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Tonsil Removal and ADHD: Connected?

Can a fairly routine problem, enlarged tonsils, be causing attention deficit disorder (ADHD) in your child? Not quite, says a new study, but tonsil problems may be partially to blame for some of your child's behavior problems.

While the cause-and-effect relationship is not entirely understood, researchers from the University of Michigan suspect that there is a relationship between enlarged tonsils and sleep-related breathing problems. Taking the relationship one step further, they also suspect that sleep problems may underlie some cases of behavioral problems in children, including ADHD.

An undiagnosed sleep disorder is not the solution for all children with ADHD. But it could be something worth looking into for a substantial minority," said Dr. Ronald Chervin, study author and director of the University of Michigan Sleep Disorders Center.

Chervin and his colleagues assessed 105 children, 78 of whom were scheduled for a routine tonsil and adenoid removal. Tonsils and adenoids are in the back of the throat, and if infected or enlarged, they may affect one's ability to breathe at night. In fact, most of the children in the study who were having their tonsils removed had also been diagnosed with symptoms of obstructive sleep apnea, a sleep problem caused by frequent awakenings at night because of trouble breathing.

After evaluating the cognitive and behavioral abilities of all children, the researchers determined that 22 of the children scheduled for a tonsil and adenoid removal also had ADHD, while only two children from the 27 not scheduled for the surgery had this behavioral problem.

A year later, the children who had their tonsils removed to treat sleep apnea showed a significant improvement of their symptoms. Also, 11 of these children who were previously diagnosed with ADHD no longer met the criteria for diagnosis. The results of the study were published in Pediatrics.

"The findings help support the idea that sleep-disordered breathing is actually helping to cause behavioral problems in children," said Chervin.

The reason why obstructive sleep apnea may affect a child's behavior is not at all clear. While poor rest and general grogginess may contribute to behavior problems, a few children in the study developed new ADHD a year after the surgery, suggesting that sleep-disordered breathing may cause damage that is not seen until years later.

The take home message of the study, according to the authors, is that children who snore or seem to have other difficulty breathing while they sleep, should see a doctor for treatment. If the child also has behavioral problems and those dissipate as a result of the treatment, so much the better.