Researchers at the Maurice and Gabriela Goldschleger School of Dental Medicine at Tel Aviv University (TAU) have found a clear correlation between sleep-disordered breathing in children and the prescription of ADHD medication, alongside a variety of other problems. According to the study’s findings, children who suffer from breathing disorders during sleep received ADHD medication at a rate seven times higher than children who don’t suffer from sleep-disordered breathing. The researchers estimate with high probability that many children suffering from sleep disorders are treated with medication for ADHD due to a misdiagnosis.

“Sleep breathing disorders are a fairly common phenomenon among children, and can cause a variety of problems — developmental, behavioral, and physical,” the researchers say. “But despite its importance, awareness of the issue is quite low, both among parents and among medical professionals who care for children, so in many cases the disorder goes undiagnosed or misdiagnosed.”

The research was carried out by Dr. Shani Kaminsky-Kurtz, Dr. Sigalit Blumer, Professor Ilana Eli, Dr. Alona Emodi-Perlman, and Dr. Yarden Shreiber-Fridman, all from the Goldschleger School. A first study based on the research was published in the Journal of Clinical Medicine on September 22, 2022, and a follow-up study was published in the Journal of Clinical Medicine on March 29, 2023.

“For the most part, sleep breathing disorders in children usually manifest as snoring (according to various studies, between 8% to 27% of children snore in their sleep) and/or partial or as complete interruptions of breathing (between 2% to 3% of children suffer from an extreme state of obstructive respiratory arrest during sleep),” Dr. Blumer explains. “These disorders disrupt the oxygen saturation levels in the blood during sleep, which is especially important in children, because most of the growth and development processes take place during sleep. The lack of oxygen in the blood can harm the growth and development of the brain and cause cognitive and behavioral disorders while awake, such as learning difficulties, hyperactivity, fatigue, and lack of concentration. These symptoms are similar to the characteristics of ADHD or ADD, which often leads to a misdiagnosis and treatment with drugs such as Ritalin, which is ineffective and causes side effects.”

“Despite the great significance of sleep-disordered breathing, there is still a considerable underdiagnosis of the phenomenon among children, in the world in general and in Israel in particular,” Dr. Kaminsky-Kurtz says. “The most reliable way of diagnosis is by monitoring them in a sleep lab, but this is an expensive procedure with limited availability and is also unsuited for children. For this reason, a reliable and more accessible diagnostic tool was developed in the US, which has been proven to be simple and effective: the Pediatric Sleep Questionnaire (PSQ). The questionnaire, which is addressed to the child’s parents, includes 22 yes/no questions and refers to three main categories: snoring and breathing problems during sleep, alertness levels during the day, and behavior during the day. Answering ‘yes’ to 8 or more questions requires further investigation.”

“Our findings raise a red flag,” Dr. Emodi and Professor Eli warn. “There is a high probability that many of the children who suffer from sleep breathing disorders are receiving medication for ADHD due to a misdiagnosis. And so, not only is the real problem being left untreated, but the unnecessary treatment may even make the situation worse.”