Outcome of Adenotonsillectomy in Children with ADHD (Attention Deficient Hyperactivity Disorder)

Open Access

Abstract

Background: Attention-deficit hyperactivity disorder (ADHD) in children is frequently associated with sleep-disordered breathing due to adenotonsillar hypertrophy, which may exacerbate behavioral and cognitive symptoms. Adenotonsillectomy has been proposed as a potential non-pharmacological intervention to improve ADHD-related outcomes by correcting sleep disruption. Aim of the study: To evaluate the impact of adenotonsillectomy on behavioral, attentional, and sleep-related outcomes in children diagnosed with ADHD. Methods & Materials: This prospective interventional study was conducted at Bangladesh Shishu Hospital & Institute, Dhaka, from August 2023 to August 2025. A total of 100 children aged ≤10 years with DSM-5–diagnosed ADHD and clinical indications for adenotonsillectomy were enrolled. Pre- and postoperative ADHD severity was assessed using a validated ADHD rating scale. Outcomes were reassessed 4–6 weeks after surgery. Statistical analysis was performed using paired t-tests and chi-square tests, with p ≤0.05 considered significant. Results: Postoperatively, 70% of children showed overall ADHD improvement. Significant reductions were observed in mean total ADHD score (28.6 ± 4.2 vs 18.4 ± 3.8; p<0.001), hyperactivity, inattention, and impulsivity sub-scores (all p<0.001). Improved sleep quality was reported in 82% of patients. Higher grades of tonsillar and adenoid hypertrophy, presence of sleep apnea, and less severe baseline ADHD were significant predictors of clinical improvement.Conclusion: Adenotonsillectomy is associated with significant Long term improvement in ADHD symptoms and sleep quality in children with adenotonsillar hypertrophy. Evaluation and management of sleep-disordered breathing should be considered an integral component of comprehensive ADHD care.