Sleep Disorders and ADHD Misdiagnosis in Children By Victoria S. Brkovich, MD

Sleep deprivation, in its various forms, can wreck havoc on our day-to-day work lives, not to mention our health, but adults aren’t the only ones who suffer the effects.  As we are about to enter into another school year, it is important to realize disturbed sleep’s effects on our children’s scholastic performance.

In a recent study this year, published in the medical journal of Pediatrics, it was shown that sleep disorders may contribute to behaviors that resemble ADHD.  This study looked at over 11,000 British children over a six-year period, beginning at age 6 months, and discovered that children suffering from sleep-disordered breathing—ie, snoring, mouth-breathing, and apnea or stop-breathing spells—had a higher incidence of behavioral and emotional issues, such as hyperactivity, aggressiveness, depression, and anxiety.  Children who snore or have other nighttime breathing conditions were shown to be between 40 and 100 percent more likely to display symptoms of hyperactivity by age seven.

In general, pediatric or adult, a lack of sleep can damage brain neurons.  This damage may be due to a decrease in oxygen with increase in carbon dioxide levels, the interference with sleep’s restorative processes, and a disruption in the balance of cellular and chemical systems.  The resulting effects in children can be inattentiveness, hyperactivity, and impulsivity—the classic trademarks of ADHD.  Therefore, the recommendation when ADHD is suspected in a child is to review his or her nighttime sleep patterns with the primary care doctor, and possibly proceed with a sleep study.

Although it is possible that children with sleep apnea are misdiagnosed with ADHD, at the very least, OSA in children could exacerbate their ADHD symptoms.  This possibility should prompt parents and clinicians to consider an evaluation for sleep-disordered breathing if the child exhibits problems with attention and hyperactivity.  If there is a misdiagnosis of ADHD, this can be problematic when one considers the fact that medications used to treat ADHD, like Vyvanse and Ritalin, are stimulants and can cause insomnia.

What should parents watch for?  Observe your child’s breathing at sleep.  Snoring, gasping, choking, and periods of not breathing can each be a sign of obstructive sleep apnea, in both children and adults.  Discuss all this with a pediatrician, as children and adolescents (as well as us adults) should feel refreshed after a night’s sleep.  Sleep is vital for the growth and development of all children, and in light of current research, parents of children with ADHD especially should take note of any sleep disturbances. The smartest solution for their child may be less medication and more improved sleep.

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