You’ve probably heard various claims that Attention Deficit Hyperactivity Disorder is being over-diagnosed in Americans, particularly in children, who are then medicated and labeled as having a “learning disability” at school. However, this recent NYT article presents an even more interesting hypothesis: that ADHD is actually often a misdiagnosis, and that sufferers may really have a sleep problem instead.
Our bodies are most rejuvenated by the delta phases of sleep, periods of slow wave brain activity whose prevalence correlates positively with cognitive performance, including memory functions. People who don’t get enough delta sleep don’t always feel more tired, but their brains still aren’t functioning at their best during the day. We tend to think of tired people as listless and lacking in energy, but not everyone responds to chronic sleep problems in that manner. Children and adults whose sleep problems have been mistaken for ADHD instead become hyperactive, unfocused, and mentally scattered when subjected to chronic sleep deficits.
One study of children showing ADHD symptoms shows that they are much more likely to suffer from a deficiency of delta sleep than the control subjects. Another more recent study gets closer to showing a causal link between sleep problems and ADHD: Children in a group scheduled to undergo tonsillectomies to correct overnight breathing problems were much more likely than children in a control group (receiving unrelated surgeries) to display ADHD symptoms. Moreover, of the children who did have ADHD symptoms, half ceased to show ADHD symptoms after the surgery. If these children had not been successfully treated for the tonsil problem disrupting their sleep, they likely would have spent many more years being treated for ADHD instead.
If it turns out that ADHD is in fact just a symptom of a sleep disorder in many cases, that’d be both good and bad news. Happily, this would mean that many sufferers could be treated successfully with sleep hygiene and a bit of bedtime melatonin (or at least a lighter drug regimen than tons of daytime stimulants). The bad news, though, is that some patients (and even doctors) might continue to prefer the quick fix of stimulants for ADHD symptoms, as opposed to the somewhat more complicated and burdensome process of undergoing clinical sleep studies, carving out more time for sleep, and deliberately developing healthier sleep habits over time.
I do think it’s worth the extra time, money, and effort to fix children’s sleep problems up front, though. For one thing, a study in this growing field of research suggests that there is a kind of infancy critical period for sleep (as it affects ADHD): in a test group, ADHD symptoms often persisted even after children’s sleep problems subsided later in childhood. So not only is good-quality sleep important for health in adults, it’s also important that babies begin sleeping well right away. And, there’s mounting concern that labeling children – “ADHD,” “learning challenged,” “special needs” – causes their peers and their teachers to treat them differently (as well as changing the way children see themselves), and not for the better.
Handling what is essentially a sleep problem as such would also free up researchers’ energies to begin investigating what’s really going on in genuine cases of primary ADHD. Given that ADHD symptoms seriously degrade people’s quality of life while taking a heavy toll on families, workplaces, and the economy, it’s really to everyone’s general benefit that we get to the bottom of this epidemic ASAP.