Effect of Adenotonsillectomy on ADHD Symptoms of Children with Adenotonsillar Hypertrophy
Adenotonsillar hypertrophy and obstructive sleep disordered breathing can lead to attention deficit/hyperactivity disorder (ADHD). The purpose of this study was to evaluate effect of adenotonsillectomy on improvement of ADHD symptoms in a quasi-experimental (before and after) study. The efficacy of adenotonsillectomy on improvement of ADHD symptoms of 35 children aged 5-12 years with adenotonsillar hypertrophy and ADHD was evaluated six months after surgery. Diagnosis of ADHD was based on the DSM-IV criteria in three subtypes (predominantly inattentive type, predominantly hyperactive-impulsive type and combined type). Seventeen boys (49%) and eighteen girls (51%) with mean (± SD) age of 7.4 ± 3.8 years (range: 1-10 years) were evaluated. Frequency of combined type of ADHD decreased significantly six months after adenotonsillectomy (54.3% versus 22.9%, P=0.003). ADHD inattention score (2.26 ± 1.93 versus 0.96 ± 0.45, P=0.005), hyperactivity score (4.23 ±3.57 versus 3.57 ±8, P=0.03) as well as ADHD combined score (9.66 ±2.58 versus 7.2 ±3.67, P=0.0001) improved significantly after surgery. Upper air way obstruction due to adenotonsillar hypertrophy might be an important and treatable cause of ADHD and should be considered in evaluation of affected children. Adenotonsillectomy in these children is associated with improvements in ADHD symptoms.
Chang SJ, Chae KY. Obstructive sleep apnea syndrome in children: Epidemiology, pathophysiology, diagnosis and sequelae. Korean J Pediatr 2010;53(10):863-71.
Aydogan M, Toprak D, Hatun S, Yüksel A, Gokalp AS.mThe effect of recurrent tonsillitis and adenotonsillectomy on growth in childhood. Int J Pediatr Otorhinolaryngol2007;71(11):1737-42.
Kurnatowski P, Putyński L, Łapienis M, Kowalska B. Physical and emotional disturbances in children with adenotonsillar hypertrophy. J Laryngol Otol 2008;122(9):931-5.
Ezzat WF, Fawaz S, Abdelrazek Y. To what degree does adenotonsillectomy affect neurocognitive performance in children with obstructive sleep apnea hypopnea syndrome due to adenotonsillar enlargement? ORL J Otorhinolaryngol Relat Spec 2010;72(4):215-9.
Suratt PM, Barth JT, Diamond R, D'Andrea L, Nikova M, Perriello VA Jr, Carskadon MA, Rembold C. Reduced time in bed and obstructive sleep-disordered breathing in children are associated with cognitive impairment. Pediatrics 2007;119(2):320-9.
Kurnatowski P, Putyński L, Lapienis M, Kowalska B. Neurocognitive abilities in children with adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 2006; 70(3):419-24.
Blunden S, Lushington K, Kennedy D, Martin J, Dawson D. Behavior and neurocognitive performance in children aged 5-10 years who snore compared to controls. J ClinExp Neuropsychol 2000;22(5):554-68.
Biederman J, Faraone SV. Attention-deficit hyperactivity disorder. Lancet 2005;366(9481):237-48.
Ali NJ, Pitson D, Stradling JR. Sleep disordered breathing: effects of adenotonsillectomy on behaviour and psychological functioning. Eur J Pediatr 1996;155(1):56-62.
O'Brien LM, Holbrook CR, Mervis CB, Klaus CJ, Bruner JL, Raffield TJ, Rutherford J, Mehl RC, Wang M, Tuell A, Hume BC, Gozal D. Sleep and neurobehavioral characteristics of 5- to 7-year-old children with parentallyreported symptoms of attention-deficit/hyperactivity disorder. Pediatrics 2003;111(3):554-63.
Domínguez-Ortega L, de Vicente-Colomina A. Attention deficit-hyperactivity disorder and sleep disorders. Med Clin (Barc) 2006;126(13):500-6.
Wechsler D. Manual for the Wechsler Intelligence Scale for Children. 3rd ed. San Antonio, TX: The Psychological Corporation; 1991.
Dillon JE, Blunden S, Ruzicka DL, Guire KE, Champine D, Weatherly RA, Hodges EK, Giordani BJ, Chervin RD. DSM-IV diagnoses and obstructive sleep apnea in children before and 1 year after adenotonsillectomy. J Am Acad Child Adolesc Psychiatry 2007;46(11):1425-36.
Avior G, Fishman G, Leor A, Sivan Y, Kaysar N, DeroweA. The effect of tonsillectomy and adenoidectomy on inattention and impulsivity as measured by the Test of Variables of Attention (TOVA) in children with obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg 2004;131(4):367-71.
Weber SA, Lima Neto AC, Ternes FJ, Montovani JC. Hyperactivity and attention deficit syndrome in obstructive sleep apnea syndrome: is there improvement with surgical management? Braz J Otorhinolaryngol 2006;72(1):124-9.
Li HY, Huang YS, Chen NH, Fang TJ, Lee LA. Impact of adenotonsillectomy on behavior in children with sleepdisordered breathing. Laryngoscope 2006;116(7):1142-7.
Huang YS, Guilleminault C, Li HY, Yang CM, Wu YY, Chen NH. Attention-deficit/hyperactivity disorder with obstructive sleep apnea: a treatment outcome study. Sleep Med 2007;8(1):18-30.
Mitchell RB, Kelly J. Behavioral changes in children with mild sleep-disordered breathing or obstructive sleep apnea after adenotonsillectomy. Laryngoscope 2007;117(9): 1685-8.
Wei JL, Mayo MS, Smith HJ, Reese M, Weatherly RA.= Improved behavior and sleep after adenotonsillectomy in children with sleep-disordered breathing. Arch Otolaryngol Head Neck Surg 2007;133(10):974-9.
Leiberman A, Stiller-Timor L, Tarasiuk A, Tal A. The effect of adenotonsillectomy on children suffering fromobstructive sleep apnea syndrome (OSAS): the Negev perspective. Int J Pediatr Otorhinolaryngol 2006;70(10):1675-82.
Garetz SL. Behavior, cognition, and quality of life after adenotonsillectomy for pediatric sleep-disordered breathing: summary of the literature. Otolaryngol Head Neck Surg 2008;138(1 Suppl):S19-26.
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