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May 12, 2006
Kids with breathing difficulties more likely to have behaviour problems
Second-hand smoke exposure, uncontrolled asthma and sleep apnea all possible culprits

Research continues to link breathing difficulties - whether from second-hand smoke, asthma or sleep apnea - with behaviour problems in children.

Results of the latest study (footnote 1), presented at the Pediatric Academic Societies annual meeting in San Francisco, showed that exposure to second-hand smoke, even at very low levels, is associated with behaviour problems in children and pre-teens. The study, led by Dr. Kimberly Yolton, a researcher at the Children's Environmental Health Center in Cincinnati, found that kids exposed to five or more cigarettes a day had more instances of acting out, more anxiety and depression, and more reports of behaviour problems from parents and teachers.

Dr. Yolton's team studied 225 children ages 5 to 11  exposed to the smoke of an average 14 cigarettes a day. The researchers found that the more smoke a child breathed, the worse her behaviour. Although the children in this study were all diagnosed with asthma, Dr. Yolton anticipates that the negative behaviour effects of second-hand smoke could be present in children without asthma, as well.

Dr. Yolton's study comes on the heels of other research that connects breathing difficulties to poor behaviour in kids. In a University of Rochester Medical Center study published in the journal Pediatrics (footnote 2), researchers found that city children with asthma are more likely to have problems with behaviour than their peers with no asthma. And kids with persistent asthma symptoms demonstrated even more behaviour problems compared with children with asthma who had no regular symptoms. 

Another recent study of children found a correlation between sleep-disordered breathing problems and Attention-Deficit/ Hyperactivity Disorder (ADHD) (footnote 3). Sleep-disordered breathing in children-in this case, obstructive sleep apnea usually arises when a child's tonsils or adenoids block off their breathing passages during sleep, causing pauses (apneas) in their breathing. In this study published in Pediatrics, lead researcher Dr. Ronald Chervin found that that children referred for tonsillectomies were more likely than other children to have behaviour problems like ADHD. One year after the tonsillectomy, children who'd undergone the operation showed improved behaviour. In fact, half of the children known to have ADHD before the operation (11 out of 22 kids) lost their ADHD diagnosis a year after their tonsils/adenoids were removed.

"This is one of the first studies to document, using gold-standard measures, that all of these sleep and behaviour problems tend to resolve one year after enlarged tonsils and adenoids are removed," says lead author Dr. Ronald Chervin. The author cautions "an undiagnosed sleep disorder is not the solution for all children with ADHD. But it could be something worth looking into for a substantial minority, especially those children with symptoms that suggest a sleep disorder such as sleep apnea."

More about second-hand smoke.

More about sleep apnea in children.

More about asthma in children

1. Environmental Tobacco Smoke Linked to Behavior Problems in Children and Pre-teens. Cincinnati Children's Hospital Medical Center. Press Release April 30, 2006.

2. Alterman JS, Conn KM, Forbes-Jones E, Fagnano M, Hightower AD, Szilagyi PG.  Behavior problems among inner-city children with asthma: findings from a community-based sample. Pediatrics. 2006 Feb;117(2):e192-9. 

3. Chervin RD, Ruzicka DL, Giordani BJ, Weatherly RA, Dillon JE, Hodges EK, Marcus CL, Guire KE.  Sleep-disordered breathing, behavior, and cognition in children before and after adenotonsillectomy. Pediatrics. 2006 Apr;117(4):e769-78.