Common sleep disorders in kids may be misdiagnosed as ADHD

Reduce children’s time in front of the television or computer games, especially in the evening close to bedtime, as these activities can result in overstimulation of the brain and an inability to fall asleep

By: Michael Nolledo, M.D.
   Children who have been diagnosed with ADHD — attention-deficit
hyperactivity disorder — often have trouble in a classroom setting. They
may be distracted very easily; they may not be able to stay focused on a task.
In addition to problems with inattention, they may exhibit impulsive behavior
that is inappropriate for their age and be labeled as difficult or uncooperative.
   The number of ADHD diagnoses has been on the upswing in recent
years. Today the condition is believed to affect 5 to 10 percent of school-age
children, boys more frequently than girls.
   There are studies, however, that indicate that ADHD may be
overdiagnosed in this country and that certain cases are not ADHD at all, but
a sleep disorder that has not been diagnosed. Many symptoms of ADHD mimic the
symptoms of a sleep disorder, especially the inability to focus and the lack
of a long attention span.
   Since sleep, and getting enough of it, plays such a vital
role in the emotional and behavioral health of children, it is important that
when looking at a possible diagnosis of ADHD, the possibility of a sleep disorder
is also explored.
   There are more than 80 types of sleep disorders. The most
common that affect children are obstructive sleep apnea (the cessation of breathing
that occurs during sleep because of an obstruction of the upper airway) and
periodic limb disorder, which is characterized by frequent movements including
twitches of the arms and or legs that disrupt sleep.
   Researchers at Brown University discovered that when children
were deprived of sleep for several days, they developed symptoms of ADHD. Each
additional night of poor sleep escalated their levels of hyperactivity. The
study concluded that an undiagnosed sleep disorder puts children at risk of
being misdiagnosed as ADHD. If the sleep- and related health problems remain
undetected, their health in general could be placed in jeopardy.
   Another study looked at children diagnosed with ADHD to find
out how many of them experienced the two commonly occurring sleep disorders
in that age group mentioned above.
   Twenty-two boys and eight girls were studied over a two-year
period. The mean age for the group was just under 10 years old. The study discovered
that eight of the 30 children had obstructive sleep apnea, 10 had periodic limb
movement disorder, and one child had both. Overall, 19 of the 30 children with
ADHD had either obstructive sleep apnea or periodic limb disorder, establishing
a link between ADHD and a sleep disorder.
   Additional sleep research has shown that 11- and 12-year-olds
who get less than six-and-a-half hours of sleep per night have attention and
behavior problems that mimic ADHD.
   Sleep deprivation also influences the cognitive function of
the brain. One night of sleep loss can reduce the brain processing capacity
by 30 to 40 percent. Two nights without sleep will reduce the attentive and
cognitive functions by as much as 60 to 70 percent.
   How much sleep is enough sleep? While there is a good deal
of variety in the amount of sleep people need, there are some typical minimum
sleep durations that are desirable. Infants and toddlers need the most sleep,
17-18 hours a day. At the other end of the spectrum, those aged 60 and over
need about seven hours. A typical 10-year-old should be getting between eight
and nine hours of sleep a day for optimal performance.
   One way to make sure your child gets enough sleep is to firmly
establish sleep routines and stick to defined bedtimes. Reduce time in front
of the television or computer games, especially in the evening close to bedtime,
as these activities can result in overstimulation of the brain and an inability
to fall asleep.
   It is important for both parents and physicians to be on the
lookout for red flags that could indicate a possible sleep disorder. These include:

  • Hyperactivity
  • Gasping or choking during sleep.
  • Snoring.
  • Daytime sleepiness or fatigue
  • Frequent awakenings during the night.
  • Frequent leg or arm movements during sleep.
  • Insomnia.
  • Problems with memory or concentration.
  • Unusually large tonsils (also known as "kissing" tonsils)
  • Sleepwalking.

   If sleep problems persist, a sleep study can help a physician
to determine an accurate diagnosis for a sleep disorder.
   At University Medical Center at Princeton, sleep studies are
usually performed during an overnight stay. Parents of children who may be undergoing
a sleep study are invited to stay in the room overnight.
   Technologists stay up all night monitoring physiologic information
captured by sensors that are placed on various parts of the body, including
the face, scalp, chest and legs. The data is recorded by a state-of-the art
digital sleep recording.
   These sensors measure brain wave activity, eye movements,
chin muscle activity, limb and other body movements, heart rate and rhythm,
airflow from the nose and mouth, respiratory effort, EKG, blood oxygen level,
and whether there is any snoring. The results are used to identify any clinical
problems that may be disrupting sleep.
   Adults also suffer from sleep disorders. In fact, many of
the sleep disorders and symptoms found in children are also experienced by adults.
   Anyone interested in learning more about sleep disorders can
find out more during an upcoming community education forum. To promote awareness
about sleep disorders and in celebration of National Sleep Awareness week, UMCP’s
Sleep Center and PHCS Community Education and Outreach are sponsoring a program
called "Sleep and Your Health." The event will be held on Tuesday, March 6,
at the hospital, which is located at 253 Witherspoon St.
   For more information about the Sleep Center at UMCP, call
(609) 497-4469 or visit www.princetonhcs.org.
To find a physician with Princeton HealthCare System, call (888) 742-7496 or
visit www.princetonhcs.org.