Attention deficit hyperactivity disorder (ADHD) is a complicated condition characterised by a short attention span, an inability to listen, fidgeting and excessive chatter.
In the UK, children are diagnosed only after the corroboration of several parties, including family doctors, parents and the child's school. The most up-to-date statistics show that between three to seven percent of British children are affected (some 400,000).
But there is a worrying trend toward misdiagnosis. Dr Gurjinda Dahel, from the Royal College of Paediatrics and Child Health, says there are more diagnoses of ADHD in UK children than there should be, and that often, 'it's something desperate parents push for, believing it will enable them to help their child and address problem behaviour.' It's a pattern that's familiar in the US - the American Psychiatric Association (APA) states that five percent of American children truly have ADHD but misdiagnosis means that 15 per cent of children are put on medication to control their 'symptoms' - medication which may have nasty side effects, including liver toxicity, mental problems and growth repression.
But what if disruptive behaviour has nothing to do with ADHD and everything to do with chronic sleep deprivation? A 2012 study in the journal Pediatrics that followed 11,000 British children for six years suggested there was a strong link between inadequate sleep and ADHD-type symptoms, with those children whose sleep was affected by common breathing problems like snoring or obstructive sleep apnoea (OSA) being 40 percent to 100 percent more likely than those who breathed normally to develop behavioral problems. Quality sleep is essential for young minds and growing bodies, yet many parents aren't aware of how much sleep their child needs or even that their child is sleep-deprived. Mandy Gurney, a former midwife, health visitor and nurse who advises the NHS on child sleep issues and is part of our expert team at Essential Parent makes the following observation: 'Symptoms of sleep deprivation in children are not the same as in adults. Whereas we get lethargic and slow, children become manic.'
Respected American writer Alan Schwarz, author of ADHD Nation: Children, Doctors, Big Pharma and the Making of an American Epidemic, argues too that 'just because a child has a difficult time paying attention or sitting still in school does not mean they have a potentially lifelong brain disorder'. Indeed, research from the Journal of Pediatrics that was reported on recently suggests that the time of year a child is born can make them more at risk of an ADHD diagnosis - just 2.8 percent of boys born in September are diagnosed with the condition compared with 4.5 percent of boys born in August. The researchers believe this points to the fact the August-born children are more at risk of misdiagnosis when they start school simply because they are labelled 'immature' when in fact they are a year younger than their September-born schoolmates and are, in all likelihood, behaving appropriately.
Last week's headlines decreed that if 2016 was the year of clean eating, 2017 is the year of clean sleep - a concept endorsed by doyenne of all things healthy, Gywneth Paltrow, who says good quality sleep should be your first health priority, even before diet. Do a quick inventory of your child's sleep habits and consider how 'clean' they are. Are they exposed to screens and before bedtime? Are they allowed tech in the bedroom? We know now that the blue light emitted by screens confuses the brain into thinking its daytime, which in turn stimulates the production of cortisol, a stress hormone that keeps us lively and alert. Sleep experts advise parents to reduce screen time a full two hours before bedtime, especially for children who really have trouble sleeping. A snack such as porridge, which contains an amino acid called tryptophan, can help produce the sleep hormone melatonin, as will a warm (not hot) bath followed by downtime in a cool, dimly lit bedroom. And as one in 10 children snores, it's worth listening out to make sure there's no gasping, or long pauses in-between snores, which can indicate that breathing has stopped, briefly, and is a symptom of a more serious problem called obstructive sleep apnoea (OSA), in which breathing is significantly obstructed. This results in frequent wakings, called microarousals, during which the child repeatedly wakes to take a breath.
Microarousals affect sleep significantly and result in a lack of oxygen to the pre-frontal cortex in the brain, which affects the planning, processing of and acting on information. A child with OSA may snore severely or gasp and choke in their sleep, so it's unsurprising, then, that children with OSA are rarely well-rested, display poor concentration, hyperactive or disruptive behaviour and general irritability.
If you suspect OSA, see your doctor, who will refer you to an ENT specialist. Treatment includes use of nasal continuous positive airway pressure (CPAP), which keeps the airways open and involves wearing a nasal mask that's attached to a small compressor. Surgery to remove tonsils and adenoids is usually also very successful.
Diana Hill is co-founder of expert-led parenting website Essential Parent