Children with attention disorders often suffer from motor problems. This discovery can be used to develop alternatives to medication.
Remember, at school, how there were always those who would stumble in the playground, knock over their tube of glue or were incapable of catching a ball? The awkward ones. There were also those who would never listen in class, forget their gym bag and disturb the class by getting up without asking permission. The halfwits. Medical research has shown that the latter do not suffer from a lack of intelligence but of concentration (attention deficit hyperactivity disorder, or ADHD). We now know that those who are chronically clumsy frequently share the same problem. A study has recently proved it.
When Ritalin improves
The Ergotherapy Service at Lausanne University Hospital (CHUV) sometimes receives children suspected of having motor disorders, like the awkward ones described above, but motor and coordination tests reveal nothing abnormal. However, their lack of dexterity significantly affects their daily life. “We believed that there was another cause,” says Marie-Laure Kaiser, chief ergotherapist at the CHUV.
To test her hypothesis, she compiled 45 studies that covered both attention and motor disorders during a research sabbatical from March to October 2014 at the University of Groningen in the Netherlands. The specialist focused on two types of studies: those involving the motor skills of children diagnosed with an attention disorder, but who were not treated with medication, and those involving the influence of psychostimulants (like Ritalin) on the motor skills of children with an attention disorder.
She found that more than half (51% to 73%) of children with ADHD also had a motor disorder. Moreover, the psychostimulants improved the motor functions in these children in 28% to 67% of cases. “This compilation brings proof that there is a correlation between attention and motor disorders,” Marie-Laure Kaiser says. Children without a motor problem may fall all the time because their head is always in the clouds or miss a ball because they are not concentrating.
“This study shows that, in addition to learning disabilities such as dysorthographia and dyscalculia often associated
This development is part of a movement to provide a broader scope of care for hyperactivity and attention disabilities, which affect 5% to 6% of children.
with ADHD, we must take into consideration motor and coordination disorders,” says Michel Bader, child psychiatrist and privatdozent at the Faculty of Biology and Medicine at the University of Lausanne. The existing synergies between neuropaediatrics, child psychiatry and paediatrics, the areas that generally deal with ADHD, and ergotherapy, will grow stronger through joint consultations and combined therapeutic strategies. This will benefit the patient. “When a child with coordination problems is taken to a psychiatrist, a year is often wasted before the child is referred to an ergotherapist,” says Marie-Laure Kaiser. But time is precious. “A child aged 6 or 7 has plenty of room for improvement and progresses quickly. However, for a 10-year old child who comes to see us, it’s often too late.”
This development is part of a movement to provide a broader scope of care for hyperactivity and attention disabilities, which affect 5% to 6% of children. “It is important not to limit ourselves to medication but rather to enlarge the spectrum of appropriate therapies, such as psychotherapy and parent and children’s groups,” says Michel Bader. Speech therapists, ergotherapists and psychotherapists now focus on having the patient work on other disorders associated with ADHD. New neuro-cognitive approaches are also used, such as working memory training with computer programmes.
Pilot study focussed
on a game
Michel Bader, working with Hansel Schloupt – a second-year Master’s student in product design at the Lausanne Art School, has recently developed a construction game using wooden and rubber pieces that is specially designed for children with ADHD. “The child has to be concentrated, control his or her motor functions, follow directions, make decisions and not get angry in order to build the highest tower possible,” the child psychiatrist explains. The game is to be played by two people, with a parent in a fun and relaxed environment. “The point is for these children, who often have major difficulties in school, to have a successful experience and feel enjoyment from playing with their parents outside of the tense environment of homework,” he says.
A pilot study on this game-based approach is expected
to begin in February 2015 with the collaboration of Marie-Laure Kaiser. Ten children between 6 and 9 diagnosed with ADHD and ten other children who do not have an attention disorder will participate in 20 game sessions over four weeks at home. They will be assessed before and after treatment. By this autumn, we expect to know if this type of game can be combined with, or even substitute, psychostimulant drugs.
It was long believed that attention deficit hyperactivity disorder (ADHD) only affected children, and that they grew out of it in their teens. But this is not true. “Today, we know that ADHD persists in about 60% of cases,” says Nader Perroud, a psychiatrist at Geneva University Hospitals and head of a practice specialising in adult hyperactivity which opened in 2011.
Some 2% to 3% of adults, both men and women, are affected by the disorder. The symptoms are internalised with age. The person experiences an endless series of thoughts and ideas that prevents them from concentrating, especially when they have to perform boring or repetitive tasks. “Adults with ADHD are also very impulsive. They say that they think without really giving things consideration, cut other people off mid-sentence and take decisions without weighing the consequences,” says the Geneva-based psychiatrist.
But hyperactivity can also be transformed into an asset. “Hyperactive people can process information with great speed and show extraordinary energy and determination when they enjoy something.” In this case, they no longer count the hours, overflow with ideas and often demonstrate immense creativity.
Hansel Schloupt (pictured), Product Design student at Lausanne Art School and child psychiatrist Michel Bader have developed a construction game specially designed for children with ADHD.