Local Orthodontist Examine ADHD & Pediatric Breathing Link
By Wynce Nolley
Local orthodontist Dr. Kerwin “Buddy” Donaldson has recently published a new study in the Journal of the Louisiana Dental Association that connects pediatric sleep and breathing problems in children to Attention Deficit/Hyperactive Disorder.
Sleep-disordered breathing and sleep apnea – commonly associated as adult problems – also appear in children, and both can create learning performance and IQ issues, as well as future heart-related problems.
“I starting looking at a connection with Pediatric Sleep Disordered Breathing, sleeping and sleep apnea, and I think that everybody associates sleep apnea with adults and that’s where 99 percent of the information has been published,” says Donaldson. “My goal is to try and increase awareness that sleep apnea is not just in adults, but in children as well.”
According to Donaldson, children’s sleep disordered breathing is basically just sleep deprivation, which can affect performance in adults and can even lead to heart attacks and strokes.
In children, however, sleep deprivation can lead to one of two things: either they can’t pay attention and are tired, sleepy or have a hard time waking up in the morning; or just the opposite – they get hyper, tense or irritable, which can negatively affect their social interactions with other children or cause them to fall asleep in class.
This is where children are often diagnosed with ADD or ADHD.
AD/HD is one of the most common neurodevelopment disorders of childhood, and it is usually first diagnosed in childhood and often lasts into adulthood. Those with AD/HD may have trouble paying attention, controlling impulsive behaviors, or be overly active.
According to the Centers for Disease Control and Prevention, the percentage of children estimated to have AD/HD has changed over time and can vary by how it is measured, but recent surveys of parents show that approximately 11 percent of children 4-17 years of age, or roughly 6.4 million children, have ever been diagnosed with AD/HD as of 2011.
The American Psychiatric Association states in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that 5 percent of children have AD/HD. However, other studies in the U.S. have estimated higher rates in community samples.
Donaldson suggests that his research can help parents understand why their children may be hard to wake up; why either snoring or sleeping soundly may be normal or abnormal for their child; and why their social skills at school or their school performance in general may be affected.
“I think that, basically, if people can take this information and let the parents become aware of what’s going on with their child, some of their children’s behavior may be explainable,” says Donaldson.
According to Donaldson, there are common warning signs parents can look for if they believe their child may be affected by sleep-disordered breathing:
Heavy breathing and snoring: Children should breathe through their nose with no noise. If they struggle to breathe through their nose – opting instead to breathe through their mouth at night or during the day – blocked airways and sleep-disordered breathing is commonly the cause.
Awakes groggy, grumpy or with headaches: Children who awake unrefreshed – or if teachers report that a child appears sleepy during the day – may be experiencing a breathing disorder. Parents should consider the combination of breathing and snoring as an indicator of blocked airways.
Obesity can create blocked airways: Obesity can result in breathing disorders. As body-mass index increases, so does tongue volume, which results in airway decreases. According to the American Academy of Pediatrics, the prevalence of overweight children has doubled in ages 6-11 and tripled among children in the 12-18 range.
Although AD/HD can’t be cured, it can be successfully managed and some symptoms may improve as the child ages. But in order to treat ADD and AD/HD, children are often medicated with attention-deficit drugs.
However, Donaldson suggests that there may be an alternative, and that early treatment options are readily available and in most cases are fairly simple.
“Medication is certainly one option for a child with ADD or ADHD, but if we can get some of these children off of Ritalin or if we can get them off of Adderall, I think that can help long term,” he says.
According to Donaldson, the first line of defense in treating obstructive sleep apnea is removing tonsils and adenoids. Another option is Rapid Palatal Expanders – or RPEs – that improve the breadth and width of the palate. He says that weight loss is helpful as well.
Continuous Positive Airway Pressure, or CPAP, devices can also be used if other treatments don’t work out, though compliance in children can be problematic.
Donaldson suggests that parents who think their children may have a sleep disordered breathing should ask themselves two questions: Does your child snore at night? and Does your child breathe through their mouth?
“If you hear an adult that snores, that’s not good, but you never ever want to hear a child make any sounds when they’re breathing,” says Donaldson. “A child should never have breathing episodes where they’re snoring.”
He states that mouth breathers typically have some type of airway problem that needs to be addressed.
“Mouth breathing is not good and there are some studies out that show if your child is breathing through their mouth then they are at an increased risk for getting ADD and AD/HD.”
Donaldson recommends that parents coordinate with pediatricians, Ear Nose and Throat specialists and family physicians, as well as orthodontists and dentists, to determine treatment options.
Donaldson practices in offices located in New Iberia and Broussard and is Louisiana’s only dual-trained specialist in pediatric dentistry and orthodontics. As a board-certified orthodontist, he earned the distinguished Diplomate designation from the American Board of Orthodontics as part of his continuing education. Donaldson is a member of the American Association of Orthodontics, the Louisiana Dental Association and the Acadiana District Dental Association, as well as a past president of the Louisiana Orthodontic Association. He is a graduate of the LSU Dental School, the University of Alabama Department of Pediatric Dentistry and the LSU Orthodontic Program.
Donaldson’s academic paper on sleep disordered breathing, which is titled “The Relationship Between Pediatric Sleep Disordered Breathing and Attention Deficit Hyperactivity Disorder,” appears on the LDA website at http://www.ladental.org/lda/latest-news/223.