What is ADHD and the role of Occupational Therapy in ADHD?
Definition of ADHD (Attention Deficit Hyperactive Disorder)–
According to DSM-IV: ADHD is a disruptive behavioral disorder characterized by a set of chronic and impairing behavior patterns that display abnormal levels of inattention, hyperactivity or their combination.
Symptoms of ADHD –
Children who have symptoms of inattention may:
- Be easily distracted, miss details, forget things, and frequently switch from one activity to another.
- Have difficulty focusing on one thing.
- Become bored with a task after only a few minutes, unless they are doing something enjoyable.
- Have difficulty focusing attention on organizing and completing a task or learning something new.
- Have trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities.
- Not seem to listen when spoken to.
- Daydream, become easily confused and move slowly.
- Have difficulty processing information as quickly and accurately as others.
- Struggle to follow instructions.
Children who have symptoms of hyperactivity may:
- Fidget and squirm in their seats.
- Talk nonstop.
- Dash around, touching or playing with anything and everything in sight.
- Have trouble sitting still during dinner, school, and story time.
- Be constantly in motion.
- Have difficulty doing quiet tasks or activities.
Children who have symptoms of impulsivity may:
- Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences.
- Have difficulty waiting for things they want or waiting for their turns in games.
- Often interrupt conversations or others’ activities.
The brain and ADHD –
Let’s understand the basics of developing brain and what happens to it when affected by ADHD. This is a simplified version of the changes that occur in the brain of a child with ADHD.
One of the major areas of the brain affected by ADHD is the prefrontal cortex. This is the part of the brain that lies in front above our eyes and behind our foreheads. It is the most important part of the brain as it is involved in attention, planning and decision making. It is also involved in judgment and rational decision-making.
The child with ADHD often has difficulties in paying attention and concentration due to this part of the brain being affected. The child with ADHD is also forgetful and shifts from one task to another due to the brain here being affected. The child with ADHD is often accident prone and impulsive i.e. acts without a thought about future consequences of the action he will undertake due to an impaired prefrontal cortex that does not allow him to take rational decisions at times.
The prefrontal cortex is also responsible for executive functions that are impaired in ADHD. Executive function is a function aimed at planning when multiple tasks have to be undertaken for example when writing an exam answer paper or planning a study time table which is affected in ADHD.
At a chemical level, our brain is equipped with a chemical called dopamine that acts a messenger to transfer information from one neuron to another. There are some abnormalities in the dopamine system seen in ADHD whereby dopamine may be more or less in different parts of the brain. The role of medication used in ADHD is to stabilize the dopamine system. Dopamine is an excitatory chemical and keeps the brain active when in excess in certain areas of the brain, accounting for the symptoms of hyperactivity seen in a child with ADHD.
Achieving chemical stability in the brain takes time and hence the medicines prescribed might take 3 to 4 weeks to show the full effect.
Multi-Model Approach in ADHD –
Children with ADHD suffer not because of the core symptoms of lnattention, Hyperactivity and Impulsivity but because these symptoms lead to disruption of normal neuro-developmental processes like learning. This results in impairment in the child’s ability to lead a normal life in the community around it.
The two major areas of dysfunction are academics and social behavior. If unchecked, these lead to further deterioration in self-esteem, motivation, behavior, and mood. These are associated with higher incidence of anxiety, depression, substance abuse and suicidal ideation.
In order to effectively intervene in children with ADHD, the following points must be borne in mind:
The child suffers from problems in a cluster of areas, hence one modality of intervention is unlikely to benefit.
Active participation by parents is a must; active participation includes the ability to effectively understand the concerns.
Academic underachievement is caused by the core symptoms which persist; however, cumulative worsening in academic achievement occurs over a period of time since new learning is based on mastery of the previously learned material. Thus, if a child with ADHD has failed to master Grade 3rd syllabus, it is further difficult for him to connect to Grade 4th syllabus.
Multi Model approach for ADHD kids includes-
The main components of this approach are medications, behavioral therapy, parent education, and occupational therapy.
Behavioral therapy and ADHD-
Behavioral therapy is used to control the undesired behaviors of ADHD child. It may help in children to control his/her impulses and response to emotional stimuli.
Parent Education and ADHD-
Educating parents about the disorder, its feature and most importantly the strategies occupational therapist used during the session. The behavioral strategies, sensory strategies, skills can be learned by the parents for effective intervention planning.
Since changes cannot happen overnight, it is easy to lose track of progress. Recognizing time-bound progress as a necessary component and factoring this into the intervention is crucial.
Finally, none of the above is possible unless one involves a multi-disciplinary team with each professional’s role well laid out. This can be achieved only if the same is documented, so that there is a plan to cross check one’s progress, as well as re-evaluate the latter at regular predetermined intervals. This underlines the necessity to have an Individualized Therapy Program (ITP)or Individulized Educational Program (IEP).
Occupational Therapy (OT) for ADHD children-
Occupational Therapy with Sensory Integration is a vital cog of this wheel with its role, benefits, and limitations well defined.
As its name indicates, Occupational Therapy is a form of rehabilitation; its express role is to enable the child to overcome his/her physical functional deficiencies. Hence, sitting tolerance, hyperactivity, restlessness, impulsivity, distractibility, fine motor control, grip, handwriting (form, shape, orientation and presentation of written material), eye—hand coordination, etc. are the domains which it encompasses.
ADHD kids, preferably refer to an occupational therapist for their attention and hyperactivity issues. The symptoms of ADHD kids restrict them to involve him in a functional and meaningful task. Occupational therapist generally administers sensory integration technique in these kids for a better outcome. By using sensory integration technique, OT helps them to calm down and focus on an activity.
Many children with ADHD will also have sensory processing disorders and this can contribute to their inability to pay attention, focus and concentrate. These children will either withdraw from or seek sensory stimulation like movement, touch, bright light, busy rooms and loud noises and do not engage appropriately in an activity as expected. An Occupational therapist may accompany sensory integration along with the activities, for better results. ADHD kids have many issues in a daily living task like donning and doffing of the shirt, buttoning-unbuttoning, and other fine motor skills.