Kids acting up? Maybe they need an old-fashioned T&A

The connection between behavior problems and sleep interrupted by breathing problems presents two questions:

Research published in the April 2006 issue of Pediatrics hints at an answer. The authors followed a group of 105 children 5 to 13 years old scheduled for surgery: 78 of the children were to undergo adeno-tonsillectomy (AT), usually for suspected sleep-disordered breathing (SDB), and 27 were scheduled for surgical procedures unrelated to sleep problems. Before the surgery, the AT patients were judged more hyperactive by their parents and were more likely to be diagnosed with ADHD by a child psychiatrist: 22 of the AT patients (28%) were diagnosed with ADHD before surgery, compared to only two (7%) of the controls. When the children were re-examined a year after surgery, however, only 11 (50%) of the AT children still qualified for the ADHD diagnosis. These improvements in the AT children are remarkable, according to the authors, because "hyperactivity and inattention generally are expected to be chronic features in affected school-aged children."

These findings suggest that even mild SDB carries the risk for substantial neurobehavioral morbidity, and that the morbidity may be reversible after AT surgery allows the children to get a solid night's sleep. The sample is small and the study was not a prospective study, but it may be worthwhile asking parents whether their ADHD child snores and, if he does, exploring the possibility of AT surgery to relieve both breathing difficulty and ADHD.