The diagnosis of ADHD (attention deficit hyperactivity disorder) has grown dramatically in recent years. Some recent studies are reporting that 1 in 5 high school boys are being diagnosed with ADHD, and the number is increasing.
While the diagnosis of ADHD should be made by a child's medical doctor after a careful evaluation of all the factors involved, there are times when the cause of the hyperactivity can be difficult to pinpoint.
Based upon my studies in the last year surrounding the dentist's role in evaluating and assisting physicians in treating sleep apnea, some of those patients may actually be misdiagnosed cases of sleep apnea.
Some who are reading this may be asking, "What does sleep apnea have to do with ADHD? Isn't sleep apnea basically a middle-aged obese guy's issue?" Those readers would be correct. By far the most common person with obstructive sleep apnea is in fact an overweight male over 40. However, at least 30 percent of those eventually diagnosed with the condition do not fit that profile. Patients of all ages, gender and size can have sleep apnea, including young children.
I can hear the reader asking the next question, "How does that work? Aren't kids with ADHD by definition hyperactive, not sleepy?" That is true. However, adults and kids react differently sometimes. When adults don't get enough sleep, they are tired the next day. Kids don't always respond that way. They often get hyperactive during the day and exhibit symptoms like poor behavior or performance in school, crankiness, lack of focus and daydreaming. These are very similar to the symptoms used to diagnose ADHD.
The next logical question would be, "So what types of things should a parent look for? How do you tell the difference between true ADHD and symptoms that may be caused by a lack of oxygen during sleep?"
There are things to look for, that your pediatrician or a properly trained dentist should be able to see and share with you. Tell them if your child snores, or has been diagnosed with ADHD previously as part of their medical history review. Ask them to look for enlarged tonsils, a high palate, a small lower jaw or crooked teeth.
Other signs may include sweating heavily at night and bedwetting in younger children or at least frequent trips to the bathroom. These all point toward the need for evaluation for Obstructive Sleep Apnea.
Poor sleep also affects growth and development, including a tendency toward obesity, which only makes the sleep apnea problem worse due to increased fat deposits around the neck.
What should a parent do if they see some of these symptoms in their child? The first thing is to realize that timing is critical. A chronic lack of oxygen to the brain of a developing child can have serious consequences to their cognitive development, not just their behavior. Get them evaluated by a dentist or orthodontist trained in sleep apnea screening or a pediatrician or ENT specialist knowledgeable in pediatric airway issues. Obstructive sleep apnea can only be diagnosed in children through sleep testing procedures done in a hospital setting.
Depending on the diagnosis, a child may have to have their tonsils and adenoids removed. An orthodontist may also need expand the upper jaw to properly develop the floor of the nasal cavity and further develop the jaws to make room for the tongue.
This evaluation should be done early in life, when the baby teeth are still present, if you suspect sleep apnea or hear your child snoring routinely.
Snoring is not normal, especially in children, except when they occasionally have a cold or allergy issues. The old idea of waiting to have orthodontic evaluation until all the permanent teeth come in is outdated and, for a child with sleep apnea issues, could have dangerous and permanent consequences to their overall health.
If a parent suspects or has been told that their child has ADHD, they owe it to them to look at sleep apnea issues as a possible cause or contributing factor before placing a child on a lifetime prescription of ADHD medication.
There are several qualified dentists, orthodontists and ENT specialists right here in Auburn that are be able to help you save your child from the complications surrounding undiscovered sleep apnea. Get them evaluated today.
Stuart Rich, DDS is the owner of Simply Smiles, a general dental practice in Auburn. He also has a special interest in sleep medicine, and is a member of the American Academy of Dental Sleep Medicine and the Academy of Clinical Sleep Disorders Disciplines.