What does lisp, bedwetting and attention/behaviour problems have in common?


Bed-wetting, lisps and behaviour problems: These are all signs of airway dysfunction.

They may occur together in the same person or a person may only experience one or two of them at the same time. And of course there are children with airway dysfunction who fly under the radar because their symptoms are different again. Human beings are complex, so that the same problem may cause different symptoms in different people.

However a growing body of research suggests that airway dysfunction should be assessed in people who exhibit the following:

1. Prolonged bed-wetting
Current evidence suggests that children with sleep disordered breathing may experience bed-wetting beyond the normal age. Sleep disordered breathing is an umbrella term for a range of sleep disorders that involve a breathing problem. Obstructive sleep apnoea is an example of sleep disordered breathing. It is estimated that 1 out of 5 adults has mild obstructive sleep apnoea. Unfortunately, 75% of severe cases of OSA go undiagnosed. OSA carries risk of heart attack, stroke and serious accidents due to excessive daytime sleepiness.

Some experts propose that abnormal hormone production during sleep due to breathing problems may result in bed-wetting. In older children and adults it may not be bedwetting, but needing to use the toilet more than 2 times during the night. Bed-wetting is even more common than snoring in people with OSA, so it is now regarded as a screening tool for OSA.

A recent study found that allergic rhinitis increased risk of bed-wetting, particularly in boys and in kids under the age of 6.

Experts now recommend that children with prolonged bed-wetting be screened for sleep disordered breathing.

2. Lisps.

An interdental (frontal) lisp indicates a problem with the tongue. Sounds s and z are produced too far forward in the mouth, in between the teeth. Sometimes other sounds may also be produced too far forward in the mouth. Commonly this includes the sounds l, n, t, and d. It usually accompanies a tongue thrust swallow, also known as a reverse swallow, where the tongue moves forward (against or in between the teeth) during the swallow. A tongue thrust is commonly associated with a low, forward tongue resting position. Children with this problem may posture their tongue between their teeth, especially when looking down.

What’s the connect between airway dysfunction and lisp? You won’t find any research on this yet, however there is anecdotal evidence Moving the tongue forward may be an attempt to gain more airway space in the throat behind the tongue.

Unfortunately, the connection between lisp and airway dysfunction has not been studied. The connection is acknowledged by many experts in the fields of Speech Pathology, Orofacial Myology and Orthodontics/Dentistry and ENT, particularly amongst those who have studied airway dysfunction. Nicole Archambault Besson is an American Speech Pathologist who wrote of the connection in a peer-reviewed paper (see references below).

3. Attention and behavioural problems
A high quality study in 2014 showed a moderate correlation between ADHD symptoms and sleep disordered breathing. The researchers recommended that SDB be screened in all children showing signs of ADHD. Adenotonsillectomy can improve behaviour in children who present with airway dysfunction and behavioural problems. Kids with breathing difficulties during sleep can experience significant sleep disturbance and struggle with daytime sleepiness. Daytime sleepiness in children sometimes looks like hyperactivity; at other times they frequently appear tired during the day and may require more daytime sleep than other children their age. They may struggle with constant fidgeting, wriggling, and other physical behaviours, which may get them into trouble at home and school. Other kids don’t present as “naughty”, but are daydreamy and have trouble remaining on-task or following instructions. Inattention at school may lead to learning difficulties, including difficulties learning to read and write.

In my clinical experience, a lot of kids who come to me for help with learning problems (eg. Reading and writing) also have signs of airway dysfunction.
If you have concerns about your child’s or your own airways and sleep, it is important to be assessed by an Ear Nose and Throat Specialist. I can also help you onto the road to getting the help you need.


Sedkya, K, and Carvalhob, K.S. (2014) Attention deficit hyperactivity disorder and sleep disordered breathing in pediatric populations: A meta-analysis. Sleep Medicine Reviews 18 (4), 349-356, 2014

Owens, J.A. (2009) Neurocognitive and behavioral impact of sleep disordered breathing in children. Pediatric Pulmonology 2009; 44:417–422

Lai, P-H, Yang, P-S, Lai, W-Y, Lin, C-L, Hsu, C-Y, Wei, C-C. (2018) Allergic rhinitis and the associated risk of nocturnal enuresis in children: a population‐based cohort study. International forum of allergy & rhinology 8 (11), 1260-1266.

Oztura, I, Kaynak, D, Kaynak, C. (2006) Nocturia in sleep disordered breathing. Sleep Medicine, V7, Issue 4, 362-367.

Archambault Besson, N. (2009). The tongue was involved but what was the trouble? Asha Leader, V 20, Issue 9.