Dr. Nina Shapiro: Everyone knows that a good night's sleep leads to better performance the next day and all days. We also know, even though we don't get the recommended eight to nine hours that we should each night, our kids need to get their zzz's. Bedtime needs to be consistent, with whatever routines or techniques we've developed to get your kids to sleep. So if a good night's sleep means daytime focus, better behavior, and even better grades, does a bad night's sleep mean lack of focus, poor behavior, poor grades, or even ADHD? Can an ADHD diagnosis be caused by a sleep problem? Well, yes ... and no.

In other words, sleep problems probably don't cause ADHD, but they may exacerbate the symptoms. And in general, kids with ADHD are more likely to have sleep problems than kids who don't.

One of the earliest studies looking at sleep and school performance showed that kids with the lowest grades (these were elementary school students) were more likely to have a sleep problem (specifically, sleep apnea) than kids with higher grades. Half of the kids with poor grades had their tonsils out to reduce their sleep apnea. The kids who had their tonsils out had better grades the following school year than those who did not.

More recently, reversal of sleep apnea has been examined as a possible treatment for ADHD. The reasoning behind this is that maybe these kids can't focus because they are sleep deprived. Unfortunately, no study has been able to prove that ADHD can be cured simply by removing tonsils and reversing sleep apnea. However, many studies have shown that if a child has both ADHD and a sleep problem (with symptoms of loud snoring, gasping for breath, apnea, restlessness, or frequent wakening), curing the sleep problem (tonsil removal, allergy therapy, etc), will reduce ADHD symptoms significantly, sometimes to the point of being able to stop or reduce medications.

While sleep problems aren't a direct cause of ADHD, if ADHD is being considered as a diagnosis for your child, make sure you talk to your doctor about the possibility of a sleep problem. A good night's sleep won't be a cure, but it can help.

Dr. Nina Shapiro is a graduate of Harvard Medical School, and she completed her residency in ear, nose, and throat surgery at Harvard. She is an Associate Professor and Director of Pediatric Ear, Nose, and Throat at the Mattel Children's Hospital at UCLA. She has treated tens of thousands of children with ear problems, sleep problems, and breathing problems. She lives with her husband and two young children in Los Angeles.