A group of top ADHD specialists has warned that primary care physicians often miss the signs of sleep disorders, and sometimes misdiagnose the condition as ADHD because they are not trained well enough in medical schools.

“It has been our collective experience, supported by the results of several survey studies, that primary care clinicians often fail to screen for sleep problems in general, and frequently overlook sleep disorders in the differential diagnosis of children presenting with attentional impairments, in particular,” they wrote in a letter to the editor published in the December 2, 2011 online edition of NeoReviews, a journal of the American Academy of Pediatrics.

The letter was written specifically in response to the AAP Subcommittee on Attention-Deficit/Hyperactivity Disorder’s updated AD/HD Clinical Practice Guideline, commenting on the importance on sleep.

The group included top ADHD researchers Judith A. Owens, MD, MPH, Director of Sleep Medicine, Children’s National Medical Center; Thomas E. Brown, PhD, Department of Psychiatry, Yale University School of Medicine; Penny Corkum PhD, Samuel Cortese MD, Reut Gruber PhD, Louise O’Brien PhD, Mark Stein PhD, and Margaret Weiss, PhD.

“At least in part as a result of inadequate exposure to sleep medicine during and after training, primary care practitioners and even behavioral medicine specialists are not always well versed in the recognition of sleep disorders such as obstructive sleep apnea and restless leg syndrome which can “mimic” AD/HD symptoms or which may exist as co-morbid conditions in children diagnosed with AD/HD.

“Moreover, healthcare providers managing children with AD/HD may not adequately assess these patients for the presence of sleep problems at baseline or monitor their emergence over time,” they wrote. “As sleep disturbances are highly prevalent and often present substantial management challenges in these children, the failure to recognize the contribution of sleep issues to the core symptoms of AD/HD can also result in sub-optimal treatment of these daytime impairments,” they added.

Children who are sleep deprived, and children with ADHD can present with similar symptoms, making it difficult for a doctor to differentiate between the two if a comprehensive evaluation is not done. Further complicating the diagnostic picture is the fact that a significant number of children with ADHD also suffer from sleep disorders as well, making the clinician’s job that much harder — but underscoring the importance of getting an expert evaluation.