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Teen Can't Get Up in the Morning
Q: I really need help. My brilliant, almost-16-year-old son with ADD just cannot get up in the morning. I'm beside myself. He takes 15 mg of Adderall® at 8 a.m. and rarely takes 10 mg about 2 p.m. He can't fall asleep before midnight so he takes an over-the-counter Tylenol/Benedryl pill at about 9:30 p.m. This gets him to sleep around 11 p.m. He needs to be up by 7:45 in order to get to school on time. It is now 9:10 a.m. and he has yet to walk out the door. His first period is orchestra. After four and a half years of playing, he will probably fail it. He has recently pushed through a lot of his other difficulties (homework, in particular) and is fully up-to-date. But not getting to school for his first period is a major problem.
Is there anything we can do with his 504 accommodations? Is there something we should do about his medications? He says he really wants to do it - he seems to be determined -- but it's so discouraging when the morning comes and he just can't. Are there other things he could be trying?
A: As you probably know, some kids have a so-called "rebound effect," which results in a greater degree of excitation when the medications wear off. It is unlikely that this is the case if your son's last usual dose is at 2 p.m. If, on the other hand, his sleeplessness is only on the days when he takes the afternoon dose, then the medication is the likely culprit. It could also be that he isn't tolerating the Tylenol/Benedryl well. I would ask your son's pediatrician if he thinks the medication is a factor.
Another thing to look at is your son's consumption of caffeine -- not only coffee or tea, but also colas, chocolate, or foods/snacks that contain "hidden caffeine" (such as Mountain Dew or coffee ice cream). Sensitivity to certain foods at night could also affect his sleep patterns. He could be "hyped up" by music he listens to at bedtime (try switching to classical -- yawn!), or movies he watches before falling asleep. If he exercises late at night, the increased activity could be keeping his body and mind from relaxing. On the other hand, early morning exercise can get his body and his brain moving in the morning, and the effect will at least get him through orchestra. A brisk walk with you or the dog can jump-start his day.
Some studies suggest that exposure to bright lights late at night can make sleep difficult by upsetting the body's internal clock. The same is true about lights coming through the window in the night or in the early morning. Has your son considered yoga, biofeedback, or relaxation tapes prior to bedtime? How about books on tape? Or a machine that plays calming background sounds, like waves (unless he's a surfer!) or rainfall?
What about that old stand-by, warm milk (it contains tryptophan, which is said to have a natural sedative effect)? Other foods high in L-tryptophan include turkey (remember how sleepy we get after that Thanksgiving meal?), pumpkin seeds, bananas, figs, dates, yogurt, tuna, whole grains, and nut butters. What about a warm bath? Not too cool for a teenager, but it just might do the trick. A hot tub, maybe?
Although it's unlikely, your son may have a sleep disturbance. This is a problem that goes undetected in many kids, and can have a very negative impact on learning. Ask your son's pediatrician to refer you for a consultation to a sleep disorders clinic at your local children's hospital.
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Jerome (Jerry) Schultz is the founding clinical director of the Learning Lab @ Lesley University, a program that provides assessment, tutoring, and case management services for children with learning challenges. Schultz holds a Ph.D. from Boston College, and has completed postdoctoral fellowships in both clinical psychology and pediatric neuropsychology.