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Some ADHD may be airway trouble
About 10% of children in the country have ADHD, which is treated as a neurological condition, and the drugs work. What causes it is the open question. Researchers who looked back through the data asked what happens when a child's inflamed tonsils or adenoids are removed, since both make nose breathing hard and push a child to breathe through the mouth. In well over 50% of the children who had those surgeries to clear their airways, the symptoms of ADHD disappeared.
The proposed link is sleep. A child with chronic sleep apnea is constantly choking on their own breathing, wakes tired and irritable, and can't think or focus. Sleep-disordered breathing also blocks the stages of sleep in which human growth hormone is released, so it affects growth and brain development. Not all cases of ADHD come from sleep-disordered breathing, and this is extremely controversial, with a lot more work still to be done.
How can swollen tonsils block a child's airway?
Tonsils and adenoids are lymph tissue at the back of the throat and behind the nose, and they are largest relative to the airway between about ages three and seven. Adenoids sit directly behind the nose, so when they swell they can block nasal airflow and push a child to open the mouth. A child's airway is also much smaller than an adult's, so the same swelling matters more. Removing both, called adenotonsillectomy, is the first-line treatment for pediatric obstructive sleep apnea in the American Academy of Pediatrics guideline.
Why does deep sleep matter for growth?
Growth hormone is released in pulses, and the largest one comes during slow-wave deep sleep early in the night. Children spend a larger share of the night in deep sleep than adults do. Repeated airway blockages fragment sleep and cut into those stages. Some studies have found that children with sleep apnea grow more slowly and catch up after their tonsils and adenoids are removed.
How can poor sleep look like ADHD in children?
Sleep-deprived adults slow down, but sleep-deprived children often turn hyperactive and inattentive instead of drowsy. Long-term research led by Ronald Chervin at the University of Michigan found higher rates of attention and behavior problems in children who snored or had sleep-disordered breathing. In some of these children, those problems eased after the breathing problem was treated. ADHD is diagnosed from behavior, and the criteria do not include a sleep test.
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