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Sensory Integration Techniques for ADHD

Posted Apr 05 2011 12:00am

ADHD, Asperger’s syndrome , PDD –NOS and other disorders have many symptoms in common. The overarching similarities include difficulty with attention and focus, poor internal organization, and disruptive behaviors. They also include a variety of sensory issues, from tactile defensiveness to auditory defensiveness and more. While good cognitive-behavioral therapy programs target social –emotional problems, and medication reduces hyperactivity and related issues, additional treatment is often still needed for sensory based problems.

Children with any of the above disorders need to be able to organize internally. The peripheral nervous system connects the limbs and organs to the central nervous system. The central nervous system carries information to and from the brain. Working together, they control behavior. Behavior in this context refers to any type of physical response that is manifest in a given situation. If signals to and from the brain are irregular in any way, behavior is altered. What this means to the ADHD child is that when their sensory system does not respond appropriately, behavior is affected.

I believe that all behaviors can be improved to some extent. All it takes is the right treatment. The key to finding the right treatment is in good diagnosis. Once you know the problem, you are on track to the solution. While I am a strong believer in a multi-treatment approach, certain symptoms may respond better to a specific protocol. Sensory integration is designed to treat symptoms related to sensory dysfunction. There is a variety of techniques which can help a child with sensory issues.

There are two very popular protocols which are designed to help organize the central nervous system. One is a brushing protocol. The other is a joint compression protocol. The brushing and compressions affects the receptors which carry signals to the CNS. While there is little clinical evidence to support the validity of these treatments, there is quite a lot of anecdotal reporting which praises their efficacy. The brushing protocol should be overseen by a trained therapist. The only reservation I have regarding brushing is that it has to be repeated frequently throughout the day. Instead, I personally like to use joint compression during treatment. I believe it helps improve physical awareness. It also helps stimulate the muscle receptors and tendon reflexes which is valuable when working on motor skills.

Another option for a child with oversensitive or over-reactive sensory system is a weighted vest. The weighted vest was designed to help give external pressure and proprioceptive input. Proprioception is the sense of your body in space which comes from the receptors in joints, muscles, tendons and ligaments. Again, the theory is to alter nervous system processing so that responses are delayed or calmed. In addition to vests, there are and lap pads that children can use at school.

Heavy work activities can be used to calm an over-stimulated child. Not only do they slow the child down, but the physical work helps the child gain awareness of their body in space. One therapist I know used to load up a kids shopping cart with bags of sugar and flour and make the child push it around right before bedtime.

If your child has severe problems in self-calming or with hyper-stimulation, you can try making a sensory friendly environment. This can be costly, however, because many of the sensory lights and tools are expensive. But you can start with a small space with dimmed lighting and a bean bag chair and a few fiber optic lights or simply a lava lamp. Most people are mesmerized by a lava lamp. By the way, Mesmer was a physician whose work was the basis for the development of hypnosis (an altered state). So certain lights and environments have the capacity to alter our state and create relaxation. These things also work the same way for your child.

Overactive children who never seem to slow down can benefit from , spinning and jumping activities. Jumping helps with proprioception, and swinging and spinning help with vestibular organization (movement and coordination and spatial organization).

There are a few tools which can be used both at home and at school which address different sensory issues. For children who need to and have oral input, there are special “chew toys” and fidgets which fulfill the need. Vibration also seems to calm the over stimulated sensory system. It is soothing and provides tactile input as well.

The strategies listed above touch on the more common tools. In addition to these, there are programs which claim to address sensory dysfunction. A few of these programs are: Interactive Metronome , the Astronaut board and Integrated Listening Systems . These programs vary in their approach. I believe all of them require supervision by a trained specialist.

For those who might want to try joint compression at home, I have provided a description of the protocol.

1. Grasp your child’s right hand with your own as if you were going to shake hands
2. Grasp your child’s forearm with your left hand and without squeezing
3. Push your child’s hand toward the forearm/wrist with quick, firm movements. 10 repetitions
4. Next move your left hand to hold your child’s elbow and with your right hand hold her forearm
5. Push your child’s forearm into her elbow firmly and quickly. 10 repetitions
6. Keep your left hand on her elbow and move your right hand to her shoulder
7. Push your child’s arm up toward the shoulder firmly and quickly. 10 repetitions
Repeat the same protocol with her left side.
You can also do compression for the legs. It is easiest if you have your child sit in a small chair with her feet touching the floor.
1. Place your hand over her right knee and grasp.
2. Push knee toward hip with quick, firm movements. 10 repetitions.
3. Now with hand over knee, push down toward feet with quick movements. 10 repetitions
Repeat with other leg.
You can also do this with the child lying on her back and leg straight. You would grasp at the knee and push up, and then grasp the foot and push.
This exercise should never hurt. As a matter of fact, it should feel calming to your child.

Nancy Konigsberg is a pediatric occupational therapist and child development expert with more than 16 years of clinical experience. She specializes in neuro-muscular disorders, behavior problems and genetic disorders. Read her O.T. blog Milestone Mom in which she describes developmental disorders and offers treatment protocols and advice.

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