Article
Occupational Therapy and ADHD

Occupational Therapy for Children with ADHD

For children with ADHD, OT focuses on enhancing skills and adapting environments to support their participation in daily activities

Sensory Integration

Many children with ADHD experience challenges with sensory processing – the way their brains interpret and respond to sensory input from the world around them. This can manifest in several ways:

• Sensory Over-Responsivity (Hypersensitivity): Children may feel overwhelmed by sensory input. For example, they might find bright lights, loud noises, or certain textures unbearable. This can lead to meltdowns, anxiety, or withdrawal.

• Sensory Under-Responsivity (Hyposensitivity): Children may seek out intense sensory experiences because they crave more input. They might spin excessively, love to crash into things, or need to touch everything they see.

• Sensory Seeking: Children may constantly seek out specific sensory experiences, such as jumping, swinging, or chewing on objects, to help them regulate their nervous systems.

Occupational Therapists (OTs) qualified in Sensory Integration Therapy are trained to identify these sensory processing differences and develop tailored interventions to help a child's nervous systems process sensory information more efficiently, leading to improved focus, attention, self-regulation, and participation in daily activities. Interventions typically focus on vestibular, proprioceptive, tactile, auditory and visual inputs;

•  Vestibular Input: Activities like swinging, spinning, or using a therapy ball can provide vestibular input, which is essential for balance, coordination, and overall body awareness. This type of input can be calming or alerting, depending on the child's needs. For example, rhythmic swinging on a swing can be very calming, while spinning can be more alerting and energizing. OTs will carefully select activities based on the child's individual sensory processing needs.

• Proprioceptive Input: This type of input involves activities that provide deep pressure and muscle/joint compression. Examples include using weighted blankets, vests, or lap pads, pushing/pulling heavy objects, or engaging in activities like climbing or jumping. Proprioceptive input can be very calming and grounding for children who feel overwhelmed. OTs might also incorporate proprioceptive activities into everyday routines, such as suggesting deep pressure hugs or heavy work tasks like carrying groceries.

• Tactile Input: OTs use a variety of textures, such as sand, playdough, water, or different fabrics, to provide tactile input. This can help children become more comfortable with different textures and learn to self-regulate their tactile sensitivities.  For example, children who are hypersensitive to touch might benefit from activities that gradually expose them to different textures, such as starting with smooth textures and progressing to rougher textures. Conversely, children who crave tactile input might enjoy activities that provide deep pressure touch, such as squeezing theraputty or building with heavy clay.

• Auditory and Visual Input:  OTs might use noise-cancelling headphones, calming music, or dim lighting to create a more soothing environment for children who are overstimulated by auditory or visual input. They might also use visual schedules or calming visuals to help children transition between activities and stay on track. Additionally, OTs can help children who seek out auditory stimulation explore different calming sounds, such as nature sounds or white noise, to help them self-regulate.

Behavioural Strategies

Children with ADHD often struggle with impulsivity, difficulty following directions, emotional regulation, and maintaining focus on tasks. By equipping children with effective behavioral strategies, OTs empower them to manage their ADHD symptoms, build confidence, and participate more fully in their daily lives.

• Visual Supports: OTs often use visual aids to help children understand expectations, routines, and schedules. Visual Schedules involve pictorial representations of different activities throughout the day helping a child anticipate transitions and know what to expect next. Visual Timers: help a child understand how much time they have for a task or activity, reducing frustration and increasing on-task behavior. Simple Checklists with pictures or words can help a child break down tasks into smaller, more manageable steps and track their progress.

• Self-Regulation Techniques: OTs teach children specific strategies to manage their emotions and impulsivity. Deep Breathing can help a  child calm down when feeling overwhelmed or frustrated. Progressive Muscle Relaxation involves tensing and then relaxing different muscle groups to promote relaxation and reduce anxiety. Sensory Breaks provide a short break to engage in a calming sensory activity (like squeezing a stress ball or swinging on a swing) which helps a child reset and return to the task at hand when feeling dysregulated.

• Positive Reinforcement: OTs often use positive reinforcement to encourage desired behaviors. Reward Systems such as sticker charts, or token boards can motivate a child to complete tasks and follow directions. Verbal Praise brings specific and genuine praise for positive behaviors, helping a child feel good about their efforts and reinforce those behaviors.

• Social Skills Training: Some children with ADHD struggle with social interactions. OTs can teach social skills like turn-taking, sharing, listening, and understanding others' perspectives. This might involve role-playing, group activities, or practicing social skills in real-life scenarios.

• Parent and Teacher Collaboration: OTs work closely with parents and teachers to ensure consistency in strategies and create a supportive environment for the child. They might provide training on behavioral management techniques, offer suggestions for adapting the home or classroom environment, or collaborate on developing individualised education plans (IEPs)/individual development plans (IDPs).

Fine Motor Skills Development

Fine motor skills involve the coordinated use of small muscles in the hands and fingers, crucial for tasks like writing, drawing, cutting, buttoning clothes, and using utensils. Children with ADHD often experience challenges with fine motor skills, which can impact their academic performance, self-esteem, and independence in daily living activities. By focusing on building hand strength, dexterity, hand-eye coordination, and handwriting skills, occupational therapists empower children with ADHD to participate more fully in school, play, and self-care activities.

• Strengthening Hand and Finger Muscles: OTs use a variety of fun and engaging activities to strengthen the muscles needed for fine motor control. Manipulating Playdough or Clay involves squeezing, rolling, pinching, and shaping playdough or clay thereby building hand strength and dexterity. Using Tweezers or Tongs to pick up small objects helps refine hand-eye coordination and pinch strength. Stringing Beads or Lacing Cards promotes bilateral coordination (using both hands together) and finger control. Scissor Skills Activities cutting different materials (paper, straws, playdough) helps a child develop hand strength, coordination, and visual-motor integration. 

• Improving Hand-Eye Coordination: OTs use activities that require precise movements and visual tracking to enhance hand-eye coordination. Puzzles of varying sizes and complexity help a child develop spatial reasoning and visual-motor skills. Construction Toys such as LEGOs promote hand-eye coordination, spatial awareness, and problem-solving skills. Drawing and Coloring encourages a child to draw, color, or trace shapes helping refine hand movements and develop pre-writing skills.

• Promoting Handwriting Skills: OTs work with children to improve their handwriting legibility, speed, and endurance. Proper Pencil Grip teaches a child how to hold a pencil correctly which can significantly improve their writing control and also reduce hand fatigue. Handwriting Exercises practice specific handwriting strokes, letters, and words to help develop muscle memory and improve writing fluency. Adaptive Writing Tools: OTs might recommend specialised pencils, grips, or other adaptive tools to make writing easier and more comfortable.

• Integrating Fine Motor Skills into Daily Activities: OTs help children generalize their fine motor skills by incorporating them into everyday tasks. Self-Care practicing buttoning, zipping, and tying shoelaces helps develop fine motor skills and also gain independence in dressing. Mealtimes using utensils, opening containers, and spreading butter or jam on bread all require fine motor skills and coordination. Play Activities like drawing, painting, or playing with small toys helps strengthen a child's hands and fingers while having fun.

Environmental Modifications

Creating a supportive and structured environment is key to helping children with ADHD thrive at home, school, and in other settings. Occupational therapists (OTs) are skilled at assessing environments and recommending modifications that minimize distractions, promote focus, and support positive behaviors. These modifications can be tailored to a child's specific needs and sensitivities, creating a space where they feel safe, calm, and able to concentrate.

The Home Environment

• Organized Spaces: OTs help parents create designated areas for specific activities, such as a quiet corner for reading or a designated homework space. This can help a child understand expectations and transition more smoothly between activities.

• Visual Cues: Using labels, color-coding systems, or picture schedules can help a child with ADHD stay organized and remember routines. For example, a visual schedule with pictures representing getting dressed, eating breakfast, brushing teeth, and going to school can help a child start their day independently.

• Sensory Considerations: OTs can suggest adjusting lighting, noise levels, and textures to create a calming and less overwhelming environment. For example, dim lighting, calming music, or weighted blankets can help some children feel more relaxed and focused.

• Movement Opportunities: Incorporating opportunities for movement throughout the day can help children with ADHD release excess energy and improve focus. This could involve setting up a mini trampoline, providing a rocking chair, or allowing for regular physical activity breaks.

The School Environment

• Preferential Seating: OTs often collaborate with teachers to find the optimal seating arrangement for a child with ADHD. This might involve seating the child near the front of the classroom, away from distractions like windows or doors, or near a peer who can provide positive modeling.

• Fidget Tools: Fidget toys or sensory objects can be incredibly helpful for children with ADHD who need to move or touch something to stay focused. OTs can help identify appropriate fidget tools and teach children how to use them discreetly.

• Visual Aids: Teachers can use visual aids, such as graphic organizers, charts, or diagrams, to help children with ADHD understand and remember information.

• Breaks and Movement: Incorporating scheduled breaks for physical activity can help children with ADHD release pent-up energy and improve their ability to focus when they return to their desks.

Other Environments

OTs can help parents plan outings to public places, such as grocery stores or restaurants, by suggesting strategies for managing potential challenges and creating a positive experience.

Summary

Occupational Therapy is a powerful enabler for individuals facing specific and everyday challenges  with ADHD. It offers a range of techniques that are tailored to the unique needs of every patient with ADHD, significantly improving their ability to manage daily tasks and achieve personal goals.

If you're interested in learning more about how Occupational Therapy can help you or someone you care about, get in touch with The OT Centre. We have a team of experienced OTs with expertise in Neurodivergence and Paediatrics for support with ADHD .

Reviewed and Approved
Helen Spencer, Clinic Director, The OT Centre
BSc Occupational Therapy, HCPC Registration: OT35913