ADHD, Anxiety, Sensory Processing Disorder: Are They Pieces of the Same Puzzle?
Attention deficit hyperactivity disorder (ADHD), anxiety and sensory processing disorder (SPD) are often related. Unfortunately, the interrelationship creates some confusion both for therapists and parents. In this article, I will review the basics of sensory processing disorder, how its symptoms tend to overlap with those of ADHD, and how anxiety factors into it all.
Read on to gain an important perspective on how to discern what a child is experiencing, and how to help them when they act out.
The Connection Between the Three
Here is a useful way I like to frame the connection between these three conditions:
- There are always sensory processing components in ADHD.
- There aren’t necessarily always ADHD symptoms in SPD.
- Anxiety will usually be a third wheel.
Many people look at both ADHD and SPD as discrete disorders with identifiable markers. While these conditions are rooted in biological realities, and can be treated with medication, their impact on the emotional and mental wellbeing of a child shouldn’t be underestimated.
Let’s start with sensory processing issues, which are often a cause of extreme behaviors, anxiety and distress.
Sensory processing disorder is when the sensory system is not functioning the way it should. This makes a person feel unsafe and anxious in themselves and in their environment. People with SPD often have an oversensitivity to sensory sensations, such as moderately loud sounds, bright lights and touch. All of these things are processed as dangerous, which stimulates a defense response.
Sensory processing disorder causes dysregulation in how people experience the world and how they process what they experience.
The challenge is this: often, when a sensory system isn’t working well, it can manifest in symptoms that look like ADHD. It can create a lot of inattention, distractibility, anxiety, impulsivity, hyperactivity, learning challenges, social challenges, etc.
It is easy to mishandle someone with SPD, because what we see looks so much like a behavioral issue. The problem is that when you treat a sensory issue with behavioral treatments, it’s like giving a child medication for asthma when they actually have a backache. This dysregulation has far-reaching effects.
Little “t” Trauma
When the sensory system is dysregulated, children may experience some forms of trauma, and even begin traumatizing themselves. As difficult as it is for parents to manage challenging behaviors, it’s a lot scarier for children who are out of control to manage themselves. They don’t know why they can’t function in society or why they’re so impulsive. Very often, they’ll lash out and you can see their immediate regret or frustration.
We all know how terribly uncomfortable it is to feel out of control. When children react in ways that seem extreme, it may be helpful to consider what they experienced before the reaction. Because of the interplay in symptoms, it is vitally important that the adults who best know a child work with them through these reactions.
This little “t” trauma is real and often followed by anxiety. Children can be impressed by this trauma in a way that shapes their future behaviors and reactions. A very common example occurs in the classroom:
A child who’s out of control and is disrupting a classroom will probably get in trouble. This can cause what I call “little ‘t’ classroom trauma.” Once they have been called out and gotten in trouble for their behavior, every time they look at a classroom, they perceive it as being an unsafe place.
In a classroom, children with SPD are often being told to do things they simply cannot do:
Their sensory system is too hungry and cannot “settle down” the same way their classmates can.
Whether rooted in ADHD or SPD, a constant issue of troublesome behaviors is that they make it hard for a child (and parent) to form meaningful connections.
Very often, children with ADHD or SPD present difficult behavior, which makes it hard for them to attach properly. Parents end up feeling that it is impossible to forge meaningful connections. Children who are living in a constant state of fight or flight (from an inability to process sensory experiences), or who are having trauma triggers, don’t have the emotional bandwidth to relate on a personal level. This generates anxiety both in adults and children.
Some of these scenarios may sound familiar:
Young children with ADHD or SPD may act and react totally on instinct. This impulsivity doesn’t fit norms, which causes adults in their lives to react harshly to them, causing even greater anxiety.
A child is constantly misbehaving, so the parent spends all of their “relational” time correcting or redirecting, rather than conversing and connecting. The parent then feels guilty that they don’t have a meaningful relationship with their child.
Many children, consciously or unconsciously, feel ashamed or frustrated that they make adults upset by their lack of self control. In this case, an adult’s reactions compound a child’s anxiety.
A child feels isolated and alone, unable to escape the tumult of their mind or an inability to react “appropriately,” causing them to feel even more anxious that they aren’t meeting expectations.
Without meaningful adult connections, it can be very hard for a child to ever escape the cycle of anxiety, or even guilt, they feel at being “out of control.”
Some of the very tools commonly used to treat children with ADHD or SPD may also contribute to a state of anxiety.
Sometimes, the medications that are being used to treat ADHD symptoms, to help focus or control impulses, can cause anxiety. ADHD has historically been treated by stimulant drugs. In some children, ADHD stimulant medications cause mood issues, including depression and anxiety.
Treating children with both anxiety and ADHD presents a real challenge to psychiatrists and other therapists. Only recently are there FDA-approved non-stimulant ADHD medications. Often, kids will be on stimulant meds and anxiety meds at the same time.
It may seem like kids who struggle with either ADHD or SPD have the deck stacked against them in terms of anxiety. It’s important that we spend time focusing on the many options parents have to help children who struggle with these conditions as well as anxiety. For me, it starts with addressing a child’s physical needs and how they feel in their own bodies.
Solutions: Helping Children Feel Safe in Their Bodies
The common thread of anxiety is apparent. Dysregulation, little “t” trauma, attachment challenges and even medication may contribute to anxious feelings. This anxiety is an important indicator for adults that a child is struggling. The goal is to truly get to the bottom of what is causing the issues, then equip children to self-manage.
Unraveling the complexity of these and other conditions can be accomplished by regulating the sensory system:
- Once a person feels safe in themselves and the world, that itself reduces surface-level ADHD symptoms like hypersensitivity to stimuli, hyperactivity, impulsivity, etc.
- Regulating the sensory system helps a person feel safe in their body and in the world. This allows them to function more successfully, improves relationships and could potentially reduce the need for medication, thereby reducing anxiety.
- Once symptoms have decreased, there may be an inverse of the challenges, including an increased ability to attach.
I like to explain to parents that every emotional experience is a sensory experience, and vice versa. These imprint strongly on children, and their responses to the things they experience, including anxiety-laden ones, should not be ignored.
Regulate the Sensory System
There are a number of ways to regulate the sensory system, and I strongly recommend that you look into some of the Bloom online training courses or schedule a session. Ideally, a professional will assess your individual child and provide tailored approaches for their treatment. Here are a couple of treatments that I use with great success.
From Fear to Freedom
Children in states of stress may lock down. We call this the fear paralysis reflex (FPR). Some of the treatments surrounding this are similar to sensory integration therapy.
To help children through these challenges, here are two ideas:
Trigeminal Nerve Tapping — Tap lightly with small jumps of two fingers towards the center of the forehead and then back to the temples. Next use the same motion from the temple along the cheek bone to the bridge of the nose and back to the temple. Then from the temple to under the nose and back to the temple. Then from the temple to the clef of the chin and back to the temple and then around the ears. Repeat 5-7 times.
Hands Swinging — Hand swinging can be done as little as two or as many as thirty minutes a day. You can find YouTube videos to illustrate this process, or view it in my Fear Paralysis Reflex Toolkit. Prompt the child to lift their arms up to about shoulder height and swing them rhythmically back and forth, four times. On the fifth swing, bounce twice with the knees, all the while breathing through a closed, relaxed mouth. After as many repetitions as they want, end with stillness and controlled breathing.
Here are three tips to making exercises like these successful:
- Less is more: stop when a child is done, even if it is a very brief time.
- If a child is uncomfortable with any touch, they may be willing to do exercises on themselves.
- Occasionally, a primary caregiver can do a light integration exercise on a child when they are sleeping at night.
The activities you choose should be selected after you specifically observe your child and what they need. Ideally, you will practice these every day until symptoms subside.
Once the sensory system is becoming regulated, children may be able to function in an environment that may have previously felt unsafe or traumatized.
Bloom: Resources for ADHD, SPD, Childhood Anxiety and Other Challenges
I started Bloom to address the overwhelming need children have for personalized care as they deal with the inherent challenges of conditions like ADHD, SPD and childhood anxiety. It is our mission to provide time-tested tools that will equip adults and children alike with strategies that truly work.
There are three resources I highly recommend if this article resonated with you:
Included with a Bloom membership, the Anxiety Toolkit will teach you the mysteries of regulation and dysregulation. You will learn how to incorporate anti-anxiety parenting techniques into your daily routine
Sensory Processing Toolkit
Also included with a Bloom membership, the Sensory Processing Toolkit takes a deep dive into the difference between sensory seeking and sensory defensiveness, and includes tutorials on the most powerful strategies available to help your child overcome sensory challenges.
I am personally available to Bloom clients for one-on-one coaching. Sometimes, it just takes a professional to provide you with the right perspective and the right approach for your child. Even if anxiety, sensory issues, attention issues or other challenges are part of what you face each day, know this: you can do it. This child is yours for a reason. You are not alone. I am here to help.