Hyper kid? Sleep apnea may be the culprit

The recommended treatment in most cases is surgery, called adenotonsillectomy, to remove both the tonsils and the adenoids. If that doesn’t solve the problem, children can learn to sleep with a kind of special nasal mask, called Continuous Positive Airway Pressure (CPAP), that many adults with apnea use. CPAP uses an electronic device to deliver constant air pressure and assure continuous breathing, and children as young as ages 2 or 3 have been reported to adjust to using it.

But first a child must have an overnight sleep study done. The study, called a polysomnogram, is usually conducted at a sleep center, where a parent and child spend a night, the child hooked up to a series of monitors, or leads, that measure brain waves and monitor stages of sleep, breathing movements and blood levels of oxygen and carbon dioxide.

The study is designed to detect pauses in breathing — more than five an hour is considered abnormal in children — as well as drops in oxygen that accompany the pauses.

“The first thing you tell the kids is that there are no needles involved here, just a bunch of wires, and you relate it to their favorite science fiction cartoon,” says Owens.

She strongly recommends having a sleep study done to rule out obstructive sleep apnea if a child is being evaluated for ADHD and has other risk factors for sleep apnea. “I will not start a child on stimulation medication [for ADHD] if the child has a history of snoring or large tonsils — I send them for a sleep study,” she says.

Several studies have found improvement in behavior after adenotonsillectomy. One study, published in the journal Laryngoscope in 2005, followed 52 children from ages 2 to 15 who had their adenoids and tonsils removed. The study assessed behavior before and after the surgery, and found significant improvement in hyperactivity and aggression, as well as a reduction in anxiety and depression.

For 5-year-old Ben Kidd, enlarged tonsils were not the problem, so instead of having surgery, he was fitted with a CPAP mask that he started wearing just before Thanksgiving. The difference in his behavior and his ability to concentrate and learn has been striking, his mother says. He now loves math and has already started to read simple books.

The truth, Michele Kidd says, is that she had been concerned about her son’s breathing ever since he was an infant in a bassinet by her bed. But she says none of the physicians she consulted seemed to take her concerns seriously. Eventually, she took Ben to a neurologist to discuss his behavior, and the neurologist suggested running a sleep study.

Her advice to parents? “Listen to your gut. If you see something wrong with your child, don’t let anybody — doctors or anybody else — poo-poo you or tell you it’s nothing,” she says.

Roni Caryn Rabin is a health writer who lives in New York City. She has written for The New York Times, The Washington Post, Newsday and Real Simple magazine, among other publications, and is author of the book, "Six Parts Love: A Family's Battle with Lou Gehrig's Disease." She teaches journalism at the Columbia University Graduate School of Journalism.

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