Does Adenotonsillectomy Change ADHD Symptoms In Children-various aspects-
By ENT Specialist – Dr. Sagar Rajkuwar, Nashik, Maharashtra, India
Clinic Website: www.entspecialistinnashik.com
Table of contents-
- Why there might be an effect
- What the studies show (evidence summary)
- Important caveats & why results vary
- Practical implications (for clinicians & parents)
- Conclusion
Short answer: Sometimes — often for ADHD-like behavioral symptoms linked to sleep-disordered breathing (SDB)/obstructive sleep apnea (OSA), but not consistently for core cognitive measures of attention or for all children with an ADHD diagnosis. The effect depends on whether a child’s ADHD symptoms are driven (or worsened) by SDB, the severity of the sleep problem, how outcomes are measured, and follow-up time.
Why there might be an effect
Adenotonsillar hypertrophy is the most common cause of pediatric SDB/OSA. SDB causes fragmented sleep, intermittent low oxygen (hypoxia), and daytime sleepiness — all of which can produce or worsen symptoms that look like ADHD (inattention, hyperactivity, impulsivity, irritability). Removing obstructing adenoids and tonsils (adenotonsillectomy, AT) restores airflow during sleep and can therefore improve sleep quality and the physiological stresses that can impair attention and behavior. Several clinical studies describe marked improvements in parent-reported hyperactivity, inattention and oppositional behaviors after AT in children with adenotonsillar hypertrophy and SDB.
What the studies show (evidence summary)
Observational and before-after studies: Many studies (clinical series and small cohort studies) report significant reductions in parent-rated ADHD symptoms within weeks to months after AT in children who had adenotonsillar hypertrophy and SDB. Improvements are often seen in hyperactivity, inattention and oppositional behaviors at 1–6 months post-op. These are common and compelling reports, but mostly nonrandomized.
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Systematic reviews / narrative reviews: Reviews of the literature generally conclude that AT can improve behavioral symptoms in children with OSA, and may reduce the need for psychotropic medications in some cases — but the reviews also stress heterogeneity in study quality, small sample sizes, and mixed outcome measures (parent reports vs objective tests).
Randomized / higher-quality trials: Larger, more rigorous trials provide a more nuanced picture. A high-quality trial reported in JAMA (2023) comparing AT vs watchful waiting in children with mild SDB found no significant improvement in objective executive function or attention at 12 months, although AT did improve some secondary outcomes (behavioral symptoms by parent report, symptom scores, quality of life, and blood pressure). This suggests that for mild SDB, routine AT may not reliably improve neurocognitive test scores even if parents observe behavioral gains.
Bottom line from the evidence: AT most consistently improves parent-reported behavior and quality-of-life outcomes in children whose sleep problems are prominent. Effects on objective cognitive tests of attention and on long-term ADHD diagnoses are less consistent, and benefit is less clear in children with mild SDB or when ADHD is primary and unrelated to disordered sleep.
Important caveats & why results vary
Who the child is — children whose ADHD symptoms are driven by significant SDB/OSA (often with snoring, witnessed apneas, restless sleep) are the ones most likely to improve after AT. Children with primary neurodevelopmental ADHD without SDB are less likely to have symptom remission from surgery.
Severity of OSA — clearer, larger benefits tend to occur in moderate–severe OSA; mild SDB shows smaller, inconsistent cognitive gains.
Outcome measures — many studies use parent/teacher questionnaires (subjective) and report large improvements; objective neuropsychological tests sometimes show smaller or no significant change.
Follow-up duration — short-term gains (1–6 months) are commonly reported; long-term durability (years) is less well proven. Some recent reviews call for longer follow-up and higher-quality randomized trials.
DISCLAIMER-Some patients go to net and directly take treatment from there which can lead to catastrophic consequences-Then- Many people ask then why to read all this text -the reason is that it helps you to understand the pathology better ,you can cooperate with treatment better ,your treating physician is already busy with his patients and he does not have sufficient time to explain you all the things right from ABCD ,so it is always better to have some knowledge of the disease /disorder you are suffering from.
Practical implications (for clinicians & parents)
Evaluate sleep first. If a child with ADHD symptoms snores, has witnessed apneas, gasps, restless sleep, or daytime sleepiness, evaluate for SDB — history, ENT exam and often a sleep study (polysomnography) are appropriate. If adenotonsillar hypertrophy is present and OSA is moderate–severe, AT is frequently recommended and may improve behavior.
Don’t assume surgery will “cure” ADHD. If ADHD is well-established and unrelated to SDB, AT is unlikely to eliminate the need for behavioral interventions or medication. Continue multidisciplinary ADHD care (pediatrics/child psychiatry/psychology) while treating sleep problems.
Set realistic expectations. Parents should know that behavioral improvements are common after AT in children with SDB, but objective cognitive gains are variable and some children will still need ADHD treatment. Discuss risks and benefits of surgery.
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Conclusion
Adenotonsillectomy can reduce ADHD-like behaviors in many children who have adenotonsillar hypertrophy and sleep-disordered breathing — especially when SDB is moderate or severe and when outcomes are reported by parents — but it is not a universal cure for ADHD. High-quality trials suggest limited effects on objective attention/executive function for mild SDB. The best approach is to assess sleep in any child with ADHD-like symptoms and to use a combined plan (ENT/sleep medicine + ADHD care) tailored to the individual child.
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Clinic address of ENT SPECIALIST doctor Dr Sagar Rajkuwar-
Prabha ENT clinic, plot no 345,Saigram colony, opposite Indoline furniture Ambad link road ,Ambad ,1 km from Pathardi phata Nashik ,422010 ,Maharashtra, India-Dr Sagar Rajkuwar (MS-ENT), Cell no- 7387590194 , 9892596635
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