Diagnosing the Wrong Deficit - ADHD or Sleep Disorder?

Tuesday, November 19, 2013

I recently posted an updated version of my blog ADHD U.S.A. - Is Rise in ADHD Treatment Truly Justified? Well, apparently in my research for this blog I overlooked an article from the New York Times published in April, 2013 entitled Diagnosing the Wrong Deficit, by Vatsal Thakkar. As I have pointed out many times, ADHD is a much "trickier" diagnosis to make than most pediatricians, family doctors or mental health professionals give it credit. In many instances, children have sleep disorders such as sleep apnea that manifest themselves in daytime inability to focus, irritability, distractibility - you name it. A simple checklist of symptoms of ADHD will almost invariably show elevations in these symptoms, leading many down the primrose path and a wrong diagnosis.

Unless I forget (I am human afterall) I try to obtain a good sleep history in each of my new patient evaluations. Does the parent or caregiver ever hear Johnny snoring at night? Are there periods where Suzie's breathing stops or appears to be gasping for air? Are the Tyler's tonsils the size of grapefruits (only a slight exaggeration - I have witnessed some childrens' tonsils actually touching each other!)

Mr. Thakkar's New York Times article cited one study where 50% of children who had their tonsils surgically removed had complete "cure" of their ADHD-like symptoms. I have had similar results in my own clinical practice by referring some children to a sleep specialist who, in turn, referred the child to an ear, nose and throat doctor for a tonsillectomy. Voila! No more need for Ritalin!