Can A Stimulant Improve Postural Sway?

Recently, my 2015 post on ADHD and Postural Sway shot to this blog’s #1 most-visited. This newfound interest in Postural Sway motivates me to share  more fascinating research details with you on this important topic.

Details include the possibility that methylphenidate (the active ingredient in Ritalin, Concerta, etc.) can help offset such physical challenges. For people with ADHD and maybe others, too.

But first, why the recent upsurge in interest?  A friend in Mexico City tells me it’s due to a Tik-Tok video. In it, a woman with self-proclaimed ADHD demonstrates cat-like agility, smoothly weaving through her apartment, dodging tight obstacles and sailing through hairpin turns, until…she bangs into a coffee table for no apparent reason. That’s ADHD for you: Predictably unpredictable.

Somehow, the video included the term postural sway. Folks went a-Googling — and found my 2015 blog post: Research: ADHD, Balance, and “Postural Sway”.

In This Post:

In this follow-up post, I’ll

  1. Define various  balance-and-coordination conditions commonly co-existing to ADHD
  2. Share three published papers providing evidence that methylphenidate (the stimulant in Ritalin, Concerta, etc..) can help resolve these challenges
  3. Highlight, as one study concludes, the possibility that methylphenidate (Ritalin, Concerta, etc.) might even help those struggling with balance-motor issues who do not qualify for the ADHD diagnosis.

To the last point, we know that first-degree relatives of people with ADHD have elevated symptoms, even if not at a diagnosable level. That means  millions of other people with balance issues might benefit from stimulant medication. Including the elderly.

ADHD postural sway

ADHD By Any Other Name:  Dys- and That

We’ve long known that medication can help certain ADHD-related issues with fine-motor control. For example, some parents  clearly see a child’s handwriting devolve into indecipherable loops and scrawls as the child’s ADHD medication wears off.

Other parents tell me of their child’s diagnosis,  dysgraphia. I always ask: “Has your child had an ADHD evaluation? Because this might be a treatable, ADHD-related issue.”

There can be other neurological contributors to dysgraphia, some are not treatable. Therefore, the distinction is important. Why attempt to treat dysgraphia —with physical therapy, for example—when the child also has many other ADHD-related challenges not responsive in any way to that treatment?

Here’s a major problem, though: medical and educational “silos”. That is, different specialties have different terms, causes, treatments, and longterm outlooks for the same issue. This makes for poor “cross-disciplinary” unity.

Dysgraphia is one of those terms.  But there’s also dyscalculia (math) and dysxlexia (reading).  All three are more highly associated with ADHD.

We could keep going, into the non-dys terms, such as sensory processing disorder and auditory processing disorder. These terms come from other fields (i.e. occupational therapy and hearing/speech therapy).  Yet, both disorders are associated with ADHD. And, evidence suggests, both tend to respond positively to ADHD treatment. In such cases, consider them not entirely separate conditions but rather downstream effects of untreated ADHD. As with postural sway.

Dysgraphia, Dyspraxia & DCD

Let’s return to dysgraphia. Specifically, might stimulant medication truly improve this fine-motor disorder? And, if so, what that means for larger coordination issues?

First, Merriam-Webster defines dysgraphia this way:

Impairment of handwriting ability that is characterized chiefly by very poor or often illegible writing or writing that takes an unusually long time and great effort to complete

This brings us to the umbrella term under which dysgraphia falls: Developmental Coordination Disorder (DCD) (also known as dyspraxia). That was the subject of my 2015 post, Research: ADHD, Balance, and “Postural Sway”

Informally defined: a neurodevelopmental disorder characterized by impaired coordination of physical movements as a result of brain messages not being accurately transmitted to the body.

Deficits in skilled motor movements interfere with age-appropriate activities of daily living (e.g. as an infant, unusual postures, difficulty stacking blocks; as a young child, tying shoes, being clumsy, knocking into things, running, and jumping).

Can Methylphenidate Improve DCD?

Research provides evidence for methylphenidate (MPH for short) mitigating dyspraxia and larger motor-coordination issues?   Consider three highly cited papers.

1.

Fine motor skills and effects of methylphenidate in children with attention-deficit—hyperactivity disorder and developmental coordination disorder

Results demonstrated that children with ADHD-DCD performed more poorly on the manual dexterity subtests, had poorer quality of handwriting, and drew more rapidly, more fluently, but less accurately than controls on the graphomotor task. On methylphenidate , manual dexterity and quality of handwriting improved, and strokes on the graphomotor task became less fluent but more accurate….

Up to 50% of children with ADHD also have motor coordination problems that are severe enough to meet criteria for DCD. In DCD, children demonstrate functional motor performance deficits not explained by the child’s (chronological) age or intellect, or by other neurological or psychiatric disorders.

2.

Influence of methylphenidate on motor performance and attention in children with developmental coordination disorder and attention deficit hyperactive disorder

We assessed the influence of methylphenidate on motor performance in children with comorbid DCD and ADHD. Participants were 30 children (24 boys) aged 5.10-12.7 years diagnosed with both DCD and ADHD. …

Motor performance and attention scores were significantly better with methylphenidate than without it (p<0.001 for improvement in the Movement Assessment Battery for Children-2 and p<0.006 for the online continuous performance test scores).

The findings suggest that methylphenidate improves both attention and motor coordination in children with coexisting DCD and ADHD.

More research is needed to disentangle the causality of the improvement effect and whether improvement in motor coordination is directly affected by methylphenidate or mediated by improvement in attention.

3. MPH Decreases Postural Sway

The effect of methylphenidate on postural stability under single and dual task conditions in children with attention deficit hyperactivity disorder — A double blind randomized control trial

Methods

A randomized controlled double-blind study analyzing postural stability in 24 ADHD children before and after MPH vs. placebo treatments, in three task conditions: (1) Single task, standing still; (2) dual task, standing still performing a memory-attention demanding task; (3) standing still listening to music.

Results

MPH resulted in a significant improvement in postural stability during the dual task condition and while listening to music, with no equivalent improvement in placebo controls.

Conclusions

MPH improves postural stability in ADHD, especially when an additional task is performed. This is probably due to enhanced attention abilities, thus contributing to improved balance control during performance of tasks that require attention. MPH remains to be studied as a potential drug treatment to improve balance control and physical functioning in other clinical populations.

Motor Function And Interpersonal Synchrony

I’ll leave you with one more fascinating nugget. What about ADHD and motor function that allows coordination with others?  That brings us to one paper I found particularly interesting.

As it happens, one of the authors also wrote a paper that previously snagged my attention: Theory of mind and empathy in children with ADHD

My friend had reported an increase in empathic behaviors when her oldest daughter started stimulant medication for ADHD symptoms. She wrote this post:  ADHD & Lacking Empathy: Was I Raising a Narcissist?

Before we get to the paper, we need to define the term interpersonal synchrony.  Here’s one discussion from a 2020 paper in Social Cognitive and Affective Neuroscience:  A syncing feeling: reductions in physiological arousal in response to observed social synchrony

Interpersonal synchrony is a specific form of movement coordination that has captured recent attention, especially that of social, music cognition and developmental psychologists.

Here, we define interpersonal synchrony as time-locked movements between two or more individuals. This can be achieved by, for instance, dancing, marching, rowing or singing in synchrony with others. In naturalistic settings, interpersonal synchrony often involves a series of movements that are rhythmic and predictable. In contrast to mimicry, the timing of movements must be closely aligned, and the nature of the movements themselves is less important than timing.

Experiencing interpersonal synchrony firsthand has been shown to facilitate social bonding and prosociality. Adults rate one another as more likeable, and help, trust and cooperate with one another after moving synchronously compared with asyn- chronously (Hove and Risen, 2009; Wiltermuth and Heath, 2009; Kokal et al., 2011). 

Dopamine Connections

With Interpersonal Synchrony loosely defined, here is the study:  The Potential Role of Dopamine in Mediating Motor Function and Interpersonal Synchrony

Here, we present attention deficit hyperactivity disorder (ADHD), as an example of a disorder that involves the dopaminergic system, and review findings regarding both motor and social difficulties and recent findings regarding difficulties in interpersonal synchronization.

Finally, we put forward evidence linking dopaminergic modulation by the administration of methylphenidate to improvements in both motor and social domains.

I always welcome your comments. Thanks for visiting!

Gina Pera

8 thoughts on “Can A Stimulant Improve Postural Sway?”

  1. Hi Gina

    Is your background as a researcher as I am continually amazed at the depth of your knowledge about ADHD. Curiously, in Drs. Hallowell and Ratey’s latest book, ADHD 2.0 they mention how improving balance improves a person’s ADHD. They talk about standing on one foot, standing on one foot with eyes shut. That proved too challenging for me–but doing a grapevine–moving to the left by putting a foot behind the other, and then the next foot in front of the other, then going back to the right, in the same fashion, has been a simple way to improve my balance. I feel successful when I get put on my trousers without sitting down or holding onto something.

    1. Hi Cynthia,

      Thanks for reading! I guess one could say my background is as a researcher. The journalism program where I went to college (UT-K) has a very strong college of communications.

      Our training was rigorous, including with vetting studies, understanding statistics, etc.. It was our job to translate the research we reported on, including its limitations, for readers.

      My work in ADHD over the years was a natural outgrowth of my journalism career of inquiry and reporting.

      I take this topic (though not myself) very seriously. I feel it my duty, when so many lives could be affected by my words, to be responsible and get it as “right” as I can.

      I’m happy for you….standing while putting on your trousers! :-). It’s definitely important to do balance exercises, especially post 40. I’ve found benefit myself.

      I’ve not seen evidence that balance exercises improve ADHD symptoms. That was the (false) claim made by the entrepreneur behind the Dore Method, at least a decade ago.

      Hallowell sold it from his clinic and touted its benefits, as if there were scientific evidence. Trouble was, there wasn’t. As I recall, the package was about $5,000.

      Dore Method bilked thousands of Australians, closing shop after taking their treatment payments. Many parents, as you know, are vulnerable to hearing the word “ADHD” describing their children. They want to believe that an exercise, a strategy, etc. will treat the ADHD symptoms.

      https://en.wikipedia.org/wiki/Dore_Programme

      Now there are many copycat centers, making similar unsubstantiated claims. We could call them charlatans.

      cheers,
      g

  2. Excellent blog article ! Finally recognition of this motor coordination (and social too!) dopamine link : treating ADHD first will help or solve the so called learning disabilities/ comorbidities highly associated with ADHD. Are there studies linking ADHD and higher rates of Parkinson disease or falls in elderly ? And those tested versus untreated ?

    1. Hi Lisane,

      Thank you!

      re: elderly

      https://adhdrollercoaster.org/essays/adhd-misdiagnosed-alzheimers/

      re: Parkinson’s

      The recent large-scale Swedish study found an increased risk for dementia and PD, but less so than with other conditions.

      https://adhdrollercoaster.org/adhd-news-and-research/adhd-poses-health-risks-for-physical-conditions-and-diseases/

      That study links these outcomes to ADHD-related genetics, but it’s unclear how much is straight genetics (unlikely) and how much is the behaviors driven by those genetics (more likely).

      cheers,
      g

  3. I totally agree and thank you for your response. I think my doctor is just a puffed-up person who treats drug addiction at some local hospital here and he’s impossible to talk to so I just have to just shut up or go without and going without means having no life

    1. I hear you, Cindy. If you can get what you need from him, it’s better than nothing, I suppose. But meanwhile, keep your eye out for alternatives. 🙂

      g

  4. This is an interesting website. The problem I have with info websites is that you are giving information to the patients, which means nothing to the doctor. I have a psych that thinks “one size fits all” and often reduces my adderall or raises it, as if he doesn’t even have a chart on me! So, I found another doctor (P.A.) that treated me for a while but then decided he can’t handle “comorbidity” with adult ADHD and thought my dose of adderall was too high, even though I had been on that dose for almost 10 years! SHEESH! So, the only choice I had (no insurance) was to go back to the first doctor, and once again, he’s got me on a dose lower than he had me on for several years. WHY DO THEY DO THAT? Is it fun for him or it a power trip? Anyway, thanks for the website, I do learn things like how to handle the lack of the proper dose of medications. Ravinlunatic

    1. Hi Cindy,

      I know. If only more prescribers read my blog.

      In fact, though, ADHD experts at a few medical schools tell me they direct their medical students to subscribe. 🙂

      It’s really something….that people with ADHD must manage their own dosing, titration, etc.. But what is the alternative? Remaining at the whim of these prescribers?

      There should be a REASON for whatever the prescriber is doing — and the patient should know that reason.

      There should be targeted treatment goals and rating scales.

      My first two books empowered consumers and therapists to take a more active role. In Course 2 of my online training (working on it right now), I take things step by step, with PDF worksheets, so participants can take the information to their prescriber.

      good luck,
      Gina

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