Sleep Disorders & ADHD

It’s suspected that nearly 25% of all cases identified as attention deficit hyperactivity disorder (ADHD) are not really ADHD at all, but are symptoms related to sleep disorders.

One of the leaders in this research is University of Michigan professor Ronald Chervin.  Chervin theorizes that very important brain development is done during sleep. Among other things, this includes the ability to regulate emotion and processing. So, if a child has chronic sleep problems, brain development may be impaired. Chervin also suspects that the brain does not receive enough oxygen if the child snores which further inhibits development.  According to Chervin’s research, children who snore are more likely to have ADHD.

He likens the ADHD-sleep connection to a child who doesn’t get a nap; he becomes restless, irritable, and acts out.

Chervin developed his theory based on a sleep/behavior survey of the parents of 866 children.  Chervin’s data exposed a sleep disorder -behavior relationship.  It was only logical to conclude that if the sleep disorder could be corrected, the ADHD symptoms would be extinguished.

According to Newsweek: “To test this theory, Chervin then studied 79 kids (5 to13 years old) who were about to have an adenotonsillectomy. Prior to the surgery, 22 of the 79 were categorized as having ADHD, based on standard measures for such a diagnosis. One year later,  Chervin’s team tracked down the kids for a follow-up. Of the 22 identified as having ADHD, 11 kids no longer qualified as having the disorder.”

Two problems lingered: 1) New cases of ADHD cropped up and 2) 50% of the surgical patients received no benefit at all.

Before you go and get your child’s tonsils and adenoids out, let’s discuss the distinct problems in the logic associated with this research.

First, we have a problem of antecedence; does ADHD exist because of sleep problems? or does the sleep problem exist because of  ADHD? That relationship cannot be clearly identified and is a confounding problem.

Secondly, new cases of ADHD appeared and others did not benefit at all from the surgery. This would lead one to think that the outcomes may not be related at all to the procedure.

I’m reminded of an old story about researchers who taught a frog to jump upon saying, “Jump!” Many weeks were spent training the frog.  The researchers were quite happy that they had proved the frog could hear and could respond to the human voice. One of the researchers  decided they should amputate the frogs hind legs. After carefully surgically removing the frog’s legs and rehabilitating the poor frog, the researchers stood in front of the frog and yelled, “Jump!” When the frog did not respond, they all heartily nodded in agreement that the frog’s hearing was severely impaired by the removal of his hind legs.

There is little doubt that sleep problems affect brain development. Past studies have demonstrated that preschoolers with a sleep disorder are twice as prone to substance abuse by early adolescence and more likely to suffer from anxiety in their 20s. Even the American Academy of Pediatrics concurs that sleep problems are not benign.

However, before we undertake invasive, painful surgery as an option, far more research should be performed to absolutely indicate a direct correlation. One currently does not exist and other options should be explored. playing241

It has become obvious that adequate, restful, uninterrupted sleep is essential to our personal well being. Abnormal sleep patterns may result in behaviors that can be easily confused with ADHD.

If your child has a sleep problem, taking them to a sleep specialist may help. Getting adequate exercise, providing a consistent sleep routine/schedule, reducing stress,  and eating a proper diet may also assist in getting better sleep and better behavior.

 

  • Chervin RD, Arcbold KH, Dillon JE, et al. Inattention, hyperactivity and symptoms of sleep disordered breathing. Pediatrics. 2002;109:449-456
  • Chervin RD, Dillon JE, Bassett C, et al. Symptoms of sleep disorders, inattention and hyperactivity in children. Sleep. 1997;20:1185-1192
  • Chervin, RD, Rusicka DL, Giordani BJ, et al. Sleep disordered breathing, behavior and cognition in children before and after adenotonsillectomy. Pediatrics. 2006;117:e769-e778
  • Cortese S, Konofal E, Lecendreux M, et al. Restless leg syndrome and attention deficit/hyperactivity disorder: a review of the literature. Sleep. 2005;28:1007-1013
  • Cortese S, Konofal E, Yateman N,et al. Sleep and alertness in children with attention deficit hyperactivity disorder: a systematic review of the literature. Sleep. 2006;29:504-511
  • Harnish MJ, Boyer S, Kukas L, Bowles AM, et al. The relationship between sleep disorders and attention deficit hyperactivity disorder (ADHD): objective findings. Sleep. 2001;24:A14.
  • Owens JA. The ADHD and sleep conundrum: a review. Journal of Developmental and Behavioral Pediatrics. 2005;26:312-322.

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