ADHD and Sleep Disorders – What Are We Missing?

Budgeting in the New Year
January 13, 2017
Know Thy Neighbor
January 31, 2017
Budgeting in the New Year
January 13, 2017
Know Thy Neighbor
January 31, 2017

“Sleep is the golden chain that ties health and our bodies together.” — Thomas Dekker

Is there a link between Attention Deficit Hyperactivity Disorder (ADHD) and sleep disorders in children?

The following excerpt from Chicago Parent (2014) offers a personal glimpse of the correlation between sleep disorders and ADHD symptoms:

Connor Deegan punched holes in the wall. He attacked a girl at school. He threw violent temper tantrums to the point of vomiting. He threatened to kill himself.

“I wish I was dead,” he repeatedly hissed to his parents.

Connor was just 10 years old.

“He was one violent temper tantrum away from being admitted to a behavioral health hospital,” says his mother, Valerie Deegan, of Woodstock.

His frustrated mother was tempted to do so, anything for a short reprieve.

“He was tearing our family apart,” says Valerie, who also has two daughters. “I know it sounds horrible, but I was wishing he wasn’t even born.

Was Connor suffering from ADHD, Oppositional Defiance Disorder or a medical condition often overlooked and under diagnosed:  sleep deprivation?

The term Attention Deficit Hyperactivity Disorder (ADHD) is used to describe impulsivity, inattentiveness, and hyperactivity. It starts in childhood and may, in some cases, persist into adulthood. People with ADHD have trouble sitting still, staying focused, and controlling their emotions and behavior. This can lead to isolation, dependence, lower social skills, and poor performance in school. Children with ADHD, therefore, require the concerted efforts of parents, teachers, healthcare and mental health professionals to identify coping skills to help kids succeed in school and sports

A recent study conducted at the Albert Einstein College of Medicine of Yeshiva, the largest and most comprehensive of its kind,  evaluated and followed more than 11,000 children for over six years.  This study concluded that toddlers with sleep-disordered breathing  are at greater risk for behavior, emotional problems and are more likely to develop behavioral problems including hyperactivity and aggressiveness, as well as emotional and friendship difficulties.

Sleeping problems

Sleep-disorder breathing can be classified into two categories and manifests itself in both through snoring:  upper airway resistance syndrome (UARS), and obstructive sleep apnea-hypopnea syndrome (OSAHS).  Upper airway resistance is characterized by sleep arousals due to diminished airway and is often associated with snoring in children. Apnea literally means “without breath,” and occurs when your child stops breathing while asleep. Sometimes it happens hundreds of times in one night and each incident can last a minute or longer. These breath stoppages don’t really trigger full awakening, and the sleeper is, therefore, unaware of them. The result is poor quality sleep, which makes one tired during the day leading to daytime sleepiness.

What to look for in your child

In most cases, the causes of airway obstruction are anatomical in nature.

Is your child a mouth breather? Without the pressure of the tongue on the roof of the mouth while your child is growing, a narrow palate can develop. Having a mouth that develops a higher arc while asleep prevents ease of air flow into the lungs. Additionally, enlarged adenoids and tonsils can take up most of the space at the back of your child’s throat. With an airway constricted to the size of a straw, air cannot flow freely into the lungs.

Symptoms of sleep deprivation

In the case of Connor Deegan, physical signs included lips apart with mouth closed, dark circles under his eyes, forward head posture, mouth open, recessed jaw and long face.  Valerie Deegan experienced her son as a noisy eater, noticed him snoring and gasping during the day and night, and found that he troubled with asthma. She described his sleep as restless; he would fall asleep very fast, fighting to stay awake yet hard to wake in the morning and was embarrassed by nighttime bed wetting.

A child who wakes up in a messy bed is more likely to be experiencing sleeping problems. Unlike adults who look and act tired after a bad night’s sleep, children often manifest sleep deprivation by becoming more hyperactive in order to keep themselves awake. Snoring during sleep is a sure sign that a child is having problems breathing, and is likely to be sleep deprived. A kid who takes a long to get to sleep, and wakes up too early should also be watched closely.

Evaluation

It is important if your child is diagnosed with ADHD, a thorough evaluation of your child’s tonsils and airway be sought to determine if ADHD is the correct diagnosis or if sleep deprivation are the cause of symptoms. If you are wondering if your child might by suffering from sleep disordered breathing, a simple screening device called the Medibyte can be used at home to evaluate the quantity and quality of your child’s sleep. Although the Medibyte can be purchased over the counter, reading and interpreting the results can be confusing.  Dentists and pediatricians trained in diagnosing and treating sleep disorders can evaluate your child’s airway, dispense the Medibyte and refer for additional testing if indicated.

For more information about sleep-disorder breathing or to find a professional in your area to discuss treatment options, visit the American Academy of Physiological Medicine and Dentistry at www.aapmd.org.

Kathryn Druzbicki, MS, LMHCA

Therapist

Clarity Clinic

References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders DSM-5 (5th ed.). Washington: American Psychiatric Association.

Chervin, R., Ruzicka, D., & Giordani, B. (2006). Sleep-Disordered Breathing, Behavior, and Cognition in Children Before and After Aden tonsillectomy. Pediatrics, 769-778.

Davich, J. (2014). Finding Connor. Chicago Parent, 36-40.

Fischman, S., Kuffler, D., & Bloch, H. (2015). Disordered Sleep as a Cause of Attention Deficit/Hyperactivity Disorder: Recognition and Management. Clinical Pediatrics, 713-722.

Gottlieb, D., Vezina, R., & Chase, C. (2003). Symptoms of Sleep-Disordered Breathing in 5-year old Children are Associated with Sleepiness and Problem Behaviors. Pediatrics, 870-877.

O’Brien, L., & Holbrook, C. (2003). Sleep and Neurobehavioral Characteristics of 5-to7-year old Children with Parentally Reported Symptoms of Attention-Deficit/Hyperactivity Disorder. Pediatrics, 87-92.

Palombini, L., Lopes, M.-C., Tufik, S., Christian, G., & Bittencourt, L. (2011). Upper airway resistance syndrome: still not recognized and nor treated. Sleep Science, 72-79.

Park, S. Y. (2009). Sleep, Interrupted. New York: Jodev Press, LLC.

Leave a Reply

Your email address will not be published. Required fields are marked *

For security, use of Google's reCAPTCHA service is required which is subject to the Google Privacy Policy and Terms of Use.