http://health.dailynewscentral.com/content/view/0001664/52/

     Children who have symptoms of Attention Deficit/Hyperactive Disorder
(ADHD) actually may be sleep-deprived, according to researchers at the
Technion-Israel Institute of Technology Sleep Laboratory.
     Doctors should consider that possibility before prescribing Ritalin
and other ADHD drugs, they suggest.

     An estimated 8 percent of US children suffer from ADHD, according to
the US Centers for Disease Control, and more than half of them are being
treated with drugs.

     ADHD is characterized by overalertness and nervousness, with affected
children being fidgety and overstimulated. Paradoxically, the use of
stimulant medications like Ritalin seems to be the most effective method for
treating ADHD symptoms in the majority of children.

     Fighting to Stay Awake?

     Dr. Giora Pillar wondered whether some children diagnosed with ADHD
might simply be sleepy. Their excessive motor activity could be a tool to
stay alert, he conjectured, which might explain the effectiveness of
stimulants that increase activity in the central nervous system.

     "Sleepy children, unlike sleepy adults, may demonstrate hyperactivity
and attention-deficit behavior rather than excessive daytime sleepiness,"
Pillar explained.

     "This theory is supported by parental reports that children, when
extremely tired, tend to be cranky, overactive, angry and aggressive," he
pointed out.

     Sleep Apnea, Limb Movement Disorder

     Pillar and colleagues studied 66 children with an average age of 12.
Of these, 34 already had been diagnosed with ADHD, and the rest served as a
control group. The ADHD-diagnosed children had significantly higher levels
of sleepiness during the day than those in the control group, the
researchers found.

     Half of the test subjects with ADHD (vs. 22 percent of the control
group) suffered from some degree of sleep-disordered breathing, such as
sleep apnea, which is characterized by interruptions in breathing that last
10 seconds or more, occurring at least five times per hour during sleep.

     Fifteen percent (vs. none in the control group) had Periodic Limb
Movement Disorder (PLMD), which is relatively uncommon among children.

     Studies have shown that treatment of these sleep disorders in children
often leads to substantial improvements in behavior and cognitive
achievements, Pillar said, as well as a significant reduction in
irritability, bad moods, anger and fear.

     For example, school performance, which is low in children with sleep
apnea, has been found to improve markedly following the removal of adenoids
and tonsils to correct the disorder.

     Enforce Good Sleeping Habits

     The researchers urge parents of hyperactive and attention-deficit
children diagnosed with sleep disorders to have breathing irregularities and
limb movements treated, to enforce good sleeping habits, and to avoid giving
them caffeinated drinks at night.

     Only if these steps do not work, they say, should parents consider
medication for ADHD.

     The researchers' findings originally were published in the February
2004 issue of the journal Sleep.