Data from 2016-2019 shows there was an estimated 6 million children in the US between the ages of 3-17 diagnosed with ADHD (1). And there's no doubt in my mind that number has, and will, continue to rise.
3-5 years: 265,000
6-11 years: 2.4 million (10%)
12-17 years: 3.3 million (13%)
ADHD is being diagnosed, and many times misdiagnosed, at an alarmingly increasing rate. In my opinion, a huge portion of these diagnosis's are stemming from sleep disordered breathing and/or the feminization of the education system.
The Link Between ADHD and Sleep Disordered Breathing
Often times "ADHD" is actually a symptom of a sleep breathing disorder. What happens is that the child (or adult) is not breathing properly, and therefore not sleeping properly. This puts them in a constant state of sleep deprivation, to which their brain must over-stimulate their body in order to stay awake - thus the hyperactivity symptoms. These kids are then diagnosed with "ADHD" and put on medication. These medications are often times stimulants in and of themselves, therefore continuing to fuel the fire and create a vicious cycle. Initially, ADHD medications may appear to work. However, if the underlying problem is not addressed then you will often see the dosages needing to be slowly increased as time passes.
Southhampton research now reveals a clear link between ADHD and asthma. I wonder why? Could it be because people with asthma tend to not breathe as well...(2) This is just me speculating. Ha!
So how can I tell if my child has a sleep breathing disorder?
First and foremost you want to find a provider who specializes in pediatric sleep and airway dentistry. You will find lots of providers who claim they specialize in this, but I would beg to differ on many of these claims. A good place to start is to try and find a provider who has trained under The Breathe Institute or Airway Health Solutions. Or if you are in the DFW area, Dr. Hal Stewart and Dr. Adriana Corredor-Stewart or Dr. Melissa Rozas.
There are a few things you can look for at home:
Dark circles under the eyes
Blood shot eyes
Forward head posture (shoulders rolled forward)
Large tongue
Snoring
Bruxism (teeth grinding)
Do they wake up disheveled and looking like a tornado hit them/their bed while they slept?
Are they, or did they, experience prolonged bedwetting?
Are they, or did they, experience nursing/feeding issues?
Are they tongue or lip tied? (best diagnosed by an above dr)
Do they have an elongated face/underdeveloped jaw? (best diagnosed by an above dr)
Mouth breathing (watch your child during the day and while they sleep - their mouth should never be open while breathing!)
ADD/ADHD
Daytime sleepiness/fatigue
Headaches
Brain fog
Frequent night wakings
Restless leg syndrome
And since ADHD is also an above symptom, even if your child is not experiencing any of the others, I would always recommend seeing a specialized sleep and airway provider before resorting to medication - at least to rule it out!
The Link Between ADHD and the Feminization of the Education System
Boys are (13%) more likely to be diagnosed with ADHD than girls (6%) (1). I believe a large part of this is due to the US education system being deeply feminized over the last couple of decades. Boys and girls are different. We cannot expect them to learn and behave the same across the board.
Boys and Hearing
Many studies show that females, in general, hear at higher levels than males. Through Dr. Leonard Sax's research, he has found that the average boy may need his teacher to speak roughly 6-8 decibels louder in order to hear her as clearly as the average girl (3). In fact, Dr. Sax has stated that one of the first questions he will ask a little boy brought to him with the possible diagnosis of ADHD is, "where do you sit in the classroom?" If the answer is in the back one of his recommendations (amongst many others) is to move to the front. If a boy cannot clearly hear his teacher, his mind is more likely to wander. And what little boy is going to raise his hand and tell his teacher he cannot hear properly? Most likely, the little boy isn't even realizing that's an issue.
Boys and the Arts
Boys typically have more aggressive and violent imaginations than girls. This is not a bad thing! In fact, it's developmentally appropriate. During my time as a reading and writing educator I would have boys constantly writing stories and drawing pictures involving weapons, blood, fights, etc. I always allowed this in my classroom (within reason). However, most of the other teachers throughout the district did not. In fact, many of them would report the student to the counselors office for a mental health check. This absolutely crushed those little boys' sense of creativity, and in turn put a bad taste for the arts in their mouth. 9/10 of the above teachers would continue to have problems with these same boys turning in "lousy" work and not paying attention the rest of the year. I wonder why?
Without fail I would always have at least one boy who's other teachers were concerned about his lack of concentration, participation, and work, or who was already on a 504 plan due to ADHD, but would have zero problems in my classroom. This is not because I was an overly exceptional teacher. Trust me, there are MANY teachers 1,000x better than me. However, I was fortunate to have been following Dr. Leonard Sax's work for a while and knew a little bit more about the differences between boys and girls in the classroom setting. I never told a student what they could or couldn't read, write, or draw (within reason). I never let violent stories or pictures bother me (again, within reason). And in return, I had boys who otherwise "hated" reading and writing end up LOVING it.
Boys and Movement
Another thing we are seeing more and more in the classroom from a VERY early age is expecting boys to sit still for hours throughout the day. I taught 12-14 year olds, and my class period was almost two hours long. It is NOT developmentally appropriate to expect 12-14 year olds, especially boys, to sit still and concentrate on schoolwork for that long. I have had many conversations with mom's concerned about their son's behavior in the classroom saying, "He knows better. If he puts his mind to it he CAN sit there." I'm not arguing that he couldn't if he really tried, but that doesn't mean it's fair of us to expect that of him every single day.
I have one student in mind (let's call him John), who was extremely energetic and hyper-active. He was an amazing athlete and constantly wanted to be moving, scooting, dribbling, etc. As a little boy should! It was quite literally impossible to get him to sit still and concentrate on reading and writing for almost two hours - especially with his class period being the very last one of the day. Duh!!! I started letting him do all sorts of movement activities throughout the class period. I would let him do push-ups, jumping jacks, sprints if it was nice outside, etc., in order to let him get some of his energy out. I would also let him walk up and down the hallway while reading and writing if it was an especially energetic day. At one point I even put up a mini basketball hoop in the classroom and would let him take a shot each time he completed an assignment.
With out fail every other month, if not more, we would have a team meeting regarding John's behavior in the classroom and his failing grades - all but in my class. There was even discussion with his mom to have him evaluated for ADHD. Thankfully it never happened because COVID hit. But it made me so mad! He did not have ADHD! He was a 12 year old boy who was being forced to sit still for two hour class periods. That is not fair. And I knew he was capable of succeeding without medication, because he was doing so in my classroom. It just took a little extra time, energy, and work on my end.
So all of this to say. If you have a little boy, or a little girl for that matter, who is having trouble sitting still and concentrating at school - it does NOT mean there is something wrong with them! In fact, it's quite the opposite. I'm not sure what to do about it, but the US school system needs to do a better job at accommodating normal childhood development - especially in boys.
All in all, if your child has been diagnosed with ADHD I'm not saying they for sure don't have it. I would just encourage you to rule out all the other possibilities before resorting to medication - just to be safe!
Books I Recommend All Parents Read
Why Gender Matters by Dr. Leonard Sax
Boys Adrift by Dr. Leonard Sax
Girls on the Edge by Dr. Leonard Sax
References
1. Bitsko RH, Claussen AH, Lichstein J, et al. Mental health surveillance among children—United States, 2013–2019. MMWR Suppl. 2022;71(2):1-48.
2. https://www.southampton.ac.uk/news/2018/07/asthma-adhd-study-link.page
3. Sax, Leonard. Advances in Gender and Education, 2 (2010), 13-21. Sex Differences in Hearing: Implications for best practice in Child & Adolescent Development.
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