If you take a look around you today, it is likely that you will know at least one parent with a child with attention deficit hyperactivity disorder, also known as ADHD. According to the CDC, some 5 million kids aged between 3 and 17 are currently diagnosed. Interestingly, however, this seems to be more than it should be.
The American Psychiatric Association states in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that 5% of children have ADHD1. However, studies in the US have estimated higher rates in community samples.
So what does this mean? Is the CDC wrong? Is the APA wrong? Are children being diagnosed with behavioral issues when there is actually something else going on? According to many experts and according to parents who have children who truly have ADHD, the disorder is greatly over-diagnosed. According to the general public, ADHD actually points to parents not being able to control and discipline their children anymore. But according to experts, the real source is sleep.
Sleep and ADHD
The National Sleep Foundation is currently looking at the link between ADHD and sleep patterns and they have come to some very interesting conclusions by studying over 11,000 children.
ADHD is linked with a variety of sleep problems. For example, one recent study found that children with ADHD had higher rates of daytime sleepiness than children without ADHD. Another study found that 50% of children with ADHD had signs of sleep disordered breathing, compared to only 22% of children without ADHD. Research also suggests that restless legs syndrome and periodic leg movement syndrome are also common in children with ADHD.
What is particularly interesting in this is the cause and effect relationship, better known as the chicken or the egg paradox. Do people with ADHD develop sleep problems, or do sleep problems lead to ADHD? A pediatric study looked at three specific sleep problems: apnea, breathing through the mouth and snoring. It found that the more children suffered from these conditions, the more likely they were to develop ADHD.
When someone does not sleep enough, the neurons in the prefrontal cortex region can become damaged. This is believed to be because the neurons do not receive sufficient oxygen. As a result, the restorative processes of sleep cannot be completed properly, leading to different issues when children are awake.
Because of the fascinating results of this preliminary study, it was repeated to target more specific children. This study looked at 263 children who were slightly older. Some of these had sleep disordered breathing (SDB), and some did not. They were monitored twice at a five year interval and the results were fascinating.
Youth with current SDB exhibited hyperactivity, attention problems, aggressivity, lower social competency, poorer communication, and/or diminished adaptive skills.
These results were incredibly significant and made experts review and rethink a lot of the knowledge available on ADHD. Many children who suffer from apnea have their tonsils removed. A group of 78 children who had their tonsils removed in 2006 was studied. When going for the surgery, 28% had an ADHD diagnoses. One year later, however, half of those no longer had the diagnosis. As such, it may be that sleep problems are being misdiagnosed as ADHD.
If ADHD is indeed being misdiagnosed, this could cause significant problems. The biggest problem is that the medication used to treat ADHD, such as Ritalin and Vyvanse, are stimulants and have negative side effects.
Common side effects of Ritalin include nervousness, agitation, anxiety, sleep problems (insomnia).
Considering the rate of ADHD diagnosis is going up, and the rate of prescriptions is going up as well, this could actually be creating a huge problem.