We all remember that kid in class who caused everyone grief. Their behavior was difficult for not only the adults but classmates; we hated working on their team or being the one unlucky enough to sit next to their desk. The go-to response now seems to be "Oh, they must be ADHD."
Becky, a mother with one seriously grumpy son, wrote about her adventure in trying to help her son through his misbehaving and all-around grumpiness. He had varying issues such as becoming sleepy in the evenings, irregular sleep at night, being upset all the time and more. Becky's son began to have a reputation among his family as a "hot head". As his behavior evolved, the more and more he seemed to fit a diagnosis of Attention Deficit Hyperactivity Disorder, also known as ADHD.
Even more puzzling--Becky was a Child Development Therapist and still didn't know what to do. All of the tactics that worked with her clients were proving useless with her son. She finally sought the advice of a therapist who then suggested a Neurologist rule out any hidden issues. Then began a waterfall of doctor appointments when one doctor suggested a sleep study for her son. And thank goodness he did. Turns out, Becky's son was diagnosed with Central Sleep Apnea or CSA. Becky's son's sleep disorder was disguised as a behavioral issue, in turn being diagnosed as ADHD.
The National Institute of Health has conducted studies where children who are medicated for ADHD have their sleep-disordered breathing corrected. After the disorder is resolved, within 6 months 70% of these children were no longer in need of ADHD medication. And why is this? Because they probably never had ADHD to begin with.
You heard that right. 70% of those children had been misdiagnosed with ADHD when they had a treatable sleep disorder. This is because sleep deprivation in children can mimic behavioral symptoms seen in ADHD children.
I'm grateful that Becky was able to get a proper diagnosis for her son. At the same time, it infuriates me that a "misbehaving" child is automatically deemed ADHD. It seems to be the catch-all decision when nothing else makes sense. Considering that I do have a son with ADHD, reading the symptoms exhibited by Becky's son would not have led me to ADHD. Why? Because ADHD is not a synonym for bad behavior. Or at least it shouldn't be.
Did you know that according to the Center for Disease Control and Prevention, ADHD is the most commonly diagnosed behavioral disorder for kids in the United States with at least 6.1 million diagnoses among children under the age of 18 in 2016? And this number is down, yes DOWN, from 2011 where it was 6.4 million. The CDC also adds to these statistics stating that 5 in 10 children with ADHD had a behavior or conduct problem. Doesn't Becky's story make you wonder about this statistic? Do these ADHD children have behavioral problems or were they misdiagnosed?
So what does this mean? According to Sleep Review Magazine: “Dentist Michael Fulbright, DDS, sleep apnea in children is a big problem, particularly when it goes undiagnosed or is misdiagnosed entirely. “These days, many children are being diagnosed with ADHD (attention deficit hyperactivity disorder). Some of them are acting out in school and getting in trouble. Well-meaning doctors may misdiagnose some of these children and prescribe Ritalin for ADHD, when the cause of their behavioral problems may be sleep apnea,” he says in a release.
If you have a child with behavioral issues, my first recommendation (as a Mom who has an ADHD child) is to start a log of their behavior and actions. A quick google search will show you free templates to help with behavioral tracking. A doctor's diagnosis, especially in instances such as behavioral issues, is only as good as the information they are presented with. Doctors are relying on those that observe the child every day to assist them in making a diagnosis. Err on the side of way too much information versus too little.
Still not sure where to start? Take a look at some common symptoms of pediatric sleep disorders as well as hyperactive and impulsive ADHD.
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Symptoms that your child may have a sleep disorder are:
- falls asleep immediately after their head hits the pillow,
- grinds their teeth,
- wakes up in the night,
- has night time accidents or daytime accidents,
- has impulse control issues,
- is hard to understand when speaking,
- has under-eye circles
- has crooked teeth or a misaligned bite,
- wakes up insanely early,
- is irritable during the day,
- has bad appetite,
Symptoms of hyperactive ADHD are:
- Fidgets with hands or feet or squirms in seat.
- Leaves seat in classroom or in other situations in which remaining seated is expected.
- Runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness).
- Has difficulty playing or engaging in leisure activities quietly.
- Appears “on the go” or acts as if “driven by a motor”.
- Talks excessively.
Symptoms of impulsive ADHD are:
- Blurts out the answers before the questions have been completed.
- Has difficulty awaiting turn.
- Interrupts or intrudes on others (e.g., butts into conversations or games).
- Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7.
- Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home).
- There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.
- The symptoms do not occur exclusively during the course of a pervasive developmental disorder or other psychotic disorder, and are not better accounted for by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, or a personality disorder).
What does this all mean for you? First and foremost, just because you have a child who's struggling behaviorally does not mean they have ADHD. ADHD is not, nor should it ever be, a synonym to bad behavior.
Second, before putting your child on any kind of stimulant, regardless of their diagnosis, it would be a great idea to have a sleep study performed; especially if they are displaying more than one sleep disorder symptom listed above. No good can come from placing a child on a stimulant who doesn't need it. A few well-known side effects of a stimulant are sleep problems, decreased appetite, moodiness, irritability and more.
Third, you know your child best. Gather all the information possible to help your healthcare providers make the best diagnosis possible. Be understanding that sometimes a diagnosis can be wrong and a second (or third, or fourth) opinion can't hurt. Even when I was convinced my son had ADHD and needed something to assist him, I did my due diligence in trying dietary changes, natural remedies and more. The medication was a last resort my husband and I agreed on after careful consideration with our doctor. The medication was a godsend for my son, but it isn't necessary for everyone.
In a world of over-diagnosed ADHD, it is our responsibility to educate ourselves. Talk to each other about personal experiences, like Becky did. Becky came across a viral Facebook post that hit close to home. Melody Yazdani wrote of her experience with her child's sleep disorder, pleading with others to share her story and bring awareness to childhood sleep disorders.
Continue to share your story with other parents. Let's help teach one another about real-life experiences that have led to solutions; you never know when your story will ring true to someone else and in turn, save them from a world of trouble and heartache.