There Is No Need to Cry Over Spilled Milk, But We Can Stop the Flow

The image on the left can be considered a Rorschach inkblot test, in which you interpret the image according to how you perceive children who have ADHD.

If your perception of children with ADHD is that they are just simply bad kids (you’d be surprised, some people do), you’re probably interpreting the image as, Oh no, there he goes again.

If your perception of children with ADHD is that they are purely driven by uncontrollable impulses, you might be thinking, Why would anyone even put a glass of milk in front of her? The mess was inevitable.

If your perception of children with ADHD is that they are hyperactive and out of control, you might be thinking, That child should have been bottle fed or supervised.

Is there a different way to interpret the picture?

What if children with ADHD are not simply bad, not purely driven by uncontrollable impulses, and not just hyperactive and out of control? What if there is an actual underlying associated disorder that causes them to be clumsy and impacts their ability to be coordinated?

It turns out that there is another way to look at spilled milk. According to a research study published in the journal Child and Adolescent Mental Health in 2009, there is an undertreatment of motor problems in children with ADHD.

As if bearing the social and emotional consequences of living with ADHD isn’t enough, a large percentage of these children also have Developmental Coordination Disorder (DCD).

Developmental Coordination Disorder – Defined

DCD, also know as developmental dyspraxia, is characterized as being “clumsy” or “awkward”. Children with DCD have difficulties with motor coordination as compared to other children of the same age. These children have difficulties in mastering gross motor coordination tasks such as crawling, walking, jumping, standing on one foot, catching a ball and fine coordination task such as tying shoelaces, writing, and playing with toys. Some children also demonstrate expressive speech problems as part of this disorder.

The following are the diagnostic criteria for DCD as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV):

A. Performance in daily activities that require motor coordination is substantially below that expected given the person’s chronological age and measured Intelligence. This may be manifested by marked delays in achieving motor milestones (e.g., walking, crawling. sitting), dropping things, “clumsiness,” poor performance in sports, or poor handwriting.

B. The disturbance in Criterion A significantly interferes with academic achievement or activities of daily living.

C. The disturbance is not due to a general medical condition (e.g., cerebral palsy, hemiplegia. or muscular dystrophy) and does not meet criteria for a Pervasive Developmental Disorder.

D. If Mental Retardation is present, the motor difficulties are in excess of those usually associated with it.

Are these children receiving help?

According to the researchers, approximately 40% of children with ADHD were found to have developmental coordination disorder. Of these children, less than half were receiving any type of intervention to help them with these movement deficits.

It is important for us to keep in mind that all children are doers, and when they are unable to “do” things efficiently, other areas of function, such as behavior and academics, might suffer as well.

The researchers point out that the most neglected children were those who have behavioral problems, as the parents and professionals focus on the behavioral issues at the expense of treating the motor deficits.

Another disconcerting result the researchers found was that children who also have anxiety disorders were less likely to be referred for occupational or physical therapy for their motor issues because their parents did not want to “expose” them to therapy.

What does it mean for us?

It is hard to judge, but a child with ADHD should not be treated for either behavior issues or motor issues. The two are not mutually exclusive. In fact, there is actually a connection between a child’s clumsiness and incoordination and his or her behavioral problems.

Additionally, while it is perhaps sensible to think that children with anxiety disorders should not be “exposed” to therapy, evidence exists that children with anxiety actually benefit from training in various exercises that focus on balance and motor skills, as I wrote in this post.  Talk about shooting two birds with one stone: Treating your child’s clumsiness and alleviating some of his or her anxiety at the same time.

The take away message

There are several messages we can take away from this research study. Here are three the researchers offer:

• ADHD and motor problems are frequently co-occurring. Children with ADHD may have issues with hyperactivity and impulse control, but they sure are not bad kids. Spilled milk? He might have a disorder that results in his movement being erratic and uncoordinated. Remember: Up to 40% of children with ADHD have motor related disorders.
• Only half of children with ADHD receive occupational or physical therapy treatment. There is not much to add to this point other than to encourage all involved to work toward reducing this statistic. Parents and teachers should be on the lookout for children with ADHD who appear clumsy and lack coordination, as they may have delays in gross or fine motor skills, and these children should be referred for the appropriate treatment.
• Health workers should be aware of the impact of motor problems on the daily life of children with ADHD. Children with ADHD often face various difficulties and delays. It is important for physicians, nurses, and therapists involved in the screening and evaluation process of children to also assess motor skills in children who have ADHD.

As parents, teachers, and therapists, we are sometimes faced with difficult choices. When it comes to treating children who have complex disorders such as ADHD, the choices often become even more challenging to make. It is important for us to keep in mind, though, that all children are doers, and when they are unable to “do” things efficiently, other areas of function, such as behavior and academics, might suffer as well.

Therefore, treating one deficit in a child’s life should not come at the expense of another. It is of utmost importance to treat behavioral issues; it is of equal importance to treat motor related problems as well.

As Dr. Stanley Greenspan, in his book Overcoming ADHD, eloquently makes the case, in a way only he could, for taking a holistic and all-encompassing approach to treat children who have ADHD:

Can children and adults with ADD and ADHD overcome their difficulties without pills? The answer is absolutely ‘Yes’ for the vast majority. Attention involves taking in sights and sounds and touch; it involves processing information; it involves planning and executing actions based on this information. If you can learn to do these things, as children we’ve treated have done, you can pretty well pay attention. It’s not just about sitting still.

Up next: A simple four step approach to help children who are clumsy and uncoordinated.

Related posts:

1. Children with ADHD and DCD Should also be Evaluated for Mood and Anxiety Disorders
2. How to Help Your Clumsy Child in 4 Simple Steps
3. Balance Training: A Simple Yet Effective Way to Treat Anxiety in Children

Tagged as: ADD, ADHD, Anxiety, Balance Exercise, Behavior Management, Developmental Coordination Disorder, Hyperactivity in Children, Occupational Therapy, Physical Therapy