School Based Occupational Therapy for ADHD?
Attention Deficit Hyperactivity Disorder (ADHD) presents significant challenges for both students and teachers in the school setting. Formidable barriers continue to exist between the child with ADHD and their ability to access the support they require to function in the school setting.
With 1-3 students in every general education classroom with the diagnosis, students and families are struggling. Teachers need improved resources and training. School psychologists and counselors are in short supply, seriously overstretched by post pandemic outcomes and the national emergency in youth mental health.
The American Academy of Pediatrics Practice Guidelines emphasizes the need to include school based support in any treatment plan for ADHD. Recommended supports include individualized educational interventions, behavioral supports, accommodations, and strong parent-school partnerships.
The same questions remain. How can schools best support students with ADHD? What are the educational and behavioral interventions they actually need? Who is responsible for providing them?
ADHD is a “Performance Disorder”
ADHD is a brain based neurodevelopmental condition that impacts the development of executive function and self regulation.
Dr. Russel Barkley best conceptualizes ADHD as a self regulatory disorder of performance.
Performance, not knowledge or skills.
These students know what to do, they are having difficulty doing what they know.
The inconsistent performance difficulties caused by ADHD are commonly misunderstood as motivation deficits or worse as willful misbehaviors because the student is observed to perform the skill in one setting but not in another.
While most school staff have expertise around teaching student skills, one often overlooked school based profession, occupational therapy, has specialized expertise in developing strategies and environments that help facilitate student performance.
This may be surprising some readers, as the role of occupational therapy in school is not well understood outside the profession.
Similar to ADHD, the role of an occupational therapy provider (OTP) is surrounded by misconceptions, suffers from terrible name branding, and is challenging to understand due to its contextual dependence.
Administrators, parents, teachers, and school psychologists typically only have a limited view of the scope of occupational therapy practice in the schools. OTP’s support so much more than fine motor and “sensory”.
Unfortunately school based therapists frequently operate in a scope limited by others outside the profession, causing occupational therapy to remain a virtually untapped, often overlooked support service for our most misunderstood students.
Understanding the Full Scope
To truly understand occupational therapy’s unique value, specific to ADHD, the reader must zoom out to see that the overarching goal of OT is to facilitate participation and performance in any meaningful and necessary occupation. The scope of occupational therapy is both endless yet singular. Performance.
School based OT’s purpose is to help a child access, perform and participate in their general or special education curriculum.
OTP’s have a broad understanding of how developmental disabilities affect participation, drawing from a background in neurology, anatomy, physiology and psychology. OTP’s are skilled at finding barriers that may be interfering with learning and participation in the educational environment.
OTP’s collaborate with school teams to help children succeed through practical classroom strategies, individualized adaptations , environmental modifications and when needed development of new skills to enable classroom participation.
This professional background makes occupational therapy practitioners well suited to help create universal as well as individualized supports and accommodations for students with ADHD. We meet them where they are and modify the environmental barriers that prevent the child from being able to access, participate and perform in the classroom.
Who’s to Blame?
Who is to blame for the untapped support within our education system?
Outdated stereotypes , broad overgeneralizations and lack of understanding surrounding both occupational therapy and ADHD may be why occupational therapy remains a virtually untapped, often overlooked essential support service for our most misunderstood students.
If we want to move the needle on outcomes of the most prevalent performance disorder impacting children today, including a performance expert in your treatment plan is how we do it . ✨
Learn More:
OT4ADHD is dedicated to providing the knowledge, tools and resources providers need to sustainably support student with ADHD.
References:
Mark L. Wolraich, Joseph F. Hagan, Carla Allan, Eugenia Chan, Dale Davison, Marian Earls, Steven W. Evans, Susan K. Flinn, Tanya Froehlich, Jennifer Frost, Joseph R. Holbrook, Christoph Ulrich Lehmann, Herschel Robert Lessin, Kymika Okechukwu, Karen L. Pierce, Jonathan D. Winner, William Zurhellen, SUBCOMMITTEE ON CHILDREN AND ADOLESCENTS WITH ATTENTION-DEFICIT/HYPERACTIVE DISORDER; Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics October 2019; 144 (4): e20192528. 10.1542/peds.2019-2528
American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi.org/10.5014/ajot.2020.74S2001
Barkley, R. A. (2012). Executive Functions: What They Are, How They Work, and Why They Evolved. Guilford Press.
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