alternative Treatments 

American Psychological Association: Easing ADHD Without Meds
Psych Central: Neurofeedback Therapy an Effective, Non-Drug Treatment for ADHD

Psychiatric Times: Integrative Management of ADHD: What the Evidence Suggests

Attention Deficit Hyperactivity Disorder: Diagnosis and Treatment in Children and Adolescents

Looking for more?

Many parents benefit from support groups to learn from others who have gone through or are currently going through similar situations, fears, failures, and successes. Find one in your area that might help you go through the process with others who share your concerns. If you know of a support group that deserves mention, please share!

ADHD

CHADD is the nationwide support group that offers a lot online and has many local chapters, such as ADHDKC. I am a volunteer board member of ADHDKC and have been impressed with the impact they have made in our community in the short time they have existed (established in 2012). I encourage parents to attend their free informational meetings. The speakers have all been fantastic and there are many more great topics coming up!

Anxiety

Many parents are surprised to learn how much anxiety can affect behavior and learning. To look for local support groups, check out the tool on Psychology Today.

Autism

The Autism Society has an extensive list of resources.

Dyslexia 

Dyslexia Help is designed to help dyslexics, parents, and professionals find the resources they need, from scholarly articles and reviewed books to online forums and support groups.

Learning Disabilities 

Learning Disabilities Association of America offers support groups as well as information to help understand learning disabilities, negotiating the special education process, and helping your child and yourself.

Tourette’s Syndrome and Tic Disorders 

Tourette’s Syndrome Association is a great resource for people with tic disorders.

General Support Group List 

For a list of many support groups in Kansas: Support Groups in Kansas .

School information

Choosing schools for kids with ADHD and learning differences isn’t always possible, but look to the linked articles on ways to decide what might work best for your child. When choosing colleges, look specifically for programs they offer for students who learn differently and plan ahead to get your teen ready for this challenge.

Midwest ADHD Conference – April 2018

Check out the Midwest ADHD Conference coming to the KC area in April, 2018. I’m involved in the planning stages and it will be a FANTASTIC conference for parents, adults with ADHD, and educators/teachers.

Midwest ADHD Conference
The Midwest ADHD Conference will be held in April 2018, in Overland Park, Kansas.

 

Sleep Tricks

I preach about sleep to kids all the time, both at the office and at home. It’s one of my three most important things for overall health along with eating nutritious foods and daily exercise. Most of us don’t get enough sleep. Here are some tricks to get in a few extra minutes each day… they all add up!

Most of these tips are appropriate not only for kids and teens, but also for their parents! In November I wrote about the problems I often see with teen sleep deprivation specifically.

Know how much sleep is typical for every age group.

A great infographic of this is found at the Sleep Foundation.

Warning: It shows generalizations. For example, when tweens and teens go through a growth spurt many need 10-11 hours of sleep per night, which is more than the graph shows.

Just remember that individuals are just that: individual.

Think of sleep as a currency.

We can go into sleep debt when we don’t get enough. If it’s just a little loss of sleep, it’s easy to catch up and pay back the debt. The further into debt you go, the harder it is to get out of debt.

Don’t let the bank come after you in terms of health problems!


Listen to your body and teach kids to listen to their needs.

If you’re tired, you need more sleep. It’s sometimes easy to recognize but not always. Some kids are notoriously not able to do this well.

The longer you stay up, the harder it will be to fall asleep. It’s ironic, but sleep deprivation leads to insomnia. If you suffer, try to allow extra zzz’s on a weekend to fill the deficit. But don’t let the sleep deprived person sleep in so late that he can’t go to bed on time that night.

Many parents have realized that the later the kids stay up, the earlier they wake. Despite waking early, they didn’t get enough sleep. Behavior shows that they’re tired when they don’t sleep enough – you might see whining, tears, frustration, and irritability when this happens.

Many kids get hyper when they’re tired, so don’t be fooled if they have lots of energy in the evening. If they don’t wake easily in the morning or are whiney during the day, they are tired!

Routines.

Go to bed and get up at the same times every night and morning. If you let your kids stay up later on a weekend, be sure it isn’t more than 2 hours past their ideal bedtime.

Remember that going to bed just 15 minutes late each weeknight gives over an hour less sleep during the week – it all adds up!

Resetting the internal clock.

If someone has a hard time getting up, have them get natural sunlight as soon as possible in the morning. It helps set the circadian rhythm. If you can’t get natural sunlight, turn on lights in your home.

Conversely, start turning down lights a few hours before bedtime. Avoid screens (tv, computers, smart phones). Lights keep you from feeling tired. Don’t let them keep you up!

Use a night mode on a screen if you must work online prior to bed – a common problem for teens who have homework these days. I have used a free app called f.lux with great success. I can tell the difference in tiredness and ability to fall asleep when I have this active on my computer.

Winding down.

There are many ways to wind down before climbing into bed.

  • Journal before bed if thoughts keep you awake. People who spend bedtime thinking about everything can’t sleep. Jot a few things down to give yourself permission to not think anymore. Sounds weird, but this “worry list” works for many people!
  • Coloring is another way to relax. It’s not just for kids anymore!
  • Learn meditation. There are many apps available for smartphones and tablets, just do a search in your store. I refer kids to Stop, Think, & Breathe often. There’s also an adult version. I have many of these apps (mostly free) on my Mindfulness Pinterest Page.
  • Belly Breathing is very effective and can be taught to kids. Some kids will put a stuffed animal on their tummy and try to raise the animal with a slow, deep breath.
  • Set the mood in the room: darken the room, get the temperature “just right”, and find the number of blankets that helps you sleep. Setting up a fan or other white noise maker helps many people sleep. For more tips on setting up the perfect room for sleeping, see Bedroom.
  • Weighted blankets have been shown to help many people, especially those with anxiety fall asleep faster but there is a concern about safety when used by kids.
  • Listen to Weightless – music that’s been shown to help initiate sleep.
  • Reading at bedtime can be a great relaxing thing, but if you have a page turner, be careful to not get caught up in the book for hours. I find that stopping at a lull mid-chapter is better than waiting until the end of a chapter. A good author leaves you hanging at the end of a chapter and begging for more! Set a time limit and stop reading when time’s up! That’s what bookmarks are for.
  • Take a warm bath. This can help relax you for a good night’s rest.
  • Ask a family member to give you a massage or back rub. Again, a great way to relax!
  • Warm milk or herbal teas might help some sleep.
Be active during the day.

Lounging around makes you feel more tired during the day, but it’s then harder to fall to sleep at night.

Experts recommend avoiding exercise for a few hours before bedtime, but I know that is really hard for kids in sports. I don’t have a great fix for that, unfortunately.

Skip the snooze.

Kids and their parents who hit snooze several times miss out on all that sleep that they are in a half awake zone. If you really don’t need to get up until the 3rd snooze time, set the alarm for that time. You will be more well rested so it will be easier to get up immediately. Train your body (or your kids) to get up at that time. After several days of an extra few minutes of sleep, you’ll notice the difference!

Kids sleep alone.

Keep kids out of the parent bed so everyone gets the best sleep. Snoring, different bedtime, and other body movements makes it hard to sleep together. No one sleeps well, which makes everyone grumpy the next day.

If kids are anxious about sleeping in their own room, see The Most Common Reasons Why Kids Are Afraid To Sleep.

Pets

Pets can either help an anxious child calm down and sleep or can keep kids awake. Know the situation and act accordingly.

If pets make noise or try to wake their person, they should not be in the bedroom at night.

If the pet is quiet and lets kids sleep, they can provide reassurance to a child who doesn’t like being alone. But be sure they don’t wake the child!

Melatonin

Melatonin is a hormone that’s made in our body and helps us feel tired. It’s also available as a supplement. I think that if other sleep techniques fail it can be a great sleep aid, but I also think that if you’re going to give it to your child you should talk to his physician first.

Dr. Craig Canapari is a pediatric sleep expert who has written a great deal on how melatonin works, when it would be appropriate to try it, what concerns there are regarding melatonin, and more. Check out his Melatonin Guide for Parents.

Avoid Caffeine

Most of us know that caffeine will help wake us up, but many think they can drink it later in the day and it doesn’t affect their sleep. Dr. Melissa Welby has a great blog on how caffeine works and what it does to our sleep cycle.

Don’t be fooled with hidden sources of caffeine. I have occasionally gotten ice cream with coffee for a family bedtime treat, only to find out upon tasting it that it had coffee. Caffeine is often added to drinks, so read labels. But be careful! It might not say caffeine directly. Some are labeled as “guarana” — a plant with caffeine. Pretty much anything that is labeled as an energy drink (or food) is a likely culprit. Even decaf coffee has a small amount. Chocolate naturally has caffeine… the darker the chocolate the higher the caffeine content. Some pain relievers and other medicines have caffeine.

Especially for those not accustomed to caffeine, it will disrupt sleep even if taken several hours before bedtime.


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Sleep Deprived Teens: Health, Safety, & Mental Well Being Are At Significant Risk

Teens do not get enough sleep. Most teens need 8.5-10 hours of sleep each night. Not 6 hours. Not even 8 hours. Most don’t get even close to meeting their needs and that’s a bigger deal than many realize. Sleep is very undervalued, but we need to prioritize it. Sleep deprived teens suffer from many physical and emotional problems.

Why don’t teens get enough sleep?

One of the most common reasons is that their biological clock (AKA circadian rhythm) makes it hard to fall asleep before 11 pm and school starts too early to allow them to sleep until 8 am, which would allow for 9 hours.

In addition to their circadian rhythm, some of their habits and activities can interfere with a healthy bedtime.

Screens are a big problem.

The light interferes with our natural melatonin rising. I regularly ask teens (and parents) to limit screen use for at least an hour before bedtime, but most teens say that’s impossible because they have to finish their homework at that time and they need their computer or tablet to do homework. If you can’t turn off the screen, at least use a program that limits the blue light that prevents the rise of melatonin. I personally use f.lux. (It’s free and works on PC, Mac, ipad, android, and Linux). I find that it really helps. (This is not a paid endorsement, just a personal statement.)

Phones.

On a similar note, phones distract kids from what they’re doing, delaying falling asleep. It takes longer to finish homework when there are distractions from the phone. Kids often are tempted to check in one more time on all their social channels, which delays sleep time. And then friends who are still up will text to see who’s up (or who they can wake up).

Activities are too late. 

I’m not talking about kids just out and about on a school night. I’m talking about regularly scheduled activities that otherwise help build a well rounded person. It’s not uncommon for activities to be scheduled to run until 9:30 or 10 on school nights for middle and high school aged kids. They get home and are hungry, need a shower, and are ramped up so not ready for sleep.

Activities start too early.

I know many kids who must be at school before school actually starts. Whether it’s band practice, church study groups, sports, or taking a missed test before school, they all interfere with sleeping in, which is what teens need.

School starts too early.

Most school districts around the country start school well before the recommended 8:30 earliest start time. School districts that have initiated later start times have shown improved test scores, fewer absences and tardies, less depression, improved athletic performance, and better graduation rates. Unfortunately, those schools are still in the minority.

Medical causes of sleep deprivation and fatigue can also occur. 

If you suspect any of these, you should schedule a visit with your doctor.

  1. Anxiety
  2. Restless leg syndrome
  3. Sleep apnea – pausing of breath, often associated with snoring
  4. Medications that affect sleep cycles
  5. Heartburn or acid reflux
  6. Hormone imbalances, such as thyroid problems
  7. Anemia, or low red blood cell counts
  8. Depression
  9. Nutrition: not eating enough, or eating foods that are not nutritious. If you eat foods that cause spikes in your blood sugar, as those sugars drop you feel fatigued.
  10. Infections
  11. Celiac disease
  12. Chronic pain conditions
  13. Chronic sleep deprivation – I know this is counter-intuitive, but being tired can make it harder to sleep.

 What happens with too little sleep?

sleep is needed
Teens who are sleep deprived suffer in many ways. Make sleep a priority!

Sleep deprivation can lead to many problems that are often not attributed to poor sleep, such as irritability, poor academic performance, accidents, obesity and more.

Moodiness.

We all associate the teen years with angst, so we can easily attribute a teen’s moodiness to just being a teen. But being chronically tired can lead to emotional dysregulation. This will look like irritability, frustration and anger.

School problems. 

It has been well established that getting proper amounts of sleep can help with focus and learning. When our teens fail to get enough sleep, they often report problems with attention, memory, decision making, reaction time, and creativity. It’s no surprise that teens report problems paying attention to a lecture or trouble completing homework in a reasonable time with full accuracy. Grades can easily fall, which leads to anxiety and depression, which in turn leads to more moodiness and trouble sleeping.

Sleep deprivation mimics ADHD. Whenever I see a teen who wants to be evaluated for ADHD because of new loss of focus, falling grades, problems with behavior, or similar issues, I always look at sleep. Most often they don’t have ADHD if this is a new problem. They need more sleep, not a stimulant medication. You can’t put a band aide on a broken bone. Fix the problem, not the symptoms! (The same goes for a teen with ADHD who thinks the medicine that’s worked for years suddenly isn’t sufficient. Unless the medicine recently changed, they need sleep.)

Injuries.

Teens with chronic sleep deprivation are more likely to be accidentally injured.

Drowsy driving is comparable to drunk driving. Teens are at the highest risk for falling asleep at the wheel. Drowsy driving is the most likely to occur in the middle of the night (2-4 am), but also in mid-afternoon (3- 4pm) as teens drive home from school.

Athletes are more likely to be injured while playing their sport, so it is in the best interest of the team to let players sleep.

Risky behaviors. 

Teens with chronic sleep deprivation have been shown to participate in more risk taking behaviors, such as driving without a seatbelt, drinking alcohol, skipping the bike helmet and tobacco use.

Pros and Cons of later school start times for our economy

There are many temporary issues with changing school start times. Parents might have to find solutions to child care of younger kids if they rely on teens babysitting after school. New bus schedules need to be started. Sports programs will need to change practice times. After school job availabilities will change.
Despite these common arguments, economic analysis from the Brookings Institution shows that a one hour delay of school start times could lead to a $17,500 earnings gain for students, compared to a cost of $1,950 during the student’s school days.
Another study that presumed all students start school at 8:30, with a year-by-year economic effect. The study did not take into account other potential benefits of later school start times, such as decreased depression and obesity rates. They found an average annual gain of about $9.3 billion due to fewer automotive accidents, improved graduation rates, and other factors.

What can teens do to get more zzzz’s?

Go to bed when tired at night.

Fighting sleep initially will make it harder to go to sleep when you finally go to bed.

Attempt to follow a regular sleep schedule.

Going to bed and getting up at about the same time every day helps. While sleeping in on weekends can help repair a sleep deficit, it can make it harder to get to sleep Sunday night and getting sufficient sleep every night is better than just getting more sleep a few days/week. Try to sleep in no more than 2 hours past your school day wake up time.

Follow the same routine each night at bedtime.

Brush teeth, read a book or color, take a bath or shower — do whatever helps you wind down and relax. Repeating this every night can help your brain get ready for bed.

Nap to help make up missed sleep.

A short 15-20 minute nap after school can help revitalize the brain to get homework done. Just don’t sleep too long or it can interfere with bedtime.

Turn off the screens an hour before bedtime.

This includes tv, computer games, computer/tablet use for homework, and smartphones for socializing. Use night mode screen lighting and apps that dim the screen (like the f.lux app I mentioned above).

Avoid caffeine in the later afternoon.

The time it takes half of the caffeine to be removed from your body is 5-6 hours. Ideally teens would sleep and never drink caffeine, but I know that isn’t reality. Any caffeine in the later afternoon can make it harder to fall to sleep. Don’t forget “hidden” sources of caffeine, such as chocolate, energy bars, and workout supplements.

One interesting concept that has scientific backing (but goes against the “no caffeine after 3 pm” rule) is the coffee nap. Basically, you drink coffee then quickly nap for 15-20 minutes. Sodas and teas don’t work as well as coffee due to too much sugar and too little caffeine. The coffee nap has been shown to be more effective than either a nap or caffeine alone. Don’t do this often — use it at times you really need it. Don’t do this too late in the day or the caffeine will inhibit your regular night’s sleep.

Skip the snooze button.

Set your alarm for the last possible moment you can, which allows your body to get those extra minutes of sleep. If you need to get out of bed by 6:45, but set your alarm for 6:15 and hit snooze several times, you aren’t sleeping those 30 minutes. Set your alarm for 6:45!

Skip the late night studying.

Studying too late is ineffective. When the brain’s tired it won’t learn as well and you will make mistakes more readily. It takes a lot longer to get anything done when you’re tired. Go to bed and get up a little earlier to get the work finished if needed. Of course you should also look at your time management if this happens too often. Are you involved in too many activities? Do you work or volunteer too many hours? Did you waste too much time on tv, games, or socializing? Do you put off big projects until the last minute? Homework needs to take priority when you’re more alert in the afternoon and evening. If you have problems with this, talk to parents and teachers about what you can do.

If you lay awake for hours or wake frequently, try these techniques to help fall asleep: 

If these fail, talk to your parents and doctor to help find a solution.

Charge your phone in another room. 

Friends who decide to text in the middle of the night keep you from sleeping. Even phones on silent have blinking lights that can spark your curiosity. It’s too tempting to look at your social media apps one more time.

Don’t use the excuse that you need your phone as an alarm. Alarm clocks are cheap. Get one and put your phone elsewhere!

Use your bed for sleep only.

Stop doing homework in bed. Stop watching YouTube and Netflix in bed. Train your brain that your bed is where you sleep.

Exercise.

Exercise helps our bodies sleep better, but it should ideally be earlier in the day. Too close to bedtime (which is common with athletes and dancers) wires us up.

Get natural sunlight in the morning. 

This helps to set your circadian rhythm.

Keep the bedroom cool and dark.

It is harder to sleep if the room is too warm or too bright. A fan can be used to circulate air.

Use blackout shades if needed.

Keep pets out of the bedroom. 

Your animals might love you and you love them, but if they keep you up, it’s just not worth having them around at night.

Nicotine and alcohol affect sleep.

These should not be used by teens in an ideal world, but I know teens will not always follow the rules. Teens should know that if they are using nicotine or alcohol, their quality of sleep will be affected.

Nicotine is a stimulant (like caffeine), which leads to more time sleeping lightly and less time in deep sleep. And yes, vaping and chewing lead to this problem too, since it’s the nicotine that causes the problem.

Alcohol reduces the time it takes to fall asleep but it increases sleep disturbances in the second half of the night, often leading to early wakening. Alcohol relaxes muscles, which can lead to sleep apnea (often noted as snoring). Sleep apnea does not allow the body to have restful sleep. Alcohol is also a diuretic, which might increase the need to wake to go to the bathroom during the night.

We all need to prioritize sleep: for our kids and for ourselves. Our bodies and minds will thank us.

Resources:

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