ADHD vs sleep deprivation: what your teen really is struggling with

TimesLIVE

22-05-2025

The symptoms of attention-deficit/hyperactivity disorder (ADHD) have become a popular conversation topic on the internet. While this may be an attempt at normalising conversations concerning mental health, it can often lead to misdiagnosis — something that has been considered by medical doctor Alison Bentley.
Speaking recently at the Education Incorporated Private School, Bentley said it's important to note sleep history, especially with teens. Here are three important factors to consider when it comes to differentiating between ADHD and a lack of sleep.
Bringing sleep into the ADHD conversation
Bentley cautioned against the widespread tendency to overlook sleep problems in teens presenting with ADHD-like symptoms. 'We have to ask whether a teenager is inattentive or simply sleep-deprived,' she said. 'It's not uncommon for teens to be medicated without a proper sleep history being taken.'
She explained that delayed sleep phase syndrome, which is a biological shift in teenagers' internal clocks, causes adolescents to become naturally sleepy much later than expected — often leading to sleep deprivation when forced to wake early for school.
'These children aren't lazy or defiant — they're on London time, not South African time,' noted principal Gershom Aitchison. 'If we continue to ignore their biology, we're setting them up for failure.'
Bentley echoed this sentiment. 'Sleep is a passive activity that requires letting go — and that's very difficult when you're anxious or when your natural rhythm is out of sync with your schedule. We need to stop treating sleep as optional or secondary. The other two-thirds of your life depend on what happens in that one-third of sleep.'
Other factors affecting teens' sleep
Teens' sleep can also be compromised by caffeine abuse, overuse of screens and the pressures of school performance. Amy Dewes-Goulborn, a psychologist working in a high school environment, expressed concern about the growing number of teenagers relying on energy drinks and late-night device use — behaviours that further disrupt sleep and can be misinterpreted as psychiatric conditions.
Practical insights were shared from the classroom, too. Aitchison reflected on the success of school camps, where increased physical activity and structured routines reduced students' reliance on sleep medication. 'We also allow students to eat when they're hungry at school,' he said. 'Their digestive systems are on a delayed wake-up, just like their brains — so we listen to the body.'
Parental involvement
Bentley emphasised the need for education — not just for teenagers, but for their parents and the healthcare system. 'No child should be medicated for ADHD without a thorough conversation about their sleep. And parents need support to understand that setting boundaries around bedtime isn't just discipline — it's an act of care.'
She also highlighted the importance of giving teenagers agency. 'Teens respond when we ask, 'Does this make sense to you?' or 'Can you follow this plan?' They need knowledge, and they need to feel seen. When we hand them some control, their anxiety drops — and so does the need for intervention.'
The speakers agreed that there is a need for more honest conversations, more informed medical referrals, and for sleep to be treated not as a luxury but as a cornerstone of wellbeing.
'We need to stop medicating away symptoms without asking why they're there. If we get sleep right, we change everything — from mood and focus to health and academic success,' concluded Bentley.