Research: ADHD, Balance, and “Postural Sway”

ADHD Balance problems

 

Can ADHD create physical balance problems? Yes, we’re hearing more about ADHD-related challenges with something called “motor control.” Simply put, balance.  I’ll share a few examples and then results from a very interesting study.

This issue is important because poor coordination is associated with physical injuries, some of them severe.  It can even affect the results of roadside sobriety tests. As a reader comments on this piece when it first posted (11/11/15):

This is another reason why anyone with ADHD should never consent to do standardized field sobriety tests. It is 100% legal to decline them.

Sober people fail them all the time, and anyone with ADHD has zero chance of performing them as a neurotypical person would.

“Clumsy” or Poor Brain-Based Coordination?

My friend and I walked behind her little girl, age 7, riding her bicycle. Every 30 feet or so, she’d veer off the sidewalk, and hit the dirt.  The little trooper always jumped back up—and on the bike. Undeterred.

Still, I found it painful to witness. Was it poor vision? She did wear eyeglasses, which kept slipping down her little nose. Perhaps that distracted her? Marred her depth perception? Weren’t addressing the problem?

Then there’s my husband, who had always described himself as clumsy. “I knock into things,” he’d warn early on in our relationship, “so don’t put anything you value around me.”  (He was right!)

Before we knew about ADHD, he mostly attributed his “Bull in a China Shop” tendencies to his Lumberjack build. Yet, there seemed also an issue of balance and coordination. For example, certain yoga poses eluded him, despite years of practice.

Having taken medication for more than 10 years now—and for 6 years taking a class that works chiefly on balance—his “clumsiness” seems resolved. (For the most part. Hey, sometimes he’s still a big guy in small spaces.)

 

ADHD balance problems

 

For 50 Percent of Children with ADHD? Brain-Based

For years, I’ve also heard reports about “clumsiness,” from both adults with ADHD and their partners. It results not only in bumps and bruises but in broken treasured objects. Was there a connection between clumsiness and ADHD?  Turns out, yes, there is. Some new research is particularly interesting. We’ve long known that children with ADHD experience greater-than-average challenges with “motor control”—in particular, balance.

Almost 50 percent of children with ADHD have difficulty balancing and controlling motor function. This has been seen when testing children with minimal demands such as standing on a fixed platform, eyes open. With more challenging demands—such as standing with eyes closed or with a visual surround that disrupts the senses—even greater impairments have been seen.

It’s been suggested that these challenges around balance might account, at least in part, for the increased risk of injuries in children with ADHD (and adults as well).

What Is “Postural Sway”?

Recently, a study focused on examining “postural sway” in adults with ADHD found evidence to explain this phenomenon.

Fortunately, this is one study you can download for free (Postural sway and regional cerebellar volume in adults with attention-deficit/hyperactivity disorder) and read it yourself.

First, to define postural sway (thank you, Wikipedia):

In biomechanics, balance is an ability to maintain the line of gravity (vertical line from center of mass) of a body within the base of support with minimal postural sway. Sway is the horizontal movement of the center of gravity even when a person is standing still.

In other words, postural sway looks something like this:

ADHD problems with balance

As you can imagine, excessive postural sway can be hazardous on the job:

ADHD problems with balance

ADHD and Balance: Research Highlights

I found the research results interesting for several reasons:

  • It extends to adults with ADHD what we know about balance-related challenges in a subpopulation of children with ADHD. This indicates these children might not “outgrow” these challenges.
  • It emphasizes in yet another way that ADHD is not a “cookie-cutter” condition; not all subjects with ADHD experienced greater postural sway.
  • It indicates a positive association between postural sway and gray matter volume in the posterior cerebellum. Lower sway was associated with smaller volume. (Here’s a good little video, The Function of the Cerebellum.)
  • It provides the first evidence of a link between balance and cerebellar shape/size.
  • It provides one more piece of physical evidence that ADHD is not all about “behavior,” that there can also be physical manifestations.
Fig. 3. Regional cerebellar volume in posterior motor areas has a linear association with sway. The more difficult conditions, eyes closed/feet apart and eyes open/feet together, show similar regional distributions, with lobules VIIIa, VIIIb, IX and posterior vermis showing effects. Effects of sway are not seen in the biomechanically most stable conditions, eyes open/feet apart with shoes on or off. The overlay maps are shown in grayscale with t = 2.3–3.5, superimposed on the SUIT Atlas background.

Research Methods

Thirty-two adults with ADHD and 28 control subjects performed various standing-posture tasks on a Wii balance board.

From the paper:

During each trial, participants were instructed to remain as still as possible for the duration of the 30 s trial. The first 5 s of each trial were not analyzed. Postural sway was quantified as the path length (in cm) of the center of pressure (COP) (e.g., Bucci et al., 2014; Shorer et al., 2012).

Whole-brain structural MR images were collected for each participant.

Study Results

Postural sway was significantly higher for the ADHD group, compared to controls. Higher sway was positively associated with regional gray matter volume in the right posterior cerebellum (lobule VIII/IX).

For More Information On This Topic:

Here is a collection of related research:  https://pubmed.ncbi.nlm.nih.gov/23584172/

 

ADHD problems with balance

What do you think about these research findings?

Are you (or your loved one) among the estimated 50 percent

of folks with ADHD thought to have issues with balance?

If so, has that resulted in inconvenience or injury—

or perhaps the enticing challenge of a circus career?

—Gina Pera

 

 

72 thoughts on “Research: ADHD, Balance, and “Postural Sway””

  1. Well, what a find you are!!!

    “Gifted” as kid (but with some dramatic exceptions – mom wondered why her 3rd grader could read at the college level but not remember how to set the table/ dad thought I’d never get out of 3rd grade because I couldn’t remember multiplication tables, etc – interestingly, my ADHD testing bore this out, with results spreading from 98th percentile in some things to a a low of 21%); depression/anxiety/eating disorder (complicated family/trauma); dx w ADHD age 40 (when I finally got semi-stable but still struggled). We think there’s more going on, yet undiagnosed – sensory issues, possibly Aspergers, etc.

    I could write volumes about this – story after story. A few years ago, I started taking an adult ballet class to support a friend and discovered that ballet is exactly many of the things I’m most terrible at: balance, coordination, memory, following instructions (paying attention to instructions and not getting distracted by what’s going on in my head), telling left from right, etc. Frustration/enjoyment level teetered back and forth between 49/51% [many times leaving class early and having meltdown in car], tho psychiatrist thought it was a brilliant strategy to work on all those things (COVID-19 has curtailed classes for now).

    In high school marching band, other kids would yell “hey, drunk-o” as I weaved my way down a parade route.

    After a beginning contra dancing class, the teacher slapped my hubs on the back and said, “you’re a natural!” And then patted me and said “and you … um.. – keep trying!”

    I think what has made the biggest difference for me has been taking Feldenkrais classes (highly recommend!) and lessons and some Alexander Technique lessons as well. In the beginning, I was so anxious it was difficult to stay on the mat for the whole class – and again, I often became so distracted (or totally overwhelmed) by what I was thinking or feeling emotionally that it was impossible to sense what was going on physically. Has definitely improved praxis, too.

    You know that line from James Joyce?: “Mr. Duffy lived a short distance from his body.” I think that’s a contributing factor for many of us.

    Ah – I often find that when I’m feeling more emotionally off-balance, it manifests physically (to my great embarrassment). Trying to hide it probably makes it worse. (Similarly, with any attempts at rushing, there’s an exponential increase in clumsiness).

    Off to discover what other gems you’ve written! Thank you!

    Ah – btw, I’m from middle TN (now in NC).

    1. Hi Sabrina,

      I’m glad you found me, too! The first and oldest website on Adult ADHD. Since 2008. 🙂

      Thanks for reminding me about Mr. Duffy. Excellent.

      I invited a very good occupational therapist to speak to my local group years ago. She talked about….proprioception (?)….about finding fidgeting or squirming as finding one’s place in space. And several in the group (adult ADHD group) explained how they could relate to the concept.

      Isn’t it crazy that you didn’t know about possibly having ADHD until age 40? Amazing.

      Not sure I’d like it better if we came with operating instructions. But it sure could have saved many of us plenty of grief!

      I’m from Memphis but went to UTK. Drove through Nashville coming and going, never spent time there. Now I hear it’s the hot town!

      Thanks,
      G

  2. I was diagnosed with ADHD in May of this year, at the age of 42. I’ve been very clumsy my whole life, and hated sports in school, probably because they fully consisted of team sports and ball sports, where I felt completely like a spare part. I couldn’t concentrate on all the multiple moving parts of a game, and would hide in a corner of the pitch as much as possible. Any connection with the ball was purely co-incidental and accidental! However, I was quite strong (for a girl, as people used to say) and was fairly fast. I was a decent sprinter and ok gymnast, but all those things were activities my parents brought me to outside of school. I think because they were individual, somewhat predictable activities, I could focus on what I was doing more. Because I was a day-dreamer and my teachers didn’t see me do ok at my extra curricular sports, I was written off as unsporty and not worthy of bothering with when it came to anything athletic.

    I kind of internalised that, and like most teenage girls, abandoned any training for my teens and a lot of my 20s. (although one memory that always makes me smile was when my secondary school Physical Education teachers took a break from hockey and soccer and making us run around a field, and took out all the really cool old-school gym equipment they had in the school since the 60s to make an obstacle course. Proper leather pommel horses, and wooden climbing frames, thick climbing ropes, that kind of thing. To this day I’ll never forget the look of astonishment on my teacher’s face when I finished first before all the “sporty” girls! Talk about judging a fish by its ability to climb a tree.

    Anyhoo, what I originally wanted to comment for, was to say that I took up weightlifting and powerlifting in my early 30s, and it was life changing for me! Improving my strength helped my balance so much, and there’s nothing like trying to get a heavy barbell off the ground to focus the mind. I didn’t know at this time that my brain chatter and distractibility was ADHD, but I knew my focus and balance was better the more I trained. I thought of it as meditation via barbell. Funnily, my coaches alway commented on my speed under the bar in the snatch (Olympic weightlifting move where you move the barbell off the ground and over your head in one fluid movement). But I’ve always had quite quick physical reaction times for a dopey space cadet! I don’t know if that’s an ADHD thing, would be interesting to know.

    1. Thank you for sharing that vivid picture, Julietta!

      I can almost imagine the look on that PT teacher’s face! lol

      re: is quick physical reaction times (even “in a dopey space cadet”) an ADHD thing?

      I don’t think we could say. For every person with ADHD who has quick reaction times, I know another person with ADHD with delayed reaction times.

      Just depends on those individuals’ manifestations of ADHD, I guess.

      Gina

  3. I was useless at sports at school, and ‘clumsy’ and socially awkward.
    Back then it as just how you were tough luck.
    My son starting school had fidgeting and inability to read or write. His teachers response ‘your child is below average intelligence and always will be – get used to it, and order him to pay attention!’
    Fortunately my sister worked in special needs and sent us to hospital with the word ‘dyspraxia’ and he received some OT and sets of exercises to do. A year or so after he sat down at home with a Harry Potter book, no pictures, and stared at the first page all day. After a week I noticed he was staring at page 10, then a month later several chapters in. Within a year he would demolish such a book in a few hours and tell you what happened on page 117. But at school they were still handing him one word picture books (which he had trouble with) and had him in the remedial class.
    He recently graduated masters in engineering and now researches rotor blade technology.

    For me, after years of martial arts and Tai Chi improving coordination I found my sweet spot in sports as a goalkeeper – where I can hyperfocus on just the ball and lack of fear allows me to throw myself in front of it regardless.

    1. Hi Jeffrey,

      Goalkeeper is a very important job! 🙂

      That’s interesting about the OT and reading. I’ve heard from many parents getting OT for their children who have ADHD but I’ve never seen much in the way of results.

      OT isn’t a treatment for ADHD. And, dyspraxia is largely considered an off-shoot of ADHD — not a diagnosis in his own right. It might be associated with other conditions. But with ADHD, it tends to be more of a symptom. And typically, it does respond to medication.

      I wonder if it was more the Harry Potter series that lured him into reading. That was a phenomenon with “reluctant readers” when HP first came out.

      Whatever it is, I’m glad you intervened instead of leaving him to one-word picture books. (OF COURSE a child motivated by interest will not be motivated by one word…..duh!)

      Masters in engineering. Rotor-blade technology. Kudos to him and you!

      thanks for your comment,
      g

    2. I agree! Goalkeeper is a very important job and the Euro soccer final between England and Italy is an excellent recent example, although I doubt it was such a big deal outside of Europe, but in UK there was no other news for about a week… on and on and on over and over again… Wimbledon got a mention, Le Tour de France hardly a glance. At least we are once again reassured that England still can’t play football 🙂
      Sorry, soccer!
      Btw, Jeffrey, very impressive stuff about your son! Clearly well above average intelligence!
      PS: sorry this isn’t really related to ADHD, just a selfish distraction (ah, maybe it *is* related to ADHD 🙂

  4. Hi Gina,

    You wrote: “What do you think about these research findings? Are you (or your loved one) among the estimated 50 percent of folks with ADHD thought to have issues with balance? If so, has that resulted in inconvenience or injury—or perhaps the enticing challenge of a circus career?”

    The research is very interesting, and thought-provoking. At age 62 I do have occasional problems with balance although I think that’s probably my body catching up with my age 🙂 I was late-diagnosed with ADHD at age 55 and like so many others it was a revelation that put so much of my life into perspective, and I began to understand so much about why I had been the way I was for all my life.

    Anyway, back to enticing challenges, and the research. I think that balance when on one’s feet can often be very different from balance when off one’s feet. Some personal examples:

    I was mad for roller-skating when I was aged 6-10 and spent every available minute roller-skating everywhere and anywhere like a crazy child, but I refused to wear shoes unless I was on skates, so maybe that affected my walking gait, who knows? I learned how to ride a bicycle when I was 10, but it took time, I never really enjoyed it, and I never felt properly balanced. When I was 12 I won a trophy in Austria for “best girl skier”, this was a different kind of balance. At age 20 I won “ladies champion” for endurance windsurfing, again a different kind of balance. At 33 I learned to rock-climb (aerial balance, maybe aerial ballet?). At 46 I passed my motor-cycle test and started racing 650cc and 950cc sports motor-bikes (“No Fear”… Ha!… Much fear, also much fun :). The day after my 39th birthday I gained my BPA freefall skydiving licence, and a year later got my BPA group formation skydiving licence. Not too bad for a pigeon-toed, non-shoe-wearing person. Balance did always seem different when I was off my feet, or perhaps the adrenaline had something to do with it.

    Now I often struggle to walk in a straight line or navigate a flight of stairs unaided. Wish there was a way I could take my weight off my feet! In my recurring dreams I float through the air, which is a lot of fun! 🙂

    Thanks for all your great work
    Josie G xx

    1. Josie! I am so envious of your athletic prowess!

      Thanks for detailing your interesting perspective on this ADHD & Balance issue.

      Just as I was thinking…..hmmmm, I wonder if the highly stimulating sports had anything to do with this…..I read “Balance did always seem different when I was off my feet, or perhaps the adrenaline had something to do with it.”

      We are complicated organisms!

      I too fly in my dreams….always disappointed when I awaken earthbound. lol

      g

  5. In the original post, you mentioned “a class that works chiefly on balance.” If I wanted to find such a class, do you have suggestions for terms to search for? If there isn’t something specific in my area, what do folks think about taking yoga or tai chi? Or going to a teacher in my sport, explaining that balance is an issue, and seeing if they could adapt lessons to help me?

    1. Hi Betty,

      It wasn’t solely due to a class that his balance improved. It was also due to stimulant medication.

      A quick search shows several balance classes on YouTube. Maybe you could sample those.

      best,
      g

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