11-year-old with sleeping problems

Question

My 11-year-old son has trouble sleeping alone, because of what he calls "nightmares". I don't think they are sleeping nightmares, but rather overactive imagination causing frightening thoughts while he's still awake. His solution is to leave his room and sleep in his brother's room, or with us; when he has company in the room, he is able to sleep.

This has been going on for a couple of years now. At first we thought it was something he'd grow out of, but there's no sign that he is doing so. We have tried to see if there's any particular trauma that initiated this, and there doesn't seem to be anything; nor does he show signs of hiding anything like that.

He was having some stress in his classes when the issues started. He is ADD, and once we worked with the school to accommodate this, the stress has improved, so that he has seemed reasonably cheerful about school now, while the sleep issues have if anything worsened. His daily life is reasonably comfortable and stable.

We have tried many approaches: Sitting with him until he goes to sleep (then when he wakes up at 2:00 AM he goes to another room); lights on while he sleeps; etc. During the school year we are fairly solid with his bedtime routine, during the summer we are flexible; neither approach makes any difference.

We have discussed his fears. He is aware that they are not logical, but that doesn't help. I believe that his thoughts have an obsessive quality to them so he can't stop them. During his ADD evaluations, the psychologists noted that he might be at risk of anxiety disorder as well, but that he wasn't in the range where that would be a major concern. He started Vyvanse during the school year; that didn't affect his sleeping in either direction.

He plays video games, and we've tried stopping them for a week or two; no effect. Games and other screen time stops before bedtime, when he's expected to do something quiet (usually reading); that hasn't helped.

He is physically very active; even on days when he does lots of physical exertion he doesn't get particularly exhausted. It may be possible to tire him out, but I haven't seen it happen. Aside from his sleeping he is very healthy and reasonably happy.

We've mentioned this to his pediatrician, who didn't seem particularly concerned. Before we raise it again, are there any suggestions?

Answer 1

Children with ADHD often have co-morbid (all that means is that they happen at the same time) conditions, such as OCD; up to 25% of kids with ADHD may have OCD as well.

It's very commendable that you're in touch with your child about this and you are understanding and open with him. Your experience would be the same with an adult with OCD as with a child. Adults and adolescents are, indeed, aware that their fears are not logical, but that doesn't help at all. That's because their thoughts are intrusive; they're unwanted and irrational, but they come anyway. If this is painful for an adult, it is much more so for an adolescent. Furthermore, he may not be telling you about the worst obtrusive thoughts he has because he may be ashamed of them.^*

For now, let him get comfort where he can find it without judgement (it sounds like you're doing this anyway). An extra bed in his brother's room where he could slip in without waking anyone up is fine.

We've mentioned this to his pediatrician, who didn't seem particularly concerned.

It's time now for your pediatrician to take this more seriously. Your son may have or develop some self-esteem issues from his fears; conversely, learning how to handle them himself may improve issues he may have. Make an appointment now to see them. Your son can get a referral for an adolescent psychologist with experience in treating ADHD and OCD. OCD can be treated with Cognitive Behavioral Therapy, which works as well as pharmacologic interventions, if not better.

You can also talk to your son's doctor about perhaps using melatonin.

_{* People presenting with panic attacks often are reluctant to divulge the nature of their obtrusive thoughts for fear of appearing ridiculous, or worse, criminal. One patient had an intrusive thought that she would intentionally harm her baby by putting them in the clothes dryer. She was afraid if anyone knew this, her baby would be taken away from her. She simply didn't know that this kind of intrusive thought is common, and it didn't mean she wasn't a wonderful mother. Imagine holding something like that in for a couple of years, and you get an idea of how unwelcome intrusive thoughts are.}

_{Comorbidity of Psychiatric Disorders and Parental Psychiatric Disorder of ADHD Children
Does ADHD moderate the manifestation of anxiety disorders in children?
Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication
Clinical obsessions in obsessive–compulsive patients and obsession-relevant intrusive thoughts in non-clinical, depressed and anxious subjects: Where are the differences?
Meta-analysis of randomized, controlled treatment trials for pediatric obsessive-compulsive disorder
Canine-Assisted Therapy for Children With ADHD}