Children with ADHD have difficulties with tasks requiring focus and concentration. They have trouble paying attention and remembering things. They may need help to get started on homework, get organized, manage their time and even control their emotions. Occupational therapists (OTs) are trained to address the skills needed for a child to be able to function in their daily life, but how exactly can occupational therapy (OT) help a child with ADHD?
Even though every child with ADHD is different and the presentation of the signs and symptoms vary greatly, the following are the general ways in which OT can help a child with ADHD to function better at home, school or in any other setting:
1. Improve Self-Regulation:
Children with ADHD may struggle to regulate their attention, energy level and emotions. They might seem “on the go” and rush through coloring, have big reactions to small events or get distracted with minor details around them. OTs can help children become aware of how their behavior affects a situation and/or other people. For example, learning about different expectations in terms of activity level while learning in class vs. playing with others in playground or understanding how others perceive a big emotional reaction after losing a competitive game.
Using curricula such as “The Zones of Self-Regulation” or “The Alert Program”, children learn to recognize they feel and how they might go through different energy levels throughout their day. These programs help children visualize their behavior using colors or analogies. They also understand how different emotions feel or look and eventually learn to select activities or use certain techniques to improve their self-regulation in order to better attend and/or meet the demands of tasks at hand. With the help of an OT, a child might find inflating their belly like a balloon allows them to cool down before taking a test.
No matter how old your child is, it is never too early or too late to help kids learn to control their impulses, manage their activity level and process their emotions.
2. Develop Specific Executive Function Skills
Executive function (EF) deficits are a hallmark of ADHD and go hand in hand with self-regulation. Difficulties with inhibitory skills, flexibility of attention, remembering information, planning, organization and problem-solving are all related to poor executive function. Children are not born with these executive functions, but they have the capacity to develop them. Nevertheless, kids with ADHD struggle more than the average child to acquire these skills.
Some important executive function skills with examples are:
- Inhibition: Following stop and go commands during a Red Light, Green Light game.
- Shift: Cleaning up an activity when asked to do so.
- Self-Monitoring: Checking for errors in their written work.
- Emotional Control: Managing frustration after losing a game.
- Working Memory: Remembering multi-step directions given by the teacher.
- Initiate: Problem-solving how to start their homework.
- Task Monitor: Staying on track during an activity.
- Plan/Organize: Planning and organizing their ideas when building a free Lego creation.
- Organization of Materials: Keeping a school backpack fairly organized.
Occupational therapists can help children participate in activities that challenge these specific skills so they can develop them through play. For example, they will often use: competitive games to teach children how to better manage their frustration, obstacle courses to improve a child’s ability to stay organized and sequence through the steps, timed-tasks in order to help kids develop better time management skills and projects to develop thinking, planning and organization skills. They can educate a child’s family on different techniques to help with transitions and make a cleaning up process go more smoothly or recommend adaptations to help compensate for poor working memory for improved independence with a self-care routine.
3. Improve Relationships and Social Interactions
Many times, children with ADHD need help developing age-appropriate social skills. If they are struggling to attend to what’s happening around them, they might miss important social cues during everyday interactions. They might also find it difficult to learn how to predict what others are thinking. Others who have a hard time managing their emotions, benefit from learning how manage peer relationships.
Using curricula such as “Social Thinking”, OTs can help children improve their social awareness, learn to understand other’s motives and allow them to practice appropriate ways to express themselves. For example, an OT can teach children to become better social observers while working in a group. This may mean helping a child understand how a friend might feel more comfortable when good listening skills are demonstrated while he/she is sharing something of interest. It can also mean learning to identify when it is time to stop sharing what is of interest to us and time to welcome someone else’s opinion or alternative solution to a group problem.
4. Work Child Specific Skills
Every child is different in how they learn and develop. If a child with ADHD is having difficulties in any area of developmental (e.g. fine-motor coordination, manual dexterity, visual-motor coordination, handwriting, gross-motor coordination, visual perception), an OT can use activities to help improve the skills that need to be developed. For example, an occupational therapist might help a child improve their handwriting legibility due to a fine-motor coordination deficit and, in turn, help improve school performance.
5. Recommend Sensory Strategies
Sensory processing difficulties are very common among children with ADHD. An OT can work with a child and the family in order to determine sensory patterns and preferences and recommend which sensory strategies, if appropriate, could be beneficial to improve performance at home, school or any other setting. For example, for a child with big difficulty sitting still while playing a board game with peers, the OT might determine that having a bean bag present for the child would allow him or her to get the sensory input needed and allow for better concentration and participation in group games.
An OT that has further education on sensory processing would be recommended to make these recommendations. The USC Chan Division of Occupational Science and Occupational Therapy and The STAR Institute for Sensory Processing Disorder are two places offering training and/or certifications for occupational therapists and other professionals on this subject.
6. Recommend Adaptations
Occupational therapists are skilled at determining the root causes of specific behaviors and are also trained in breaking down activities into steps, allowing them to be great problem-solvers when it comes to finding adaptations to help a child improve their function. OTs can see behind a specific problem and for example, instead of seeing a child as “just lazy” for not completing their homework, the therapist might implement a binder check program before leaving school in order to learn to better plan and organize homework deadlines, stay organized and self-monitor themselves.
7. Educate/Empower families
The main role of an occupational therapist working with children with ADHD is the same as it is with any other child, to be an educator. An OT can help parents understand where a child’s behaviors are coming from, translate these behaviors for them to empower them and be better prepared to prevent, manage or find solutions for issues. This will allow parents to become better advocates for their children when needed. An OT can also teach parents behavior modification techniques using positive reinforcement and motivation as tools.
The Center on the Developing Child at Harvard University. Executive Function & Self-Regulation.
The Understood Team. Understanding ADHD.