Dr. Lawlis has written a very interesting column today on the association between attention deficit and hyperactivity disorder (ADHD) and sleep disturbances. This association has been well described and is becoming increasingly well known to pediatricians, teachers and parents. I, too, encounter this frequently in my clinic, most commonly in children with obstructive sleep apnea whose behavioral symptoms are dramatically improved, if not completely resolved, after their nighttime breathing difficulties are definitively treated.
One study by Ron Chervin, MD and others, published in Pediatrics (the journal of the American Academy of Pediatrics) in April of 2006, found that 28% of children referred to an Ear Nose and Throat clinic for removal of their tonsils and adenoids because of symptoms of obstructive sleep apnea had ADHD. When these children were followed up one year after surgery, 50% no longer qualified for the diagnosis.
It is true that many children have ADHD without underlying sleep disturbances. Others with ADHD have difficulties initiating or maintaining sleep for a variety of reasons (including the very medications given to treat the ADHD in the first place), which can make the ADHD worse. However, many children with ADHD do suffer from an underlying physical disorder causing fragmented and disrupted sleep, such as obstructive sleep apnea, or periodic limb movement disorder, which is either the sole or main cause of the ADHD. As Chervin's study and many others demonstrate, treating the underlying sleep disorder can markedly reduce the behavioral impairment.
I have been seeing a growing number of children referred to my clinic because of parental concerns that their behavioral problems may in fact reflect an undiagnosed sleep disorder. While many times a good history and physical examination can help to tease this out, some of the children require an overnight sleep study in order to be certain of the diagnosis. Overall, I think this trend reflects a growing awareness amongst parents that identifying and treating their child's underlying problem, rather than its symptoms, makes the most sense, and is ultimately best for their child.
Dennis Rosen, M.D.
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