To the Editor.—
In the article by O’Brien et al, “Sleep and Neurobehavioral Characteristics of 5- to 7-year-old Children With Parentally Reported Symptoms of Attention-Deficit/Hyperactivity Disorder,”1 the authors present interesting findings concerning sleep disturbance and attention-deficit/hyperactivity disorder (ADHD) symptoms. However, some of their recommendations and conclusions are not supported.
The authors recommend that “a child who presents with parental complaints of hyperactivity and who does not meet the diagnostic criteria of ADHD” should, if he snores, undergo an overnight polysomnographic evaluation. The authors’ use of a parental Conners’ score between 1 and 2 standard deviations above the mean as a proxy for mild hyperactivity is inappropriate. Children with behaviors between 1 and 2 standard deviations from the mean are best described as normal and not as having “mild ADHD-like behaviors.” Such a score on a behavior rating scale may be informative as an element of a comprehensive evaluation,...
