Why Won’t My Child With ADHD Get Out Of Bed On Time? Why Are They So Messy And Unmotivated?

Can they control this?

The truth is- probably not entirely. Individuals with ADHD often have atypical circadian rhythm patterns and tend to struggle with initiating tasks or transitioning from one task to another. Now, that being said, this does not mean that they are incapable, inflexible, or excused from certain responsibilities. It means that certain tasks may require significantly more effort than others, and it may be most helpful for both them as individuals and as parents of children with ADHD to pick your battles and prioritize accordingly. For example, when I attended college, when possible, I always elected to take courses in the afternoon or evening, as I knew it took my brain more time than others to fully “turn on.” I continue to reserve my most demanding tasks for the nighttime hours when I am able (it is currently after 10pm as I write this). I also struggled with organizing my belongings, remembering to respond to an email from the morning, or meet deadlines with enough time to review my work.

Okay, let’s get technical for a second. Arousal is considered to be the given level of alertness required to be able to adapt for situational requirements. For example, if you are asleep and you hear a baby crying, that might prompt you to be awake and alert. If you are learning a new skill in school, a certain level of alertness is required to intake and process the information presented to you. ADHD has been described as a chronically hypo-aroused state, meaning there is often a decrease in alertness and inefficient functioning (attention selection/filtering what is and isn’t important to attend to) as well as lowered vigilance levels and faster vigilance decline in children and adolescents with ADHD. This means these children tend to fatigue quicker and more easily, especially the longer they attempt to engage in a complex or uninteresting task.

This variability in brain arousal can lead to involuntary hyperactivity, in the brain’s attempt to avoid drowsiness. Hyperactive and impulsive behavior patterns considered auto-regulatory strategy to increase stimulation. So when you have a child tapping their desk or walking around the room while listening to the teacher, this may be their attempt at self-regulation. Now of course, limits to the extent of such self-stimulatory/fidgeting behaviors are sometimes required in a group learning environment, but it helps to understand the function of these behaviors.It is hypothesized that impulsivity and distractibility affect response inhibition (stopping yourself from saying or doing something), sustained attention (maintaining attention over time), and goal directed tasks/poor activation (beginning a new task), secondary to neurotransmitter dysfunction. As you can see, difficulties with arousal can affect cognitive, motor, and performance tasks in ADHD. As such, ADHD performance improvement has been evidenced when they are neither over nor under-aroused by their environment, consistent with the assumption that the underlying impairment in ADHD is associated with the ability to self-regulate arousal, rather than having a constant under or over aroused physiological state. Additionally, people with ADHD have been found to have decreased sympathetic (flight or flight activation system) and increased parasympathetic activity (calming, relaxed system), demonstrating a delay in brain and body response in certain situations.

Now that we know the symptoms of ADHD are affected by arousal state, not surprisingly, most children with ADHD have atypical sleep patterns. In fact, approximately 50% of children with ADHD have trouble falling asleep, experience waking during the night and/or restlessness during sleep, and hypersomnia. Short periods of sleep and excessive daytime sleepiness are common in ADHD along with altered circadian rhythms. For children with ADHD, shorter sleep duration was associated with reduced sustained attention and response inhibition, both skills improved with additional sleep. Interestingly, the research has shown that the development of the sleep-wake cycle has significant influences on the physical and mental developmental of children. In fact, one study found that differences correlate with ASD/ADHD by 2 years of age. The development of REM and non-REM sleep can be said to be dependent upon the development of control systems for parts of the brain responsible for arousal and wakefulness.

So what can be done? And how to people with ADHD ultimately achieve success? Well two big factors in follow-through on tasks and deviating from old habits are: motivation and stimulation. Think about your child with ADHD- can you think of three games, topics, or activities that they seem to have no problem engaging in any time of day? Never seeming to forget any details and not giving up until they succeed to their expectations? This is actually quite typical- because as long as someone with ADHD is interested and/or stimulated by something, they are actually MORE than likely to complete it. Now, some tasks are tedious and there’s not much that can be done to change it. Sometimes “bribing” is not the enemy if done appropriately (for example, an allowance for chores). But often, it is the marriage of re-evaluating priorities and being creative with certain tasks. If your child struggles to get up for school, you can consider allowing several “snoozes” or “warnings” to allow with the transition from sleeping to beginning their day, you may offer a “reward” of sorts for effort and independence in flexibility of arising earlier and without assistance, and you can explore options for schooling or scheduling that may be more flexible for your child to be most organically successful.