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When we think about what should be included in a thorough ADHD evaluation, most clinicians and experts highlight several key components. These typically include a detailed clinical interview with both the individual and their family, standardized rating scales of symptoms (such as ADHD, anxiety, and depression) completed by parents and teachers, a physical exam to rule out other health issues, academic testing to identify possible learning disorders (which frequently co-occur with ADHD), assessments of executive functioning, and neuropsychological computer screeners for visual or auditory attention. But one surprising finding in a recent literature review is how rarely sleep assessments or screenings are mentioned as part of these “essential” components in an ADHD diagnosis.
Years ago, I worked as a psychologist on a multidisciplinary team in a children’s hospital diagnostic clinic. Our comprehensive evaluations often evaluated and confirmed ADHD in children. Yet, every so often, our developmental pediatrician discovered that the real issue was a sleep disorder—like insomnia or sleep-disordered breathing caused by enlarged tonsils—rather than ADHD. Once the sleep problem was addressed, many children’s attention and behavior issues either disappeared or improved significantly. In cases where the symptoms persisted even after sleep concerns were resolved, we had clear evidence that ADHD was indeed present.
The truth is that poor sleep or chronic sleep deprivation can look a lot like ADHD. People without ADHD who aren’t getting enough rest can appear just as inattentive or hyperactive as those who have the condition. Meanwhile, individuals who do have ADHD tend to experience their symptoms more intensely when they’re also struggling to sleep well.
Complicating matters, many people with well-diagnosed ADHD also face issues that disrupt their sleep—problems that can exacerbate their distractibility and inattention. Beginning around puberty, people with ADHD often get less sleep, have trouble falling or staying asleep, and may be at higher risk for a formal sleep disorder. Nightmares are also relatively common in children with ADHD. Without proper attention, these sleep troubles can worsen over time, making ADHD symptoms feel even more unmanageable.
That’s why it’s so important for an ADHD evaluation to include an assessment of sleep. If sleep problems are detected, the next step could involve trying out better sleep hygiene strategies or getting a referral to a specialist. Addressing sleep first not only helps some people resolve their attention struggles but also ensures that an ADHD diagnosis, if warranted, is made with confidence—free from the confusion caused by inadequate rest.
By looking at sleep as part of the evaluation, we can pinpoint what’s really driving a person’s symptoms and avoid misdiagnoses. Ultimately, this more complete, accurate assessment guides us toward the most effective treatment options, leading to better outcomes and, most importantly, relief and support for the individual and their family.
