Robert Wood Johnson University Hospital
New Brunswick • Somerset

Children Sleep

Any adult who has children-or was one himself-can spot a tired child. They can be uncontrollable and unable to focus.

Years ago, the conclusion would have been, "that's a tired kid," but today teachers, parents and school nurses look at the same child and automatically ask if he or she might have Attention Deficit Hyperactivity Disorder (ADHD). The diagnosis has become widespread-but is it always correct? Because ADHD mimics the symptoms of sleep disorders in children, many children whose sleep is "broken" by a disorder are swept into a growing tide of ADHD diagnoses.

ADHD is treated primarily by two drugs, methylphenidate (Ritalin) and amphetamine, known in its prescription form as Adderall. Use of these drugs has sky rocketed in the United States since 1990. Methylphenidate prescriptions rose dramatically in the early 1990s and have since leveled off at approximately 11 million per year. In comparison, amphetamine prescriptions, primarily Adderall, have increased dramatically recently, from 1.3 million in 1996 to nearly 6 million in 1999. What's especially troubling is that the medications used to treat ADHD in children are powerful drugs whose long-term use is still not fully understood.

Alarmed at the escalation in prescribed use of amphetamines and other stimulants, leading scientists have conducted research on other probable causes of ADHD-like symptoms and have made the connection between sleep disorders and symptoms of inattention and hyperactivity. And studies have concluded that between 7 and 12 percent of children snore regularly, putting them at high risk for sleep-disordered breathing problems, such as obstructive sleep apnea.

Children who suffer from obstructive sleep apnea have broken sleep. Their normal sleep pattern is interrupted as many as 50 times a night, resulting in perpetual exhaustion. At school these tired children can't focus, and they show signs of inattention to classroom tasks.

Before any medication is given, these children need to undergo a simple paper sleep screen, a series of questions answered by themselves and their parents about the quantity and quality of their sleep. If the screen is positive, children should then be tested in a full-service sleep disorders treatment center. Only with an accurate sleep screen, sometimes followed by a study, do we protect children from unnecessary stimulant medication.

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