title: Improved behavior after adenotonsillectomy in children with higher and lower IQ.
abstract: OBJECTIVE
  To examine whether high intellectual ability, in comparison to average or lower performance, reflects the consequences of sleep-disordered breathing and limits behavioral benefit observed 6 months after adenotonsillectomy.
  
  
  METHODS
  Children aged 3-12 years (n=147) recruited from otolaryngology practices at two hospitals and assessed with Conners' Parent Rating Scales and an age range-appropriate intellectual measure, the Stanford-Binet Intelligence Scale at baseline and 6 months after clinically-indicated adenotonsillectomy. Subjects were classified as having high (IQ≥110), average (90≤IQ<110), or low (IQ<90) cognitive ability.
  
  
  RESULTS
  After adenotonsillectomy, improvements in Conners' internalizing, externalizing, hyperactivity, and cognitive domains were observed across IQ groups (main effects for time, all p<0.01 or better), with no evidence for differential improvements among the groups (no significant time by IQ group interactions). The magnitude of behavioral improvement among children with high IQ resembled that observed among the other two groups. Changes in the Conners' domains were not significantly correlated with baseline IQ, age, socioeconomic status, body mass index z-score, or respiratory disturbance index.
  
  
  CONCLUSIONS
  Behavioral function can improve after adenotonsillectomy even among children with relatively high intellectual ability at baseline. Diagnosis and treatment with expectation of neurobehavioral benefit should be considered among high-performing children as readily as it is more traditionally among their lower-performing peers.
authors.affiliation: Sleep Disorders Center, Ann Arbor, MI, USA; Department of Neurology, Ann Arbor, MI, USA; Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea. Electronic address: schung@amc.seoul.kr.
authors.forename: Seockhoon
authors.initials: S
authors.lastname: Chung
authors.affiliation: Neuropsychology Section, Department of Psychiatry, Ann Arbor, MI, USA.
authors.forename: Elise K
authors.initials: EK
authors.lastname: Hodges
authors.affiliation: Sleep Disorders Center, Ann Arbor, MI, USA; Department of Neurology, Ann Arbor, MI, USA.
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Ruzicka
authors.affiliation: Sleep Disorders Center, Ann Arbor, MI, USA; Department of Pediatrics and Communicable Diseases, Ann Arbor, MI, USA.
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Hoban
authors.affiliation: Sleep Disorders Center, Ann Arbor, MI, USA; Department of Otolaryngology/Head and Neck Surgery, Ann Arbor, MI, USA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Garetz
authors.affiliation: Department of Biostatistics, Ann Arbor, MI, USA.
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Guire
authors.affiliation: Sleep Disorders Center, Ann Arbor, MI, USA; Division of Child Behavioral Health, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Barbara T
authors.initials: BT
authors.lastname: Felt
authors.affiliation: Department of Psychiatry, Central Michigan University College of Medicine, Saginaw, MI, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Dillon
authors.affiliation: Sleep Disorders Center, Ann Arbor, MI, USA; Department of Neurology, Ann Arbor, MI, USA.
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Chervin
authors.affiliation: Department of Neurology, Ann Arbor, MI, USA; Neuropsychology Section, Department of Psychiatry, Ann Arbor, MI, USA.
authors.forename: Bruno
authors.initials: B
authors.lastname: Giordani
mesh_terms: D000233:Adenoidectomy / Q000523:psychology*; D001289:Attention Deficit Disorder with Hyperactivity / Q000209:etiology; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007360:Intelligence; D007361:Intelligence Tests; D008297:Male; D012891:Sleep Apnea Syndromes / Q000523:psychology* / Q000601:surgery*; D014068:Tonsillectomy / Q000523:psychology*
keywords: Intelligence; Neurobehavioral function; Sleep apnea syndrome; Tonsillectomy