A recent New York Times article reports on the shortage of medications for people with ADHD, or attention deficit hyperactivity disorder. There’s a lot of speculation about why this is happening. One explanation that was put forth was that the FDA (Food and Drug Administration) is limiting the available supply, due to the high rates of possible abuse of these stimulant medications. My response was a little off-topic, but I just had to comment. Here’s a reprint of what I wrote:
“There’s no doubt that ADHD medications can be lifesaving for millions of Americans, but there’s another dimension to this issue that’s being ignored by the mainstream media and the general public, despite growing evidence in published studies.
It’s a general consensus in sleep medicine that sleep deprived adults get drowsy, whereas children become fidgety and hyperactive. Not only are todays’ children sleep deprived (homework, TV, etc.), many are not able to breathe properly at night, due to narrowed airways.
In a study published in Pediatrics in 2006, 28% of children scheduled for tonsillectomy were found to have undiagnosed ADHD, compared to 7% in controls. After tonsillectomy, 50% of the ADHD group were cured. Another study showed that children with ADHD are more likely to snore, and that about 25% of children with ADHD could be treated effectively by treating their sleep apnea.
Notice all the typical findings in a child with sleep-breathing problems that are also found with ADHD: inability to sleep supine, snoring, nasal congestion, mouth breathing, snoring parents, unrefreshing sleep, frequent urination, inability to focus or concentrate, history of needing braces, and bottle-feeding. You don’t have to be obese or snore to have sleep apnea.
It’s clear that in some children with ADHD, stimulants like Ritalin or Adderall work because they’re sleepy. My feeling is that all children with ADHD should be screened for obstructive sleep apnea.“
Let me make it clear that I’m NOT saying that all children with ADHD have obstructive sleep apnea. But even if it’s only 25% (a very conservative number), the implications are huge. If you look at the CDC’s website on ADHD statistics, it’s frightening.
- 9.5% or 5.4 million children 4-17 years of age have ever been diagnosed with ADHD, as of 2007
- Rates of ADHD diagnosis increased an average of 3% per year from 1997 to 2006 [Read article ] and an average of 5.5% per year from 2003 to 2007
- Prevalence of parent-reported ADHD diagnosis varied substantially by state, from a low of 5.6% in Nevada to a high of 15.6% in North Carolina
- As of 2007, 2.7 million youth ages 4-17 years (66.3% of those with a current diagnosis) were receiving medication treatment for the disorder
- Rates of medication treatment for ADHD varied by age and sex; children aged 11-17 years of age were more likely than those 4-10 years of age to take medication, and boys are 2.8 times more likely to take medication than girls.
Remember that these are 2007 statistics. Ten percent of the pediatric population has ADHD, and 6-7% are on medications! As a population, we’re much heavier than we were 5 years ago, which means that these figures are probably an underestimation. The children that we’re medicating now are mostly likely the ones that we’re going to have to give even more medications to later in life after they develop the medical complications of untreated obstructive sleep apnea (diabetes, depression, anxiety, hypertension, high cholesterol, obesity, heart disease, heart attack and stroke). In my mind, all these conditions are connected. They are all one and the same disease, but with different manifestations.
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