Aim To study the incidence and effects of adenoid hypertrophy on sleep, cognition, attention, learning, speech and language development in children with ADHD.

Material and Method A 10 years retrospective randomized controlled study was done by review of clinical records of 1500 children with ADHD in age group 3- 5 years and > 5–7years with age and sex matched controls. Our data included Vanderbilts for Parents, Connors test, Behavior scales, Children QL -P, OSA- 18, Children sleep habit questionnaire, IQ BKT, LD test, ENT Consultation for airway evaluation, PSG( parameters (apnea-hypopnea index [AHI] and the lowest SaO2), EEG and Lab Tests: Hemogram, iron profile, TFT, Vit. D, IgE, Heavy metals. Statistical test of Chi square was done using SSPS 20.0. P valueignificance was <0.05. Inclusions: All children with confirmed diagnosis of ADHD, assessed by multidisciplinary team. EXCLUSIONS: Children with global delay, seizure disorder, syndromes, abnormal MRI brain, and other psychiatric, or neurological disorders.

Results About 33.8% had adenoid hypertrophy vs. 11.2% in controls, 26.4% had obstructive sleep apnea vs. 0.3% controls, 5.3% had Enuresis vs. 0.1% controls, 18.2% had speech and language problem vs. 1.6% in controls, 42% had cognitive difficulties vs. 4.8%, sleep disturbances in 78% Vs. 31% controls. Adenoidectomy was done in 28%, ABA was done in 93% and Medication was required in 17% cases. Post adenoidectomy, symptoms of OSA measured by Pediatric Sleep Questionnaire Sleep showed 83% improvement in first six months and 92% improvement by one year. Quality of life was shown to significantly improve on the PedsQL and OSA-18 scales.

Conclusions ADHD is one of the neurodevelopmental disability that is increasing rapidly today. Worldwide incidence from 5 to 11%. Our study suggests that adenoid hypertrophy is one of the contributing factors in causing sleep disorders, poor cognition, speech articulation and inattention in ADHD