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Sleep Disorders and ADHD
Is there a connection between sleep disorders and ADHD in children. I recently came across a very provocative study that appeared in the December 1997 issue of the journal Sleep which suggests that this may be the case.
The authors of this study sought to determine whether children with higher levels of inattention and hyperactivity more frequently have symptoms of sleep related breathing disorders (SRBDs) or periodic limb movement disorders (PLMD) than children without these symptoms.
Parents of 70 children at a child psychiatry clinic and 73 children at a general pediatric clinic were interviewed to assess their child's behavior, snoring, complaints of "restless legs" at night, and daytime sleepiness. Standardized ratings of DSM-IV symptoms of ADHD were used to establish a whether a child had ADHD (this was really not a full diagnostic work up) and a validated pediatric sleep questionnaire was used to assess sleep difficulties.
The authors report that habitual snoring was more common among the children with ADHD (33%) than among other children from either the psychiatric clinic (11 %) or pediatric clinic (9%). Associations between ADHD symptoms and the other sleep difficulties assessed (e.g. restless legs, daytime sleepiness) were also found, although these results were not as strong as for snoring.
The authors suggest that their results SRBDs and perhaps some other sleep disorders could be a cause of ADHD in some children. (It is important to note, however, that nothing about this study established any causal connection between snoring and ADHD. In other words, these results suggest that snoring is associated with ADHD but it can not be concluded that this sleep difficulty is a cause of ADHD.) If a causal connection were to be established, the authors suggest that as many as 25% of children with ADHD could have their ADHD eliminated if their habitual snoring and any associated sleep difficulty were successfully treated.
This is a very interesting study and replicates prior work in which an association between sleep difficulties and ADHD has been documented. Although it is premature, in my opinion to suggest that sleep difficulties are an important cause of ADHD for some children, this information can still have important clinical implications.
For example, other work in this area has found a link between children's sleep and their cognitive functioning (see the March 1996 issue of the Seminar in Pediatric Neurology). Apparently, inadequate sleep results not only in tiredness, but also can produce difficulties with focused attention, irritability, and difficulty modulating impulses and emotions. Clearly, this mimics some of the symptoms of ADHD, and it would appear prudent to rule out sleep problems as the source of a child's difficulties when making the diagnosis.
It may be thus be quite important to assess whether your child or patient with ADHD experiences the type of sleep difficulties that were found to be more frequent among the children with ADHD in this sample. Even if these sleep problems are not the cause of a child's ADHD symptoms, it is certainly the case that inadequate sleep is likely to make things worse. Treating these sleep problems could potentially have a beneficial effect on the ADHD symptoms for some children. In my own practice, I have found this to be true on several occasions. Discussing this issue with your child's physician would be a good thing to do.
Note: This article originally appeared in Attention Research Update, an online newsletter written by Dr. David Rabiner, a Duke University psychologist and former member of CHADD's Professional Advisory Board. You can learn more about Attention Research Update and sign up for a free subscription at www.helpforadd.com.