Snoring and mouth-breathing may be a sign your ADHD kids is actually just sleep deprived. ADHD medication may be doing harm
Parents turn to physicians to get an ADHD diagnosis to explain troubles at school or play with friends. And more and more adults are coughing up $600 in Canada to get an adult ADHD diagnosis online through clinics like Frida. But before you dispense the Brillia or get a prescription for Ritalin or Concerta for your kid’s ADHD, there may be other causes in play, finds a new study that points to sleep:
“There is a high probability that many children who receive medication for ADHD actually suffer from breathing disorders during their sleep. Due to the incorrect diagnosis, the real problem is left untreated, and the unnecessary treatment may even worsen the situation,” say researchers from Tel Aviv University.
The study’s findings showed that children who suffer from breathing disorders during sleep received ADHD medication at a rate 7 times higher than children who don’t suffer from sleep-disordered breathing.
The article was published in the Journal of Clinical Medicine and a follow-up study was published in the same Journal of Clinical Medicine in 2023.
Dr. Shani Kaminsky-Kurtz, Dr. Sigalit Blumer, Prof. Ilana Eli, Dr. Alona Emodi-Perlman, and Dr. Yarden Shreiber-Fridman, all from the Goldschleger School of Dental Medicine at Tel Aviv University carried out the research.
“People with ADHD may experience sleep issues, such as insomnia or circadian rhythm disorders,” say specialists on the Frida website: “These issues may cause delayed sleep patterns, poor sleep quality, and difficulty waking up in the morning.”
Or the reverse may be true, at least in children: sleep issues may be causing what looks like ADHD. A recent unrelated study on sleep also found how lack of sleep can be linked to suicide in teens. Dr. Blumer explains: “For the most part, sleep breathing disorders in children usually manifest as snoring (according to various studies, between 8% to 27% of children snore in their sleep) and/or partial or as complete interruptions of breathing (between 2% to 3% of children suffer from an extreme state of obstructive respiratory arrest during sleep).
These disorders disrupt the oxygen saturation levels in the blood during sleep, which is especially important in children, because most of the growth and development processes take place during sleep. The lack of oxygen in the blood can harm the growth and development of the brain and cause cognitive and behavioral disorders while awake – such as learning difficulties, hyperactivity, fatigue and lack of concentration. These symptoms are similar to the characteristics of ADHD or ADD, which often leads to a misdiagnosis and treatment with drugs such as Ritalin, which is ineffective and causes side effects.”
Dr. Shani Kurtz-Kaminsky: “Despite the great significance of sleep-disordered breathing, there is still a considerable under-diagnosis of the phenomenon among children, in the world in general and in Israel in particular. The most reliable way of diagnosis is by monitoring them in a sleep lab, but this is an expensive procedure with limited availability, and is also unsuited for children.
For this reason, a reliable and more accessible diagnostic tool was developed in the US, which has been proven to be simple and effective: the Pediatric Sleep Questionnaire (PSQ). The questionnaire, which is addressed to the child’s parents, includes 22 yes/no questions and refers to three main categories: snoring and breathing problems during sleep, alertness levels during the day, and behavior during the day. Answering ‘yes’ to 8 or more questions requires further investigation.
The study was conducted among 227 children aged 4-12 who were treated at the children’s clinic of the TAU School of Dentistry in the years 2020-2022. The children underwent a comprehensive clinical examination of the oral cavity, and their parents were asked to fill out a PSQ questionnaire, alongside a questionnaire surveying the child’s general health. A statistical analysis of the findings of the tests and questionnaires revealed an unequivocal picture: children who suffer from sleep-disordered breathing were taking ADHD medication at a rate 7 times higher than children without sleep-disordered breathing.
In addition, the findings indicated clear correlations between the disorder and the symptoms of discontinuous sleep (6 times higher than their counterparts), mouth breathing (5 times higher), and snoring (3 times higher). Dr. Emodi and Prof. Eli warn that “Our findings raise a red flag: there is a high probability that many of the children who suffer from sleep breathing disorders are receiving medication for ADHD due to a misdiagnosis.
And so, not only is the real problem being left untreated, but the unnecessary treatment may even make the situation worse. Following the study, we compiled a list of 4 characteristics related to sleep-disordered breathing, which can be identified with the help of a few simple questions presented to parents: taking medications for ADHD, discontinuous sleep, snoring, and mouth-breathing.
We wish to shine a spotlight on the phenomenon and its dire consequences, and recommend that medical professionals who treat children – dentists, family doctors, pediatricians and others – ask a simple series of questions for each patient. A positive finding should raise a red flag, and requires further inquiries.”
