In this episode, we speak to Ashley Jones, an Occupational Therapist based in South Africa. She discusses the topic of ADHD in children with us, from an occupational therapist perspective.
Link to Audio Episode on Spotify
Oliver:: So you know, the reason we started doing this, and it’s amazing given hear you hearing you say this is, I think healthcare practitioners have so much value to offer. And, you know, I see healthcare practitioners do courses, and that’s, that’s really cool. But it’s amazing that they only do courses to other healthcare practitioners, and they don’t do courses to, you know, to parents, and just people that, that actually really need to understand this.
And so I’m glad to have you on board. And also talking about the topic of ADHD because I don’t know if it’s just me, but it seems to be everywhere at the moment. Can you maybe just introduce it for us? I mean, for anyone that doesn’t know ADHD, which I’m sure there’s very few, you know, that don’t know this, but just introduce it for us and tell us why you started working with that. special interest in mind.
What is ADHD?
Ashley :: Sure, yeah so ADHD is generally a neurological condition that many children and adults have. So I mainly treat children with ADHD. And my interest developed, with the fact that my brother was actually diagnosed with ADHD from quite an early age. So it was so interesting for me to grow up and see, what were the challenges he faced and just what an impact people made in his life. Specifically, an occupational therapist, which eventually resulted in me studying occupational therapy.
But it’s a, very complex condition and there’s so much research out there about it, although also not enough. So we sitting with this bit of a gap in between what the public knows and what health practitioners know. But there’s still this gap and to actually breach it.
You know many of the symptoms of ADHD. We have difficulties with attention or impulsiveness, but there is also the inattention. There are many different thoughts, and very different presentations of it. So often, that actually overlaps with other conditions. It’s really important to start treating events you see, is it ADHD? Or is it a sensory integration difficulty? Perhaps it’s a child that’s not coping so it’s a very diverse thing? But yeah it’s amazing to treat children with ADHD.
Oliver :: I’m quite embarrassed to say this. But, before we started working with our practice management software, I didn’t really know what it does. And I remember we went to an ADHD workshop and it was done by one of the psychiatrist’s in Johannesburg. The way he explained it was it was like, the child is like this Ferrari but the Ferrari doesn’t have any brakes and that’s what ADHD. If you don’t treat it, it’s like this the super-car or the super person and they just don’t have any control but I’m interested in so how would an OT help a child with ADHD
How does an occupational therapist help a child with ADHD
Ashley :: So it goes with a two pronged approach and it all depends, on what the child presents with and the age of the child. We work on so a lot with our focus on if a child with ADHD is the sensory integration difficulties linked with that. That’s usually my first base of it because ADHD and sensory integration difficulties overlap quite a lot.
You have this wide overlap of conditions and presentations. so the first place to start is to treat the sensory integration difficulties. Research shows at the moment that more than 67% of children with ADHD have sensory integration difficulties. That’s where my my interest is I love sensory integration.
And it all works on a child’s inherent drive, so my focus has to start with that. And once you’ve treated that, and it’s under control, and you know the child’s reaction to touch their reaction to sound and to visual input. When you’ve got that a bit more in control we then do a lot of adaptions in the classroom in the home environment that can help the child. Things like routine and structured plans a lot to do with regulating. Like you said their little systems are like a Ferrari so they in overdrive most of the time. So we actually teach them how to calm the sensory system, how to calm their little body in general especially when they need to focus on a school based task or or something like that.
How do you assist with the sensory issues a child might have
Oliver :: I suppose you cant really speak to an occupational therapist without speaking about the sensory stuff. Our little boy has sensory integration disorder. I remember at the school they had this room where the kids could go for a time out to cut out all of the sensory stuff. And I thought it was a cool idea. We also came across weighted blankets and and other things, that occupational therapists use. But is almost like occupational therapists have all of the cool little tricks that help kids.
Ashley :: So it’s very specific to each child as well. That hideout is a phenomenal thing, but some children hate it they don’t want to sit there. But then the next child needs a lot of pressure, say, from your weighted blanket, or a nice deep input from, say, climbing under the therapy mats or getting a tight hug. So it’s a very unique thing for the child for what works for them. And that’s what occupational therapy is, especially with the sensory integration, in terms of calming the system is to find out what works for that child, and that we can carry over into the home environments and into the school environments.
How do you determine what interventions to use to help a child.
Ashley :: Usually in the initial assessment, you’ll see a preference for the child, and you almost elicit some ideas for them. Sometimes with a kid I will say “ooh, that brain is a bit busy, do you think we must go and climb under my therapy mats”? The mats are huge and squishy and, and some children will come in and be okay while others will not like it. And so then you do almost go into that trial and error area approach. But generally, anything with a heavy muscle work, or a lot of deep pressure, works well for a child, it’s just to see what is the most effective. So all will play a role, but depending on likes, and interests, and all of that.
And it’s very often, I actually had a laugh with a mom the day because very often what the parents do to calm their sensory system is what the child almost mimics. So I had a child that would always want to hide in my cupboard during therapy. I couldn’t figure this out, I mean it’s very good it’s nice enclosed space, so great we went for it. Then I thought where did he start this. And chatting to mom a little bit because I had the parents in therapy. She said, when she has had too much, or had a rough day, she’ll go and make yourself a cup of coffee and sit in a cupboard because then the kids can’t bother.
We often see mimicking behavior, and there’s a bit of trial and error to see what works the best for each child.
How do you manage the regulation strategies for ADHD in children
Shaz :: I was just thinking on what you were saying there about how children tend to adapt from their parents. And learn certain coping mechanisms. Obviously, these aren’t always the most ideal coping mechanisms, you often hear that you’re the reason why mommy drinks kind of comments.
As an occupational therapist,how do you almost change that. Rather than hiding in the cupboard, we need to do something more socially acceptable, because you as you grow up and go to work, you can’t exactly go and hide in the filing room.,Or like I used to do when I worked at the pub, go and hide in the cold room for half an hour.
Ashley :: Yeah, that is a very important thing and the regulation strategies change at different ages. For a two year old to go and hide away, totally effective. But when you’re sitting with a 12 year old or an adult, you can’t quite do the same. And that’s where therapy aims is to provide the child with a wide range of these regulation strategies.
So what can I do? How much do I need a bed? What is intensity I need of it. And then as you grow up, you can start feeling okay, cool, maybe I can’t like, go to work and hide in the cupboard for a while, it’s not gonna work. But what else can I do? Oh, I can eat chewy food. Or I can drink water out of it a water bottle where I have a nice sucking action, you know, and that’s very calming for this system. So there’s so many out there and it’s important to show the children in therapy, what there is, and what they can bring in later on. And it’s very important there again, for the parents.
Especially in my view of therapy and the in the way I treat kids. I always request that the parents sit in, in therapy. Because they also need to know these regulation strategies and need to carry them over at home. And it mustn’t be seen as like a punishment when you actually need to calm down. It’s to help the parents and especially with our children with ADHD, they need that support. They need the parent to step in and say “Oh, do you feel a little bit busy?” or “How’s your engine running”?
Like Oliver was saying with their Ferrari. So there’s a really nice picture with a truck,a car and a Ferrari and then you can say to the child, “Where do you fall here”?. And they’re like, Okay, cool “my brains like a truck or race car? What can we do?” Then the parent can guide that and with do you hide away? Or do you want to have something nice to eat? So it’s just really exposing them to a wide range that they know what they can do and adapt from there?
How would a parent mimic the amazing tools and toys that an occupational therapy room has?
Oliver :: I do want to say this, because again, I’ve been through, this with a little boy in occupational therapy. And it’s kind of unfair when you say the parents are going to do this, because occupational therapists have such cool toys. When the kids go, they can figure out all these tunnels and ball pits. And now the parent has to try to mimic that and it like, doesn’t happen. Unless we shop at the same places that you do, but we normally don’t.
Ashley :: I know and we’ve got weird and wonderful things. But there’s actually so much you can do at home. I had a parent that child loves tunnels, and she was like, I looked on take a lot these tunnels are so expensive. And I said to take to dining room chairs and cover them with a blanket. You’ve got your hideout at home and and that’s my view as that’s what we need to carry over to a home. Parents will say like, I can’t take this huge swing home and hang it in my living room. It’s not gonna work. What can we do from there?
Oliver :: I considered it as well, you know maybe converting a room in our house. Then I thought okay, but they’re going to get older and what am I going to do with all these things.
Where do you get your referrals from for kids with ADHD
Ashley :: My referrals generally come from the parents. And it takes quite a while for the child to land with you. So my most of my referrals, especially for ADHD, come from the psychiatrist or child psychologist. So the parents almost go through the behavior management route, and then they come to me. But luckily for me, I have a very strong interest or passion for early intervention. So I love treating children from very young ages. So you often then starting the children or the parents that are having a concern, not necessarily ADHD. But as they developing and from your assessments and the results you’re seeing through through therapy, you realize, okay, there’s a need to now refer on to the psychiatrist or the pediatrician for an official diagnosis.
Oliver :: Out of curiosity, I mean, you know, because I always compare our kids to when we were up growing up. And I don’t think I’d heard the term ADHD. Normally, it would be remedial with one or two kids and they would go to, remedial classes. Because they weren’t coping with school, or that particular subject or something like that. But is this a fairly new thing? Or is it a condition that’s not been diagnosed for years, if not generations, and now are we seeing it? Or is there something from our environment or the way life Is that we just kind of making it worse?
Has ADHD in children always been around or is it a new thing
Ashley :: ADHD has been around for for a long time, but they wasn’t the awareness that there is now. So, if you say ADHD to someone, they all have a picture in their head, or they will generally know somebody that’s been diagnosed with ADHD.
The new research and just awareness about it has really made it a focus. But definitely, if you look at the causes for ADHD, there’s not a clear cut cause. So parents or siblings with psychiatric disorders, or ADHD is often a risk factor for child so there’s a genetic tie with it. But then they also say there’s things from an environmental perspective but there’s no clear cut, this is the cause.
I think that with there being more awareness about ADHD in children, and people knowing where to go for help has resulted in more diagnoses.
Shaz :: On what you were saying there from a genetic point of view,. Is it possible that in a family there could be more than one sibling that has got some level of ADHD? And aside from sensory integration, are there any other things that are common as indicators that this person might also have ADHD. Like dyslexia or dyspraxia, or you know any of those things that a parent could also be on the lookout for?
Are there any signs that a parent could be on the look out for to indicate that their child might have ADHD
Ashley :: Definitely so look there’s many different overlapping factors and like not just sensory integration. But a thing like tactile defensiveness there’s a lot of children with ADHD that are tactile defensive. And then also being hyper aware of the noises or sounds that is a very good thing to be on the lookout for. Obviously to monitor the child’s attention age appropriately.
If you already have a child with ADHD or know of a child with ADHD you can compare. Is my child a lot more on the go then another child and to try some of the strategies that you’ve learned with the child diagnosed with ADHD? Do they respond to it?
But ADHD has a lot to do with function. If you’re not coping in your environments then it becomes a disorder and anxiety is also a big thing we see with kids with ADHD so also to look out for signs of anxiety.
Can children with ADHD overcome their sensory issues or do they just learn to cope better?
Ashley :: Look it depends what the difficulty is. So sensory modulation which is your your response to the input coming and so to touch whether you like it or not, whether you’re sensitive to clothes, sounds and all that modulation part of it that is lifelong. And we all respond to input do I like it? Do I like it? What is my system I’m over responsive or am I under responsive? And so that always plays a role you know and that you always have to be aware of.
In occupational therapy what we do is we calm your systems. So where if someone used to touch you previously and you turn around and hit them. We work on that through therapy and sensory integration so that you don’t have that response. You are still going to be sensitive to touch and have certain preferences with clothes. But it’s not going to be again like the socially acceptable where you can only shop for one shop for life. You don’t want that but you will have it present, so we do treat it and it does get better on that over responsive side or slightly more sensitive to noises or touch. Wherever you are and you can differ from system to system.
In terms of the discrimination which is more the skill with ADHD there’s no clear cut evidence or research that I’ve found that says that they they definitely will have difficulties with the skill. Except for balance so balance is being researched and very often children with ADHD battle with balance and that you can fix. Almost revert to that skill part you definitely can improve on functional status. But the modulation is something that your child will be functional after it but they might not necessarily you know be a child is going to roll in mud every day.
If a parent is listening to this and considering speaking to an OT, around ADHD in their children, what would you recommend?
Ashley :: The signs of ADHD to look out for is, their attention, impulsivity, difficulty sitting still fidgeting. So that’s definitely what to look out for anything I almost say to parents trust that gut feeling of yours. You know, if you feel that something, you know, isn’t hard should be or is bothering you, or anything like that, go and look for the heart because rather than someone tell you no, no, there’s nothing wrong and rather have that their way through four years and your process and therapy takes so much longer. So there could definitely be on the sides of what to look out for and then what to expect from it.
You know, each it is different and each OT uses different approaches. So definitely, you want to find the approach that goes best with what you believe. And so the approaches that I do is sensory integration and then DIRFloortime®, which is a lot about just following a child at a developmental needs. But it there’s a range out there. So to actually go and just research what you want, but in terms of what you’ll find from it is that it’s not a quick process.
And with children with ADHD, we want to get into the school environment, we want to get into the home environment, because where can we adapt from there. And that makes the process so much quicker. But what a parent will see in therapy as adults swinging and having fun and absolute ball, and it’s the highlight of the week. But there’s a lot of method in the madness. There’s, so much work that we’re doing with that to help your child not only to calm the system, to work on any difficulties.
But I believe, occupational therapy is a great place to start if you’re having concerns because we’re going to look at academic performance, we’re going to look at play, we’re going to look at the activities of daily living, so they’re both in their dressing, the grooming. So you get quite a holistic view from that. And then it is the responsibility of he OT, that if they suspect something to refer you on further.
Do you find that children with ADHD need to be reminded on a constant basis to do things.
Ashley :: Yes, definitely. So you obviously get the range with, what you going to see from a child. But for a lot of the time, if your brain’s in overdrive and you’re going at 100 Km’s an hour, things like brushing your teeth, and sitting down to finish a meal aren’t going to be important.
That’s part of what we bring in with that routine that we spoke about earlier. Is like, when to do things and how to to do them and a big thing is a reminder to do it. And,later on we want to lessen that as much as possible, so that you’re not overly reliant on it. But these apps that are coming out are amazing, and it definitely has a role and can be used very, effectively. For the parents, the help to just take that bit of pressure off.
What happens to kids who don’t wind up going into occupational therapy, at some point they become adults that now are adults with ADHD?
Ashley :: Definitely a lot of the time that adults will go more through a psychology route to cognitive behavioral therapy, and all of that. But they definitely, there’s a lot of occupational therapists, in mental health that do fantastic jobs with that.
Occupational therapists assist in getting things that are effective for adults, and showing them how this is working, and how to implement it in their daily life. With what they’re going through, according to their job, so they may have been doing OT, but then it’s more specializing in mental health. And if there are sensory aspects, as part of that ADHD, there’s a lot of occupational therapists that are doing sensory integration with adults, linked with mental health. It’s a growing field at the moment. So an adult definitely still can and go to OT, but oftentimes, you’ll see they’ll follow more a psychiatrist treatment and then psychology and then may end up at OT.
For more information on Adult ADHD please listen to our episode with Dayne Williams
Thanks very much for your time. This was amazing. And, we will your contact details in the show notes, so anyone that wants to contact you, has those details. And I’m sure, this is going to open up a lot of eyes, hopefully, for people that that do have children even if they are on medication.
So thanks for your time. I really, really, really appreciate it. Thanks