What if Your ADHD Kid Really Has Sleep Apnea?

Attention-deficit hyperactivity disorder is the bane of many parents nowadays, and the subject of a lot of debate. Some believe that the inattentiveness and impulsivity that are characteristic of ADHD is simply behavior within the range of normal restlessness on the part of highly energetic kids. Others say that it’s a genuine neurological disorder requiring some level of clinical and/or pharmaceutical intervention.

But what if some number of cases are neither? What if, in some cases, sleep apnea is masquerading as ADHD? Consider the following example. In the spring of 2010, a patient walked into a doctor’s office reporting problems with procrastination, forgetfulness, and an inability to consistently pay attention – in short, a textbook case of ADHD. The twist was that all the symptoms had only surfaced two years earlier at the age of 31, contrary to the usual childhood onset associated with ADHD.

In time, the patient was found to be suffering from a chronic sleep deficit. (His troubles began when he took on a job that required him to wake up at 5 a.m., conflicting with his natural inclination as a night owl.) Once the patient’s sleep schedule was properly addressed, his symptoms almost vanished within two weeks.

Well, this is all fine and good, particularly for an adult who only began experiencing the ADHD-like symptoms well into adulthood. But this misdiagnosis prompts a closer look at the relationship between sleep and ADHD, challenging the conventional understanding of these conditions. Consider:

  • Research indicates that a significant number of children diagnosed with ADHD also experience sleep-disordered breathing, such as apnea or snoring, restless leg syndrome, or non-restorative sleep. A 2004 study published in the journal Sleep found that children with ADHD displayed a deficit of delta sleep, a deep, rejuvenating sleep crucial for growth and development.
  • A 2006 study in the journal Pediatrics revealed that children scheduled for tonsillectomies due to sleep-breathing problems showed a higher incidence of ADHD compared to a control group. Remarkably, a year after the surgery, half of the children who initially met the criteria for ADHD no longer did. This suggests that what appeared to be ADHD was, in fact, resolved by treating a sleeping problem.
  • While the focus on sleep and ADHD is more prominent in childhood, adults with ADHD exhibit similar sleep dysfunctions. Research from Massachusetts General Hospital draws parallels between sleep issues in adults and children with ADHD. A study published in the journal Nature Neuroscience indicates a correlation between the amount of delta sleep in seniors and memory test performance, reinforcing the significance of quality sleep across all age groups.

None of this should be interpreted to claim that ADHD isn’t an actual condition, or that some (or even most!) of the people who are diagnosed with it wouldn’t benefit from the right kind of clinical or pharmaceutical treatment. But before reflexively going for a prescription, it might be worth looking to see if your kiddo isn’t simply suffering from a sleep disorder such as pediatric sleep apnea. Giving a sleep-deprived kid some meds to keep them focused seems like cruel and unusual punishment.

Source: Diagnosing the Wrong Deficit (NYT)