Early Morning Challenges with ADHD

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ADHD symptoms occur from the moment a person wakes up and last all day. Early mornings, the time between waking up and leaving for school or work, can be significantly impacted in patients with Attention Deficit Hyperactivity Disorder (ADHD). Even people who are taking ADHD medications may struggle with symptoms in these early morning hours.

If ADHD symptoms are impacting your mornings, fill out the Before School Functioning Questionnaire (BSFQ) and share your responses with your doctor.

Pie Chart - 91%
91% of caregivers identified early morning as a time when their children had ADHD symptoms despite being on treatment.1*†
Pie Chart - 79%
79% of caregivers had previously discussed their child’s early morning challenges with their doctor.1*‡
Pie Chart - 48%
48% of caregivers said they had woken up early to give their child their ADHD medication.1*‡

“Many parents express that the morning routine sets the tone for the rest of the day; positive mornings result in a constructive, more focused attitude that lasts throughout the day”

- Andrea Marraffino, PhD

As seen on Access Health airing on Lifetime Television®, get more insight into living with ADHD from the perspective of a child, a parent, and physicians.


“Despite treatment with a stimulant, children with ADHD still display early morning challenges—horrible mornings, children in grumpy moods, and difficulty getting out of the house on time.”

- Ann Childress, MD

Early Morning Behavior

The early morning routine can be especially challenging for people with ADHD because it involves finishing a range of activities before the deadline of school or work, like:

Affected Activity - Getting out of bed
Waking and getting out of bed
Affected Activity - Getting dressed
Getting dressed
Affected Activity - Brushing teeth
Brushing teeth and self-hygiene
Affected Activity - Eating breakfast
Sitting down for breakfast and eating
Affected Activity - Going to school
Getting ready for school or other activities and remembering items
Affected Activity - Leaving house
Getting ready to leave the household
Completing these behaviors requires time management and working memory—skills frequently affected by ADHD symptoms, even when someone is already on treatment.1,2
Research shows that it's harder for people with ADHD to gauge time compared to their non-ADHD peers.3
People with ADHD tend to have difficulty completing tasks because they underestimate the amount of time required to complete them as compared to their non-ADHD peers.3

“Is it really that difficult for her to get dressed, eat, brush her teeth, pack up her stuff, and catch the bus? She’s in middle school already. Why can’t she just remember and follow through? I shouldn’t have to tell her and remind her a million times!”

- Mother of 12-year-old child with ADHD

Early Morning Impact

The impact of ADHD symptoms on your early morning routine

“His medications have kicked in by the time he gets to school. At least they don’t see what I see when he’s home. But at times, I do feel like it’s unfair. I’d like to see that side of him too.”

- Mother of 9-year-old child with ADHD

Caregiver Impact

How caregivers rate the impact of ADHD symptoms in the early morning

76% of caregivers described early morning issues as either moderate or severe1

3 out of 4 caregivers reported that the most frequent ADHD symptoms during the early morning routine were1:

Icon - Getting Distracted
Getting easily distracted
Icon - Failure to Listen
Failure to listen

Early morning functional impairments affect children and adolescents with ADHD already on treatment1

Unwanted behaviors frequently occurring during the early morning routine1*

Chart - Unwanted behaviors frequently occurring during the early morning routine
*Information was obtained from primary caregivers (n=201) of children and adolescents with ADHD currently treated with stimulants, using a self-administered, anonymous, online, quantitative research survey.

Talk to your doctor about how ADHD impacts your family’s early mornings

Mothers of children with ADHD are more likely to report:

Icon - A lower overall quality of life

A lower overall quality of life

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Viewing their child as limiting their family’s activities during the morning period and less likely to report that their child made them feel good as a parent, in comparison to mothers with children without an ADHD diagnosis4

Caregivers value better management of their child’s ADHD during the early morning to:
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Reduce their and their families’ levels of stress and frustration

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Improve quality of life

Results obtained from a study designed to map the challenges of everyday family life in a sample of children (27 with ADHD, 25 without ADHD). Children with ADHD included in the study were treated with stimulants. Across 7 days, mothers and children independently reported their moods, behaviors and social contexts every 30 minutes during nonschool hours, using an electronic diary. After each day, morning and afternoon/evening summary diaries were also obtained from mothers.

Caregivers of children with ADHD describe the early morning experience as generally chaotic.

Chaos is a result of the untimely actions or inactions of their children from the instant they awaken to the moment they leave the household for school.3

Children with ADHD frequently display behaviors associated with inattention, restlessness, disruptiveness, impulsivity, noncompliance to instruction and disorganization that affect those living in the same household.1,3

“Parents become so frustrated with their children who are off task, disorganized, and running late, that they end up yelling and getting the day off to a very stressful start for themselves and their children.”

- Mary Ann McDonnell, RN, MS, CS, FPNP, Child and Adolescent Clinical Nurse
Specialist and Family Nurse Practitioner

Early morning ADHD symptoms impact family dynamics

ADHD has been shown to have negative effects on families as a whole, causing1:

Affected Activity - Getting out of bed
Disturbed interpersonal relationships
Affected Activity - Getting dressed
Less perceived family cohesiveness
Affected Activity - Brushing teeth
Greater caregiver-child and sibling conflicts
Affected Activity - Eating breakfast
Higher incidences of divorce and separation

Because of the child’s ADHD symptoms during the early morning, caregivers of children with ADHD report1:

Affected Activity - Getting out of bed
Feeling overwhelmed and exhausted
Affected Activity - Getting dressed
Raising their voice more than they want
Affected Activity - Brushing teeth
Feeling constantly stressed
Affected Activity - Eating breakfast
Feeling inadequate as a parent
Affected Activity - Eating breakfast
Punishing more and praising less

Adapted from Sallee, 2015.

“Many caregivers of children with ADHD describe the stress caused by early morning routine as ‘chronic’ and ‘severe’. Factors that contribute to this stress include sibling conflicts and failure to get ready in the morning, resulting in difficulty getting to school and/or work on time.”

- Floyd R. Sallee, MD, PhD

Before school functioning questionnaire (BSFQ)

The BSFQ was designed for doctors to assess common challenges in the early morning before school. The BSFQ contains 20 items that address early morning, before-school activities, including2:

Use the BSFQ to see how ADHD symptoms impact your morning and bring it to your doctor to start the conversation.
Affected Activity - Getting out of bed
Overall organization
Affected Activity - Getting dressed
Breakfast
(not sitting down to eat, distracted while eating)
Affected Activity - Brushing teeth
Dressing
Affected Activity - Eating breakfast
Forgetfulness
Affected Activity - Eating breakfast
Hygiene
Affected Activity - Eating breakfast
Time awareness
Affected Activity - Eating breakfast
Procrastination
Affected Activity - Eating breakfast
Independence
Affected Activity - Eating breakfast
Getting to school

The BSFQ is a validated tool used by doctors to interview caregivers. It has undergone formal testing to demonstrate its reliability and validity.2

How to use the BSFQ2:

You should complete the questionnaire:

Icon - Checkmark
On school days
Icon - Checkmark
Either daily or weekly
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Between the hours of 6:00 a.m. and 9:00 a.m.

Rate each item on a Severity Scale from 0 to 3 using the following rating methodology for symptom severity:

Chart - BSFQ Severity Scale

Record the following times to set up a baseline for the early morning routine:

Time to wake up and get out of bed:_______(min)

Time to complete routines (from out of bed to leaving home):_______(min)

Download the Before School Functioning Questionnaire, and then share your answers with your doctor.

Click to download or print

Tips to help improve early morning functioning in children with ADHD

The early morning challenge

The following booklets contain tips that have been provided by Michele Novotni, PhD to help children with ADHD stay focused throughout the morning routine. Each tip has been tailored for children of different age groups—young children (ages 6–8), pre-teens (ages 9–12), and teens (ages 13–17).

These tips are designed to offer caregivers strategies to handle specific behaviors that may prevent children from getting ready in the morning.

So whether children need help improving their listening skills or getting dressed for school, these tips can help children of all ages complete their morning responsibilities so that everyone can hopefully leave the house on time.

From Michele Novotni, PhD,
Counseling Psychology,
Licensed Psychologist,
Senior Certified ADHD Coach

Michele Novotni, PhD is an internationally recognized expert and thought leader in the field of ADHD.

As a parent of a child with ADHD, she is dedicated to helping individuals with ADHD be successful in school, in interpersonal relationships, and in the workplace.

She is an inspiring speaker, best selling author, psychologist, ADHD coach, and the former president and CEO of the national Attention Deficit Disorder Association (ADDA).

She currently serves on the Scientific Advisory Board for ADDitude Magazine and has been on the Professional Advisory Boards for both ADDA and for the ADHD Coaches Organization (ACO). Inspiring individuals to unlock their potential is her passion, whether it is one-on-one or speaking to thousands.

Personalize with photos

A photo timeline may serve as a fun reminder for young children. Take pictures of your children during each step of the morning routine, including:

  • Getting dressed
  • Eating breakfast
  • Brushing teeth
  • Putting on their backpack
Icon - Photographs

Posting the photos on the wall will provide children with a personalized reminder of what they need to do each morning.

Chore Monster

Download Chore Monster:
A helpful app that will allow parents or caregivers to create a schedule of chores and assign point values to each task. Whenever your child completes a task, approve it and he or she receives the points associated with the task.

A fun way to get children to follow directions!

Frequently Asked Questions

What is Early Morning Functioning (EMF)?

Early morning functioning (EMF) occurs from the time of awakening until school or other morning activities. It involves performing activities such as getting out of bed, getting dressed, brushing teeth, sitting down for breakfast, and getting ready to leave the household.1,2

Why is EMF important?

The early morning is often described as a time of chaos and stress for family members of people with ADHD. ADHD symptoms affect a person's ability to get dressed, eat breakfast, brush teeth and prepare for the day. Symptoms can also negatively affect the rest of the day as they may put them at risk of being late for school or work, or forgetting things.1-3,5

Even people already on treatment for ADHD may be affected in the early morning hours.1,2

What is the Before School Functioning Questionnaire (BSFQ)?

The Before School Functioning Questionnaire (BSFQ) is a tool designed to assess behaviors and activities associated with the early morning. It contains 20 items that address early morning activities and is completed by a doctor based on a structured interview with the caregiver.6

How can the BSFQ be used?

The BSFQ should be completed on school days, either daily or weekly and between the hours of 6:00 a.m. and 9:00 a.m.6

Caregivers are asked to rate each item on a Severity Scale from 0 to 3 using the following rating methodology for symptom severity and the impact on activities3:

0 = None,
1 = Mild (Somewhat different from peers/siblings; some days),
2 = Moderate (Different from peers/siblings; most days),
3 = Severe (Different from peers/siblings all days; all settings)

Online Resources

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