The content on or accessible through Medpedia.com is for informational purposes only. Medpedia is not a substitute for professional advice or expert medical services from a qualified health professional.
Read more
Medpedia Answers
(Other)Medpedia Answers is a platform for asking and answering questions about health and medicine. Read more.
Why do stimulants work for ADHD?
I've been prescribed Vyvanse for ADHD and it's remarkable! It seems a bit counter-intuitive that a stimulant would be so helpful. I've read in the articles that stimulants are usually the first-line medications. Why do they help?
41 yr old, Female
asked Jan 20, 2010 at 04:43PM in Other
-
3VotesWe do not know at this time how exactly stimulants work in the treatment of ADHD. Stimulants tend to modulate the neurotransmitters in the brain that affects hyperactivity, impulsivity and inattention. It tends to balance these neurotransmitters.
A good article on stimulants can be found in Medpedia News and Analysis section :
http://www.medpedia.com/news_analysis/16-Brain-Blogger/entries/13307-Stimulants-May-Offer-Protection-in-ADHD -
2Votes
answered Jan 27, 2010 at 11:52AMHere's an interesting study that's related to your question:
A study published in Pediatrics in 2006 (Chervin, et al, Pediatrics 117(4) e769-778) showed that 28% of children scheduled for routine tonsillectomy had undiagnosed ADHD. After tonsillectomy, 50% of these children with ADHD who underwent tonsillectomy no longer had ADHD.
It's been estimated that anywhere from 30 to 50% of all children with ADHD have a potentially treatable sleep-breathing problem. Not sleeping efficiently due to multiple obstructions can definitely change your behavior, as well as your brain biochemistry.
The reason why stimulants work in hyperactive people is that they're sleepy. Even if you don't snore and are thin, you can still have major sleep-breathing issues, since this problem is due to smaller jaw structures. Most people with ADHD can't sleep on their backs, since they wake up too often in this position. If you're not sure if you may have a sleep-breathing problem, take a look at your parents—do either of your parents snore heavily?
Treating any underlying sleep-breathing problem is a long discussion in itself, but in general, options include eliminating upper airway inflammation (diet and lifestyle changes), enlarging your jaws (through orthodontics or even jaw surgery in severe cases), and shrinking your throat soft tissues (tonsillectomy and other nose and throat procedures). Oral appliances can also be used to enlarge the space behind the tongue. -
0Votesanswered Jan 27, 2010 at 03:03PMThank you Dr. Francis and Dr. Park for your answers! The article was interesting.
It doesn't surprise me that it's a neurotransmitter issue because I also have schizophrenia and depression, both of which are stable on medication. I developed schizophrenia when I was 18 years old and my depression started when I was 16 years old. I'm certain I've had ADHD since I was a child...no doubt about it. I'm not sure why I have all of these issues...are they connected somehow? (As far as I know, I wasn't dropped on the head or anything when I was born.)
I'm working on my Masters now and for the first time I'm actually consistent in school. I actually read all my assignments (even if they're boring), do all of my homework, don't forget about quizzes, etc. I've been fired from every job that I've had after graduating from college due to "poor performance." That has really done a number on my self-esteem. Between the behavioral things I'm learning and the medication, I feel more hopeful that once I graduate, I'll be able to hold a job for more than 10 months. (Another plus, it's really nice not to fidget all day long and have to listen to punk rock music on '72'...maybe I won't be deaf by the time I'm 50, afterall.)
Thank you. -
4VotesHi Dr. Park,
With all due respect, I take significant issue with your characterization of ADHD and its treatment. It simply does not meet with the facts.
Specifically on these points (your answer excerpted in quotation marks):
"A study published in Pediatrics in 2006 (Chervin, et al, Pediatrics 117(4) e769-778) showed that 28% of children scheduled for routine tonsillectomy had undiagnosed ADHD. After tonsillectomy, 50% of these children with ADHD who underwent tonsillectomy no longer had ADHD."
If that is the study I'm thinking of, it had an "n" of about 12. And the baseline validity of the diagnoses for these children wasn't well-established. Moreover, follow-up ended at 6 months and reports were made by the parents, with parental reports regarding ADHD being well known as unreliable. (There is an inherent bias in wanting the strategy you've chosen for your child to work; this seems especially true among parents who are unduly fearful of ADHD medications.) If that is not the study you refer to, perhaps you could provide a link or more details.
YOU WROTE:
"It's been estimated that anywhere from 30 to 50% of all children with ADHD have a potentially treatable sleep-breathing problem. Not sleeping efficiently due to multiple obstructions can definitely change your behavior, as well as your brain biochemistry."
I've not seen studies indicating those figures. Can you please refer me to some?
And while certainly obstructions can inhibit proper sleep, I've seen no proof that children with ADHD have this in higher numbers than other children or that removing "obstructions" cures their breathing problems or ADHD.
I'm reminded of the traditional belief among back surgeons that back pain was caused by ruptured discs -- until studies showed that many people had ruptured discs and no pain. Perhaps the same is true for "obstructions."
Indeed, I've known many adults with untreated ADHD who were told they had "obstructive sleep apnea" and given CPAP (which most will not use on a regular basis or they forget to use) or even extreme surgeries (jaws sawn in half, throat tissue removed). Not only did these interventions fail to improve their ADHD, they often did not treat the breathing problems. And yes. most of these people had gone to the world-famous Stanford Sleep Center.
More and more, we are learning about the connections between dopamine and sleep-related disorders such as sleep apnea and Restless Legs Syndrome. But, frankly, it seems the sleep experts do not want to acknowledge that these problems have much cross-over with ADHD, for which there are already existing, safe treatment strategies.
Anecdotally, people with ADHD seem to have greater-than-average challenges with allergies. It is shocking to me that a physician would advocate a risky surgical procedure before recommending that the allergies (and swollen tonsils, etc.) be treated first. Sometimes, it's as simple as eliminating wheat or casein from the diet. (Perhaps that is what you are suggesting with your later point below.)
YOU WROTE:
"The reason why stimulants work in hyperactive people is that they're sleepy. Even if you don't snore and are thin, you can still have major sleep-breathing issues, since this problem is due to smaller jaw structures. Most people with ADHD can't sleep on their backs, since they wake up too often in this position. If you're not sure if you may have a sleep-breathing problem, take a look at your parents—do either of your parents snore heavily?"
No, the reason stimulants work is absolutely NOT because people are sleepy. Perhaps stimulants have that effect in people who don't have ADHD and are sleep-deprived for other reasons. But, please, this is totally fallacious.
YOU WROTE:
Treating any underlying sleep-breathing problem is a long discussion in itself, but in general, options include eliminating upper airway inflammation (diet and lifestyle changes), enlarging your jaws (through orthodontics or even jaw surgery in severe cases), and shrinking your throat soft tissues (tonsillectomy and other nose and throat procedures). Oral appliances can also be used to enlarge the space behind the tongue.
This might be true in some cases. I don't know because I am not a sleep expert. But I can tell you that sleep experts who do not consider the role of the brain in sleep disorders -- especially ADHD and it's well-known challenges with going to sleep, staying asleep, and getting sound sleep -- are doing a grievous disservice to their patients.
No area demands more cross-disciplinary medical knowledge than ADHD, in my opinion. t
Gina Pera, author
Is It You, Me, or Adult A.D.D.? -
1Votesanswered Feb 04, 2010 at 10:38PMGina Pera,
Thank you for your response about Dr. Park. I think he made everything up honestly. I just reread his post and this guy has got to be a fraud. I hope he rsponse. He wrote " the reason stimulants work is because people are sleepy. Are you freaken kidding me? This is a doctor?-
Hi there- Angela here from Medpedia. Just wanted to point out that any approved editor has been individually vetted and their credentials have been verified. You can confirm this by looking for the Medpedia Editors symbol, which you can see on Dr. Park's profile here: http://www.medpedia.com/users/9245.Angela S Dilaura commented Feb 05, 2010 at 04:31PM
-
-
1VotesHi Angela,
Sadly enough, many sleep specialist share this gross misperception.
I attended a Stanford University public lecture a few years ago by the noted sleep expert Dr. William Dement. He spoke with Dr. Clete Kushida, another Stanford expert at the so-called "Center of Excellence for the Diagnosis and Treatment of Sleep Disorders." About 300 people were in attendance.
Now, I'm sure these physicians know a lot more about sleep than I do. But they had the most bizarre ignorance of ADHD. I'd call it an almost willful ignorance.
When it came time for audience questions, one person asked, "What do you recommend for the sleep problems caused by ADHD?" (These problems are well known, including delayed sleep phase and more, and strategies are well known, too.)
But Dr. Kushida said, "Yes, lack of sleep can cause ADHD......(and so forth)." I was just stunned that he would purposefully turn the question around like that. So, I asked a follow up question -- more like made a statement -- to clarify the facts.
Afterwards, I was thronged by attendees who figured I knew something these docs didn't. After all, they'd already been to the clinic, done as ordered, and they still had ADHD, not to mention sleep problems.
My ten years as an advocate in the trenches has really taught me the #1 priority for healthcare reform: MORE CROSS-DISCIPLINARY KNOWLEDGE AMONG SPECIALISTS AND LESS TERRITORIAL GRANT-GRABBING. It's reached epic and scandalous proportions in both its cost and its harm. Am I holding my breath? Nah.....;-)
Gina Pera, author
Is It You, Me, or Adult A.D.D.? -
1Votesanswered Feb 05, 2010 at 12:41AMHonestly, I wasn't quite sure what to make of Dr. Park's answer. I thought it odd when he mentioned that the reason stimulants work in hyperactive people is because they're sleepy. His theory is that people are hyperactive because they're sleepy and the stimulant will "pep" them up and make them less tired, hence less hyperactive? It doesn't work like that.
It's interesting, Gina, that you mention that people with ADHD tend to have more problems with allergies. I have problems with allergies/asthma and have started allergy shots. Do you know why there's a correlation?
Thank you. -
2VotesHi Lisa,
I wish I knew. I've long noticed the correlation but could not find a study or any evidence to back it up.
I know that magnesium deficiency can sometimes exacerbate allergies, and there is limited study showing magnesium deficiency in some populations of people with ADHD. We know for sure that most Americans are deficient in magnesium, though. And this is no doubt worse for those who take calcium supplements without magnesium. I'm guessing it's worse for kids who drink a lot of milk.
Magnesium is a critical element to healthy functioning in the brain and the rest of the body. It has a sort of push-me/pull-you relationship with calcium. Simply put, calcium gives rigidity and structure to muscles, tendons, and cells, whereas magnesium gives flexibility. Calcium stiffens and magnesium relaxes, in other words.
Magnesium is also a precursor, or building block, to norepinephrine, a brain chemical often targeted with ADHD medication treatments.
So, magnesium is one issue. I've become known as the "mag nag" in our local Adult ADHD discussion group, because it can help with so many of the physical complaints that people have -- stiff neck, stiff back, hypertension, allergies, restless legs syndrome, migraines, constipation, etc. Dr. Carolyn Deane wrote an excellent mainstream book (with a regrettably hokey title) called "The Miracle of Magnesium." You can read that for more info.
My husband, who has ADHD, has been helped immensely by mag supplementation -- less acute allergies during pollen season, no more "startle response," etc. One of my friends who has ADHD finally relented to my nagging and tried it. He said that the ball of his anxiety in the pit of his stomach -- present for 20 years -- finally went away with magnesium. So, maybe it's not too hokey to call it a miracle. ;-)
There's a product called CALM that's available online. There are various versions, some with calcium. The thinking is, if one is deficient in magnesium, one should forgo supplementation with calcium until the mag is built up. So, I'd go with the straight mag if you're going to try it.
Beyond magnesium, Dr. Charles Parker emphasizes the importance of screening for food allergies among people who present with ADHD-like symptoms. He's an expert on Medpedia. And you can check his excellent blog at http://www.corepsychblog.com
Back to your original question about Vyvanse.....you can search Dr. parker's site for great info on Vyvanse titration, etc.
I hope that helps.
Gina Pera, author
Is It You, Me, or Adult A.D.D.? -
1Votesanswered Feb 05, 2010 at 12:02PMAll your comments are respectfully acknowledged.
Gina, by no means am I saying that a sleep-breathing problem is the one and only cause of ADHD. I believe that there's a consensus in the medical community that ADHD is a multifactorial disease, with a handful of major factors and a larger number of minor factors. What I am proposing is that sleep-breathing problems can aggravate any underlying condition that causes ADHD, and sometimes may be a major aggravator. I think everyone will agree with the first part of my last sentence, but you may disagree with the latter half.
One of the biggest misconceptions within the medical community as well as the alternative and complementary fields is that all humans are able to breathe normally while sleeping. This is absolutely not true. Due to our unique ability to talk and communicate, we're all susceptible to swallowing and breathing problems. Evolutionary biologists and comparative anatomists all agree that speech and language development was ultimately detrimental to humans. This is why for the most part, only humans have so many problems with choking and swallowing difficulties. If one part overdevelops (speech), then the other two have to suffer (swallowing and breathing).
We did fine until a hundred years ago when we adopted modernized, Western diets, eating processed foods and refined sugars. Dr. Weston Price, a dentist, describes in his classic book, Nutrition and Physical Degeneration, a process where indigenous cultures that ate completely off the land had wide jaws, perfectly aligned teeth, and no cavities. One they started to adopt modern Western diets, their children's teeth came in much more crooked, with narrow jaws and faces, and more cavities. They were also much more prone to infectious disease. He found this phenomenon occurring across all cultures throughout all the different continents. Dentists state that humans didn't get impacted molars hundreds of years ago. Bottle-feeding (another modern concept) is also thought to aggravate malocclusion and dental crowding.
If you accept this process to be true, then there are there are a number of important implications, which I describe in my book, Sleep, Interrupted. If your jaws start off slightly smaller than normal, then your tongue (which grows to its' normal size) takes up relatively too much space. This prevents you from sleeping properly on your back since the tongue will fall back more in the supine position and relax even more during deep sleep, leading to frequent obstructions and arousals. This prevents proper amounts of deep sleep (REM and non-REM) that is so important with memory, focus, and cognitive functioning. Furthermore, any degree of obstruction causes a vacuum effect in the throat that literally suctions up your normal stomach juices into your throat, which can then go into you nose and lungs, causing further swelling and inflammation. This not only includes acid, but also bile, digestive enzymes, and bacteria.
Your tonsillar tissues (palatine tonsils, adenoids, and lingual tonsils) are lymphoid tissues that help to educate your immune system as to what's self and what's foreign. They're most active around ages 3-6, and most likely to become enlarged at this time. But the smaller your jaws, the more likely you'll have reflux and inflammation, aggravating more obstructions and arousals, leading to more reflux. Nasal congestion from this process aggravates a vacuum effect downstream that causes even more tongue collapse. This is why children with large tonsils have various degrees of dental crowding and narrow jaws, which also makes the tonsils look large (due to a smaller space in the back of the throat).
Anything that causes further inflammation and swelling (allergies, weather changes, diet, etc.) can aggravate this vicious cycle. Conversely, anything that improves the airway (treating allergies, proper nutrition, orthodontics, weight loss, surgery, etc.) can improve your sleep efficiency through better breathing. Our upper airway (from the tip of the nose to the voice box) is constantly changing and highly dynamic, with even small amounts of narrowing leading to more frequent obstructions and arousals. Even if you're completely "normal", you'll still stop breathing once in a while—this is why if your nose is stuffy from a common cold, you'll toss and turn more when you sleep. It's because your tongue keeps falling back and prevents you from staying in deep sleep. Once your cold goes away, you're sleeping fine again.
continued.... -
1Votesanswered Feb 05, 2010 at 12:04PMWhat I describe more fully in my book is a sleep-breathing continuum, where all modern humans are one a line, and the extreme end is called obstructive sleep apnea. However, you don't have to have apneas to have major sleep-breathing problems. An apnea means that you stop breathing for 10 seconds or longer, and you need at least 5 apneas (or hypopneas, a lesser version) per hour. However, if you stop breathing 25 times every hour, but wake up to turn over after 1 to 9 second pauses, then you're told you don't have obstructive sleep apnea.
By no means am I advocating surgery for everyone with ADHD. But if you are a heavy snorer, and have huge tonsils, doesn't it make sense to address this issue first, beginning with dietary, lifestyle issues, allergy management, and lastly with surgery if all else fails? It's painful to see young children who snore heavily with huge tonsils who continue on allergy shots for years, hoping that their healthy diets can alleviate the problem. Yes, it will work in some cases, but many parents are completely against any kind of surgery, being told by some physicians that their child will "outgrow" their problems. Some eventually do outgrow them, but with certain consequences. Many will go on to develop various medical complications related to untreated obstructive sleep apnea. If you don't snore, and have normal jaw anatomy, then you should look for other reasons for your ADHD. More often than not, parents of children with ADHD have parents that snore heavily and have undiagnosed obstructive sleep apnea.
Gina, regarding your point about the role of brain neurotransmitters, I'm not discounting any of it. By definition, you'll find various deficiencies if you look for it. But this is the classic chicken or the egg question that's common with these type of issues: Which comes first? If you artificially block a brain neurotransmitter, you'll find specific results. However, sleep-breathing problems have been also found to radically change brain structure and biochemistry. For example, take a look at this month's article in Sleep (http://www.journalsleep.org/ViewAbstract.aspx?pid=27698), where they found that sleep apnea patients had multiple areas of lowered density of gray matter in specific regions of the brain. These areas control memory, executive function, autonomic function, and respiratory control. Numerous other studies have shown that even mild cases (or subclinical) cases of sleep apnea can cause neurologic impairment. Chronic hypoxia and sympathetic nervous system overload, along with a propensity for small vessel clotting all contribute to this process. Children's brains are much more sensitive to the effects of hypoxia—even having one apnea per hour is considered abnormal.
continued... -
1Votesanswered Feb 05, 2010 at 12:04PMYes, allergies and food sensitivities can also aggravate ADHD. However, both these conditions can also increase upper airway swelling and narrowing. You can even argue that sleep-breathing problems can cause immune and nervous system hypersensitivity to make people more prone to allergies or have sensitivities to certain dietary proteins.
The way I see it, ADHD doesn't exist alone in a vacuum. It's a small part of a much bigger picture that's aggravated by many of our modern diets and stresses, environmental exposures, toxins, and poor sleep hygiene. I think you'll agree that if there's obvious upper airway obstruction, then it needs to be dealt with, starting with conservative, then medical and lastly surgical options. Granted, some people won't respond to traditional sleep apnea treatments, but a great number of people do respond. Just yesterday, I saw a young child that came in for snoring, poor concentration and chronic fatigue about one month prior. He had huge tonsils. It turns out that he drank milk before bedtime. Just by stopping this habit, his mother reported that his snoring was significant reduced, and he was much more energetic and could focus more clearly. Some kids respond to conservative options, whereas some don't. It's never a black or white situation.
Yes, there needs to be more interdisciplinary cooperation between different specialists, but that's not going to happen any time soon, especially with our medical system. What I'm describing doesn't contradict anything you're talking about—in fact, it only complements it. Sorry for this long response, but I wanted to explain my comments in a bit more detail. Looking forward to your response.
If you want, here's a link to a chapter from my book, Sleep, Interrupted, called "A Stimulating Discussion About ADHD." (http://files.me.com/sypark/93s1wu)
It's better to read it in the context of the entire book. The references you asked about are in the chapter. What I described above is just a brief summary of what I write about in my book.
Steve
Steven Y. Park, M.D.
Author of Sleep, Interrupted: A physician reveals the #1 reason why so many of us are sick and tired. Endorsed by New York Times best-selling authors Christiane Northrup, M.D., Dean Ornish, M.D., Mark Liponis, M.D., Mary Shomon, and many others. -
1VotesDr. Park,
All that's very interesting, but we still have your initial, foundational comment: "The reason why stimulants work in hyperactive people is that they're sleepy. "
And this comment betrays a entire gap in your understanding of ADHD (including your using it synonymously with "hyperactive." Without a core understanding of ADHD, including its high heritablity rate, all the other factors that might exacerbate ADHD are not going to help people with ADHD.
The fact that you unabashedly cite chapter and verse from your book does not help your case, I'm afraid, insofar as accuracy of information and helping people being the goal here.
Gina Pera
. -
1VotesDr. Park --
I've read that ADHD chapter in your book (which you've specifically cited here what, three times now?) and find many gross mischaracterizations, not to mention outright misrepresentations.
I will give you the benefit of the doubt and assume it is based on ignorance and not willful disregard for the facts. People with ADHD and their families must battle enough stigma and misinformation from society in general, they certainly don't need more of it from physicians who ostensibly have been trained to use medical terms with precision, not to mention study the literature before writing authoritatively on any medical topic.
The crux of the problem, I believe, is that you are confusing ADHD with other conditions that might, to the untrained eye, mimic parts of ADHD symptomatology. Surely, many physicians misdiagnose ADHD as some other condition. No doubt, as I mentioned before, other issues such as allergies might create similar-looking cognitive challenges, and psychiatrists are often the least adept at sorting out these issues.
But we do have significant research on the neurobiological underpinnings of ADHD, and any physician who wants to know how to distinguish ADHD from other conditions owes it to patients (and readers) to do their homework.
Gina Pera, author
Is It You, Me, or Adult A.D.D.? -
3Votesanswered Feb 10, 2010 at 03:22PMI am glad that Gina Pera had the energy to refute Dr. Park's long and unusual notions about the mode of action of stimulants in patients with ADHD. The actual mechanism of benefit of the stimulants for ADHD is complex; these effects likely involve dopaminergic and noradrengergic stimulation of specific underaroused brain regions, but on the whole are not fully understood. There are many reasonable opnions within the psychiatric community about the specific underlying neurological/physiological difficulty in patients with ADHD; however "sleepiness" is not considered one of them.
-
0Votesanswered Feb 10, 2010 at 07:36PMGina,
I'm not trying to refute anything you're saying, or go against all the research that's out there for ADHD. Perhaps my initial post over-estimated the significance of sleep-breathing disorders as a cause of ADHD. I do agree that the term ADHD is used very loosely not only by the public but also by the medical profession. What I do see over and over in my practice is that patients are placed on stimulants for ADHD by their doctors, when in fact taking care of the sleep-breathing problem allows patients to function better without stimulants. It's difficult to know if they ever actually had true ADHD, but the fact is that they are labeled as such very often and placed on medications. It's based on this experience and numerous published reports that made me conclude that a significant number of children (and adults) with ADHD (real or assumed) may have a treatable sleep-breathing problem such as obstructive sleep apnea. What that exact percentage is, I can't say. Even if it's only 10%, that's still a significant figure. If we accept current figures that about 1-3% of children and up to 24% in men (and 9% for women) have obstructive sleep apnea, you can imagine there's going to be some degree of overlap in symptoms.
Based on these facts, would you agree with me that you should at least think about sleep apnea or any other sleep disorder in anyone officially diagnosed with ADHD before being placed on medications, especially if the child doesn't sleep well or snores, or has parents that snore? If you search the literature on ADHD and sleep apnea, you'll see numerous papers and opinions agreeing with my position. Some go even one step further and state that any child with an ADHD diagnosis should undergo an overnight sleep study.
Also, yes, there are countless papers showing abnormal neurotransmitter activity in subjects with ADHD. But here's food for thought: numerous recent studies are showing that people with untreated sleep apnea have multiple areas in the brain that are either dead (lacunar infarcts), smaller in volume, or more recently, much lower density of neurons in gray matter. These lesions are preferential for areas that involve memory, behavior, executive function, and autonomic function. Children's brains are much more sensitive to the effects of hypoxia due to repeated obstructions. One pediatric researcher stated at a sleep meeting that after tonsillectomy, children catch up pretty quickly with normal children in terms of cognitive ability, memory recall, etc., but there's some degree of permanent damage. I'll be happy to provide references—there are too many to list here.
In all areas of medicine there are heated disagreements on etiology and treatment options. With ADHD there are the prevailing theories, and there are numerous alternative explanations besides my own. I realize what I'm proposing is coming out of left field, but what I'm describing also applies to almost every other area of medicine, including heart disease, depression, anxiety, stroke, Alzheimer's, and even frequent urination. It's just a different perspective on standard views, which can be upsetting for most mainstream health care practitioners. Just like with depression, if you're convinced that it can only be due to a brain chemical imbalance, you'll close your eyes to any other possible explanations. What I'm proposing is that not breathing well at night can cause or aggravate almost every common medical condition that we see today.
It's possible that we're describing two totally different populations, but it's a safe bet that there's a significant degree of overlap.
Do me a favor: The next time you see a child or adult with ADHD (real or presumed), ask both parents whether or not they snore, and see if they can sleep at all on their backs. Do this for 10 patients in a row and you'll see what I mean.
Steve -
0VotesDo me a favor, Steve. The next time you see a child or adult with ADHD who fails to respond to the various sleep treatments, please refer them to a competent psychiatrist before submitting them to dangerous surgeries of removing throat tissue and sawing their jaw in half.
The mistake you make is thinking that a competent psychiatrist is as myopic as some sleep experts. They routinely refer for sleep studies. But unlike the sleep specialists, they are more careful in looking at global causes of sleep problems. -
0Votesanswered Sep 02, 2010 at 10:27PMI am not a doctor, but I am a student and a mother. I have two children that were diagnosed with ADHD. I wanted to research all my options for treatment. I found the study that Dr. Parks commented on. I talked it over with my childrens Doctor. We both came to the conclusion that it was the path for my children. We scheduled the surgeries, about a month apart. Both my 5 year old daughter and my 3 year old son had the tonsillectomy. I did not notice any difference in either of them right away. However, almost a year later, they are both sleeping better, but most of all they are showing an improvement in their behavior. I have done nothing differently than before the surgeries. I take offense to Gina's comment that parent reports are unreliable. I have been researching everything I can and I actively persue research of all areas of treatment before making a decision on anything. As for how a report my children issues and successes, I am reporting my observations as well as those of Doctors, teachers, therapists, and psychiatrists. All were involved in my decision. I weighed all my options and felt this was the way to go. I will not say it was a magical cure. We have had to be consistant with therapy, disapline, and encouragement for my kids. However, with a lot of hard work and the help of the surgery, we have seen my children go from out of control, to basically normal kids. Just so there is no misunderstanding, All the hard we have done since the surgeries that I mentioned, have been continued from before the surgeries. I don't think it will work for all kids, nor do I think it should be a decision made without a lot of research, discusions with health professionals, and knowing whether or not there is a sleep condition. I feel that what I did for my kids was way better than putting them on medications, that have not been proven to be safe for really young children. Also, even though they were unhappy and in a lot of pain for a week, they are also not going to have to be on meds for the rest of their lives, nor do they have to live with the stigma of having ADHD. I feel that too many parents are too willing to put their kids on meds, because they look at it as a quick fix. I have talked to a lot of parents that wouldn't go for the surgery, because it isn't a quick cure. They want results now, it's easier on them, but not the kids. Also asked my kids opinions about the surgery, they were told what would be done, and both said they were ok with it. If you ask them now, they will say they are happy they did it. They are happier now, and actually enjoy school and preschool. I just had to give my two cents worth, because you are all bickering back and forth, and all you are going on are studies you read. How many of you have actually been right in the thick of it. How many of you have actually seen the before and after, and the joy on the kids faces when they can actually sit and finish a puzzle y themselves. Well I have, and I am a supporter of this surgery. I am sure you will have something to say about my grammer and spelling, but as I said I am a mom and a student, not a Doctor. I am only on here to say that this can work and worked for me, TWICE. that's a 100% success rate. Yes, I know it is not a large study group, but I would say that since I had a 50/50 chance with each of them, that there is obviously something there to look at and study.
-
1Votesanswered Sep 03, 2010 at 04:09AMSarena, thanks for sharing. Although my own son didn't officially have ADHD, around age 5 he was tired, snored, and couldn't focus or sit still. After his large tonsils were taken out, what a difference!
I want to reiterate that I'm not advocating adenotonsillectomy for all children with ADHD. But whenever there are clear signs of a sleep-breathing problems, at least take the steps to address it, starting with conservative options that can alleviate the inflammation and swelling first (such as allergy management, timing of meals, etc.) Eating or snacking close to bedtime is a major aggravator of poor sleep, since reflux of stomach contents causes enlargement of lymphoid tissues, such as the tonsils and adenoids. Often, children with ADHD symptoms improve dramatically by avoiding eating or snacking within 2-3 hours of bedtime. I've even had bedwetting resolve simply by avoiding pre-bedtime snacks.
Another way to manage this problem, especially if the tonsils are small, is through orthodontics. Children with crowded teeth by definition have narrowing of the jaws, leading to smaller airways. By widening the jaws through orthodontics and/or palatal expansion, sleep can improve through better breathing.
Also, many children with ADHD are mouth breathers. Sleeping with your mouth open causes the tongue to rotate back, further aggravating obstruction. This is why doing everything possible to help the child breathe through the nose is so important.
Regardless of the wide differences of opinion on this discussion, I think everyone can agree that there is a subset of children with ADHD that can be significantly improved by addressing the sleep-breathing issues. -
0Votesanswered Sep 03, 2010 at 11:05AMI agree, I don't believe that the decision I made, should be made for every child. However, I would like to see it offered as an option, when all else has failed, or to give parents a choice, for something other than meds Not all parents are looking for a quick fix. They are looking for a way to help their children, without having to medicate them for life. I know for me, I am very catious about meds. I was put on a med that almost caused complete and irreversable blindness. I have also been on meds, that are now on the news for class action lawsuits. My mother was one of the first people to be put on the phen-phen diet (not sure if that is the right spelling) she now has damage to her heart. Because of this I research every option before giving the ok for meds. I am not knocking the benefits of most meds out there, just careful of what I will use for my family.
I don't know if you could help me with a concern I have had for the last three years or not? Three years ago,( before I was catious about meds) my daughter was put on a three day treatment of steroids. She had a bad case of croup, they felt it was the best option to get her better. My som was also put on the same treatment. During the three days, both children were CRAZY. they had massive mood swings (they made bi-polar look good) my daughter also was extremely violent. I called the doctor, and he assured me it would go away as soon as they were off the meds. Well the treatment ended, and my son went back to normal, my daughter on the other hand, just kept getting worse. Over the next 9 months, the rage, lack of sleep, violence, and complete lack of control continued. I was lucky to get 2-3 hours of sleep, usually broken up. She would not and could not fall asleep, and so I would take her to bed at 8 pm, and for the next 10 hours it would be a nonstop fight. We tried sleep depravation, so she would be exhausted at bed time, no luck. We tried everything the doctors and psychiatrists told us to do. Nothing worked, I did research and found that the way she was acting was similar to steroid psychosis, however I was told that that was impossible, because she hadn't been on it long enough. My problem is she had been a totally different kid before. She was calm, sweet , quiet, gentle, and slept great. Three days of treatment, and I was given the exact opposite. She has gotten a little better with most of it, but occasionally we have a flare up. when she does, it is almost like she is gone. Her eyes get this weird look to them, she gets completely out of control, most anything you do makes it worse. I have taken her to just about everyone in my home town, but it is a small town, and not a lot of specialists. I am scared, that she will only get worse, and I fear what her future will be like. If you can't help, if you could point me in the direction of someone who could. I may never get my little girl back to what she was, but I would at least like to find a way to control the temper issues. She does not deserve what has happened to her. PLEASE HELP!!!!
Sign-in
to post an answer to this question.
Related Questions
in
Other
- Does the Feingold Program work for ADHD?
- "High IQ Is No Help For Those With ADHD"
- ADHD Medication and Writing
- Is there a link between Schizophrenia, ADHD, and OCD?
- Is there a genetic component to ADHD? What is the research on this?
- Could switching from ritalin to dexadrine possibly help with feeling exhausted and burned out?
- Do stimulant medications for ADHD help over time?
- Is ADHD curable?
- My son will be 14 this month. He's been on ADD/ADHD medicines since he was 5. My doctor mentioned that he may "outgrow" the needs for medicine at some point. Is this possible?
- Does running help control ADD / ADHD?
- »» See All
The content on or accessible through Medpedia.com is for informational purposes only. Medpedia is not a substitute for professional advice or expert medical services from a qualified health professional.
Read more