Occupational therapists (OTs) have an essential role in improving occupational performance for people with ADHD.
Six million children aged 3-17 have been diagnosed with Attention Deficit Hyperactive Disorder (ADHD), according to the 2016-2019 data from the Centers for Disease Control and Prevention (CDC). The National Institute of Mental Health cites the prevalence of ADHD diagnoses in adults aged 18 to 44 as 4.4%.
Some signs and symptoms of ADHD are distractibility, forgetfulness, impulsivity, and neurodivergent thinking. Occupational therapy practitioners (OTPs) have an essential role in improving occupational performance for people with ADHD by supporting strengths, addressing needs, and recommending modifications and accommodations.
Recommended course: Attention-Deficit/Hyper-Activity Disorder: The Role of Occupational Therapy
Areas of occupational participation
People with ADHD can require support for engaging in one or multiple meaningful activities. Challenges with these activities may include:
- Leisure activities
- Activities of daily living
- Social activities
- Educational activities
- Pre-vocational and vocational activities
A study from the National Institute of Health found that children with ADHD can demonstrate argumentative attitudes, decreased focus, and frustration that can negatively impact their participation in team sports. However, the psychosocial-related aspects of ADHD are not the only things that can impede participation in sports and other leisure activities.
In 2016, Olympic gymnast Simone Biles announced on social media her need for medication to address her ADHD. This announcement was in response to accusations of illegal drug use for her sport which could have had dire consequences.
Activities of daily living
A 2019 study found that fine motor deficits were more prevalent in children with ADHD. Fine motor impairments can affect engagement in activities of daily living (ADLs).
Some ADLs affected can include:
- Manipulating fasteners on clothing during dressing/undressing and toileting
- Orienting clothing correctly on the body due to decreased attention when getting dressed
- Using hand-held eating utensils for eating
- Keeping track of finances and paying bills on time
An article on the Children and Adults with Attention Deficit/Hyperactivity Disorder website details how ADHD impacts a person’s ability to engage socially with others. People with ADHD can appear to have impaired social skills when they have ADHD-related socialization difficulties.
These challenges can be displayed as:
- Difficulty staying on topic. Family, friends, and peers can have difficulty engaging in a topic-specific conversation with the person who has ADHD. This can cause frustration for both parties, making each feel like they are not being heard by the other.
- Making impulsive decisions that can fracture relationships with others.
In a video from Child Mind Institute, accomplished Olympic swimmer Michael Phelps, who has ADHD, recounts how he was told in school that he would never be successful. The skills and positive attributes of people with ADHD can be overshadowed by ADHD signs and symptoms when the environment, tasks, modifications, or accommodations do not support their strengths.
Signs and symptoms that can mask other skills include:
- Getting distracted when others are talking, especially if more than one person speaks. This can cause a person with ADHD to miss important information at home, at work, or in the classroom. A child with ADHD may struggle with participating in group projects at school or completing individual work when others are talking in the classroom.
- Impulsive speaking in class can be perceived as rude or disruptive. Repeated outbursts can be seen as intentional and lead to consequences at school.
- Difficulty expressing thoughts and needs. Students with ADHD may not have their needs adequately met because they cannot organize their thoughts to request assistance or to complete class assignments. This is not limited to school-aged children but also students in higher education that are required to do more self-advocacy to garner academic support.
Pre-vocational and vocational activities
Three-time Grammy-Award-winning singer/songwriter Adam Levine told ADDitude magazine in 2019, “I had trouble sometimes writing songs and recording in the studio. I couldn’t always focus and complete everything I had to. I remember being in the studio once and having 30 ideas in my head, but I couldn’t document any of them.”
Engagement in pre-vocational and vocational activities can be hindered by:
- Difficulty organizing thoughts and information to complete work tasks.
- Forgetting details or important information can make it appear that the worker does not value what was said or is careless with deadlines.
Addressing barriers to occupational performance
Occupational Therapists are skilled in helping people with ADHD increase functional performance by addressing barriers to occupational performance. OTs and COTAs can provide clients and caregivers with client-centered techniques that support a person’s strengths and provide education for environmental modifications to increase success.
OTPs can assist by teaching the person with ADHD:
- To break down instructions and tasks into smaller, easier-to-manage parts
- Use visual aids to organize thoughts and increase understanding of information
- Use technological aids to support memory difficulties and challenges with staying on task
- Understand time-related interventions that address time perception, time orientation, and time management
- Identify optimal environmental conditions that emphasize strengths
- Identify occupations where client factors are a strength and not a barrier
- Identify community supports
In her continuing education course on the OT’s role in addressing ADHD, Dr. Shelley Mulligan, PHD, OTR/L, FAOTA provides a case study example for a multi-faceted approach to ADHD intervention. Dr. Mulligan lists the following interventions for a pediatric client who had successful outcomes:
- Parent education and implementation of a behavior plan to address his lack of self-control, temper outbursts, and inability to engage in nonpreferred activities.
- Play-based sessions combining sensory integration techniques, social skills training, and incorporating cognitive strategies during play and task performance.
- Suggestions for establishing and modifying routines concerning self-care activities, mealtime, bedtime, and community outings.
- Development of specific skills, including printing his name and other fine motor skills, as well as toileting and dressing skills.
Modification and accommodations
Different environments require their own methods for OTPs to relay recommendations for accommodations, modifications, and techniques to involved parties. For school-aged children, a 504 plan or an Individualized Education Program (IEP) will contain recommendations made by the school-based occupational therapist that have been agreed upon by the whole team. These two legal documents ensure that the student with ADHD receives a free and appropriate education (FAPE).
An OTP providing services in a pediatric clinic setting may provide written information for the child and parent to use at home. Adults receiving OT services may also receive written information for themselves and their employers.
OTP intervention addresses many of the barriers people with ADHD face when engaging in meaningful activities. The first step in skilled OTP support for people with ADHD is the self-education of the clinician. OTPs can use the sources below to continue learning about the OTP’s role in supporting people with ADHD.
This article was written by Tasha Holmes, MOT, OTR/L, BCP.