Attention deficit hyperactivity disorder (ADHD) has again made top news in the past couple days. The federal Centers for Disease Control and Prevention recently released data demonstrating that 11% of U.S. school-age children have received a diagnosis of ADHD, and that almost 1 out of 5 boys in the U.S. have been diagnosed with ADHD. 6.4 million children 4-17 years of age have been diagnosed in this country, making for a 53% increase over the past decade. Millions of prescriptions have been written for these children, often, paradoxically, stimulants such as methylphenidate and amphetamine derivatives.
These are stunning figures, no doubt, sparking a renewal of debate regarding potential causes and solutions. Fingers have been pointed at the pharmaceutical industry, doctors, parents, schools, and our burgeoning quick-fix technology, with iPhones and video games cluttering the landscape of our–and our children’s–lives. However, there is a medical disorder–a sleep disorder–whose symptoms can be very similar to those of ADHD. This sleep problem is very real, and one that is very often overlooked.
Obstructive sleep apnea (OSA) is much more common in children than many may realize. The stereotypical sleep apnea patient is older, male, and overweight, and a misconception that may result from this stereotype is that young children, particularly skinny ones, are not prone to developing OSA. Not only is OSA quite prevalent in children, it is also easy to miss, in part because the daytime symptoms from OSA can be different in children as compared to adults.
For adults, the most common daytime symptom is excessive daytime sleepiness: drowsiness, a tendency to struggle to stay awake or to fall asleep at inopportune times, no matter how much sleep is obtained at night. Children are different. For many kids, the primary daytime manifestations of OSA are distractibility and irritability, potentially leading to poor school performance, problems concentrating, an inability to stay on task for long periods of time, and chronic conflicts at home or at school. Sound familiar? Patients diagnosed with ADHD also have such symptoms. Additional symptoms attributable to pediatric sleep apnea would include bedwetting, sleep-talking, sleep-walking, frequent sleep disruption, headaches, profuse night sweats, learning problems, depression, and retarded growth.
A big clue to possible OSA is snoring. The snoring of a young child, particularly 8 years of age and younger, really should be brought to the attention of the child’s pediatrician. A child’s or teenager’s loud snoring should most definitely be discussed with the doctor. And certainly if there are witnessed breathing pauses or gasping noises, the child’s doctor needs to be alerted as soon as possible.
Tonsillectomy and adenoidectomy represent the most common form of treatment for pediatric sleep apnea. For many children, the removal of tonsils completely solves the problem, and it’s amazing how much the child’s (and family’s) life can change for the better as a result.
So today’s pearl, reflecting these recent news from the CDC: sleep apnea is one of the most under-recognized and under-diagnosed medical disorders for children, and can present clinically in a way that is very similar to ADHD. If your child is snoring at night and distractible or irritable during the day, I would recommend a sleep evaluation.
Have a great day, everyone!