Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and into adulthood. Typical symptoms of ADHD include struggling to stay focused, paying attention, and having difficulty controlling impulses.
There are an estimated 7 million (11.4%) U.S. children aged 3 to 17 years of age that have ever been diagnosed with ADHD, according to national survey data of parents. Despite the high number of diagnoses, about 30% of children with ADHD did not receive medication or treatment.
ADHD is also one of the most commonly misdiagnosed disorders, especially in women. This is because its symptoms, like inattention and impulsivity, can overlap with other conditions like depression, anxiety, and learning disabilities. ADHD symptoms can also vary greatly depending on the individual.
If you’re planning a career in a health-related profession and studying a program like an occupational therapist masters online, understanding ADHD and the connection it has to physical coordination is essential. The knowledge might help your future clients who live with ADHD or a similar neurodevelopmental condition.
Everyone, whether they’re standing or sitting, their body is trying to seek balance. Their muscles and sensory systems are always trying to stay balanced to keep them from falling over.
For people with ADHD or other neurodevelopmental disorders, however, research has found it can cause motor control problems, including this process of the body ‘seeking balance.’ Trusted sources report up to 50% of children with ADHD have been shown to have motor control difficulties, including ‘postural sway.’
What is postural sway?
Postural sway is a term that describes the small, unconscious, and typically undetectable side-to-side movements that the body does to maintain balance. It is the body’s natural adaptation to a constantly changing environment.
To better understand postural sway, it’s kind of like trying to maintain your center of gravity on a balance beam, except on a smaller scale. In a person where postural sway is noticeable, through gently moving side to side or in small circles, it can be an indicator of poor coordination or a neurodevelopmental condition.
Postural sway is common for older people and those with neurodevelopmental conditions like ADHD, dyslexia, and autism spectrum disorder.
What causes increased postural sway & ADHD?
Researchers haven’t been able to identify a single cause for ADHD. It seems to be that ADHD can be caused by a combination of factors, including genes, environmental factors, and potentially even diet.
Similarly, while postural sway is something everyone does—it’s hard to find a single, definitive cause for increased postural sway. While studies have found increased postural sway linked to ADHD, it also has connections to a combination of other factors, including anxiety and bad posture.
The connection between ADHD & postural sway
There have been multiple studies throughout the years that connect ADHD and other neurological conditions to postural sway as well as other motor control functions, coordination, and cognition.
A study from University of Duisburg-Essen provides evidence that suggests the cerebellum, which is a key component in the brain linked to gait, cognition, balance control, and coordination, is a contributing factor to the balance problems stemming from ADHD.
The cause is that cerebellum development may be delayed in children and adolescents with ADHD, leading to coordination issues and ‘clumsiness.’ Recent research has also found a link between low cerebellar volume in people of all ages who have more severe ADHD symptoms.
There was a study from Charles University that consisted of 124 children—62 with ADHD and 62 typically developing children. This study investigated the association between cerebellar function and balance in children with ADHD by having all the children participate in five tests using an electronic balancing platform.
The findings revealed, similarly to other studies, that children with ADHD performed more poorly when it came to balancing compared to typically developing children, and showed more signs of swaying.
The researchers from this study also concluded in their findings that balancing deficits and impaired ability to think were tied to a common cerebellar dysfunction in children with ADHD.
The link between ADHD & clumsiness
Many people, including children, who get diagnosed with ADHD typically also have dyspraxia. This condition is also sometimes referred to as developmental coordination disorder (DCD) and is where a person finds it hard to coordinate and complete physical movements, making them look ‘clumsy’.
Recent evidence suggests that at least 50% of children with inattentive-type ADHD also have dyspraxia. Similarly, at least 50% of children who have DCD also have a diagnosis of ADHD.
Managing postural sway and clumsiness
Research and findings all point to ADHD having a close connection to the cerebellum, delayed development, and, as a result—balancing deficits and potential dyspraxia. Although it’ll be different for every individual, it is common and also manageable if it does occur.
Postural sway and ‘clumsiness’ can be managed using various physical, behavioral and/or medical strategies. Below, we’ve listed a few common methods for managing postural sway.
- Professionals, like occupational therapists and physical therapists, can help develop and personalize strategies to improve motor skills and ‘treat’ postural sway.They can assess individual challenges and develop personalized strategies, including exercises to improve proprioception (awareness of body position) and motor planning. Regular follow-ups ensure that the plan adapts as the individual’s skills improve.
- Balance and coordination exercises, like yoga, tai chi and pilates, can help improve balance and posture control. These practices emphasize controlled movements, core stability, and mindfulness, all of which are essential for mitigating clumsiness. Additionally, they help train the vestibular system—the part of the inner ear that governs balance—making it easier for individuals to navigate uneven surfaces or react to unexpected movements.
- Taking up any sports or physical activities that require fine motor and coordination skills has been proven to help with managing postural sway and dyspraxia.These activities build strength, refine coordination, and promote motor learning through repetitive practice. Over time, these skills translate into better control over everyday movements, reducing the likelihood of tripping or bumping into objects.
- In some cases, ADHD medication like Adderall or Ritalin, which helps improve overall attention and focus, can indirectly help with postural sway, reduce clumsiness, and improve motor function. By improving focus and attention, these medications may help individuals better execute motor tasks that require concentration, like balancing on one foot or stepping precisely. Although medication alone doesn’t ‘treat’ postural sway, its impact on cognitive regulation can support behavioral strategies aimed at improving physical coordination.
If you or your child are experiencing posture sway or any other motor function-related issues, it’s always best to speak to a qualified professional. They can help with finding the root cause, whether it be ADHD, anxiety, or something else, and assist with management plans.
References:
Feng, L. et. Al. (2020) Balance Training as an Adjunct to Methylphenidate: A Randomized Controlled Pilot Study of Behavioral Improvement Among Children With ADHD in China.Front. Psychiatry; 11: 10.3389.
Goetz, M. et. Al. (2017) Dynamic balance in children with attention-deficit hyperactivity disorder and its relationship with cognitive functions and cerebellum. Neuropsychiatric Disease and Treatment; 13:873-880.
Hove, M. J. et. Al. (2015) Postural sway and regional cerebellar volume in adults with attention-deficit/hyperactivity disorder. Neuroimage Clin; 8:422–428.
Goetz, M. et. Al. (2014) Notes on the Role of the Cerebellum in ADHD. Austin J Psychiatry Behav Sci; 1(3): 1013.
Buderath, P. et. Al. (2009) Postural and gait performance in children with attention deficit/hyperactivity disorder. Gait & Posture; 29(2): 249-254.
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