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Millions of children and adults struggle with symptoms of Attention Deficit Hyperactivity Disorder (ADHD), a condition marked by problems with concentration, impulse control, organization, and memory. It can be a frustrating and difficult condition, stigmatizing and often isolating for those who suffer from it.

But what if some of those who’ve been diagnosed with ADHD are, in fact, suffering from another disorder altogether — a sleep disorder? That’s the provocative and important question posed in this commentary by a practicing psychiatrist with extensive experience treating patients with ADHD. Dr. Vatsal Thakkar, who is also a clinical assistant professor of psychiatry at NYU Langone Medical Center, makes a powerful argument for the need to consider sleep problems as a possible cause when evaluating patients for ADHD.

As Dr. Thakkar points out, many of the symptoms of ADHD are very often similar to symptoms of insufficient and disordered sleep for both children and adults. In children, the symptoms of ADHD and sleep deprivation can be indistinguishable. A diagnosis of ADHD in children frequently comes about after a child exhibits some or all of behavioral symptoms such as these:

Lack of focus: difficulty paying attention, problems listening, forgetfulness, disorganization

Agitated, excitable, impulsive behavior: excessive talking, inability to sit still, difficulty playing quietly, tendency to interrupt, difficulty sharing or waiting for one’s turn

These behaviors associated with ADHD interfere with a child’s social and intellectual development, causing problems with relationships with peers and adults, at school and at home. But what if ADHD isn’t always the underlying cause of these symptoms? Signs of poor quality and insufficient sleep in children can look remarkably like symptoms of ADHD, as a number of recent studies show. There’s particularly strong evidence that children with sleep-disordered breathing exhibit many of the same symptoms — and suffer many of the same behavioral problems — as children who’ve been diagnosed with ADHD.

Sleep-disordered breathing in children has been an area of growing interest among sleep scientists — with good reason. I’ve written about the dangers of sleep-disordered breathing in children, which is linked to a range of developmental and behavioral problems — problems that often mirror those associated with ADHD:

This study found that children with obstructive sleep apnea had higher rates of behavioral problems including difficulty paying attention, hyperactivity, communication problems, and aggressiveness. These children were also more likely to have learning difficulties and low academic performance than those without sleep-disordered breathing.
This large-scale study of more than 11,000 children found that those with sleep-disordered breathing were significantly more likely to show signs of hyperactivity, trouble interacting with peers, and conduct issues including aggressiveness and inability to follow rules. The study examined the effects of sleep-disordered breathing on children as young as 6 months. Researchers found that very young children who experienced some form of sleep-disordered breathing were, by the age of 7, 40-100 percent more likely to have behavioral problems similar to those used to diagnose ADHD.