Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder (ADHD) is a medical disorder with symptoms such as:

  • http://i0.wp.com/media.urbandictionary.com/image/page/adhd-18223.jpg?resize=153%2C144Extreme hyperactivity
  • Extreme inattentiveness
  • Extreme impulsivity

The symptoms have to be be very, very severe before a diagnosis is even considered. The behaviour in ADHD has to do with low levels of the neurotransmitter (a messenger) dopamine, which helps the transmission of signals in the brain and other areas of the body. If you’re interested in more about the symptoms and physiology of ADHD  you can check out my previous post A Few Facts About ADHD”. People with ADHD often has sensory processing disorder (SPD), which makes it difficult to process sensory inputs.

There are many kinds of care for ADHD, such as medication and different kinds of therapies, which all depends on the severity of the symptoms a person with ADHD has.

My personal goal working with Occupational Therapy (OT) is to provide empowering ways to live a balanced life with as low an intake of medication as possible.

Occupational Therapy for ADHD

OT is a holistic and individualized form of therapy that targets different parts of life, depending on your current issue. It has the spirit of the person in focus and the interventions are mainly built around the meaningful Activities of Daily Living (ADL) chosen by the client. These activities are used as a means or goal for the interventions in order to enhance the independence and life quality of the individual. The intervention takes, when possible, place in the natural settings of the activity, or in an adapted environment with high transfer value.

http://i0.wp.com/vula.uct.ac.za/access/content/group/9c29ba04-b1ee-49b9-8c85-9a468b556ce2/Framework_2/images/lectures/cmop-e.JPG?resize=544%2C326&ssl=1
Canadian Model of Occupational Performance and Engagement (Townsend & Polatajko, 2013)

There are many different kinds of approaches and therapies that can be used in an OT intervention with a person with ADHD.

Examples of therapeutic skills

An OT can educate the person with ADHD and its social environment (family, friends and teachers) about the disorder and the behavioural impact it has on the person and its daily living. Furthermore, the OT may engage and coach them in actively supporting future interventions, which can unfold in the persons public, private and therapeutic settings. (Townsend & Polatajko, 2013)

The Occupational Therapist can help collaborate for an adaptation of the person with ADHD’s routines and environment with, for example, assistive devices to fit his/her individual needs. These devices may be structural tools such as a Time Timer Watch Plus, and tools to calm down such as Chewelry for oral stimulation, a Protac products for proprioceptive (movement sense) and tactile (touching sense) stimulation. The Protac products help relieve restlessness in the muscle and head, and, hereby, calm down body and mind, and makes it possible to focus or sleep. (Protac – integrating senses) (ARK Therapeutic Service, Inc.)(Townsend & Polatajko, 2013)

The Occupational Therapist may need to advocate the institutional environment, such as school or workplace, to collaborate in adapting routines (eg. small breaks during classes, possibility of extra help etc), physical surroundings (eg. a Protac Cushion) and allow the person to use different forms of strategies and skills taught by the therapist (Townsend & Polatajko, 2013)

Cognitive Behavioral Therapy

Psychologist NH | Cognitive Behavioral Therapy | CBT NHIn order to teach the client new skills and behaviours to manage ADHD, an OT may use Cognitive Behavioral Therapy (CBT), which has been proven beneficial to people with ADHD (Weiss et al.)

CBT is a form of psychotherapy based on the idea that a clients thoughts affect their feelings, which then affect their behaviour. Therefore, if you want to change your behaviour you must change your thoughts (Anderson et al.).

An Occupational Therapist working with CBT helps to identify irrational beliefs, which the client may have build through past stressful and traumatic experiences. Typically these beliefs will be identified by keeping a thought log. The beliefs will then be challenged through exercises with gradual, systematic exposure to activities/an arousing, tricking situation. The activities will be accompanied by dialogue to challenge the automatic thoughts that may occur due to the tricking situation and then create new, beneficial thought patterns, which will generate more beneficial behaviour. (David et al., 2005)

Sensory Integration Therapyhttp://i0.wp.com/www.naturalhealth365.com/images/sensory-integration.jpg?resize=310%2C213

Another commonly used therapy is Sensory Integration Therapy. This form of therapy is mainly used when a person with ADHD also has SPD.
The Sensory Integration Therapy is based upon Occupational Therapist A. Jean Ayres’ theory on how the neurological process of processing and integrating sensory information from the environment and the body contribute to learning, behaviour, emotional regulation and participation in daily life. This means that the brain must process all the sensory information to create a well-functioning sensory environment in order for a person to be able to engage in life in a productive and healthy manner. To put it into perspective, we all know how difficult it is to interact, remember, think etc. when we are under a lot of stress. That is because our inner environment is out of balance. For a certain amount of time that is okay, but if we constantly feel overly stimulated it will be impossible for us to engage with the world around us in a fulfilling and meaningful way. In order to have a well-functioning sensory environment, it is possible to create a sensory diet, which is to adapt the amount of sensory stimuli to your personal need in order to feel balanced and stable, which is optimal conditions for learning, creativity, work and social interaction.

Even though ADHD is not the same as SPD, people with ADHD are often seen to benefit from Sensory Integration Therapy. One way to do so are assistive devices such as the previously described Protac equipment or Chewelry, but there are also other solutions to help on the matter. Joint compression and The Wilbarger Deep Pressure and Proprioceptive Technique (DPPT) are professional techniques for deep proprioceptive and tactile stimulation. DPPT is a technique where a special brush is being used on the skin in order to create deep tactile stimulation (Wilbarger & Wilbarger, 2002). Using the body for heavy activities is something most people with ADHD benefit from, so other ways of giving inputs are in OT interventions in, for example, sensory rooms, or through activities (Gawrillow et al., 2013) such as:

  • Eating crunchy food/chew gum
  • Pushing, pulling and carrying heavy items (physical activities are always good!)
  • Crashing into a lot of pillows/mattresses
  • Gardening, shoveling, pushing the wheelbarrow, raking leaves
  • Doing sports with deep tactile and proprioceptive stimulation as, for example, Brazilian Jiu Jitsu
  • Doing yoga (Haffner et al., 2015)

Yoga for ADHD:

Yoga has been seen to have benefits on neurological activities in the areas in which a person with ADHD is effected. Though needed further investigation, a study by Jensen and Kenny (2004) indicates that yoga can be used to stabilising emotions, reduce oppositional behaviour and reduce restless/impulsive behaviour. Furthermore, the benefits has been proven in a study by Hariprasad et al. (2013), which showed a significant improvement in ADHD symptoms after daily yoga practices.

Since people with ADHD tend to lose focus and easily look for new activities, it may be a good idea to make routines with a frequent change of asanas (postures) and make the practice balance between calming and powerful. A routine could be a mix of soft and powerful asanas with incorporated moments of relaxation, pranayamas (breathing techniques) and eye exercises. Be aware to praise the person whenever they follow the routine and your instructions, instead of being upset whenever the routines aren’t followed.

If you have questions regarding the matter of this article, you’re welcome to write me a message.

Stay tuned to get to know some stars with  ADHD 🙂

References:

Andersson, G., Asmundson, G. J. G., Carlbring, P., Ghaderi, A., Hofmann, S. G., & Stewart, S. H. (2005). Is CBT already the dominant paradigm in psychotherapy research and practice? Cognitive Behaviour Therapy, 34(1), 1-2.

Ayres, A. Jean (2005). Sensory integration and the child : understanding hidden sensory challenges (25th anniversary ed., rev. and updated / by Pediatric Therapy Network ; photographs by Shay McAtee. ed.). Los Angeles, CA

David, D., Macavei, B., Szentagotai, A., & McMahon, J. (2005). Cognitive restructuring and mental contamination: An empirical re-conceptualization. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 23(1), 21-56.

Gawrillow, C., Stadier, G., Langguth, N., Naumann, A. & Boeck, A. (2013): Physical Activity, Affect, and Cognition in Children With Symptoms of ADHD, Journal of Attention Disorders

Gillock, K, L (2016): Cognitive Behavioural Therapy. Last visited: 25.09.16 at: psychologist-nh.com: http://www.psychologist-nh.com/cognitive-behavioral-therapy-cbt/

Haffner, J., Roos, J., Goldstein, N., Parzer, P. & Resch, F. (2015): The effectiveness of body-oriented methods of therapy in the treatment of attention-deficit hyperactivity disorder (ADHD): results of a controlled pilot studyYeitschrift får Kinder – und Jugendpsychiatrie und Psychotherapie

Hariprasad, VR., Arasappa, R., Varambally, S., Srinath, S. & Gangadhar, BN (2013): Feasibility and efficacy of yoga as an add-on intervention in attention deficit-hyperactivity disorder: An exploratory study. Indian J Psychiatry, Bangalore, India

Jensen, P. & Kenny, D. (2004) The Effects of Yoga on the Behaviour of Boys with Attention Deificit Hyperactivity Disorder (ADHD) The University of Sydney, Australia

Protac – integrating senses: How the products work. Last visited: 25.09.16 at protac.dk: http://www.protac.dk/uk/kuglernes-virkning

Townsend, E & Polatajko, H (2013) Enabling Occupation II- Advancing an Occupational Therapy Vision for Health, Well-being & Justice through Occupation. CAOT Publications ACE, Canada

Weiss, M., Murray, C., Wasdell, M., Greenfield, B., Giles, L., & Hechtman, L. (2012). A randomized controlled trial of CBT therapy for adults with ADHD with and without medication. BMC Psychiatry, 12 doi:http://dx.doi.org/10.1186/1471-244X-12-30

Wilbarger, J. & Wilbarger, P. (2002). Wilbarger approach to treating sensory defensiveness and clinical application of the sensory diet. Sections in alternative and complementary programs for intervention, In Bundy, A.C., Murray, E.A., & Lane, S. (Eds.). Sensory Integration: Theory and Practice, 2nd Ed. F.A. Davis, Philadelphia, PA.

Images:

ARK Therapeutic Service INC. Chewelry. Last visited: 25.09.16 at: arktherapeutic.com: http://www.arktherapeutic.com/chewelry/

Gillock, K, L (2016): Cognitive Behavioural Therapy. Last visited: 25.09.16 at: psychologist-nh.com: http://www.psychologist-nh.com/cognitive-behavioral-therapy-cbt/

Occupation Focused Conceptual Framework: 8. Lecture, the Canadian Model of Occupational Performance and Engagement (CMOP-E): Last visited: 05.10.16 at: https://vula.uct.ac.za/access/content/group/9c29ba04-b1ee-49b9-8c85-9a468b556ce2/Framework_2/lecture8.htm

Townsend, E & Polatajko, H (2013) Enabling Occupation II- Advancing an Occupational Therapy Vision for Health, Well-being & Justice through Occupation. CAOT Publications ACE, Canada

This page should only be used for informational purpose and is NOT intended to provide medical advice. Before seeking any form of treatment, the reader must seek direct information from his/her certified health care provider.

ADHD, Yoga and Occupational Therapy

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