Question:
This study serves to validate some of Christian Guillminault's work in the
70's with sleep in children. A lot of kids with failure to thrive/short
stature, behavioral problems in school, etc. may be misdiagnosed. As for
the Ritalin... There is a growing concern among some sleep people that a
certain percentage of kids "diagnosed" with ADHD and put on Ritalin may in
fact have sleep disorders. Kids who are chronically sleep deprived (because
of apnea, poor sleep habits, etc.) will act just like kids with ADHD. Kids
react just the opposite of adults when they are chronically sleepy. They
get WIRED. It has long been supposed that Ritalin - a strong upper as we
used to call it - had a paradoxical effect on kids with ADHD, that instead
of stimulating them it calmed them down. Now, if a kid is sleepy and
therefore acting wild and disruptive, the Ritalin will overcome the
sleepiness. Make sense???
Answer:
Actually, dosage is what determines strong or mild or whatever. In and of
itself, methylphenidate hydrochloride (tradename Ritalin) when characterized at
all, is usually characterized as a mild psychostimulant.
Doesn't affect your argument, which is an interesting one to me. It should
also be noted that ADHD (or ADD) is not a behavior disorder, rather it is
usually classified as an "Other Health Impairment" or a "Specific Learning
Disability" and no universally accepted etiology has been forthcoming.
Advocates for children with ADHD lean toward the biophysical causation, which,
indeed, could include sleep disorder or sleep-disorder related symptoms. Sleep
deprivation itself could also be a co-variant resultant from, not causative of,
ADHD and its root biophysical cause.
Thousands of pages of research are churned out each year by academics in
special education, the physical sciences (including biochemistry) and
behaviorists throughout the world. As yet, there have been no simple answers
and all possibilities, from the effects of flourescent lighting to diet to
prenatal brain aphasia (especially with *premmies*) and, yes, sleep disorders,
are being investigated.
I personally would welcome all information on the subject, though not in a
position to do research, it certainly is central to my discipline, and I will
continue to share information on sleep apnea with my professors and collegues.
I can see your point about sleep deprivation, and hyperactivity, but there is a
Real disorder called ADD and my son has a textbook case. I dont think very
many of the cases of ADD can be explained by sleep disorders. I wish it really
was that simple. Just like everyone says "oh just dont give them sugar". I
just dont think its a simple answer why a child is hyperactive. ADD showed
up even when he was little, getting plenty of sleep. Like any mother does, I
watched him sleep, and never noticed any breathing difficulties. I have
wondered before about apnea, since I have it, thought it might be genetic, so I
listened, but he doesnt stop breathing, or snore. And yes, he was one of the
"3 million" kids a day given a Ritalin tablet, and it worked wonders. Oh boy
better climb off the soapbox now before I fall off and get hurt... :o)
A pat on the back for "getting on your soapbox"--Attention Deficit Disorder is
one of those focus issues that everyone thinks they know more about than the
professionals in the field. Lots of resistance to Ritalin, even though you and
I and thousands of others have seen it work wonders. Guess there are those who
think aspirin and penicillan are somehow "sinful" too. Not the least of the
uninformed "naysayers", unfortunately, are doctors, even those who prescribe
it. Incredible.
The problem I see with Ritalin and the others (Cylert, Dexedrine, etc.) is
their over prescription and the size of the doses. Doctors have become to
quick to provide a "pill on demand" without proper prescreening and
consultation, and doses seem to be geared toward the "zonked-out" rather than
the level that would effectively lessen the symptoms of ADD/ADHD without
drugout.
It should also be noted by those who are interested that Ritalin has a very
short duration effect (two to three hours unless given in time release form)
and the effects upon the child are not cumulative. There is no storage in the
organs, no residual effect, and nothing to be gained by taking vacations from
use. ADD/ADHD is indeed a diagnosis, based upon the DSM/IV categories, and may
only be made by the professional judgment of a physician. Teachers, school
psychologists and social workers do not determine its need and ethically do not
advocate its use in an individual child. They may recommend to a parent that
the child receive medical screening; that screening, as we know, should include
sleep disorder concerns as well as ADD/ADHD, internal parasites, and the rest
of the entire range of medical conditions that could effect learning.
Guess it is sort of like cpap--only those of us who need it, use it, or
prescribe it and know its benefits are truly qualified to pass judgment. We
also know that the medical profession has not yet fully recognized the need for
proper screening and has been slow to educate itself as to the proper treatment
options for OSA.
As in adults, when doctors routinely screen children for sleep disorders, there
may be more patients on cpap, and fewer on psychopharmaceuticals, but that fact
in no way should result in ridicule for those who depend on those drugs for
survival.
Don't take any crap from those who would seek to make you feel guilty for doing
what is best for your child. Continue to speak out when need be and I
encourage you to continue to advocate for those children out there now.
