Children with ADHD often have sleep and anxiety disorders flying under the radar, and new studies are revealing treatment for these conditions can improve ADHD symptoms in children too.
More than 300,000 young Australians have Attention Deficit Hyperactivity Disorder (ADHD) and research shows 70 percent of these children are affected by sleep difficulties. Sixty four percent of children with ADHD are also affected by anxiety.
Clinical psychologist and researcher Dr Emma Sciberras told The Huffington Post Australia most children with ADHD have one or more additional conditions.
"There are some particular conditions that go under the radar and don't tend to get picked up by clinicians," Sciberras, who is an honorary research fellow at the Murdoch Children's Research Institute, said.
"It's because they're harder to see than overt behavioural difficulties."
Sciberras is leading the first Australian-focused ADHD study, the Children's Attention Project, which is analysing the outcomes of sleep and anxiety treatment for children with ADHD in 500 Victorian families.
Two separate trials are being conducted over the next four years after the success of the two studies on a smaller scale.
Cognitive Behavioural Therapy is being used to treat anxiety, with children partaking in regular daily exercises. The smaller study revealed half of the children who received the anxiety treatment no longer met criteria for an anxiety disorder while the control group remained unchanged.
Significant improvements in ADHD symptoms were also seen, with large improvements in attention symptoms.
"There could be a perception that children with ADHD might not be well suited to psychological therapies because of their attention and lack of concentration," Sciberras said.
"To simplify the intervention we have activity charts for children, we give them one minute physical brain breaks and visual reminders."
What strategy can I use to help my child when they are anxious?
From going to school or attending a birthday party, situations can get scary for children. But there are ways to help them cope.
"If there's a situation that the child is finding really scary and that they don't want to do, it helps parents to break down that particular situation," Dr Sciberras said.
"It's starting off with very small steps that the child can engage with to get confident. And building in a lot of praise for the children around tackling their brave behaviour.
"Then we kind of move up the stepladder so it gradually gets harder for the children but only at the pace that they're ready for."
The stepladder approach instructs parents to encourage their child into a situation they feel only slightly uncomfortable with. Start with this situation, and once they've overcome their fear a few times in this situation, move on to a more challenging one.
You can find specific examples of this approach for children from four to eight with anxiety here.
Sleep treatment in the expanded study introduces sleep hygiene routines focusing on setting up a specific bedtime routine for children to improve both the quality and duration of sleep each night.
Consistent bed times and wake up times are introduced, while caffeine and screens are avoided two hours before sleep.
In the smaller study, children with ADHD responded well, with improved working memory, better behaviour in the classroom, improved quality of life. ADHD symptoms were also reduced with children's daily functioning improving and teachers reported better behaviour.
Kids were also completing homework more regularly in the afternoon.
How can I get my child to sleep better?
Dr Sciberras recommended exercises from the Raising Children Network. This relaxation technique is used in the study to help children with both sleep and anxiety.
1. Get your child to close their eyes
2. While they breathe in, ask them to count to five slowly. One, Two, Three, Four, Five.
3. Then ask your child to hold their breath in for five counts once their lungs are full.
4. Then tell them to breathe out slowly for five counts. Repeat slowly.
If this exercise is too complicated there are more relaxation techniques available here.
"The thing that's good about these exercises is that they're all evidence-based and written by people with expertise in the area," Dr Sciberras said.
Throughout both smaller studies, more than 80 percent of children were still taking ADHD medication.
The research doesn't suggest replacing medicinal treatment with behavioural therapies but using behavioural therapies to complement medication instead.
"The research that we've completed to date shows children with ADHD are at risk of poorer outcomes over time and from our research we've identified that sleep and anxiety seem to contribute to poorer outcomes," Sciberras said.
"If we can target those, we're hoping that we can help children have better outcomes over time."