OT for ADHD

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurological/neurodevelopmental disorder commonly found in childhood and can persist into adulthood. While the exact cause is not known, it does have a genetic component.

According to the CDC, some other possible causes or risk factors include low birth rate, premature delivery, alcohol or tobacco use during pregnancy, brain injury or exposure to environmental factors such as lead during pregnancy or at young age.

ADHD impacts individuals differently based on the type, however it may impact academics, social life, work, career prospects, behaviors, emotional regulation, executive functioning, quality of relationships, as well as overall quality of life.

Some signs and symptoms of ADHD in children may include forgetting or losing items, fidgeting, squirming, talking too much, taking unnecessary risks, making careless mistakes or having a hard time resisting temptation, trouble taking turns, and having difficulty getting along with others.

ADHD consists of three different types which include inattentive/distractible, hyperactive/impulsive, and combined ADHD, all which exhibit different symptoms.

Some common symptoms of the three different types include the following:

• Inattention/Distractibility:
  • Client is easily distracted or forgets details of daily routines
  • Client cannot organize or finish a task, pay attention to details, or follow conversations and/or instructions

• Hyperactivity/Impulsive:
  • Fidgets excessively
  • Can’t sit still for prolonged periods
  • May run, jump or climb constantly especially if younger
  • Is impulsive and may interrupt others, grab objects from people, or speak at inappropriate times. Cannot wait for their turn or listen

• Combined:
  • A combination of both inattention/distractibility and hyperactivity/impulsive

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Occupational therapy for ADHD

While occupational therapists do not assess for ADHD diagnostically, they can screen for ADHD to provide referral sources to get a clinical diagnosis by a licensed professional such as a psychologist or developmental psychologist.

Occupational therapists can also perform observational assessments and sensory processing assessments that provide valuable insight on how ADHD symptoms are affecting the individual and their daily functioning and participation.

Skilled observation assessment may include observing the individual perform various activities including ADL and IADL tasks and how the individual performs and participates in different environments such as work, home, and school.

Clinicians are looking for executive functioning skills such as attention, time-management, organization, planning, following multi-step directions, self-control, flexibility, emotional regulation, and self-regulation.

Occupational therapy for ADHD could include at-play skills and social skills. Some sensory processing assessments may include the sensory profile or sensory processing measure.

Occupational therapists will utilize the sensory processing assessments to gain a comprehensive understanding of the individuals sensory processing abilities, preferences, sensitivities, seeking behaviors, and how they respond to sensory stimuli.

It is also important to know that ADHD symptoms vary, and sensory challenges often co-occur but one can have ADHD without sensory challenges and sensory challenges without ADHD.

Intervention strategies

Occupational therapy for ADHD can play a crucial role in management. Sensory strategies are one of the most common and least invasive treatment suggestions made to assist children with Attention Deficit Hyperactivity Disorder (ADHD).

Some sensory treatment strategies may include proprioceptive (heavy work) activities such as pushing, pulling, lifting, or carrying heavy objects, as well as engaging in activities that include jumping or climbing.

Examples of occupational therapy for ADHD

Occupational therapy for ADHD may also include deep pressure input may also calm the nervous system via deep pressure massage, weighted lap pad or blanket, or a firm hug or body squeeze.

Tactile input may include incorporating tactile play with sand, Thera-putty, silly putty, shaving cream, and other textured items.

Vestibular input may also help via linear or rotary movement with swings or spinning on a chair.

Sensory breaks

Sensory breaks are also important in the treatment of ADHD. Incorporating sensory breaks for 5-10 minutes as necessary is crucial for self-regulation, to maintain attention, and arousal levels.

Sensory breaks may include movement breaks, exercise, yoga, deep breathing, or sensory play activities.

It is important to understand that each individual’s sensory processing capabilities are unique, and that the occupational therapist is to have a full understanding of an individual’s sensory profile prior to implementing sensory strategies and techniques.

Additionally, occupational therapy for ADHD may include teachers to help cultivate an ADHD-friendly learning environment by implementing strategies such as:

• Visual supports
• Personalized accommodations
• Behavior management techniques
• Environmental modifications

Such tools assist academic tasks, self-regulation, and foster organization - all of which promote a supportive learning environment.

Active collaboration with teachers and parents optimizes built and social environments and can promote focus, organization, and social integration among students with ADHD.

Occupational therapists will also provide executive function training and interventions. Executive function intervention methodologies may include breaking down complex tasks into more manageable steps, so that individuals are more organized and can have more organized thoughts and actions.

Occupational therapists will also provide education and implement environmental modifications. This may include organizing work or play space, minimizing distractions with barriers, visual supports such as timers, reminders, visual schedules, checklists, and minimizing the amount of words on a page.

Time management skills are supported by providing timers, calendars, breaking tasks down into smaller components, incorporating breaks, and visual support. A critical component of executive function intervention and training is self-regulation and self-management.

Providing strategies for emotional regulation such as deep breathing, emotional awareness, recognizing triggers, mindfulness, and meditation can improve emotional regulation and impulse control. Providing education on one’s triggers, emotional awareness, and building emotional-regulation tools is foundational treating emotional-regulation challenges in those with ADHD.

Goal setting and planning

Goal setting and planning are important components of an occupational therapy treatment plan. It is critical to incorporate SMART goals that help provide a clear framework and criteria for successful goal management and measurement.

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It is also important to collaborate with caregivers, teachers, and individuals to identify goals that are important to the individual and to meet their specific and individualized needs.

Occupational therapy for ADHD goals may be focused on:

• Executive functioning skills
• Impulse control
• Emotional regulation
• Problem-solving skills
• Attention
• Time-management skills

It is important to recognize that children with ADHD may also have motor skills to address, which can also be incorporated into goals. With consistent and on-going evaluation, observation, and functional assessment of tasks, occupational therapists can regularly review progress with individuals and/or caregivers and make any necessary changes to the treatment plan to provide effective treatment strategies.

Progress may also be determined via a collaborative approach with caregivers, teachers, other professionals, and self-report.

Some examples of goals can be found below:

• Organization goal: In 2 months, the client will independently organize personal items in 80% of trials, as observed by the caregiver (parent/teacher).

• Emotional-regulation goal: In 3 months, the client will independently & appropriately react to the size of the problem in 75% of opportunities in two different environments (home and school).

• Time management goal: In 2 months, the client will independently & appropriately use time management strategies (timers, checklist, or one of choice) to complete tasks on time in 80% of opportunities in the workplace environment.

Overall, it is important to incorporate a holistic approach in providing treatment of ADHD through occupational therapy. As ADHD may impact various areas of an individual’s life, it is vital to gain a comprehensive understanding and picture of how ADHD is affecting an individual’s independence, function, and participation in their daily life.