New research suggests a surprising potential treatment for at least some children with attention deficit hyperactivity disorder -- surgical removal of the tonsils.
Children in the study who had their tonsils removed showed improvements in both behavior and sleeping, and half of those diagnosed with ADHD prior to surgery no longer had the diagnosis a year later.
The University of Michigan study included 78 children who had their tonsils and adenoids removed and 27 children who had unrelated surgery.
Prior to surgery, behavior and sleep problems were much more common among the children with the sleep breathing issues. By the end of the study, a year after surgery, tests showed little difference between the two groups.
“These findings help support the idea that sleep-disordered breathing is actually helping to cause behavioral problems in children, and making them sleepy,” says Ronald D. Chervin, MD, one of the researchers.
Chervin tells WebMD that it is not clear how many children with ADHD also have undiagnosed sleep-related breathing problems, but he says a “substantial minority” might.
Enlarged Tonsils Cause Sleep Problems
Chervin and colleagues had previously reported that children who snore have a higher incidence of ADHD and other attention and behavior-related problems.
Snoring is the most common symptom of obstructive sleep apnea (OSA), which occurs when breathing stops and starts repeatedly during the night. This usually happens because the throat is narrowed or blocked, keeping air from getting into the windpipe and lungs.
Enlarged adenoids and tonsils are often to blame when a child has OSA. It is estimated that about 1 percent to 3 percent of children have the condition.
In their latest study, published in the April issue of the journal Pediatrics, the researchers conducted sleep testing on children with and without suspected sleep-disordered breathing, as well as behavioral, cognitive, and psychiatric testing.
All children were assessed upon study entry, prior to the removal of the tonsils and adenoids, and then again a year after surgery. Parents also completed standardized questionnaires designed to assess their child’s behavior.
Although the children who had their adenoids and tonsils out scored worse than the other children on behavioral tests before the surgery, scores among the two groups were similar a year later.
Of the 22 children in the adenotonsillectomy group who had been diagnosed with ADHD, 11 no longer met the conditions for the behavioral disorder a year after surgery.
Sleep Improved for Most
Most of the children who had their tonsils out also had dramatic improvements in sleepiness, as measured by standardized sleep tests. Roughly 12 percent had OSA a year after surgery, compared with 51percent before surgery.
The children with OSA before tonsil surgery and those without the sleep disorder had similar levels of hyperactivity prior to surgery and similar behavioral improvements after surgery.
Chervin tells WebMD that sleep test results in children don’t always correlate with their daytime behavior, suggesting that tests used in children may need to be re-evaluated.
“It is possible that we may not be measuring the right things when we do sleep studies in children,” he says.
Pediatrics professor Michael Light, MD, tells WebMD that most doctors now recognize that children with sleep-disordered breathing issues also have a higher incidence of behavioral issues.
He adds that it is less clear that surgically treatable sleep problems are a major cause of ADHD.
Light is a professor of clinical pediatrics at the University of Miami, and he leads the American Academy of Pediatrics committee on pulmonology.
“The message I would take from this is that we need to evaluate these kids to find out if they have symptoms that suggest sleep-disordered breathing,” he says.
By Salynn Boyles, reviewed by Louise Chang, MD
SOURCES: Chervin, RD, Pediatrics, April 2006; vol 117: pp 769-778. Ronald D. Chervin, MD, MS, associate professor of neurology, University of Michigan at Ann Arbor; and director, Michael S. Aldrich Sleep Disorders Laboratory, Ann Arbor, Mich. Michael Light, MD, professor of clinical pediatrics, University of Miami; chairman, AAP committee on pulmonology.