Sleep Apnea In Kids Linked To Behavioral Problems

Obstructive sleep apnea, a common type of sleep-disordered breathing (SDB), has been linked to elevated rates of ADHD-like behavioral issues in kids, in addition to learning and adaptive problems.

The findings were published in the journal Sleep and came about after a five-year study which analyzed data from a longitudinal cohort called the Tucson Children's Assessment of Sleep Apnea Study (TuCASA).

The study assessed Caucasian and Hispanic kids ranging in age from 6 to 11 years to measure the incidence and prevalence of SDB and its consequences on neurobehavioral functioning.

Michelle Perfect, PhD, the study's lead author and assistant professor in the school psychology program in the department of disability and psychoeducational studies at the University of Arizona in Tucson, said:

"This study provides some helpful information for medical professionals consulting with parents about treatment options for children with SDB that, although it may remit, there are considerable behavioral risks associated with continued SDB. School personnel should also consider the possibility that SDB contributes to difficulties with hyperactivity, learning and behavioral and emotional deregulation in the classroom."

The study consisted of 263 kids who participated in a sleep study and a neurobehavioral test of assessments which included youth and parent-documented rating scales.

The outcomes revealed that 23 kids had incident sleep apnea that developed during the trial period, while 21 kids had persistent sleep apnea for the entire length of the study. An additional 41 children who started out with sleep apnea stopped having breathing issues during sleep when examined at the five-year follow-up.

In children with incident sleep apnea, the risk of having behavioral issues was four to five times higher. In kids with persistent sleep apnea, that risk was six times higher.

Compared with children who never experienced SDB, those with sleep apnea were more inclined to have parent-documented issues in the areas of:

• attention
• disruptive behaviors
• hyperactivity
• social competency
• self-care
• communication

Kids with persistent sleep apnea were shown to be seven times more likely to have parent-documented learning issues and three times more likely to earn grades of C or under.

Research reported at the 24th annual meeting of the Associated Professional Sleep Societies in 2010, revealed that the academic grades of children with sleep apnea are worse than students who do not have sleep-related breathing problems.

The authors noted that this was the first sleep-related study to utilize a standardized survey to measure adaptive functioning in normal youths with and without SDB.

Perfect concluded, "Even though SDB appears to decline into adolescence, taking a wait and see approach is risky and families and clinicians alike should identify potential treatments."

Sleep apnea is prevalent in approximately two percent of healthy children, according to the American Academy of Sleep Medicine. Sleep apnea in kids of this age is generally due to oversized tonsils and adenoids. Most of these children with sleep apnea also experience loud snoring.

Treatment choices include the removal of the adenoids or tonsils via surgery and the use of continuous positive airway pressure therapy (CPAP).

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Majority Of Young Children Still Suffer ADHD Symptoms Despite Treatment

Nine out of 10 young children with moderate to severe attention-deficit hyperactivity disorder (ADHD) continue to experience serious, often severe symptoms and impairment long after their original diagnoses and, in many cases, despite treatment, according to a federally funded multi-center study led by investigators at Johns Hopkins Children's Center.

The study, published online in the Journal of the American Academy of Child & Adolescent Psychiatry, is the largest long-term analysis to date of preschoolers with ADHD, the investigators say, and sheds much-needed light on the natural course of a condition that is being diagnosed at an increasingly earlier age.

"ADHD is becoming a more common diagnosis in early childhood, so understanding how the disorder progresses in this age group is critical," says lead investigator Mark Riddle, M.D., a pediatric psychiatrist at Johns Hopkins Children's Center. "We found that ADHD in preschoolers is a chronic and rather persistent condition, one that requires better long-term behavioral and pharmacological treatments than we currently have."

The study shows that nearly 90 percent of the 186 youngsters followed continued to struggle with ADHD symptoms six years after diagnosis. Children taking ADHD medication had just as severe symptoms as those who were medication-free, the study found.

Children with ADHD, ages 3 to 5, were enrolled in the study, treated for several months, after which they were referred to community pediatricians for ongoing care. Over the next six years, the researchers used detailed reports from parents and teachers to track the children's behavior, school performance and the frequency and severity of three of ADHD's hallmark symptoms - inattention, hyperactivity and impulsivity. The children also had full diagnostic workups by the study's clinicians at the beginning, halfway through and at the end of the research.

Symptom severity scores did not differ significantly between the more than two-thirds of children on medication and those off medication, the study showed. Specifically, 62 percent of children taking anti-ADHD drugs had clinically significant hyperactivity and impulsivity, compared with 58 percent of those not taking medicines. And 65 percent of children on medication had clinically significant inattention, compared with 62 percent of their medication-free counterparts. The investigators caution that it remains unclear whether the lack of medication effectiveness was due to suboptimal drug choice or dosage, poor adherence, medication ineffectiveness per se or some other reason.

"Our study was not designed to answer these questions, but whatever the reason may be, it is worrisome that children with ADHD, even when treated with medication, continue to experience symptoms, and what we need to find out is why that is and how we can do better," Riddle says.

Children who had oppositional defiant disorder or conduct disorder in addition to ADHD were 30 percent more likely to experience persistent ADHD symptoms six years after diagnosis, compared with children whose sole diagnosis was ADHD.

ADHD is considered a neurobehavioral condition and is marked by inability to concentrate, restlessness, hyperactivity and impulsive behavior. It can have profound and long-lasting effects on a child's intellectual and emotional development, Riddle says. It can impair learning, academic performance, peer and family relationships and even physical safety. Past research has found that children with ADHD are at higher risk for injuries and hospitalizations.

More than 7 percent of U.S. children are currently treated for ADHD, the investigators say. The annual economic burden of the condition is estimated to be between $36 billion and $52 billion, according to researchers.

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