Is it ADHD or a sleep disorder?

When kids fidget, act out, fail to focus or perform poorly on tests, we’re quick to blame Attention Deficit/Hyperactivity Disorder.

But we may be wrong – and the wrong diagnosis could be damaging.  To learn more, we checked with an expert, Cindy Jon, M.D., medical director of Memorial Hermann (Pediatric) Sleep Lab at Memorial Hermann Memorial City Medical Center.

“You may be hiding the symptoms and not addressing the reasons behind them,” says Dr. Jon, “If children are diagnosed with ADHD but actually have a sleep disorder, they will continue to have symptoms till you take care of the disorder.”

“Even worse, kids may be overmedicated with ADHD drugs they don’t need — drugs that can cause jitteriness, headaches, racing heartbeat, dizziness, weight loss, facial tics and even insomnia,” Dr. Jon says.

Complicating the puzzle, children may have more than one slumber-robber.

So how do you know what’s really keeping your child from performing at his or her best?

Here are the three top culprits:


What is it? While pre-schoolers naturally have short attention spans, hyperactive, impulsive and unfocused older children may have ADHD.

What are the signs? These behavioral issues last six months or longer and occur both at home and at school.

How is it diagnosed? Pediatricians make the diagnosis after getting feedback from parents and teachers.

How is it treated? Ritalin, Concerta and other stimulants may control symptoms, though kids may outgrow the need for drugs as teens.

Additionally, about 1 million school-age children – including some with ADHD — have Restless Legs Syndrome. Discomfort causes them to fidget and keeps them from nodding off. Raising blood iron levels and nixing all caffeine may fix the problem, Dr. Jon says.

Untreated ADHD can interfere with school and the ability to make friends.

Warning: Kids should heed drug timing. “If you take stimulants too late in the day, your body has not cleared them by bedtime,” Dr. Jon says.


What is it? About 2 percent of healthy children have Obstructive Sleep Apnea (OSA), where dozing is disrupted or fragmented. “Kids who are obese and have asthma, large adenoids and tonsils, Down syndrome or neuromuscular weakness are at much higher risk,” says Dr. Jon.

What are the signs? If children have more than three snoring episodes nightly, observe whether they also snort, gasp, labor to breathe or wet the bed while sleeping and have headaches upon awakening and daytime drowsiness.

“The consequences of poor sleep can be manifested in hyperactivity, difficulty concentrating and impulsivity, so there’s an overlap with symptoms of ADHD,” Dr. Jon says.

How is it diagnosed? The only way to know whether a child snores or has sleep apnea is a sleep study. Polysomnograms – using sensors to check breathing, oxygenation and brain waves — may be done at hospitals and major medical centers.

How is it treated? Usually apnea is fixed by removing tonsils and adenoids (both soft tissue masses in the throat). If that fails, the child may wear a nasal continuous positive airway pressure mask (CPAP) to deliver steady air pressure through the nose. Weight loss may also help obese kids who suffer from OSA. And sometimes asthma/allergy drugs (such as inhaled nasal steroids or Singulair) help mild cases.

If left untreated, not only can OSA spur behavioral, learning and growth problems, but it also may lead to high blood pressure, high cholesterol, heart attacks, stroke and diabetes at an earlier age due to premature hardening of blood vessels.

Warning: Not all nighttime buzz saws are due to OSA. Up to 60 percent of kids snore.


What is it? Lack of bedtime routines shaves shut-eye.

What are the signs? Grogginess, crankiness and poor grades.

How is it diagnosed? Pediatricians review bedtime habits with children and parents.

How is it treated? “We need sleep to refresh our brains,” Dr. Jon says. Routine primes kids for a snooze fest.

MH blog graphic #9763 Sleep Tips

Poor sleep hygiene can stunt growth, sexual maturation and learning, as kids miss out on the release of growth hormones and imprinting of the day’s lessons and memories.

Warning: Add a vehicle when suffering from sleep disorders or other sleep-related issues, and you’ve got a leading cause of deadly car accidents in drivers under age 30.

For more information about sleep disorders and testing, visit one of our 11 Houston-area locations.

Tashika Varma