So, the teacher is asking for sensory tools to help a student with ADHD function in the classroom, and you’re wondering, “Is there evidence? Do sensory tools work?”
The answer is as individual as a fingerprint. It depends on the child, the tool, the classroom, and the classroom culture—collectively known as the context.
ADHD is a contextually dependent condition, and the environment significantly influences how ADHD and sensory processing difficulties manifest in the classroom.
The ADHD, Sensory Processing, and Executive Function Connection
Research has established a connection between sensory processing patterns and ADHD symptoms, emphasizing how these patterns are linked to executive function challenges (Ghosh et al., 2022; Panda et al., 2023). Sensory processing difficulties are common in children and adolescents with ADHD (Rani et al., 2023; Fabio et al., 2024), and these sensory systems can impact executive functions, highlighting the importance of understanding each student’s unique sensory profile and how it intersects with their executive function challenges.
The Caution with Sensory Tools for ADHD
While sensory tools can benefit some students with ADHD, handing them out without careful assessment and clear guidelines can be counterproductive.
Relying solely on sensory interventions, without integrating psychoeducational, accommodative, and executive function supports, may limit the effectiveness of all interventions.
Moreover, improperly chosen or managed sensory tools can increase distraction or cognitive load, worsening the student’s challenges rather than alleviating them.
Evaluating the Whole Picture
Have you ever attended a meeting about a struggling student where the classroom environment was given a standardized score? Probably not. Yet, assessing the environment is crucial before introducing sensory accommodations or tools.
Before providing any tool, it’s essential to evaluate both the sensory and executive function profiles of the student, as well as the sensory and executive function demands of the environment. This comprehensive approach ensures that interventions are truly supportive.
As school-based therapists, it can be uncomfortable to scrutinize the classroom environment, but it’s essential.
Both ADHD and sensory processing challenges are dependent on the environment. To understand a student’s behavior, we must first understand the environment in which it occurs. Often, it’s the surroundings that need to change, not the individual.
Environmental Reflections
When assessing a child’s sensory processing skills using common sensory test items, it’s crucial to consider how the environment plays a significant role in shaping their responses.
As occupational therapists, we must recognize that these sensory behaviors are not just characteristics of the child but also reflections of how their environment is—or isn’t—supporting their sensory needs.
Many of the behaviors we observe—like being distracted by visible objects or people, struggling to follow verbal directions, or becoming distressed by certain textures or sounds—may be more a reflection of the environment than the child themselves. For example, a classroom filled with visual clutter, unpredictable noises, or uncomfortable seating can overwhelm a child’s sensory system, leading them to appear distracted or unresponsive.
By modifying the environment, we can often reduce these behaviors and help the child succeed in ways that are comfortable and sustainable for them.
Management of the context is management of ADHD.
Educational accommodations are an evidence-based, first-line intervention for managing ADHD. These accommodations alter how a task is completed without changing the task itself. By adjusting the physical, social, and attitudinal aspects of the environment to remove barriers, we can mitigate the impact of ADHD on the learner.
Therefore, the most valuable, evidence-based “sensory tool” is the thorough evaluation and adaptation of the sensory ergonomics of the learning environment to support the child’s function.
Collaborating with Teachers For Environmental Assessment
I realize ,to some, this sounds horrifying! How do you evaluate the classroom environment without damaging relationships with teachers? This is their environment.
Collaboratively and carefully!
You are not judging the environment; you are collaboratively measuring its impact on the student. This is an important reframe.
Completing this collaboratively with the teacher is best, as they are the experts in their environment, and the therapist must consider that others share the learning environment. Therapists and teachers can collaboratively complete an environmental rating scale or questionnaire to structure observations and promote awareness of the interplay of the environment on both sensory processing and executive functions.Therapist must carefully remember that teachers are the experts in their environment and we must consider the others that share the learning environment.
Sensory Environment Classroom Questionnaires
When therapists and teachers collaboratively complete an environmental rating scale or questionnaire it not only structures observations it promotes awareness of the interplay of the environment on both sensory processing and executive functions.
I use my own questionnaire based off the items validated by the Sensory Classroom Teacher Questionnaire (SCTQ) to structure my environmental evaluations (Preez, H. and Combrinck, C., 2022).
Promising Sensory Environment Assessment Tools:
The Sensory Classroom Teacher Questionnaire (SCTQ) (Preez, H. and Combrinck, C., 2022) . The SCTQ questions are unique in that they were developed using ADHD symptomatology to evaluate learning spaces that support children in regulating their response to sensory input (Preez, 2022). While not yet commercially available, the authors invite therapists and teachers to use and refine the current version for Grades 1-3.
The Classroom Sensory Environment Assessment (C-SEA), also awaiting publication, promises to structure observations of the classroom environment (Miller-Kuhaneck & Kelleher, 2015). The C-SEA is a criterion-referenced ‘learning environment evaluation’ tool to promote awareness of classroom sensory experiences for general elementary education teachers and foster collaboration between OTs and teachers. More information about the C-SEA can be found by exploring the Classroom Sensory Environment (C-SEA) website.
Available Sensory Environment Assessment Tools:
The Participation and Sensory Environment Questionnaire (PSEQ) (Pfeiffer, 2019) is available free online.
It was initially developed to identify aspects of the sensory environment or sensory features of the activity that impact participation in common preschool classroom activities. Authors now suggest its use for children up to 10 years of age.
In addition, the Sensory Audit for Schools and Classrooms, designed by Ian Attfield and Amy Fowler.
Although designed for autistic students , it may help structure the assessment and creation of an environment that enables participation.
The Most Effective Sensory Support for Learners with ADHD
As school-based OTPs, our role is to ensure that any intervention we recommend, including sensory tools/equipment, is based on a thorough understanding of the student’s needs and the environment. By collaborating with teachers and using structured tools to assess the classroom environment, we can develop targeted, effective strategies that truly support our students with ADHD sensory processing needs.
Changing aspects of the environment is the least restrictive method of supporting a child’s participation and performance.
For those of you who came to see if the most commonly used sensory tools (e.g., cushions, fidgets, etc.) in our arsenal are supported by evidence, stay tuned for upcoming posts. In the meantime… go observe that environment!
XO
Check out our Classroom Environment Sensory Support Questionnaire—an essential informal assessment tool designed specifically to help you identify the sensory and environmental supports within a classroom to facilitate learning in students with ADHD.
References
Fabio, R. A., Orsino, C., Lecciso, F., Levante, A., & Suriano, R. (2024). Atypical sensory processing in adolescents with attention deficit hyperactivity disorder: A comparative study. Research in Developmental Disabilities, 146, 104674. https://doi.org/10.1016/j.ridd.2024.104674
Ghosh, P., Ghosh, S., Mondal, S., & Moulik, S. (2022). Assessing sensory processing disorders in a child guidance clinic with focus on ADHD. Eastern Journal of Psychiatry, 22(1), 1-10. https://doi.org/10.5005/ejp-22-1-1
Miller-Kuhaneck, H., & Kelleher, J. (2018). The classroom sensory environment assessment as an educational tool for teachers. Journal of Occupational Therapy Schools & Early Intervention, 11(3), 338-350. https://doi.org/10.1080/19411243.2018.1432442
Panda, P. K., Ramachandran, A., Kumar, V., & Sharawat, I. K. (2023). Sensory processing abilities and their impact on disease severity in children with attention-deficit hyperactivity disorder. Journal of Neurosciences in Rural Practice, 14(3), 509-515. https://doi.org/10.25259/JNRP_22_2023
Pfeiffer, B., Piller, A., Bevans, K., & Shui, C. (2019). Reliability of the Participation and Sensory Environment Questionnaire: Community scales. Research in Autism Spectrum Disorders, 64, 84-93.
Preez, H., & Combrinck, C. (2022). The sensory classroom teacher questionnaire: A tool for assessing conducive classroom conditions for children with ADHD. African Journal of Psychological Assessment, 4, Article 107. https://doi.org/10.4102/ajopa.v4i0.107
Rani, I., Agarwal, V., Arya, A., & Mahour, P. (2023). Sensory processing in children and adolescents with attention deficit hyperactivity disorder. Journal of Attention Disorders, 27(2), 145–151. https://doi.org/10.1177/10870547221129306