Surgical Cure for ADHD? Probably Not (Article)

Recently a new study called CHAT (Childhood Adenotonsillectomy Trial) was published with results that will interest anyone who knows a child who has ADHD (Attention Deficit Hyperactive Disorder). The investigators set out to answer whether children with ADHD, large tonsils and adenoids, and associated obstructive sleep apnea (severe snoring with interruption of breathing in their sleep) would benefit from quick removal of their tonsils and adenoids (a procedure known as T+A), or whether watchful waiting would be the best course of action. Said another way, does obstructive sleep apnea from big tonsils and adenoids contribute to the cognitive impairment ADHD, and would removing the tonsils and adenoids by T+A improve core ADHD symptoms?

The authors designed an elegant, well-done study that yielded clear results. Let me summarize their conclusions:

 

  1. Children who received early T+A, what they called the “surgical group,” dramatically reduced the symptoms of sleep apnea relative to the non- surgical group. Sleep quality was dramatically improved in this group.
  2. Children in the early T+A group also demonstrated improved behavior post surgery relative to the non-surgical group.
  3. BUT, unfortunately, attention span and cognitive ability did not show improvement in the surgical group relative to the watch-and-wait group.

 

The authors concluded that a T+A benefited the surgical group’s sleep quality, daytime behavior, and general quality of life…but did not improve their core ADHD symptoms. The hopes of finding a surgical cure for ADHD did not materialize.

 

So, it looks like the decision to perform a T+A on a child with ADHD and large tonsils and adenoids, a procedure not without it’s own risks, should be decided mainly on the basis of the child’s sleep apnea and not on the hope that the surgical procedure will improve the child’s cognitive difficulties. The conclusion of this study is that ADHD or no ADHD, if a child has severe sleep obstructive symptoms from large tonsils and adenoids, they should have their tonsils out earlier rather than later. Stay tuned, however. This may not be the final word on the controversy about the interaction of poor sleep, large tonsils, and ADHD. If you have a child with ADHD and poor sleep along with heavy snoring, discuss these symptoms with your child’s pediatrician.

 

Your comments and stories are welcome at my blog, www.docsmo.com. Until next time.

 

Smo Notes:

  1. Marcus, et. al., A Randomized Trial of Adenotonsillectomy for Childhood Sleep Apnea, NEJM, 2013.

http://www.nejm.org/doi/full/10.1056/NEJMoa1215881

Written collaboratively by Jonathan Ferguson and Paul Smolen M.D.

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