Tonsil-Adenoid Surgery May Help Behavior, Too

Our Review Summary

In this story, we learn about a new study showing that a common surgery for sleep disturbance in children, adenotonsillectomy, may be effective for children with ADHD. Any new information on the treatment of ADHD is big news. According to the NIH: “between 3 and 5 percent of children have ADHD, or approximately 2 million children in the United States. This means that in a classroom of 25 to 30 children, it is likely that at least one will have ADHD.”

The story is clear that adenotonsillectomy is a common surgery for sleep apnea in the U.S., but that it is now being conisered for treating ADHD as well. This story leads the reader to believe that adenotonsillectomy could be used for all children with ADHD, a very large population given recent trends in diagnosis and treatment. However, this story is really about a research study that looked at children with sleep disturbance who also have ADHD, a much narrower population. The story also does not accurately represent the strength of the available evidence that adenotonsillectomy is effective for ADHD. The opening line of the story refers to “strong evidence,” which is really an overstatement. Although it is true that this is a randomized clinical trial, there are several limiting factors that are not addressed in this story. Specifically, this was a small study and the psychiatrists who assessed the children were not blinded to surgical status, potentially biasing the results. Furthermore, the story does not mention that sleep disturbance at baseline and at one year follow-up did not correlate with behavioral outcomes. This suggests that either there are problems with how sleep disturbance or behavior was measured in this study or that there is some other mechanism other than sleep that is mediating the relationship between the treatment and behavioral outcomes. These issues are not discussed in the story.

The story does not mention any harms associated with the surgery. The harms, although rare, include infection and respiratory complications, and are more common in children with obstructive sleep apnea, the target population in this story.

The story does provide the reader with adequate quantification of the benefits of treatment. Specifically, the number of children with ADHD is provided in the control and surgery group at baseline and at one year follow-up.

We don’t know if the author relied on text from a press release. Only a single expert is quoted, the author of the research article in the journal Pediatrics, so the reader is not provided with balanced perspectives on the importance of these new findings for clinical practice. There is also no mention of other treatment options. For example, CPAP machines should have been mentioned as a non-surgical alternative. Finally, there is also no mention of costs.