Attention-Deficit / Hyperactivity Disorder (ADHD) & Occupational Therapy
Occupational therapy can be a great addition to your child’s treatment team for managing the symptoms of Attention-Deficit / Hyperactivity Disorder (ADHD). Like other disciplines that may be involved in your child’s care, an occupational therapists’ goal is to empower children with ADHD and teach them the skills they need to be confident, independent and succeed in life.
Whether in your child’s school as part as a service provided weekly, as an occasional consultant, or someone whom your child works with outside of school, OT’s offer a range of ideas and supports that can help address some of your child’s struggles related to sensory, organization, motor coordination issues and more.
I have asked Karina Black, an outstanding Occupational Therapist in the Boulder,CO. area to answer a few questions about what OT’s do and how they can be a helpful part of your treatment team.
How can Occupational Therapy Help My Child with ADHD?
Occupational therapists (OTs) have a unique, holistic perspective. They utilize their background in anatomy, physiology, neurology, psychology as well as culture, environment, and activity analysis to formulate a comprehensive treatment plan. OTs use a child’s strengths to help them overcome their challenges and improve their participation in daily activities at home, in the community, and at school.
OTs also work closely with families and teachers to provide them with practical strategies that are customized to each child. OTs provide structured and graded activities to scaffold learning to help children increase their independence across environments.
How Can an Occupational Therapist Help a Child with ADHD in the Home?
Many parents of children with ADHD experience frustration when a seemingly quick and easy task is difficult for their child to complete autonomously. Children who struggle with ADHD may miss instructions, respond impulsively, or have difficulty sitting still or keeping their focus. In many instances, they’re too distracted to carry out essential daily tasks.
Common strategies that OTs may suggest for use in the home environment include the following:
Creating Structured Plans for Daily Routines
Create structured daily routines for the morning, afternoon, and evening. Use visual checklists with photos (not clip art) of your child doing each step of a task, or a picture of the completed task, depending on how much support is needed.
Teach your child to be a “future thinker” by including a photograph of what they look like when they finish the activity. For example, take a profile picture of your child dressed and wearing their backpack when they are ready to leave for school. End-goal images also ensure that the completed task looks the way you both envisioned it. How many times have you asked your child to clean their room and their image of a clean room is entirely different than your own?
Beginning tasks with the end in mind can help you both have the same expectations. Then, help your child break down the steps of the task to recreate the picture. In other words, plan backward and execute forward.
Coaching Parents How to Ask the Right Questions
Asking questions, instead of telling your children what to do, helps children develop situational awareness, which leads to increased task initiation and completion. It will also foster increased self-confidence instead of feelings of low self-esteem.
For example, instead of telling your child to do their homework, ask them what their priorities are for the afternoon. Or, instead of telling them to get ready for hockey practice, ask them what they need to do to be prepared. This will help them use their prefrontal cortex, the part of the brain responsible for executive functions instead of you acting as their external brain.
Providing an Organized Home Environment
An organized home helps your child learn where each of their possessions belongs. It also teaches children where to return items when they are finished using them.
Parents can incorporate cleaning up into the family’s daily routine and make it fun by turning it into a game. For example, you can play “Beat the Clock.” Set a timer for 10 minutes and see if you can work together to put things away before the timer rings. Another great option is to have everyone pick a favorite song and create a short playlist. Then, put on the music and clean up until it stops.
Using Analog Clocks to Help Your Child Visualize the Sweep of Time
Children with ADHD often lack an internal sense of time and have short time horizons. They think in terms of either “now” or “not now.” As a result, these children tend to require numerous external cues to help them stay on task and be on time.
Place analog clocks at your child’s eye level in all of the rooms your child uses to get ready for the day and does homework in. Using analog clocks helps children understand the passage of time because they can see time moving, whereas digital clocks only show numbers changing.
Next, have your child estimate how long they think it will take to do various activities. They can shade the pie of time on a glass-faced clock with a dry erase marker. Or, they can place magnets or post-it flags on their start and estimated finish time. Again, this helps them see the sweep of time and works magic with increasing sustained attention, especially during homework!
Letting Your Child Know of Plans Well in Advance
Children with ADHD frequently have difficulty transitioning from one task to another. Therefore, it’s essential to give them a heads up!
Instead of saying, “We’re leaving for _____ in ten minutes,” say things like: “Next week…,” “In two days…,” “Tomorrow…,” etc. It’s helpful to use a calendar with young kids to show the number of days until the event and expand their time horizon.
Integrating Physical Activity into Your Child’s Day
Regular exercise has been shown to increase concentration, improve sleep, and decrease anxiety and depression.
OTs also love to teach students how to incorporate movement into learning when possible. For example, have your child practice math facts or study for a test while jumping on a trampoline or standing on a balance board. Or, create a treasure hunt with spelling words and have your child practice writing each word where they found it.
Incorporating Sensory Strategies to Improve Self-Regulation
Some children with ADHD may have difficulty sitting still to complete homework or finish dinner.
Children with low sitting tolerance may benefit from using active seating, such as ball chairs, inflatable wedges, or wobble discs. They can also use a foot fidget on the chair to help maintain focus or hand fidgets so long as they don’t become yet another distraction. Your child’s OT can help determine appropriate fidgets for home, community, and classroom.
Short “brain breaks,” like doing ten jumping jacks or pushups, can also help students recharge and refocus on a task.
Creating a Safe “Calm Down Zone” in Your Home
Children with ADHD are prone to having strong emotional responses. Therefore, they may benefit from having a “calm down zone” in your home where they can go to regroup when they’re feeling overwhelmed, frustrated, or about to meltdown.
A “calm down zone” may include a rocking chair or swing for movement; stress balls or resistance bands for “heavy work”; sensory bottles filled with water, oil, beads, and glitter to look at; a noise machine or quiet, soothing music to listen to; and even weighted blankets or stuffed animals to provide calming tactile input.
Experiment with different sensory strategies and see what works best for your child in different circumstances.
Helping your Child Become Aware of Their Distractions
Help your child identify their internal and external distractions, or “time robbers” as we like to call them. Once a child begins to develop an awareness around their distractions, you can help them figure out ways to remove them and then replan the task at hand.
Some children are distracted by ideas and thoughts, while others are distracted by people, noises, and objects in the surrounding environment.
Establishing Reward Systems
Use rewards to incentivize your child to complete tasks (within the allocated timeframe). Some children need extrinsic motivation to improve compliance. Your child’s OT can help devise a specific behavior plan to help reinforce positive behaviors and achieve the desired expectations.
Establish a common language with your child that explains clear rules and expectations that are consistently enforced and are based on the team dynamics of your family unit.
Creating a Peaceful Sleep Environment
Children with ADHD can experience difficulty falling asleep. Parents can help by eliminating stimuli, winding down with quiet reading time, listening to calming music, and establishing a consistent bedtime routine and schedule.
OTs may also teach children, and their parents, how to incorporate progressive muscle relaxation into their bedtime routine to aid with falling asleep.
What Can an Occupational Therapist Do to Help a Child with ADHD in the Classroom?
Occupational therapy practitioners may focus on facilitating a students’ academic success, social relationships, leisure activities, or play while providing intervention in the school setting.
Utilizing Sensory Strategies to Improve Sustained Attention
A “sensory diet” consists of a set of specific activities to help students get the sensory input they need to prepare for academic learning.
Sensory diets may include:
- Using alternative seating like ball chairs or wobble discs to boost sitting tolerance, as well as hand or foot fidgets to increase focus.
- Doing “heavy work,” like pushing or pulling, can help calm the body and get a child ready to work.
- Using a privacy shield or noise-canceling headphones to create a quiet workspace.
- Chewing gum can also be great for improving concentration.
- Adding textures, smells, and movement to activities to make them fun and help build new skills may also improve attention and learning.
- Prescribing sensory routines, such as breaks or snacks, into the child’s day can help regulate the body to a calm alert state for increased focus. Sensory routines also provide physical outlets that are child-specific.
- Collaborating with school staff to carryover therapeutic language and behavioral strategies with the child that reinforce school principles both at school and home.
Creating a “Calm Down Zone” at School
As discussed previously, a “calm down zone” gives a child with ADHD a place to go to regroup when they’re feeling overwhelmed, frustrated, or about to meltdown. A “calm down zone” works the same at school as it does at home.
Improving Gross and Fine Motor Skills
Students with ADHD often have coexisting difficulties with motor coordination, especially with complex movements like those involved with handwriting. OTs often specialize in handwriting assessments and remediation and can help students with writing mechanics, such as developing a functional pencil grasp (this may include utilizing an assistive device like a pencil grip), developing proper letter formation habits, and improving baseline placement and letter or word spacing. Sometimes therapists recommend different types of handwriting paper (like raised line or double-lined paper) to facilitate the handwriting process. OTs also can help your child learn to touch type using programs that scaffold learning to the student’s abilities.
When OTs help students improve gross and fine motor skills, it helps them not only do better in school but also complete activities of daily living more independently.
Providing Opportunities for Movement
Students with ADHD cannot “sit still and pay attention.” Therefore, OTs may recommend ways your child can incorporate movement into their school day. For example, using active seating or incorporating movement into lesson plans.
Breaking Down Tasks into Smaller Steps
OTs can instruct students in strategies to break down tasks and projects into smaller, more manageable steps. They may also teach students how to sequence tasks by incorporating words such as first, then, and next or using graphic organizers to help students plan writing assignments.
The goal is to provide students with strategies they can implement and transfer to other projects.
Decreasing Distractions in the Classroom
An OT can make recommendations to reduce distractions in the classroom that may not be obvious to someone who doesn’t have ADHD.
For example, some students with ADHD find that black and white worksheets appear distorted under bright, fluorescent lighting, making it harder to concentrate. Providing students with colored paper instead may help them sustain focus.
Other suggestions may include:
- Reducing the clutter in the classroom.
- Seating students away from hallways or windows and moving them closer to the teacher.
- Teaching students to maintain an organized desk space clear of visual distractions.
- Obtaining a locker at the end of a row to reduce noise, crowding, and other hindrances to a smooth transition in between classes.
Teaching Students Mindfulness
OTs can teach students techniques to help reduce anxiety. For example, naming one thing they see, smell, hear, or feel when anxious that will bring them back to the present. OTs may also teach students to use deep breathing techniques before stressful situations. Or, they may have students identify their superpowers by writing or drawing things they do well.
Empowering Students to Advocate for Themselves
OTs educate students about their diagnosis as well as what tools and resources they have available to them, such as an IEP or 504 education plans.
Therapists also help students develop self-advocacy skills to communicate with their teachers when needed.
Setting Clear Expectations
OTs can help set clear expectations about behavior and academics, so students know what is expected of them. They may develop behavior plans in conjunction with your child’s teacher. Or, use rubrics to help students achieve the desired outcome successfully and independently.
Can Occupational Therapy Help My Child with Their Social Relationships?
Children with ADHD often struggle socially. They may have difficulty making friends, maintaining relationships, communicating with peers, and deciphering social cues.
Typically, they are also impulsive and impatient, especially when having to wait their turn, which can frustrate their peers and result in isolation.
Children with ADHD also generally present with a 30% delay in emotional and social maturation, which means they often gravitate to and do better playing with younger children.
To help students improve their relationships, OTs may incorporate “social stories” to teach social and behavioral expectations around a specific event or topic. Other therapeutic activities may include role-playing to teach students how to develop an awareness of social cues such as body language, facial expressions, and expressive language.
How Does a Parent Gain Access to OT Services for Their Child?
Many states require a physician’s prescription for private outpatient occupational therapy evaluation and treatment. You can check with your doctor or an OT to see if a prescription is necessary where you live.
As with any provider, OTs have specialties and approach occupational therapy in different ways, based on our specific skill sets. Interview potential OTs to see if they specialize in working with students with ADHD, and if you feel like the approaches they utilize in their practice sound like they’d be a good fit for your child.
You can also request that your child’s public school provide an OT evaluation to see if they qualify for services.
About Skills 4 Life:
Skills 4 Life Pediatric Occupational Therapy offers a broad range of pediatric occupational therapy services in the Boulder & Denver area to help your child master age-appropriate developmental skills, become more independent, increase academic success & develop confidence. The experts at Skills 4 Life specialize in handwriting, keyboarding & executive function coaching, but also work with children on social & emotional learning, motor skills, self-regulation strategies & activities of daily living. Skills 4 Life Pediatric Occupational Therapy offers your child a safe, compassionate environment to learn the critical skills they need to be successful. Learn more about our team & services at www.skills4lifeot.com, or you can contact our office by email at [email protected] or by phone at 303.351.1828 for a free consultation.