ADHD and SDB are completely different issues but both present similar signs and symptoms in children. Making a misdiagnosis in a child will have a big short-term negative impact and could have consequences that may affect them for the rest of their life.
The drug commonly prescribed for ADHD is Ritalin. Nearly 3 billion doses of this drug have been consumed. The side effects of Ritalin are:
Trouble sleeping
Nervousness
Loss of apatite
Vomiting
Headaches
What do you think would be the outcome if a drug that prevented sleeping was administered to a child with SDB?
So, what are the effects of SDB in children apart from being permanently tired, irritable and unable to concentrate? If children are not breathing correctly at night, for example, snoring or mouth breathing, they commonly fail to get into a deep sleep, termed slow wave sleep and spend the night having many small sleeps. Human growth hormone is released during slow wave sleep and this hormone is responsible for growth and development of the child. Reduction in human growth hormone due to SDB will prevent the child from developing as they should.
The specialist responsible for making an ADHD or SDB diagnosis should be the paediatrician, so could a paediatrician differentiate between SDB and ADHD? The answer to this question is mostly no. In a study of the members of the American Academy of Paediatrics which looked at sleep screening practices amongst paediatricians, researchers discovered that fewer than one in five had received any training in sleep disorders (1).
The sooner that an SDB diagnosis is made, the better. This can only be done by having a sleep study. This is the only way to differentiate between SDB and ADHD.
Doctor Karen Bonuck researched 11,000 snoring kids and studied them at 6, 18, 30, 42, 54 and 69 months. Children who had peak SDB symptoms before 18 months that resolved still predicted 50% increased odds of behaviour problems at 7 years (2). Snoring in babies is not cute and should be addressed immediately.
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- Faruqui, F., et al. Sleep disorders in children: a national assessment of primary care paediatrician practices and perceptions. Paediatrics. 2011. https://pediatrics.aappublications.org/content/128/3/539
- Bonuck, K., et al. Sleep-disordered breathing in a population-based cohort: behavioural outcomes at 4 and 7 years. Paediatrics 2012; 129: 1-9.