Attention Deficit Disorder?

When you think of a child with Attention Deficit Disorder you picture a child who can’t sit still, pay attention or follow directions. Maybe you picture a little boy bopping around the classroom or a little tazmanian devil running circles around his mom and dad.

These children are typically treated by a psychiatrist, but don’t overlook the obvious: Can the child physically sit still??? Does this child have the postural control to 1) sit in a neutral posture, 2) keep their balance while shifting side to side and while moving their arms 3) have control of their eyes when looking down at a table. Am I claiming that ALL children diagnosed with attention problems can’t physically sit still? Absolutely not. However,  I do believe that there is a subset of kids that do fall into this category and it can be addressed with exercise and neuromuscular re-education rather than by medication.

All children with ADD (and while we’re at it dyspraxia, developmental coordination disorder, speech delay, etc) should be assessed for their trunk strength, equilibrium reactions (when your weight is shifted to one side your body reacts to keep you upright), and visual-vestibular control (eye-inner ear reflexes). If there are problems in these motor pieces, a child will never develop appropriate attentional skills. Its not that they can’t pay attention because their brains work differently, but they have never had the stability and control of their bodies to allow them to sit still and develop attentional skills.

A couple of quick tests to assess these skills include:

• lie on belly and fly like superman; child should be able to lift arms and legs off the floor
• perform a crunch (head must curl)
• sit on an unstable surface like a ball and keep balance
• child should get dizzy after spinning
• have child look at your nose and turn child’s head side to side; eyes should be able to stay on your nose

Typically I see these children for the first time when they are 5-7 years old. They are just starting school and the expectations are increasing. This is when problems usually arise. At this point initial problems have already turned into compensatory patterns, behaviors and bad habits. For example, the child who doesn’t have the strength to do a crunch likely also hasn’t developed the proper visual control to do desk work. This in turn makes fine motor and academic tasks extremely challenging.  Children will then express this frustration with their behavior.

What do these kids look like during their first year of life? Well, these are the kids who are crawling before they’re sitting or just never master a neutral sustained sitting posture. I have treated a few babies this year who already had the mobility of crawling, but they didn’t have the balance to sit still! In sitting they would fall over, which led back to continued crawling. These children didn’t have the opportunity to stay with any activity for very long because they couldn’t physically sit still. Once we addressed the balance issues, all of these children improved their attention, eye contact, and play skills.

The earlier we address movement challenges the less of an impact they will have on cognitive, language, social and emotional development later on. My hope is that more and more children with attention deficits will be evaluated in a holistic manner that includes looking at their sensorimotor function so that they will be able to achieve their full potential.