Research: ADHD, Balance, and “Postural Sway”

ADHD balance postural sway

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? Wasn’t addressing the visual-space problem?

Then there’s my husband. He’d 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-esque 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% of Kids 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:

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

 

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?

An earlier version of this post appeared 11/11/15

—Gina Pera

 

 

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

  1. My husband was diagnosed with adult ADHD a couple of years ago. Among a host of challenges he faces, there is one thing I had not considered as being possibly related – and it may not be but it would be good to know either way. The impact of heights. He doesn’t have a fear of heights per se, but his perspective changes and he feels he is losing his balance. Thinks like walking across a high bridge (even when he’s on a wide footpath and there is a road next to him), climbing steps where he can still see the ground below, or standing on a balcony a few stories up can cause him to freeze. He doesn’t have any inner ear problems that we know of. Could this be related to his ADHD?

    1. Hi Kendal,

      Of course I can’t say for sure. But it sure seems that your husband’s issues with height and distorted perception is in the realm of possibility.

      Some people with ADHD, for example, have trouble when negotiating left-hand turns. They cannot accurately gauge the speed of oncoming cars. So they might turn too soon — or sit there forever.

      When you think about ADHD, think about the potential for erratic transmission of messages — throughout the body-brain and between the environment and the body-brain.

      One test could be if he’s taking medication and the phenomenon improves while the medication is active.

      The huge topic of PHYSICAL ADHD — that is, the various physical issues associated with ADHD — is a fascinating one. And it’s been too long ignored.

      I focus on it in my new course in my online training program, Solving Your Adult ADHD Puzzle.

      I will offer a “flash” 3-day sale around Labor Day, as a “soft launch” for the course. If you’re subscribed to my blog, you will receive a notice.

      Here is the product page (draft)

      Thanks for your question.

      Gina

  2. Not sure if this is the correct forum to post this… My husabnd has had adhd all his life, but very mild: lack of attention was his most noticable symptom.

    He was never treated for it until now. He is 52 and around the time of pandemic we both lost jobs and he literally lost it.

    He has MDD, panic, and a case of what seems like crippling anxiety. What I call “episodes” of meanness, verbal cruelty, strange motor movements, loss of dexterity (drops things) and he frequently falls during these episodes.

    It is very dangerous and i have had to call an ambulance a handful of times to help pick him up. He has bruises all over his body from crashing into and breaking furniture. Other odd symptoms include slurred speech (he is not drinking as the tranformation happens right in front of me) and a mean, bloodshot look to his eyes, many times his pupils are dilated. But the falling…it is like his legs give out from under him.

    Not sure if this is related to his adhd, or maybe it is both adhd and anxiety? He is on lowest dose of lexapro and has recently started Vyvanse but its not as long acting as we thought – if he doesnt take a bump of his previously prescribed adderall (2.5mg) at 2pm he has these awful episodes too. He used to just have them nearly every afternoon for at least 3 yrs when he wasnt taking adhd meds.

    We just need help in diagnosing whatever these crazy almost state of psychotic episodes are. In the mornings and afternoons he mostly fine, but if any stressful triggers happen or if he doesnt take his PM dose, the episodes start. Doctors have no idea what this could be. He has seen therapists and psychologists and even his GP that treats adhd has no idea what these are. There were even a few therapists that specialize in treating adhd and declined to treat him because they had no experince with this behavior! Now he is finally seeing a psychologist that specialzes in adhd, ptsd, etc. and he cant even say what this is. Any insight at all to what this could be would be so helpful. Thank you.

    1. Hi Debbie,

      I think you wrote to me recently — and I sent a response. Please look for that.

      It would be helpful to have a clearer timeline on these events. You can respond to my e-mail with that, if you like.

      I suspect the group of medical/mental-health professionals you have asked aren’t connecting some dots.

      best,
      g

  3. There is also a correlation between ADHD and hypermobility spectrum disorders (HSD) / hypermobile Ehlers-Danlos (hEDS). I wonder if that might explain at least some of the difference between those who have ADHD without postural sway vs. those that do.

    1. Interesting point, Denise.

      I can’t even speculate on that, other than to say the genes contributing to ADHD are many and varied. So, there are all kinds of other genetic differences as well.

      g

  4. Sally Jane (Sallyjane) Woods

    Thank you! This helps and makes so much sense! I have balance issues as I will be walking along and then either fall down or fall into the wall I am walking next to. I have talked to numerous doctors who couldn’t tell me why. Also, when I wake up in the middle of the night, I often stagger to the bathroom having to balance on walls, and furniture. I am 57, was diagnosed 25 years ago, but never given any intervention and continued to struggle till now when I started working with a phycologist, and once we are sure about the co-morbidities such as possible autism, then I will talk to a psychiatrist about medication.

    1. Hi Sally Jane,

      You’re welcome!

      It truly grieves me, to know how many people are puzzled/troubled by some physical manifestations of ADHD—but don’t know it. And neither do their physicians.

      I would not trust the average psychologist to be able to help you tease out co-existing issues. Many cannot distinguish ADHD from autistic-traits related to black-white thinking, social anxiety, not making eye contact, etc..

      Being officially evaluated for ADHD — a proper evaluation, not “eyeballing it” — will help you solve the major pieces of your puzzle. Treating ADHD properly often resolves what had previously been seen as depression and anxiety.

      My new course goes into depth on this. Because it’s too often done poorly. And so much time and money is wasted.

      https://adhdsuccesstraining.com/solving-your-adult-adhd-puzzle-for-couples-and-individuals/

      take care,
      g

    1. Hi Candra,

      He has taken classes with a local person, Lisa Allaire, DC, for several years now.

      I’m not sure if her Zoom classes are open beyond this area. But you could ask.

      But it’s other things, too. Yoga. And, of course, medication.

      good luck!
      g

    2. I have all of the balance problems. As a kid I was always falling off my bike, stubbing my toes, tripping, etc. Yoga and horseback riding have fixed SO much for me. Just rewriting my brain to calibrate my body’s movements.

  5. I am 72 and just dx’d with “ADHD – inatenntive type” 2 weeks ago.

    Since before adolescence I have never felt “normal.” I was physically uncoordinated – hated gym and PE (which in my high school was 5 days a week for 4 years, included swimming, field hockey, track & field, softball, gymnastics, etc). In middle school I failed the Presidents Physical Fitness test (1961-2). Non-school sports (other than dance) were not available – Title IX had not yet been invented – but I wasn’t really interested. I got good grades because I was intelligent and apparently absorbed information through my pores, something my son would later do before he was diagnosed at age 17 in 2003. We both have serious anxiety and depression (diagnosed for me at 41). Everything I did was/is last-minute, I was late everywhere (still am), have mediocre social skills, my room (and to this day, my house) was a clutter haven (I file in piles). I did not learn how to study until my daughter went to college; I learned from her. And until my diagnosis I believed it was my inadequacies, lack of effort, laziness and just missing something inside myself, I didn’t TRY.

    IF only my parents could have known, even 30 years ago….

    I can’t take stimulant meds for medical reasons, but I am told there are other ways of dealing with the bigger issues. I’m just starting to unravel all the tentacles ADD has in me and my life. I will still wobble all over the sidewalk when walking the dog, but she doesn’t mind. And I’m finally old enough to not care.

    To this day I bump into things randomly, acquiring bruises I don’t recognize. My balance has always been atrocious; I often joke that I’d fail a field sobriety test even if I were stone cold sober. Balance on one foot? Ha! I began weight training when I was 61. I’ve had some medical interruptions, but I still love doing it.

    1. Hi Lynda,

      Each new story just breaks my heart. So much needless suffering.

      Are you sure you cannot take a stimulant? Sometimes general doctors don’t understand.

      And yes, failing the sobriety test. horrifying.

      thanks fo your comment. take care
      Gina

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