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Have an ADHD Child or Patient? Make Sure They Get a Sleep Eval

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How do you feel when you don’t get a good night's sleep?  Maybe the kids were sick, or a neighbor had a loud party, and now you’re running on four to six hours instead of your usual eight. How do you feel the next day?  Do you have trouble paying attention? Are you spacier than usual?  Do you seem a little ADHD? There’s a growing body of evidence that, for some kids with ADHD symptoms, the underlying culprit may be sleep-disordered breathing, not a brain difference.

At the most recent American Academy of Pediatrics National Conference,  a speaker reminded pediatricians that there is a clear link between ADHD symptoms and sleep disorders.  Dr. Grace Wang, a professor of Pediatrics at Penn State, presented a case study on a young girl and used it as a jumping-off point to clarify the link between ADHD and sleep-disordered breathing.

Asking the Right Questions

The six-year-old girl had severe ADHD symptoms, and the screening tools and examination didn’t indicate any exhaustion. However, she was lucky, because her pediatrician recalled that some children with ADHD need to be screened for sleep issues.  When the doctor asked the parents more questions, she discovered that the child was a mouth-breather, snored, was a restless sleeper, sleepwalked, and fell asleep in the car every day on the way home from school. 

Because the parents were used to these quirks in their daughter’s behavior, they didn’t think to mention them to the doctor until asked.   After a sleep study, the child was diagnosed with SDB. She underwent surgery and her ADHD symptoms resolved.

ADHD Symptoms are Linked to Sleep Disorders

Dr. Wang used this child as an example, not because she was unusual, but because she represents a common set of symptoms:

  • 25% of ADHD kids have full-blown obstructive sleep apnea (OSA)
  • 33% of ADHD kids snore
  • 25-64% of ADHD kids have sleep-disordered breathing that does not meet the diagnostic criteria for OSA
  • Restless leg syndrome, which is treatable by iron supplements, is also common among kids with ADHD symptoms
  • Children with Delayed Sleep-Wake Phase Disorder also present as ADHD

Taken all together, these are an important reminder:  A tired kid looks a lot like an ADHD kid.  

Get Those ADHD Kids Screened for Sleep!

Some ADHD children may simply be tired children.  When you fix sleep breathing and other issues, their symptoms will disappear.  Because medications have side effects, sleep should be our first line of investigation when a child presents as ADHD, especially if there is no family history of the disorder.

For kids who have brain differences causing ADHD, sleep is still important. Poor sleep will exacerbate the symptoms of ADHD in these kids. Because it takes them more work to concentrate, sit still, or control their emotions, they need a full night’s sleep to function.  Even if better sleep can’t totally cure their ADHD, it can make them more responsive to therapy and medications and set them on the path to success.

If a parent reports that their child has an ADHD diagnosis or is on ADHD meds, make sure you do a sleep screening with them.  Ask the right questions so that these kids can get help.

If you’re the parent of an ADHD child, talk to your physician or dentist about pediatric sleep issues – let’s get sleep breathing settled, so that every child can have the tools to succeed!