Why Can’t My Child Fall Asleep? Anxiety, ADHD, and Bedtime Struggles
Clinically reviewed by Deborah Brewer, LCSW, Clinic Director, Certified SPACE Therapist and ADHD-Certified Clinical Services Provider at Palo Alto Therapy
It is 9:15 p.m. Your child has brushed their teeth, gotten into bed, and said goodnight.
Then the questions begin.
“What if I can’t fall asleep?”
“Who is picking me up tomorrow?”
“I forgot to tell you something about school.”
“What if my teacher calls on me?”
“Can you stay for five more minutes?”
For many families, bedtime is when everything that seemed manageable during the day suddenly comes to the surface.
This can be especially common for children with anxiety or ADHD. It may become more noticeable during periods of change, such as going back to school, starting a new grade, getting a new teacher, changing activities, or adjusting to a different family schedule.
During the day, kids are busy. At night, things get quiet.
Sometimes that is when a busy or worried brain gets loud.
Understanding what is happening at bedtime can help parents respond in ways that provide comfort while also helping children develop confidence in their own ability to settle, tolerate uncertainty, and eventually fall asleep.
Why Does My Child Get Anxious at Bedtime?
Bedtime asks children to do quite a lot.
They have to stop doing something interesting. They have to transition from activity to stillness. They may have to separate from their parents. There are fewer distractions from their thoughts. And they have to accept something they cannot completely control: exactly when they will fall asleep.
For an anxious child, that quiet can create plenty of room for “what if” thinking.
What if I don’t fall asleep?
What if I’m exhausted tomorrow?
What if I forgot my homework?
What if something happens to Mom or Dad?
What if nobody sits with me at lunch?
Then another worry can appear:
What if I’m still awake an hour from now?
Now the child is not only worried about tomorrow. They are worried about sleep itself.
Why Can ADHD Make Bedtime Harder?
For children with ADHD, bedtime can involve another set of challenges.
Shifting away from a stimulating activity, following a multistep routine, keeping track of belongings, remembering what needs to happen tomorrow, and slowing down an active mind can all be difficult.
Some children experience both anxiety and ADHD.
The result can be a child who is genuinely tired but seems unable to settle.
From Our Therapist: Jenny Estes, LCSW
For some children, the first quiet moment of the day is also the first opportunity their brain has to bring up everything they have been carrying.
“Parents sometimes see a completely different level of worry at bedtime. Instead of trying to get rid of every thought or feeling before a child can sleep, we can help children learn that they can notice those thoughts, tolerate some discomfort, and allow their bodies to settle.”
Jennifer “Jenny” Estes, LCSW is a Cognitive Behavioral and ERP therapist at Palo Alto Therapy who works with children, teens, and families. Her areas of work include anxiety, ADHD, insomnia, parenting, and SPACE.
Why Can Back-to-School Anxiety Affect Sleep?
Even positive changes can create stress.
The beginning of a school year brings uncertainty. Children may wonder:
Will I like my teacher?
Will my friends be in my class?
Can I handle the homework?
What if I’m late?
Will I be able to keep up?
For older children and teens, worries may involve grades, friendships, sports, extracurricular activities, social pressures, or academic expectations.
In high-achieving communities like Palo Alto and throughout Silicon Valley, the transition from summer back into packed schedules can happen quickly.
Children do not always say, “I’m anxious about school.”
Instead, parents may notice that their child suddenly cannot fall asleep.
They may ask more questions at bedtime. They may complain of stomachaches. They may repeatedly leave their room. They may suddenly want a parent to stay with them until they fall asleep.
Temporary changes in sleep during transitions can happen. The important question is what happens when the pattern continues.
When Helping at Bedtime Becomes Family Accommodation
When your child is distressed, comforting them is a natural response.
You answer another question.
You check the room again.
You lie beside them for five more minutes.
You reassure them that tomorrow will be okay.
Sometimes that is exactly what a child needs.
But when the same pattern happens night after night, parents can gradually become part of what the child believes they need in order to feel safe enough to sleep.
Eli Lebowitz, PhD, of the Yale Child Study Center and colleagues have studied a pattern known as family accommodation. Family accommodation refers to changes family members make in their own behavior in response to a child’s anxiety.
At bedtime, accommodation might include:
- Staying with a child until they fall asleep every night
- Repeatedly reassuring them that nothing bad will happen
- Checking the room over and over
- Allowing a child to avoid sleeping independently because of anxiety
- Answering repeated worry questions
- Adding more and more steps to the bedtime routine
- Changing the family’s evening routine around the child’s anxiety
This does not mean parents have done something wrong.
Accommodation makes sense because it often works in the short term. Your child becomes calmer, and everyone may finally get some sleep.
The challenge is what the child has an opportunity to learn over time.
If a child repeatedly experiences, “I can only get through this feeling if my parent changes something for me,” they have fewer opportunities to discover:
“This feeling is uncomfortable, but I can handle it.”
Research by Lebowitz, Shimshoni, and Silverman specifically examined family accommodation and sleep-related problems in clinically anxious children. Their study included 277 children ages 6 to 17 and found evidence linking family accommodation with sleep-related difficulties.
What Is SPACE Therapy?
SPACE stands for Supportive Parenting for Anxious Childhood Emotions.
SPACE is a parent-based treatment developed by Eli Lebowitz, PhD, at the Yale Child Study Center for children and adolescents with anxiety, OCD, and related difficulties.
A central focus of SPACE is helping parents increase supportive responses while reducing accommodations that may unintentionally maintain anxiety.
One of the most useful ideas from SPACE is that parents do not have to choose between compassion and confidence.
They can communicate both:
“I understand that this is hard for you, and I believe you can handle it.”
The worry does not have to disappear for the child to be okay.
A SPACE Perspective From Our Clinic Director
Deborah Brewer, LCSW, Clinic Director at Palo Alto Therapy and a Certified SPACE Therapist, encourages parents to think about the difference between helping a child escape anxiety and helping them discover that they can handle it.
“At bedtime, parents can get pulled into trying to make sure their child feels completely calm before they leave the room. With SPACE, we are looking for a different message. We can acknowledge that the child is having a hard time while also communicating confidence that they can handle the discomfort. The goal is not, ‘I will make this worry go away for you.’ It is, ‘I see how hard this is, and I believe you can handle it.’”
Should I Keep Reassuring My Anxious Child at Bedtime?
Reassurance is not inherently bad. Children need comfort and connection from their parents.
The issue is what happens when reassurance becomes something the child feels they must have repeatedly in order to tolerate anxiety.
A child might ask:
“Are you sure I’ll fall asleep?”
“Are you sure I won’t be tired?”
“Are you sure tomorrow will be okay?”
After enough reassurance, they may feel better for a moment. Then another question appears.
Instead of repeatedly trying to prove that everything will be okay, a parent might say:
“I know your brain is giving you a lot of worries tonight. I know that feels uncomfortable, and I believe you can handle those feelings while your body settles.”
This acknowledges the anxiety without requiring the parent to eliminate it.
Give Worries a Time and Place Before Bed
If your child remembers every concern the moment the lights go out, experiment with moving those conversations earlier.
Create a short period before the bedtime routine when your child can tell you what is on their mind.
You might ask:
“Is there anything your brain keeps bringing up about tomorrow?”
Some children like writing worries down. Younger children might draw them. Others simply need a few minutes to talk.
If there is a real problem that needs solving, make a plan.
Then close the conversation.
The goal is not to prevent your child from ever mentioning a worry at bedtime. It is to keep bedtime from becoming the family’s nightly problem-solving session.
When another worry appears after lights out, you might say:
“That sounds like something we can put on our list to talk about tomorrow. Right now your job is to rest.”
Make Bedtime Easier for an ADHD Brain
For a child with ADHD, “go get ready for bed” may actually represent a long list of separate tasks.
Take a shower.
Put on pajamas.
Brush teeth.
Use the bathroom.
Find tomorrow’s clothes.
Pack the backpack.
Remember the water bottle.
Choose a book.
Get into bed.
That is a lot of transitions and executive functioning at the end of an already long day.
A simple visual checklist can reduce how much verbal prompting is required from parents. It can also allow the child to gradually take more ownership of the routine.
Starting the wind-down earlier can help, too. Moving directly from homework, gaming, texting, or another highly stimulating activity into bed may be difficult for a child who already struggles with transitions.
From Our Therapist: Jenny Hays, LMFT
“For some kids, bedtime is not one transition. It is six or seven transitions packed together. Making the routine visible and predictable can reduce repeated prompting and help a child know what comes next without depending on a parent to manage every step.”
Jennifer “Jenny” Hays, LMFT, Clinical Manager at Palo Alto Therapy, works with children, teens, and families and is trained in SPACE.
Do Not Make Falling Asleep Another Assignment
One frustrating thing about sleep is that trying very hard to fall asleep can make falling asleep more difficult.
A child may start monitoring themselves:
Am I sleepy yet?
How long have I been awake?
What time is it?
How tired will I be tomorrow?
Now bedtime has become another performance.
This can be particularly difficult for anxious or perfectionistic children who feel that they need to “do sleep right.”
Instead of making sleep the assignment, make rest the assignment.
You might say:
“You don’t have to make yourself fall asleep. Your job is to rest quietly and give your body a chance to settle. Sleep will come when your body is ready.”
This can take some of the performance pressure out of bedtime.
Change Bedtime Accommodations Gradually
If you have been lying beside your child until they fall asleep for months, suddenly announcing that they are completely on their own tonight may lead to an enormous struggle.
Instead, think about building tolerance and independence gradually.
For example, the first change might be moving from lying in the bed to sitting beside it.
Later, the chair might move farther away.
Or you might leave the room and return for a predictable check-in.
The appropriate plan depends on the child and the nature of the sleep difficulty. The important point is that changes should be thoughtful, manageable, and consistent.
Your child may initially protest when a familiar accommodation changes.
You can acknowledge their distress while maintaining confidence:
“I know you wish I would stay until you fall asleep. Tonight I’m going to check on you in a few minutes. I know this feels different, and I believe you can handle it.”
Warmth and confidence can exist together.
A Therapist’s Perspective From Nicole Brunn, LMFT, LPCC
When bedtime has become a nightly struggle, parents may feel caught between comforting their child and setting boundaries.
“Parents sometimes think they have to choose between being supportive and setting a limit. You can do both. You can let your child know that you understand how hard the feeling is while still showing confidence that they are capable of handling it. Consistency and connection can work together.”
Nicole Brunn, LMFT, LPCC is a Cognitive Behavioral and ERP therapist at Palo Alto Therapy with nearly a decade of experience helping pre-teens and teens work through challenges, including insomnia, OCD, ADHD, anxiety, depression, and trauma.
When Should I Get Help for My Child’s Bedtime Anxiety?
Occasional difficulty falling asleep is common.
Consider seeking additional support when bedtime struggles are frequent, worsening, or significantly interfering with your child’s or family’s life.
It may be time to talk with a professional if:
- Bedtime routinely takes a very long time
- Your child experiences significant anxiety about bedtime or sleeping alone
- Reassurance-seeking has become difficult to interrupt
- You feel trapped in an elaborate bedtime routine
- Sleep difficulties are interfering with school or daytime functioning
- Your child is increasingly avoiding activities because of anxiety
- Bedtime regularly creates significant family conflict
- Anxiety, ADHD, OCD, separation concerns, or other symptoms extend beyond sleep
Not every sleep problem is caused by anxiety or ADHD. Persistent sleep difficulties can have different causes. Families should discuss ongoing sleep concerns with their child’s pediatrician or another qualified healthcare professional when appropriate.
When anxiety is contributing to the pattern, evidence-based treatments such as Cognitive Behavioral Therapy may help. Parent-based approaches such as SPACE may also help families identify accommodation patterns and develop responses that support a child’s ability to cope.
Can Parents Get Help Even If Their Child Does Not Want Therapy?
Yes. This is one reason a parent-based approach can be particularly valuable.
SPACE works with parents as the agents of change and does not require the child to participate directly in treatment.
Research comparing SPACE with child-focused CBT found that SPACE was noninferior to CBT for childhood anxiety outcomes in the study population. Family accommodation also decreased significantly.
For a parent who feels stuck in a cycle of bedtime anxiety, reassurance, avoidance, and escalating accommodations, working with a therapist can provide a structured plan for changing that cycle.
Helping Your Child Learn, “I Can Handle This”
When your child is lying awake and worried, the instinct to make everything feel better is powerful.
But parents do not have to eliminate every uncomfortable thought.
You do not have to guarantee that tomorrow will go perfectly.
And you cannot make your child fall asleep.
What you can do is create structure, listen, validate what is difficult, and communicate confidence.
Over time, your child can begin to learn something more powerful than:
“My parent can make my anxiety go away.”
They can learn:
“I can feel worried and still be okay.”
“I can have a busy brain and let my body rest.”
“I can handle bedtime.”
Those are skills that extend far beyond sleep.
Help for Childhood Anxiety, ADHD, and Bedtime Struggles in Palo Alto
If anxiety, ADHD, or difficult bedtime patterns are affecting your child or your entire family, Palo Alto Therapy can help.
Our clinicians work with children, teens, and parents using evidence-based approaches including Cognitive Behavioral Therapy, Exposure and Response Prevention, parent coaching, and SPACE.
Palo Alto Therapy has multiple clinicians trained in SPACE, including:
Deborah Brewer, LCSW
Clinic Director and Certified SPACE Therapist
Jennifer “Jenny” Estes, LCSW
SPACE-trained therapist working with children, teens, anxiety, ADHD, insomnia, and parenting
Jennifer “Jenny” Hays, LMFT
Clinical Manager and SPACE-trained therapist working with children, teens, anxiety, ADHD, and families
Nicole Brunn, LMFT, LPCC
Therapist working with pre-teens, teens, ADHD, anxiety, insomnia, OCD, and related concerns
Deborah Coblentz, LMFT
Therapist trained in SPACE who works with children, teens, anxiety, ADHD, insomnia, parenting, and related concerns
Palo Alto Therapy serves families in Palo Alto, Menlo Park, San Jose, and throughout California through video therapy.
Book a Free 15-Minute Consultation
Frequently Asked Questions
Why does my child get more anxious at bedtime?
Bedtime removes many of the distractions children have during the day. For children prone to anxiety, worries about school, separation, sleep, friendships, or the next day may become more noticeable when things get quiet.
Why can ADHD make it hard for a child to fall asleep?
Children with ADHD may have difficulty transitioning away from stimulating activities, completing multistep bedtime routines, organizing what they need for the next day, and settling a busy mind. Anxiety and ADHD can also occur together.
Should I stay with my anxious child until they fall asleep?
There is no single rule for every child. However, if a child comes to believe that a parent must stay with them in order for them to cope with bedtime, the pattern may become an accommodation of anxiety. A therapist can help parents develop a gradual plan that combines support with increasing independence.
What is family accommodation?
Family accommodation occurs when family members change their behavior in response to a child’s anxiety. At bedtime this might include repeated reassurance, staying until the child falls asleep, repeated checking, or allowing anxiety to increasingly determine the family’s routine.
What is SPACE therapy?
SPACE stands for Supportive Parenting for Anxious Childhood Emotions. It is a parent-based treatment developed by Eli Lebowitz, PhD, at the Yale Child Study Center. SPACE helps parents increase supportive responses while reducing accommodations associated with childhood anxiety and related problems.
Can parents use SPACE if their child refuses therapy?
SPACE is designed as a parent-based treatment and does not require direct child-therapist participation. This can make it an option worth discussing when a child is reluctant to participate in therapy.
REFERENCES
Lebowitz, E. R., Shimshoni, Y., & Silverman, W. K. (2019). Family accommodation mediates nightmares and sleep-related problems in anxious children. Journal of Anxiety Disorders, 62, 94-99.
DOI: 10.1016/j.janxdis.2019.01.004
Lebowitz, E. R., Marin, C., Martino, A., Shimshoni, Y., & Silverman, W. K. (2020). Parent-Based Treatment as Efficacious as Cognitive-Behavioral Therapy for Childhood Anxiety: A Randomized Noninferiority Study of Supportive Parenting for Anxious Childhood Emotions. Journal of the American Academy of Child & Adolescent Psychiatry, 59(3), 362-372.
Yale Child Study Center / Eli Lebowitz, PhD: Supportive Parenting for Anxious Childhood Emotions (SPACE).
Related Articles
You may also find these resources helpful:
- What is CBT (and Why it Works When Other Therapies Don’t)
- When is Anxiety in Children More Than Just Worry? Signs, Symptoms, & Support with CBT and SPACE Therapy
- 6 Easy, Effective CBT Techniques for Addressing Teen Burnout
- What is OCD? Understanding OCD Types and Related Disorders
Related Services
Palo Alto Therapy provides evidence-based treatment for:
- Cognitive Behavioral Therapy (CBT)
- Child Therapy
- Teen Therapy
- Family Therapy
- Anxiety Therapy
- ADHD Therapy
- SPACE Program for Parents
Deborah specializes in Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention (ERP) for obsessive-compulsive disorder (OCD), SPACE (Supportive Parenting for Anxious Childhood Emotions), ADHD, anxiety disorders, and Level 1 Gottman Method Couples Therapy. She is an ADHD-Certified Clinical Services Provider (ADHD-CCSP) and is committed to helping children, teens, adults, couples, and families access effective, research-supported treatment.
As Clinical Director, Deborah is passionate about clinical excellence, therapist development, and making evidence-based mental health information accessible to the community. Through her writing, she translates current psychological research into practical guidance that helps readers better understand anxiety, OCD, ADHD, relationships, parenting, and emotional well-being.
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