Why do kids MOVE so much?? Deciphering the ADD vs. Sensory Dilemma

Little 4- year old “Sally” is in constant movement, hard for her to sit still in circle time, cannot wait in line, seems to “bump” into friends, interrupts and grabs things a lot. She seems to be a bundle of immediate gratification; a whirlwind of activity always on the go.

What is driving Sally to be on the move? What it is NOT is bad manners!!

Children like Sally are typically always on the go because they do not have a body sense of where they are in space so they are constantly moving to find that space—somewhere.

What is body in space?  It is a sensory processing awareness skill that literally lets us all know “what end is up”.  Think of yourself as living in a gravity free zone all the time and not knowing if you are right side up or upside down.

Life for these children is a constant searching for a sensory anchor that they see but cannot catch onto.  Often these children become very anxious and manifest that anxiety by using extraordinary loud voices, overtly seeming to be aggressive and ignoring the “rules”.  None of this is usually the case.

However, herein lies the conundrum: these children need boundaries and structure and at the same time they have difficulty processing directions because of their internal chaos.

To understand these children one must first understand that it is their neurology that is driving them.  Inside everyone’s head going from the outer ear way in is something called our Vestibular System. It registers movement, touch, pain and body righting and mediates and processes most of all our sensations.  When this is not fully communicating with the rest of our body several things can occur.  

Some people experience tinnitus (a ringing in the ear that does not stop), positional disorientation (being dizzy when moving so children keep moving to try to stop the reaction or resist moving at all), inability to visually focus at the midline of the body (“look at me”; “keep your eyes on your paper”, etc.), poor balance etc.  In addition their ability to accurately motor plan in both fine and gross motor arenas can be impacted.

It is important to keep in mind that not all children in constant movement are ADD/ADHD.  Sensory impaired children also exhibit this need to move and have no attention issues.

So what can teachers do to address this child’s needs and to reduce classroom chaos?  (a partial list of suggestions)

•        Have sensory centers in the room, things to touch, smell, manipulate, ride on, etc.
•         Set a timer so that the child knows that when they feel the need to go to sensory center they have a specific time to be in there—limits help provide structure that these children have a difficult time understanding.
•       Body charts –each time they use a good voice, keep their hands to themselves, sit nicely in circle time, etc. they get to put a “dot” on the body part they controlled and the object is to get a dot in each part everyday. (using Velcro dots makes these body charts re-useable and you can even use a photograph for the face so the child relates the dots not just to self control but personally to themselves as well).
•        Go crazy times” in the classroom –“OK when the bell rings move ______(fast/slow/up/down, etc.) and when the bell rings again, stop”. Use these movements “breaks” throughout the day they do not have to last more than a minute!
•       Use hula hoops to give visuals for “personal space” in circle time—smaller hula hoops are perfect for this and every child sits inside their hoop.  Inside their hoop can be a squishy pad to sit on, or a doll to hold or a fidget as well to help sustain attention.
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What can parents do at home to help their constantly moving bundle of love?  Much the same as what the teachers do in school just adapted to the home environment. But a huge suggestion is to turn off, tune off and tone down the noise in the house. Electronics, the TV, computers are always good “babysitters” but children today are not learning to amuse themselves because the gadgets do it for them.

Research has unequivocally proven that children and adults who spend a lot of time with electronics actually experience a form of “mental addiction” to these devices. Additionally, research has shown that we are developing something called the “popcorn brain”—it has to happen fast and change even faster to keep our attention.

In an article by Dr. Elizabeth Cohen further describes this phenomenon. “…according to a recent article by Elizabeth Cohen, Senior Medical Correspondent for CNN, we can forget how to read human emotions when we are always communicating online.  In addition, constant stimulation can activate dopamine cells in a part of the brain responsible for pleasure.  Repeated, long-term stimulation can actually alter the structure of the brain …Cohen spoke to David Levy, (a professor with the Information School at the University of Washington) who said that a “popcorn brain” is a brain so accustomed to the constant stimulation of electronic multi-tasking that it’s difficult to live life offline, where the pace is much slower.” 

http://www.mybrainsolutions.com/library/2011/10/popcornbrain/#sthash.3e54mUXB.dpuf

Life is movement and moving is part of life. Life is also knowing when to go and when to stop. Some of children need a little more help than others in learning the when and how of this. Learning to use our sensory system to make sense of our world is a life long process starting with learning where we are and where we want to go.

Mitochondrial Disease: Preschool through High School

There are many myths about Mitochondrial Disease and that leads to complicated incorrect misunderstandings.  Although it is thought of a primarily a childhood disorder, it can actually occur at any age. 

Previously it was thought that it was only the mother that passed the gene onto the child, but it is now known that there are many genetic hereditary patterns that contribute to the DNA mutations inside cell patterns.  Mental retardation, seizures and related developmental issues do not always occur with Mitochondrial Disease, and there are many children with typical cognitive abilities.  

There is current on-going research suggesting a connection between HIV positive parents and Mitochondrial Disease in their newborns.

Diagnosis is a complicated process that may or may not include a muscle biopsy.  And at this time, there is not one test that determines the diagnosis.  Just as there is not one test, there is not one protocol for treatment.  And there is a huge gap of misunderstanding between “incurable” and “untreatable”.

There is on-going research connecting some children with Autism to Mitochondrial Disease.  This study is population based and so far it has found that this occurs only in a minority of cases.

What adds to the confusion about treatment is that each child can manifest the disorder very differently.  However the link between all of these children is the fact that learning how to play, a natural avocation of children, while conserving energy needs to be taught.  Teaching healthy play habits is where occupational therapy can make a significant contribution.

It is also crucial that this therapy/education process involve not just the parents but the siblings as well.  Including everyone in the process allows for the typical sisters and brothers to engage with their family as a contributor and not a by-stander.  This also may prevent their feelings of jealousy and rejection.

When you receive the diagnosis is very important.  If your child was diagnosed early and received services under (each state may have a different title) the Babies Can't Wait 0-3 programs than entering into the public school with special services may at least, initially be an easier process.

However many times this is not diagnosed early especially in cases where the symptoms are mild and do not manifest themselves until the child is in more task-demanding situations.

There are basically two avenues for a “Mito” child to receive services, for the child entering public education there is the IEP (Individual Educational Plan through the IDEA part C).  However state regulations can retain your child under the IFSP (Individual Family Service Plan) until age 5 when most children start kindergarten.

These are two very different systems and are not related to one another. IFSP focus is on the family interactions and what they can do to help the child. The IEP is only educationally based.  The IEP covers the child from ages 3-21.

The IFSP takes into consideration the needs and concerns of the family, and the IEP do not. These are two very different laws, and it is essential that families know the difference between State and Federal Laws.

Keeping records of milestones is very important when seeking services.  Dates of attainment of walking, sitting, standing, toileting, talking, swallowing, etc. not only are important to the pediatrician but the school in making the decision for appropriate services.

As your child progresses into elementary school you may begin to observe increased fatigue (as the school day is longer and more stressful with less “breaks), visual issues may appear and problems with reading may be noticed at this time, and increased occurrences of muscle cramping may be seen.  At this time the parents may also want to integrate benefits available to the child through the 504 (ADA law) for accommodations and modifications within the educational setting.

Provisions under the 504 are particularly important to children as they enter Middle School. Middle School is wracked with enough issues inclusive of but not limited to social expectations, increased homework and more writing writing writing! Not to mention the carrying of books from class to class.  At this time some children may opt for the use of a wheelchair to help conserve energy during the school day. 

Under the 504 parents can ask for modifications in scheduling, timing of tasks and assignment due dates, classroom settings, presentation of information and testing (such as an answer booklet instead of a worksheet), etc.

During middle school it is not too early to think about High School graduation. The type of diploma your child gets impacts post-secondary options. Be sure to ask about this very early on in middle school and again at the first high school IEP meeting.

An alternative to all this is home-schooling. This is a very personal decision and many factors need to be considered. Are your child’s needs being met in the public school setting, is health at risk during such a long school day, your child’s emotional status, etc.  However if your child is receiving related support services in the public school, you need to ask if these services will continue in the home-school setting. Some states send certified teachers into the home and other states leave that to the parent.  Related services may be provided but the parent would have to take the child to the public school, while others send the special services person to the home. All of this should be part of the parents’ investigation before a decision for homeschooling is made.

It is also important to know that under the IDEA (IEP) Plan, the mandate is for the “least restrictive environment”. That makes the priority of placement and services very rigid.  The first option is always placement in a regular classroom. Then the following is suggested: placement in a regular classroom with modifications; resource room assistance; separate classroom for children with special needs and last a residential or day program placement.

Throughout this process the occupational therapist is key in making sure that milestones and educational outcomes are met.  Working with the teachers and the families the OT addresses issues of energy conservation, balance, mobility, technical support, strength, balance, coordination, sensory modulation, play skills and activities of daily living.  These are skills that will be needed not just in school but throughout the life span.  The occupational therapist can also help with the establishment of daily exercise plans to do both in school and at home.

Because the Federal mandate of the public school is to “normalize” educational settings, parents may need to ask for occupational therapy to be part of their IIFSP/EP Plan.

Obtaining services is often a complicated process and parents can learn more about this process and occupational therapy in the book, “Learning Re-Enabled” 2^nd edition, available through Amazon.com. and other booksellers.

Susan N. Schriber Orloff, OTR/L, FAOTA is the author of the book. “Learning RE-Enabled” a guide for parents, teachers and therapists,(a National Education Association featured book) as well as the WIN™ Write Incredibly Now™ Program (available through YourTherapy’Source.com).  She is also the CEO/Exec. Director of Children’s Special Services, LLC an occupational therapy service for children with developmental and learning delays in Atlanta, GA.  She can be reached through her website at www.childrens-services.com or at susanorloff@childrens-services.com.

Is it ADD or Auditory Processing Disorder? How to tell the difference

Auditory processing is when the brain cannot “hear”.  “DA” becomes “GA” and “dat” becomes “that” and “three” becomes “free”.  This does not usually show up in reading where some children have difficulties with phonetics when “dragon” becomes “draw”.

And it is acutely different from ADD/ADHD when behavior is the component that is the distracting factor for discriminating directions and organization.  Actually APD can be 3 disorders in one; which is why it is so hard to diagnose.

All of these disorders require that a speech pathologist diagnose these issues correctly. And finding the right clinician is as important, if not more than, as seeking out the right treatment.

The child with APD may be experiencing auditory memory issues, sound discrimination, and sound localization.

A child with APD is literally living in a world of auditory chaos. It as it they are living in a world of constant “hum” that is blocking out essential information so that they are “hearing” their world through a static filter.

In contrast the ADD/ADHD child is experiencing his or her world in “fast forward”. They are catching only “snatches” of what they should be doing so that they need and require multiple repetitions so that complete information can be received and utilized appropriately.

In the clinic these children can look similar but in truth they are very different.  However, both are experiencing neurodevelopmental delays that negatively impact their ability to perform both in academic and social situations.  Both carry with it emotional factors that if misunderstood, can look like oppositional behavior issues.

The ADD/ADHD child has more active random responses to stimuli while the APD child just appears “detached” and “uninvolved”.  The APD child can shut down with too much stimuli and “phase out” while the ADD child often escalates behaviors that are hard to modulate and/or tamper down.

Both however, can be subject to temper tantrums due to frustration and both can be very hard to teach because the “message” is not getting across. With the APD child comprehension is blocked; with the ADD child it is as if the directions are being broadcasted with a lot of static.

With the ADD child creative repetition is an excellent way of teaching new skills and reinforcing old ones. With the APD child multiple sensory and cognitive pathways must be recruited for the child to understand since the auditory route is not giving direct clear information.

Characteristics of the APD and ADD Child –however keep in mind that issues such as fear of failure can be seen in both children and that there is some overlap.  These lists are meant for general clarification not as an absolute.

ADD/ADHD Characteristics	APD Characteristics
There are two main types of ADD ·       Inattentive ·       Hyperactive	Also known as Central Processing Disorder
These children can be: ·       Impulsive ·       Hyperactive ·       Short attention span Doesn’t pay attention to details ·       Makes careless mistakes ·       Has trouble staying focused; is easily distracted ·       Appears not to listen when spoken to ·       Has difficulty remembering things and following instructions ·       Has trouble staying organized, planning ahead, and finishing projects ·       Gets bored with a task before it’s completed ·       Frequently loses or misplaces homework, books, toys, or other items ·       Difficulty with transitions ·       Can be oppositional ·       Can have difficulty sleeping ·       May be tantrum prone ·       May need situational changes in order to shift to different activities ·       May be compulsive ·       May have anger management issues	These children can be: ▪       Easily distracted or unusually bothered by loud or sudden noises? ▪       Noisy environments can be upsetting ▪       Behavior and performance improve in quieter settings? ▪       Difficulty following directions, whether simple or complicated? ▪       Reading, spelling, writing, or other speech-language difficulties? ▪       Abstract information is difficult to comprehend? ▪       Verbal (word) math problems difficult for your child? ▪       Conversations are difficult to follow ▪       Tends to withdraw from social situations (even though they desire to be included) ▪       Over-reactive to corrective remarks ▪       Does not know when to ask questions ▪       Fear of failure ▪       Overly dependent upon teacher/parent/etc. ▪       May have articulation issues ▪       Does not understand jokes and may have difficulty reading facial expressions

Complicating this is the fact that often these two diagnoses can be seen co-existing in one child.  Often children with these issues are best seen in both occupational and speech therapy. When possible, co-treatments are often very beneficial for maximum therapy outcomes.  Children with ADD and/or APD are highly emotionally charged individuals. Therefore all interventions must include activities that respect both the psychological and the neuro-developmental aspects of performance.

Susan N. Schriber Orloff, OTR/L, FAOTA is the author of the book. “Learning RE-Enabled” a guide for parents, teachers and therapists,(a National Education Association featured book) as well as the WIN™ Write Incredibly Now™ Program (available through YourTherapy’Source.com).  She is also the CEO/Exec. Director of Children’s Special Services, LLC an occupational therapy service for children with developmental and learning delays in Atlanta, GA.  She can be reached through her website at www.childrens-services.com or at susanorloff@childrens-services.com.