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School children with ADHD should be encouraged to fidget in class
School children with ADHD should be encouraged to fidget in class, two new studies suggest.

Thursday, June 25th 2015

The research showed that children with attention deficit hyperactivity disorder perform better on cognitive tasks when allowed to fidget or move more freely than is typically allowed in many classrooms. The theory: Moving increases their alertness.

“Parents and teachers need to stop telling children (with ADHD) to sit still,” said Julie Schweitzer, a professor of psychiatry and behavioral sciences at the MIND Institute at the University of California, Davis, who was senior author of one of the studies. “We know that some activity can be disruptive to others, but we need to find ways to make it less conspicuous and to integrate socially appropriate ways of moving.”

The children perform better on cognitive tasks when allowed to move freely.

Interestingly, one of the studies found that fidgeting, while boosting performance in ADHD children, resulted in a performance decline in children with typical behaviors.

Dr Schweitzer and some other experts say more research is needed to determine if classroom accommodations that encourage helpful movement could allow children with ADHD to reduce their medication or in mild cases discontinue it altogether. Other children, whose parents don’t want them taking medications, might benefit from such adjustments, which might also be used in conjunction with other behavioral therapies.

Other experts doubt movement therapies will ever displace drugs. “It’s not going to be an alternative to medical treatment,” said Russell A. Barkley, a clinical professor of psychiatry and pediatrics at Medical University of South Carolina, in Charleston. “But as a coping device and as something that teachers might wish to consider in the classroom it’s very consistent with an emerging body of work showing that physical exercise in general is beneficial.”

Schools across the country are experimenting with incorporating more movement in the classroom, be it through standing desks, sitting on exercise stability balls or reading while riding a stationary bike. Other tactics are as subtle as allowing gum chewing.

Many schools make such options available for all students, figuring that movement benefits everyone. But experts suggest targeted interventions should generally be for students with ADHD or similar disorders.

ADHD is among the most the common childhood neurodevelopmental disorders. Rates of children diagnosed with ADHD have been growing about 3% a year in recent years. Approximately 11% of children in the US have been diagnosed, according to the most recent national statistics.

At the Quaker School at Horsham, in a suburb of Philadelphia, about 30% of the students have ADHD. The 60-student school is designed for children with various learning disabilities. “We accommodate kids pretty much in whatever way they need as long as it doesn’t provide distraction to other kids,” said Ruth Joray, head of the school.

Experts believe that giving kids with ADHD something to fidget with is beneficial.

Classrooms at the Quaker School at Horsham have boxes filled with fidget tools such as putty and Koosh balls for students to use whenever they want. School officials say it helps students get the sensory input that helps many children with ADHD and other disorders.

That includes being allowed to stand while others are seated, sitting in seats that allow for generous motion and playing with fidget tools. Some students use stability ball seats, others use Howda chairs, which rest on the floor and allow children to rock. Resistance bands are wrapped around the bottom of some chairs to allow children to move their feet without making noise.

The classrooms also have boxes of fidget tools with objects like squishy balls or putty that can be rolled or squeezed or stretched, said Ms Joray.

Jennifer Keller, a guidance counselor at the Quaker School, said such accommodations have benefited her 12-year-old son Jake, who is diagnosed with ADHD and a student there.

“In a typical classroom he would be squirming around in his seat, falling out of it, needing to jump up and down and walk around the classroom,” said Ms Keller. Now he’s able to get the sensory input he needs, she said. “If they move their bodies while they’re working it doesn’t disturb anybody but it fills their own neurological need for motion and activity,” she said.

In addition to Howda chairs, made by Howda Designz, products targeting children with ADHD include the Hokki Stool, which spins, and Bouncy Bands, a rubber bungee cord that fits around the bottom of a desk or chair for leg bouncing.

Scott Ertl said he came up with the idea of Bouncy Bands after watching ADHD students struggle in classrooms when he was an elementary school counselor in Winston-Salem, North Carolina. In March he quit his job to run his business full time.

In a study published in April in the Journal of Abnormal Child Psychology, children with ADHD who performed a working-memory task while seated in a chair that could swivel performed better on average the more they moved. The opposite was true for a control group of typically developing children, who fared worse the more they moved. There were 29 children diagnosed with ADHD and 23 controls.

The children—boys between the ages of 8 and 12—completed working-memory tasks in which they had to repeat back and manipulate a series of jumbled numbers and a letter. The activity, which had four difficulty levels, was repeated 24 times.

Researchers used high-speed video recording to measure how often children were getting out of their seats, spinning, fidgeting or making other movements while completing the tasks. “We didn’t put any constraints or constrictions on them,” said Dustin Sarver, an assistant professor of pediatrics at University of Mississippi Medical Center and first author of the study.

“We think a lot of this movement has to do with kids’ arousal levels in their brain,” Dr Sarver said. Certain regions of ADHD children’s brains are less active than those of typically developing children, he said. Physical movement is believed to increase that activity, helping to boost cognitive performance. But allowing typical children to fidget may push their arousal levels outside of an optimal range, he said.

For another study, published in the journal Child Neuropsychology earlier in June, researchers measured the intensity and frequency of students’ movements while they completed a computerized test. Again, students diagnosed with ADHD performed significantly better when making intense movements. The study included 26 children with ADHD and 18 typically developing children.

The children, between 10 and 17 years old, performed a 20-minute computerized test called the flanker test, which measures attention, inhibition and ability to filter out distraction. The number of right versus wrong answers was compared in 204 four-second presentations. While taking the test, an actigraph was strapped to the children’s ankles to measure the intensity and frequency of their movements.

“What we found was that when the children with ADHD had intense movement—the kind of movement a teacher or another child would notice in the classroom—they did better on the task,” said Dr Schweitzer, of the MIND Institute. Movement had no effect on the typically developing group. The analysis controlled for IQ and gender.

People with ADHD have increased activity in motor regions of the brain such as the cerebellum and the basal ganglia, Dr Schweitzer said. But other areas such as the prefrontal cortex—a higher order part of the brain that is associated with decision-making and regulating control—don’t work as effectively. “We suspect that if higher order regions are not working as well as they should be, then other areas are compensating,” she said.

The Wall Street Journal
June 23, 2015 1:56PM
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