When is ADHD not ADHD? When the ADHD is actually a tired child.
Attention Deficit Hyperactivity Disorder, or ADHD. Most of us who grew up in the 80’s, 70’s or earlier have probably thought that ADHD was a made up problem. When we were kids they didn’t say we had ADHD, they said we were “a spaz” or “high strung” or (if your parents were really supportive) “spirited.” Now it seems that thousands and thousands of children have been, and are being, diagnosed with ADHD and put on medications like Ritalin and Adderall to manage it.
So let’s look at ADHD from a different perspective--a sleep perspective.
How does a young child, say between 2 and 8 years old, typically react to staying up way past their bedtime? If you have children, or have been around younger children in such a scenario, you know the answer: they get “wired,” “cranky,” “hyper.” I’ve seen young children become completely belligerent when they were tired and unable to communicate….literally going into a “temper tantrum.”
I have 6 children so believe me, I’m an expert in this area!
On several occasions (I’m a slow learner) I have experienced the trauma of a tired child, or tired children. On one such occasion I was being “father of the year” and took my children to Disney World. Well, after walking 50 miles, standing in lots of lines in the summer heat and humidity, and spending $258 on a lunch of Disney Burgers and Mickey Fries (so much more magical than regular burgers and fries), I decided that we just had to go and watch the fireworks…because the kids would enjoy it so much. Since fireworks shows are traditionally performed in the dark, and in the summer the dark comes rather late at night, we stayed until quite late. As expected, the fireworks were very cool and the kids really enjoyed them.
Then came the march back to the train, to take us to the bus, to take us to our car, so we could drive back to our condo. My family performed this ritual with thousands of other families and I began to realize that all around me a similar phenomenon was taking place… Whining. Crying. Complaining. Not paying attention. Not following directions (and nearly getting lost every couple of seconds). I was surrounded by overly hyper children.
Now perhaps you could blame some of this behavior on the excitement of Disney, or the cotton candy and ice cream, or seeing Mickey and Minnie, but the bottom-line was that by the time we got to our car EVERY parent around wanted to kill at least a couple of their children! (Obviously we all refrained…too many witnesses!)
When we finally got in our car and began our meandering way back to the condo, I was hit from behind with a chorus of “he’s looking at me” and “she touched me”. I must admit, the “father of the year” raised his voice (i.e. screamed) and threatened bodily harm, creating a whimpering back seat for a few seconds. One more glance in my mirror…and they had all passed out! When we got to the condo I had to carry them in and put them to bed--they were completely wiped out!
Every parent recognizes this story because we know this is what happens to a child when they’re TIRED. I can’t tell you how many times my wife has counseled me, just before I was about to unleash my impatience on one of our children, “Jamison, [insert any of our 6 children’s names here] is just tired.” Just tired?! I certainly don’t act like a wild animal when I’m tired…but kids do.
So what does this have to do with ADHD?
Let’s think logically for a second. What is the drug that doctors give children who are diagnosed with ADHD? Ritalin. The street name for Ritalin is “speed”. Ritalin is a stimulant.
What?! We give stimulants to HYPER kids? Do we want to stimulate them even more?? Well, the doctors and drug companies will say that “the effect is paradoxical in children,” meaning they react in a way that isn’t expected…or basically have an opposite reaction. So, instead of getting hyped up like an adult would, they get calmed down. If you’ve ever known a child on Ritalin, and have seen them NOT on Ritalin, the difference is pretty amazing.
So here’s my point.
How does a child react to being tired? They get hyper.
How does a hyper child react to taking speed? They get calm.
In other words, if you give a TIRED child SPEED they act NORMAL!
That sounds logical. So if ADHD could actually be “tired child syndrome”, what could be making the child chronically tired? Obstructive sleep apnea (i.e when a person stops breathing during sleep, causing their oxygen levels to drop and the brain to become oxygen deprived).
In children diagnosed with obstructive sleep apnea the first line treatment is removal of the tonsils and adenoids. Research has correlated a reduction in the symptoms of ADHD after tonsilectomy for sleep apnea. In other words, if the sleep apnea is effectively treated, the ADHD goes away.
So maybe the child doesn’t have a “speed deficiency,”…maybe they’re tired. Maybe they have sleep apnea.
And now it’s time for my blanket disclaimer: NOT ALL ADHD IS THE RESULT OF UNTREATED SLEEP APNEA. However, before MY child goes on SPEED, he or she is having a sleep study to rule out sleep apnea!!!
My own son’s story:
Jefferson was 6 years old and starting 1st grade. He was excited to start a new school year. Jefferson is an extremely friendly little boy who loves to interact with other children and try to make friends. He had struggled a little bit in kindergarten though, and wasn’t reading very well yet.
After about a week, the principal called and wanted to talk to my wife and me. We met with the principal and Jefferson’s teacher. They told us that Jeff wasn’t performing at the level that he should be for a first grader and that they wanted to put him in a special program that they had…which was basically taking kindergarten over.
I left the meeting thinking, “so, my son isn’t keeping up with the other Harvard bound 1st graders, eh?! Well maybe you teachers should work a little harder! Maybe his kindergarten teacher sucked! (And eventually) maybe we should have done more at home…”
As I was going through this thought process, thinking about Jefferson and his development, I realized a few things. For one, he would wake up in the middle of the night, around 2:30am, and come into our bedroom…almost every night for years! This caused some funny experiences when my wife and I were out of town, and we had someone else staying with the children and sleeping in our bed! (Jeff’s nighttime prowls were not affected in the slightest by who occupied our bed.) Secondly, I realized that his first Kindergarten teacher had said Jeff seemed tired at school, and finally, I realized that in Church he would never sing the songs from memory like the other children would.
So I took a look at Jefferson’s teeth and found a little bit of wear on the edges of his front teeth. I don’t ever remember hearing him snore or grind his teeth. While the signs and symptoms were subtle, I realized that MY OWN SON MIGHT HAVE SLEEP APNEA!!! THE SON OF A GUY WHO LECTURES AROUND THE WORLD ON SLEEP APNEA!!!
Two nights later, Jefferson had a sleep study. And guess what? He had sleep apnea! A couple of weeks later we had his tonsils and adenoids removed. A couple of weeks later…he never woke up in the middle of the night again. He started acting very differently--less hyper. He started doing better in school. He started to be able to remember things better. He basically became a different, better, happier and healthier little boy.
If someone like me, who is involved every day with sleep and sleep apnea, can miss sleep apnea in HIS OWN CHILD, how many children are out there that have a problem that is being missed? I believe the number is staggering…and frightening…and sad.
To put all of this in perspective, I have 6 children, and so far only one of them has had a sleep study. 3 of my six children have had “palatal expansion” with the orthodontist (and I believe my youngest child will too…so likely 4 of my 6 children will have this). So bottom line, I’m not necessarily advocating that every child have a sleep study.
However, I AM saying that before MY child is put on “speed” they are going to have a sleep study!!
Maybe you feel the same way about a child close to you.
About the Author
Jamison Spencer, DMD, MS is the director of the Center for Sleep Apnea and TMJ in Boise, Idaho and Denver, Colorado. The Center for Sleep Apnea and TMJ is the only accredited dental sleep medicine center in Idaho. He is the past president of the American Academy of Craniofacial Pain and a Diplomate of American Board of Craniofacial Pain and the American Board of Dental Sleep Medicine. Dr. Spencer is married to his soulmate of 22 years, Jennifer, and they live with their 6 children in Eagle, Idaho. When Dr. Spencer isn't helping patients, consulting dentists or lecturing you will likely find him skiing or boating with his family.