Differences and Similarities Between ADHD and SI Problems

Differences and Similarities Between ADHD and SI Problems

As you can see in Table 1, SI problems can overlap with ADHD symptoms, but the two also can be quite different. A child who has an SI disorder that appears to be “causing” ADHD will possibly present with different problems involving the sensory systems than will a child without ADHD symptoms. If SI problems are evident, this child should be given the chance for an SI intervention. 

JOEY

Joey is a funny boy of seven who can be very active. He walks around most of the time, moves frequently, and talks constantly. Joey comes across as insecure and demands a great deal of attention from the adults in his life. He was born healthy after a normal pregnancy and delivery. Until now, Joey’s motor skills have developed slowly. He did not start to walk until he was a year and a half. He did not dress or undress himself until he was five. He is not yet toilet trained at night and has trouble with swimming and with riding a two-wheel bike. He cannot open or close buttons or tie his shoelaces. He did not want to lie on his stomach when he was a baby. Joey did not play with others until an older than normal age. No relevant medical history explains this delay. Nine months ago, a swimming instructor, his doctor, and his parents recognized his problems for the first time. (Note: Of course, Joey had various problems during his life, but frequently parents think that that is “just the way he is.” Families also tend to adapt their whole lifestyle to their child’s behavior. Sometimes this is perfectly acceptable, but frequently the school situation cannot allow for that. Denial on the part of parents is frequently the first emotion when one’s child is being diagnosed as having problems. This reaction is very natural and very common. But when parents have a situation or problems that can no longer be escaped, the family needs to arrive at a new constructive phase for their child. On the other hand, some parents have difficulty finding professionals who really see the child’s problems and are able to identify their condition as Sensory Integration Dysfunction. So when Joey’s parents came to the conclusion Joey’sproblem was SI based, it was time to find an appropriately trained therapist. Making this decision was a tremendous relief for them.)

At this point, Joey

• has difficulty concentrating when his surroundings are noisy, particularly when affected by unexpected sounds
• has difficulty carrying out orders, does not always seem to understand what someone is saying to him, and has trouble expressing himself
• enjoys making noise
• sometimes becomes anxious when he is on a swing, seesaw, or other playground equipment and has difficulty catching himself when he falls
• has difficulty with bright light
• is afraid of the dark
• has a lazy right eye
• finds it difficult to accept being touched or caressed and avoids being kissed (although problems with hair washing and nail trimming are usually seen in combination with touch issues, these are not a problem for Joey)
• avoids wearing certain clothes and eating certain types of food
• has problems riding a bike, is not even motivated to try, but is mad because all his friends can ride bikes
• sometimes appears to have less strength than other children have, does not seem to use both halves of his body in an appropriate fashion, and has difficulty sitting up straight
• has difficulty using the correct amount of strength for a task (e.g., sometimes squeezing something too hard and at other times misjudging how heavy an object is)
• has a generally clumsy movement pattern; does not seem fluid in his movements
• has fine motor problems (e.g., gets cramps holding a pen, has bad aim, finds exact tasks difficult)
• has a poorly developed image of his body; draws an incomplete image of a person, has difficulty with spatial relations
• has some difficulty playing alone, playing with other children, and listening to a story
• has little interest in playing outside
• has sloppy eating habits
• is afraid of new things, is quickly irritated, is moody, sometimes quickly tires, and often is aggressive without a discernible reason and hits anything within reach
• has problems with impulsivity, does things before he thinks
• displays enormous bravado (i.e., compensates by being very boastful) in class
• sometimes exhibits nervous behavior in school, has little self-esteem, is unable to sit still, has poor concentration, and is not consistent in school performance

In sum, Joey has tactile (touch), auditory (hearing), visual, and proprioceptive (muscles and joints) system problems. His most crucial problem is an aversion to touch—he never wants to be touched by others. Joey is not feeling comfortable with his body due to this and the other experiences he perceives as negative: wearing certain types of clothes and eating certain types of food. This sensory information may just be too much for him and may feel like it is bombarding him. He may be able to verbalize this. Most other children would be fine with this information, but for Joey, it probably is the cause of his inattention and hyperactivity as well as social problems, such as not wanting to play with others. He also may appear preoccupied because he is focusing—either consciously or unconsciously—on touch stimuli and how to avoid them. Joey’s behavior comes across to others as insecure and frustrated because he cannot do what he wants to do.

Active or Hyperactive?

You probably are reading this book because you have a very active child or you know one. All children can be very active occasionally or can make more than enough noise. However, some children attract notice because they are so difficult to control, exhibit overactive behavior, or talk all the time. It is difficult for these children to control their behavior, even though they can be very agreeable at times. They can be funny, full of energy, and well behaved when you deal with them one-on-one.

Dealing with these children is often a challenge, even though they can be charming, creative, and happy little people. When everything is going well, their refreshing point of view can make life exciting. However, when they have problems, they may camouflage them by playing “the clown,” for example. Many children at school enjoy seeing these children play the clown or do deliberately silly things, and the teacher may even laugh at them, despite knowing this is not appropriate behavior. A child displaying this type of behavior temporarily avoids attending to academic material.

Two diagnostic categories are used for highly active children: attention deficit hyperactivity disorder (ADHD) and attention deficit disorder (ADD). These disorders, their relationship with SI, and factors that can cause hyperactivity are discussed in this chapter.

Attention Deficit Hyperactivity Disorder

Hyperactivity is the chief symptom of ADHD. This disorder is recognizable through its display of inattention and incessant movement. Children with ADHD have a problem with self-regulation and cannot organize behavior in a way that is appropriate to the situation.

ADHD has also been termed a performance problem.2 Children who have ADHD cannot seem to find the right behavior to plan or finish a specific task in a set timeframe. ADHD as a continuing problem may be less evident in older children and adults because they may have learned to compensate for these shortcomings. Nevertheless, many of these individuals continue to have great difficulty in their jobs and home life due to ADHD.

Doctors, psychiatrists, and other health-care givers make the diagnosis of ADHD on the basis of observing a certain number of behaviors performed by the child or the adult. For some time it was thought that many doctors and psychiatrists in both America and the Netherlands were diagnosing many, many children—perhaps too many—as having ADHD and consequently prescribing Ritalin for them. To determine if this was the case, we evaluated the diagnoses of the children attending a public Amsterdam outpatient center between 2000 and 2006. This small group of 26 children had been evaluated by the full team. They were referred to an occupational therapist specializing in SI, as well as to other medical and family intervention practitioners. We evaluated the primary symptoms of the child and then compared the diagnoses. This led us to conclude that the percentage of children receiving a diagnosis of ADHD had actually declined in relationship to the percentage of other groups (e.g., children with conduct disorders, with problems dealing with divorce, or with problematic living conditions due to immigration, etc.). The reason for this is not clear, but we suspect it is related to the refinement of the diagnostic criteria, which emphasize other aspects of the child’s life. So it appeared that the doctors in this clinic had become more selective with their primary diagnosis, frequently using the “ADHD/ADD” as a secondary diagnosis.

Attention Deficit Disorder

Attention deficit disorder (ADD) is a different diagnosis from ADHD. For children with ADD, the problem is inattention without hyperactivity. Such children are not hyperactive. The DSM-IV includes a precise description of the symptoms that must be present for such a diagnosis. As with ADHD, the goal is for all medical personnel to arrive at the same diagnosis.