ADHD vs Postural control

How does the child present in the classroom/at home

ADHD

• Fidgety
• Poor concentration
• Impulsive
• Restless
• Poor listening skills
• Gets up a lot
• Talks a lot
• Shouts out answers
• Loses things
• Cannot wait for his turn
• Makes unnecessary mistakes

Postural control

• Has trouble sitting still
• Want to move continuously
• Clumsy
• Slouches in chair
• Supports head
• Changes posture frequently
• Bumps into people/objects
• Chews objects
• Loves rough and tumble games
• Loves jumping
• Adrenaline junkie

Definition

ADHD

The DSM-5^TM defines ADHD as a

• persistent pattern of inattention and/or hyperactivity-impulsivity
• that interferes with functioning or development
• has symptoms presenting in two or more settings (e.g. at home, school, or work; with friends or relatives; in other activities)
• and negatively impacts directly on social, academic or occupational functioning.
• Several symptoms must have been present before age 12 years

Proprioception

The automatic feedback we get from our ligaments and joints regarding:

• The body’s  / body parts orientation
• Rate and timing of movements
• Amount of force our muscle is exerting
• How much and fast our muscle is stretching

Vestibular system

• The sensory system that provides the leading contribution to the sense of balance and spatial orientation for the purpose of coordinating movement with balance – Wikipedia
• The system is activated by movement of the head, vibration and gravity

Signs and symptoms

ADHD

Diagnostic criteria according to the DSMV

1.  Either (1) or (2):
2.  Inattention:  six (or more) of the following symptoms of inattention have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level:

(a)  Often fails to give close attention to details or makes careless mistakes in  schoolwork, work, or other activities

(b)  Often has difficulty sustaining attention in tasks or play activities

• Often does not seem to listen when spoken to directly
• Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
• Often has difficulties organizing tasks and activities
• Often avoids, dislikes, or is reluctant to engage in tasks that require sustained metal effort (such as schoolwork or homework)
• Often loses things necessary for tasks or activities (e.g. school assignments, pencils, books or tools)
• Is often easily distracted by extraneous stimuli
• Is often forgetful in daily activities
•  Hyperactivity-impulsivity:  Six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least six month to a degree that is maladaptive and inconsistent with developmental level:

Hyperactivity

•  Often fidgets with hands or feet or squirms in seat
• Often leaves seat in classroom or in other situations in which remaining seated is expected
• Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feeling of restlessness)
• Often has difficulty playing or engaging in leisure activities quietly
• Is often ‘on the go’ or often acts as if ‘driven by a motor’
• Often talks excessively

Impulsivity

•  Often blurts out answers to questions before the questions have been completed
• Often has difficulty awaiting turn
• Often interrupts or intrudes on others (e.g. butts into conversations or games)
• Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.
• Some impairment from the symptoms is present in two or more settings (e.g. at school, work, and at home)
• There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.
• They symptoms do not occur exclusively during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder, and are not better accounted for by another mental disorder.

Proprioception

• Over-responsive

Avoids weight-bearing activities

Picky eater

Doesn’t like to move/be moved      

• Under-responsive

Low muscle tone

Breaks objects easily

Presses hard with the pencil on the paper while drawing

Let’s items fall while holding it

Untidy writing

Breaks delicate objects

Hurts friends easily

• Sensory-seeking (looks like hyperactive behaviour)

Deliberately bumps into objects/people

Sucks/bites objects

Loves rough and tumble games

Grinds teeth

Loves jumping

Prefers tight clothes/accessories

Vestibular system

• Over-responsive

Dislikes swinging/spinning/sliding

Moves slowly

No risk-taking behaviour

Uncomfortable when moving e.g. escalator/elevators

Appears clumsy

• Under-responsive

Doesn’t get dizzy when swinging

Poor protective extension in arms and legs

• Sensory-seeking (looks like hyperactive behaviour)

Can’t sit still

Craves intense movement

Adrenaline junkie

• Gravitational insecurity

Fear of falling

Fearful of heights

Anxious when feet leave the ground

Fearful when head is not in the upright position

Avoids new positions/postures

Moves slowly and carefully

Treatment

ADHD

• Medication prescribed by a paediatric neurologist / psychiatrist
• Occupational therapy – delays which have been caused by not focusing in class
• Low GI diet
• 1 hour of physical exercise daily
• Play therapy:  poor self-esteem issues/depression because of labelling

Postural control

• Occupational therapy addressing the proprioceptive and
• vestibular system
• Paediatric physiotherapy addressing the vestibular system
• (I prefer referring kids under 2 to a paediatric physio)