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[00:00:00] Hello everyone. Welcome to The Testing Psychologist podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

This podcast is brought to you by PAR.

The BRIEF2 is the gold standard rating scale for measuring executive function. A new score report, updated interpretive report, and series of 10 interventions handouts are now available on PARiConnect. Learn more at parinc.com\brief2

Hey y’all, welcome back. Glad to be here. Today is another episode in the ADHD series. As you know, I’ve been delivering bite-size elements of the ADHD research over the last few episodes, [00:01:00] and I will continue that today as we’re talking about the role of sleep and diet in ADHD.

Disclaimer. Just as before, these are not meant to be deep dives into any of these topics. Just trying to summarize what we know. A lot of the information in these episodes is coming from the consensus statement from the World Federation of ADHD. That article is linked in the show notes, but like I mentioned, just meant to be brief synopses of the recent data. As always, with any of this material, I welcome comments and discussion on the episode webpage.

All right, let’s jump into some conversation about sleep, diet, and ADHD.

[00:02:00]All right, let’s dive into it.

As many of you know, sleep, diet and ADHD often overlap, or we think they overlap, right? Over the years, I’ve heard a lot about sleep impacting attention and mood, of course, and impulse control, and there’s been a lot of discussion around diet as well. I went to grad school in the early 2000s and I feel like we have come full circle in some ways as far as the view on diet and its role in ADHD. So I’m excited to talk a little bit about some of these topics.

Like I mentioned in [00:03:00] intro, if you are interested in diving a little deeper, the consensus statement from the World Federation of ADHD goes into detail on many of these topics and has a pretty incredible list of citations to check out, but let’s start with sleep.

The relationship between sleep and ADHD is a two-way relationship in the sense that they influence one another at least to some degree. So poor sleep can certainly lead to decreased executive functioning. There’s a lot of overlap between ADHD and executive functioning, but let’s break it down a little bit further.

I think looking at it in terms of primary sleep issues versus secondary sleep issues is maybe a good way to organize some of this [00:04:00] information in the sense that, it’s that question of what drives what. Sometimes it’s hard to pull those things apart, of course, but it’s not going to stop me from trying, you all.

When I say primary sleep issues, that’s where the sleep issues are the predominant concern and they are driving the ADHD-like symptoms. Not to say that individuals with these primary sleep issues would be diagnosed with ADHD by any means, but primary sleep issues can sometimes masquerade as ADHD.

These are things like Circadian Rhythm sleep issues, people are sleeping at the wrong time and feeling groggy during the daytime when most people are expected to be at their highest level of functioning; sleep apnea, where sleep is significantly disrupted, even though they think they’re asleep, those sorts of things. So, primary sleep concerns.

The idea here, like I said, is that [00:05:00] the sleep issues are severe enough that they are disrupting executive functions like attention, concentration, memory, impulse control, etc.

The second half of that equation is when the sleep issues are secondary in the sense that ADHD is maybe worsening or influencing problems with sleep. Let’s dig into that a little bit because this is where things get a little bit more complicated and the research is mixed, of course. Research is always mixed, right?

Just a little bit of a summary.

As far as adults are concerned, there was a pretty significant or large meta-analysis recently that found [00:06:00] no real differences in terms of sleep for typically developing adults at least according to those that underwent a sleep study. They looked at many factors. They looked at sleep onset latency; how long it takes people to fall asleep, and then the different stages of sleep, including deep sleep, REM sleep, and so forth. They looked at total sleep time. They looked at waking time during sleep. They did not find a whole lot to speak of- a whole lot of differences between adults with ADHD and individuals without ADHD.

The one thing that jumped out was that sleep onset latency was much larger [00:07:00] for individuals with ADHD. It took longer to fall asleep, which perhaps anecdotally makes sense. Now, subjective reports by individuals with ADHD showed, I would say significantly more trouble falling asleep than the data maybe bore out in an actual sleep study. So individuals with ADHD self-reported more trouble and longer time falling asleep than was shown when a lot of individuals went through a sleep study. They also self-reported more nighttime wakening and slightly worse sleep quality and sense of being rested the next day.

[00:08:00] Now, let’s jump over to children and see if there’s anything worth talking about there.

Let’s take a break to hear from our featured partner.

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All right, let’s get back to the podcast.

Well, it turns out that there is, of course. When I think about kids with ADHD and sleep, they tend to fall into, [00:09:00] again, that second category a lot of the time, which is that the ADHD or let’s just say behavioral concerns are driving the sleep problems. A lot of the time this is happening in terms of problems with sleep onset.

This is not specific to ADHD necessarily. There are plenty of concerns that can disrupt a kid’s sleep onset or sleep hygiene, but we’re looking through the lens of ADHD. That is certainly one of the things that can interfere with kids’ getting to sleep.

What we’re talking about here is again, problems with what we call sleep hygiene; the behaviors that lead to good sleep. So what we find is that kids with ADHD often require unique and [00:10:00] special circumstances to get to sleep. Falling asleep requires these things and it’s pretty labor intensive for the kid, but also parents.

Sleeping is associated with a lot of problems. The kids a lot of the time don’t like to go to sleep. Parents struggle with setting limits appropriately and putting in appropriate guidelines for sleep. And sometimes, nighttime awakenings occur and kids require parents to soothe them to get back to sleep.

All these things are, like I said, it’s not like the ADHD is causing them exactly, but the incidents of these behavior problems and difficulties with sleep [00:11:00] hygiene are elevated in kids with ADHD. So we have to be on the lookout there.

Now, kids with ADHD also struggle with primary sleep disorders, but a lot of the time, it’s more of a secondary thing where ADHD is driving some of the poor sleep hygiene. And like I said, the same idea applies with kids as with adults in that poor sleep is going to affect executive functioning. So if you have a kiddo who is diagnosed with ADHD already and sleep is not going well, then that is I would say a frontline intervention to pursue to try to get the sleep dialed back in.

Let’s transition and talk a little bit about diet.

I mentioned at the [00:12:00] beginning of the episode that I feel like I’ve come full circle in terms of the role of diet in ADHD. What I mean by that is, when I went to grad school, I had an advisor who I think was reflecting the research at that time. It was pretty adamant that diet made no difference in the expression of ADHD symptoms. And that was coming on the heels of things like the fine gold diet and other diets that were debunked as having any effect on ADHD.

What we know now, is those things have changed a little bit where we’ve circled back and maybe have found some implications for certain elements of diet on ADHD symptoms. I want to go back actually and highlight [00:13:00] one thing that we know about pregnancy even is that, women who meet the criteria for clinical definition of obesity have children that have a 3X likelihood of having ADHD.

So that’s one interesting fact, just going all the way. But if we move on to children, once they are growing up in the world and think about environmental factors of diet, a lot of talk about Omega3. There have been some interesting findings around Omega 3. Again, research is mixed, but I think when you look at the totality of the evidence, there is some evidence to suggest that Omega3 [00:14:00] is one of those supplements that you would like to consider. Something that might move the needle when it comes to ADHD symptoms. Otherwise, not a whole lot of evidence for supplements or vitamins in the treatment of ADHD.

Some folks would suggest maybe adding iron or zinc or magnesium or specific vitamins only if Kids are deficient in those vitamins and nutrients. It’s not like we have to over-supplement necessarily. So, Omega3 is, again, showing tiny to moderate effects in a lot of cases. I think that’s where the research is out.

It seems like on the other side, in terms of what to eliminate from diet, pretty clear, sugar, caffeine, food additives, pesticides, and food dyes. These things aren’t [00:15:00] good. It’s not like they’re causing ADHD necessarily, but they’re just not great for anyone. So if you’re thinking about things to eliminate, those are probably the top five.

I will zero in on food dyes just for a second. It seems like, yes, there is some evidence of synthetic food dyes influencing ADHD symptoms a bit. So that is something to consider. I’m now at the point where I talk with parents about diet and make sure to dispel any myths around needing a gluten-free diet or a vegan diet or anything like that. But we know Omega3 can help and trying to keep food dyes out of the picture might help you as well.

The other component that I wanted to highlight here before wrapping up with this [00:16:00] episode is what we have found to be relatively tiny- this is funny. This is one of those statements from the research that makes you think of “small but robust” associations between inattentive symptoms and unhealthy eating.

The interesting thing about this research for me is that there hasn’t been a strong association between hyperactivity or impulsivity symptoms and unhealthy eating. There’s a weak association, but the stronger association was between inattention and unhealthy eating, which was at least in this research that I’m looking at defined as foods that were high in added sugar.

So that’s one last takeaway that if we’re working with kids with [00:17:00] ADHD, it’s worth having that conversation around diet and particularly added sugar. I know I anecdotally hear that a lot where parents come in and we’re talking about diet and they share that their kids love sugar. I mean, everybody loves sugar, but this is a little more evidence that we need to pay extra careful attention particularly for those inattentive kids to see if they are consuming more sugar than would be healthy.

As always, thanks for tuning in. I appreciate it. We’ll keep going with this ADHD series and I hope that you’re taking away some helpful info. Thanks as always for listening.

All right, y’all. Thank you so much for tuning into this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and your life. Any resources that we mentioned during the episode will [00:18:00] be listed in the show notes, so make sure to check those out.

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If you’re a practice owner or aspiring practice owner, I’d invite you to check out The Testing Psychologist mastermind groups. I have mastermind groups at every stage of practice development: Beginner, Intermediate, and Advanced. We have homework. We have accountability. We have support. We have resources. These groups are amazing. We do a lot of work and a lot of connecting. If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call and we will chat and figure out if a group could be a good fit for you.

Thanks so much.

The information contained in this podcast and on The Testing Psychologist website is intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis, or treatment.

Please note that no doctor-patient relationship is formed here, and similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and the listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor [00:20:00] with expertise that fits your needs.

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