OT Corner: Sensory Integration and Attention Deficit Hyperactivity Disorder
By Amy Wagenfeld, Ph.D, OTR/L
Originally printed in January, 2006

I would like to continue our series on sensory integration by talking about a 
few links between SI and Attention Deficit (Hyperactivity) Disorder (ADHD/ADD).  
Some information will likely be a bit repetitive from last month’s column, so I 
do hope that works for you.  I think that some of the nature of this repetitiveness 
is that, while, for instance, autism and ADHD are different disorders, SI is, no 
matter how you look at it, SI!  There are definitely some parallels in treatment 
procedures, so I will spend time exploring the general role of an OT practitioner 
in working with children with ADHD as well as in terms of specific SI therapy 
strategies.

Let’s start by talking about what ADHD/ADD is all about.  ADHD/ADD is considered 
to be the most common neurobehavioral disorder of childhood.  To set the two 
apart, ADD is attention deficit disorder, in which there is no associated 
hyperactivity (see below), whereas ADHD/ADD is associated with attention 
deficit and hyperactivity characteristics. ADHD/ADD is always present in 
children, and usually persists throughout adolescence, and sometimes even into 
adulthood.  Current statistics indicate that ADHD/ADD affects about 3-5% of 
school-aged children.  This is a significant increase in terms of diagnosis, 
but this rise is considered to be the result of better diagnostic criteria.

When we talk about characteristics of ADHD/ADD, we can think of them in terms of 
inattention, hyperactivity and impulsivity.  Specifically, inattention might be 
seen in terms of not paying attention to details, difficulty listening to and 
following through on directions, and avoidance of tasks that require a lot of 
concentration.  Hyperactivity is the inability to sit still; a child with hyperactivity 
may appear to be in constant motion (motorically and verbally).  Impulsivity might 
be seen as the inability to wait one’s turn, and the tendency to blurt out answers 
before being called on, or before a question is even asked.

Although there is no absolute known cause for ADHD/ADD, there seems to be strong 
evidence that it may be a result of neurological or neurochemical imbalances.  It 
has also been shown that ADHD/ADD tends to run in families, which link it to a 
neurological, familial pattern.  ADHD/ADD is most commonly treated through medication 
management.  A recent National Institute of Mental Health Study indicated that 9 
out of 10 children are positively helped to manage their symptoms through medication.  
Other therapeutic approaches include behavior management, counseling, and of course 
sensory integration therapy.

Let’s talk about SI, and a few other therapeutic approaches that OTs may use with 
children diagnosed with ADHD.  Because of the tendency towards impulsivity and 
inattention, OT will frequently be directed towards working with teachers and families 
to modify the classroom or home in order to reduce extraneous stimuli, and create an 
environment that is calm and directed towards helping a child be able to better focus, 
learn, and play!  OTs may also work with children diagnosed with ADHD/ADD to enhance 
social skills, learning to take turns, to share, and generally to be able to feel 
good about working and playing with friends.  And, then, of course, there is 
sensory integration therapy.  As you might imagine, because you are all experts 
on SI now… the purpose of sensory integration is to help a child with ADHD/ADD 
learn to modify his response to incoming and outgoing sensory information.  As with 
SI treatment for a child with PDD/Autism, treatment is usually quite intense, and 
for it to be most successful, it must be consistent, and carried over both at home 
and in school.  SI will not be a cure for ADHD/ADD, but it may help a child to focus, 
which will in turn lead to more success in school, in terms of learning, making 
friends, and just feeling good about him or herself.

What I plan to do next month is touch on learning disabilities, and the role of 
SI treatment in working with children who have been diagnosed with SI, and wrap-up 
our series on sensory integration.  If you have some specific questions about SI 
therapy, please let me know, and I will address your questions in my next column.