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).


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



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

  1. 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.


  2. 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,

    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 🙂

  3. 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


  4. 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.


  5. Yes. I have adhd and postural sway. I’ve always noticed it, but just thought it was a personal thing of being a clumsy person. I didn’t realize it was a trait of having adhd. Sometimes when I’m walking (just in a straight path), I can sort of veer off one step to the side. Then I have to get back to walking in a straight line again. It can almost look like I’m tipsy, like I’ve been drinking (and I don’t drink at all, I never have).

    I really appreciated reading your article. It’s good to know that it’s not just a “me” thing. (Oh and btw. I definitely have broken my fair share of objects around my home too. My sister always says as a joke, that I’m “the reason we can’t have nice things.” She’s right; don’t let me hold or move anything breakable lol).

    1. I’m the same, I’m undiagnosed and unmedicated but at 47 I’m starting to realise that ADHD could explain many things about me that I thought were just ‘off’, it’s enlightening to realise that balance issues could part of ADHD too. I’ve always been ‘the clumsy one’ – the last kid to be picked for sport in school. I had balance exercises aged 6 or 7 – trying to walk along the edge of a plank on the floor. I trip and fall every few months when out walking, I can’t descend stairs without looking down at my foot placement. I walk into door frames, spill drinks when carrying a cup – so many things that I’d be here all day if I listed them all! Thank you for highlighting this!

    2. Hi Jo,

      I’m so glad you found my post here at the ADHD Roller Coaster.

      It’s sort of been my mission to discover and share with readers the various ways in which ADHD neurobiology can affect us physically.

      Most people think ADHD is all about “focus” and “attention” — but dopamine signals affect so many physiological systems. Including how fast and well food moves through the digestive system!

      I hope you’ll keep poking around the ADHD Roller Coaster. I bet you’ll find other surprises.

      take care,

  6. Thank you for writing this post on Postural Sway.

    I thought I would share my own anecdotal story. It explains so much of what makes me, me. I could hardly walk in a straight line and had difficulty in all, any sports. I only found one activity that was somewhat attainable, skateboarding. I attribute this oddity to the sagittal plane of the body being tangent to the direction of movement. Fast-forward, at 38 I finally received a diagnosis for type-1 ADHD and now have a script for Adderall. What I have noticed is a night-and-day difference in coordination. I swim almost daily and consider myself an “ok” swimmer but up until recently lacked the coordination for interdependent movement of my arms and legs. Now, I can pull my daughter around the pool with one hand, paddling with the other and kicking legs independently. Commenting here is possible because of my medication.


    1. Dear Andrew,

      Isn’t that AMAZING???

      Isn’t it incredible that so many people struggle likewise without having a clue as to why?

      I’m glad you figured it out and that you are benefitting. Along with your daughter.

      Interesting theory about the skateboarding. I haven’t done a scientific study but it sure seems to me that skateboarders are over-represented in the ADHD population. 🙂

      thanks for your comment.


  7. It’s amazing how the more I learn about ADHD the more my life makes sense. Everything from intense emotions to auditory processing problems, and now it seems that my life long struggle with running into everything is related too!

    I am always running into door frames, tables, stubbing my toes on the bed, dropping things without any particular reason. (I also struggled with riding a bike as a kid, I hated it and gave up quickly because I just couldn’t do it.)

    I’ve been diagnosed with vertigo in the past but now it makes me wonder if it was just a symptom of undiagnosed ADHD all along.

    It’s comforting to know that it’s not just me.

    There is something though that I experience that is strange, and very difficult for me.

    When I’m walking down the stairs especially if it’s more than one flight of stairs. I have to pay very close attention and go very slowly. (It also helps if I count the steps in my head) because it’s almost as if the stairs flip in my head. It looks to me as if the stairs are going up even though I know they are going down. Because of this I have a hard time spatially knowing where to put my foot. I’ve definitely broken down crying and had a panic attack on a spiral staircase before because my brain just couldn’t process it.

    It’s very frustrating and embarrassing in the moment. But knowing that it could very well be related to ADHD makes me feel more confident in a way. Like it’s not my fault it’s just the way my brain works.

    1. Dear Nikki,

      I’m delighted to have shed some light on issues you find useful.

      I think I understand what you mean about walking down stairs. Our brain must make sense of the odd geometric space of stairs. If our brains are not “processing” that fast enough, it’s bound to case trouble. That sounds terrifying to me. I’m sorry you’ve had that experience.

      You remind me of a friend’s mother. Especially in her later years, she had trouble walking on sidewalks or other areas where she was unfamiliar (e.g. not in her home). It wasn’t that her legs were the problem; rather, it was her depth perception. Or so her doctor had said.

      But here’s the interesting thing: After her husband died (he was not the nicest man…harsh and barking and critical despite her being a great cook, mother, etc.), she started dating a widower about her age (70 or so).

      She was like a different person. Eyes wider open. More smiles. She told me, “Gina, it’s like I have awakened! I taste flavors I never tasted, hear things I never heard, felt things I’ve never felt.” (Spoiler alert: I think she was talking about sex here!)

      And of course, with me thick in the study of ADHD, I’m thinking to myself…..sounds like dopamine!

      Then I invited her to go for a walk with me. I was curious…. 🙂

      She was JUST FINE. No hesitation at all in her walking.

      The “new love” and happiness seemed to have sparked her dopamine transmission.

      So, I’m wondering if you ever tried medically treating your ADHD?

      Thanks for your comment.

    2. I just wanted to give an update. It turns out I am Autistic, and I have ADHD, and Dyspraxia. And with that info I would say that dyspraxia would explain my visual and spatial perception difficulties -especially my issue with walking down the stairs m.

      From what I’ve noticed a lot of neurodivergent people also have dyspraxia/dyspraxic traits but it’s still largely not talked about and wildly unknown, and underdiagnosed.

      It’s where your visual perception inhibits your gross motor skills- so bad at sports/riding bikes/dancing, always running into things/dropping things. Difficulty telling left from right and reading maps. Difficulty rotating objects in your head. Balance issues, and difficulty with fine motor skills like writing/shoe tying.

    1. Hi Thomas,

      I cannot speak with authority on neurospatial issues and ASD (autistic spectrum disorders). But it is definitely a problem associated with ADHD ADHD.

      I would imagine that, neurospatial coordination being a complex brain function, it would be affected by many brain-based conditions.

      But also, the last I checked the research, about 50% of people with ASD also have ADHD.

      Too often, I’ve observed, the ADHD is missed by ASD specialists.

      That means some people with ASD/ADHD do not get the treatment they deserve—treatment that might make a huge difference in their functioning, mood, etc.

      I hope that answers your question.


  8. What a great find.
    I have been receiving treatment for exactly this problem from highly specialised functional neurologist chiropractors for some years.
    I was a Family Physician in Australia, diagnosed ADHD in 2008,
    I retired due to my severe health problems stemming from the arthritic neck last year. Despite that my ADHD symptoms are vastly better than they were.
    I have seen many individuals with ADHD and virtually all have a similar pattern.
    While the pattern is less severe than overt dyspraxia in many, the vast majority that I have seen have a triad of vertical hetorophoria with dysfunctional eye movements ( a working memory hog ), balance dysfunction ( often with fear of heights and a pattern of often getting lost) detectable signs of cerebellar dysfunction and upper neck issues.
    A TBI affecting the frontal lobes, a whiplash, a birth injury can all set this pattern off, but there many other causes too.
    If eye alignment is lost the balance system and neck will also become dysfunctional.
    Most adults I have seen also have a secondary dysfunction of the sympathetic nervous system that can add a little cerebral blood when upright.

    This syndrome is sufficient to cause all ADHD symptoms, and is ameliorated by both the noradrenergic and the dopaminergic effects of psychostimulants.

    I’m currently working on fleshing out all the details on my blog.
    I now have enough new material to properly reference all the missing holes, and wil, rework it and, with luck have a publishable book within 12 months, proposing a multidisciplinary aapproach to ADHD.

    The only real limitation is that my neck issue was discovered after severe osteoarthritis set in, so my physical health. is a hindrance.

    However it is great to see another source recognising this association.

    As above, in Sweden, the classification. DAMP ( deficits of attention, motor control and perception), has been created.

    In neurological terms all thinking involves planning the next movement, (even if that is writing or speaking) , to the extent that premotor areas for the proposed movement are activated) so movement and cognition are two sides of the same coin. This changes how we think about attention.

    I have linked to the blog below. The material from the last 19 months benefits from some substantial results from upright MRII. It will all be overhauled soon

  9. I’ve been looking into ADHD a lot more lately. I’ve learned a big part of it is a dopamine deficiency. Not only does dopamine impact motivation, but it impacts motor skills. I’m wondering if our likely dopamine deficiency is the culprit, or at least a big factor, of our clumsyness.

    1. Hi Becca,

      Dopamine transmission is mostly at the center of everything about ADHD.

      It’s not a “dopamine deficiency,” however, even though many people explain it that way.

      There are various issues with the way dopamine is utilized at the synaptic gap — the space between two neurons, where they “communicate” with each other.

      Search for “dopamine” in my blog’s search box, and you’ll find more.

      I also explain the basics in my first book, Is It You, Me, or Adult A.D.D.?

      Thanks for visiting,

  10. Loved learning more about this- we’ve always assumed that our child’s clumsiness was in some related to their ADHD. We’ve enrolled them in Tae Kwon Do as a way to help and it’s been great.

  11. Hi Gina,

    Our 14 year old daughter with ADHD has no balance, cannot even ride a bicycle with training wheels and is always coming home from bruises (of course, she doesn’t remember how she got them…) We always suspected it had something to do with the ADHD, so it is so reassuring to read your post to confirm it. The best, hearing how your husband got better 🙂


    1. Hi Miriam,

      That sounds like a hard way to go through life, bruised. 🙁

      I encourage you to consider doubling-down on optimizing her medication treatment. Then maybe a class in dance, certain types of yoga, etc.

      thanks for writing,

  12. Sylvia Carlyle

    This is interesting. Being able to walk is a feat of both balance and co-ordination, so most people who can walk can improve both by taking up a sport, or dance. or strength-training. I recommend a book entitled Fitness over Fifty – it emphasizes strength and balance – the exercises work for the under-50s too! There is also now a great deal of research to show that dance is good for both mind and body, especially as one gets older.

    Joining a contemporary dance group 7 years ago has resulted in me, at age 67, being stronger and more flexible than I was at age 40! These activities aren’t necessarily for everybody, but finding some physical exercise you enjoy can make a real difference. Lastly, one of the things I do all the time is practice balancing – in queues, odd moments through the day, and the warm-ups in my dance group always include balance exercises.

    My ADHD can cause me much grief, but as a result of these activities, I feel much more confident as I move about in the world.

    1. Thank you, Sylvia, for those useful suggestions!

      Balance is definitely so important as we grow older.


  13. Just found this post while searching for info about ADHD and clumsiness. Do you think a change in meds would be the first approach to improving balance? And what else? Would practicing balance exercises help? Or physical therapy? I am mildly clumsy, was left out of sports as a kid, but as an adult have found other sports that don’t involve figuring out where myself and a ball will meet. I’ve been whitewater kayaking for about 15 years, over which, with lots of time and effort, balancing my boat on all kinds of crazy water has become instinctive, but I just cannot get the Eskimo roll (a fairly complex series of movements to flip an upside-down kayak right side up). Maybe I need an approach other than yet another new teacher?

    1. Hi Betty,

      Interesting question.

      Digression: You remind me how much I love white-water rafting! But hadn’t done it since I left East Tennessee. So, good for you!

      I remember the Eskimo roll during my limited time kayaking in rivers. I found it scary.

      I wonder if one impediment is not so much with ADHD-related balance or motor coordination but instead a fear response.

      When our brains go into survival mode (limbic system), that somewhat dampens functioning of our rational brain (prefrontal cortex).

      Is your medication in effect when you are attempting this? Does your medication work well in the rest of life?

      Maybe a new teacher….I would imagine that lots of dry-land practice might help to create some “muscle memory” — which might help in over-riding the brain’s fear or “fight or flight” response.


    1. Oh no, I think your point was apt.

      I just wanted to make clear that the U.S., like Sweden, has for a long time acknowledged this potential aspect of ADHD.

  14. Interesting, but maybe not surprising? In Sweden “motor control” issues has been one of the things connected (in official guidelines) with adhd for at least 10 years. It’s even listed as “signs to look for” in many official papers on adhd. (But there are no swedish studies on the subject that I know of though.)

    From personal experience I must say it’s obvious. Not for me personally (although I have adhd) for me I would even say the opposite, but from people close to me. So many broken arms, accidents, clumsiness. And even just watching the movements of the people I describe it’s obvious. Very little Control. Very little awareness of surroundings. Crash, boom, bang, ouch! is the norm.

    1. Hi PH,

      Thanks for sharing that tidbit about ADHD in Sweden. You make an important point.

      I think we’re talking about two different but related things.

      Motor control might be defined this way:

      Recent psychological theories of motor control present it as a process by which humans and animals use their brain/cognition to activate and coordinate the muscles and limbs involved in the performance of a motor skill. From this mixed psychological perspective, motor control is fundamentally the integration of sensory information, both about the world and the current state of the body, to determine the appropriate set of muscle forces and joint activations to generate some desired movement or action. This process requires cooperative interaction between the central nervous system and the musculoskeletal system, and is thus a problem of information processing, coordination, mechanics, physics, and cognition.[2][3] Successful motor control is crucial to interacting with the world, not only determining action capabilities, but regulating balance and stability as well.

      Here in the U.S, ADHD is generally known to be associated with risk for motor-coordination challenges. That includes fine motor skills (hand-writing, etc.) and gross motor skills (coordinating movement, such as with playing soccer).

      And here is a simple definition of postural sway:

      Postural sway, in terms of human sense of balance, refers to horizontal movement around the center of gravity. This sway is essential due to the many large and small changes in the center of gravity due to functions such as walking and breathing.

      My understanding is that “motor coordination” refers to global challenges and “postural sway” refers to one aspect of motor coordination. This research provides some evidence as to what is actually happening and to what degree — with more precision than simple observation.

      How many accidents could be prevented if this were known about individuals early on.


  15. I always thought the clumsiness was due to inattention/distraction of surroundings, hyperactivity or moving to fast without thinking or impulsive action: the core symptoms of ADHD, as noted in the DSM 5, the manual that’s used to diagnoses the deficit-trait. And I believe scientific articles show the increased risk of accidents for those with ADHD due to those core symptoms. The risk increases when medication isn’t on board. This is the first time I have heard that balance is due to a structural brain difference or the size of someone’s brain or skull or that this would have a connection to ADHD.

    Before a diagnosis of ADHD is made, usually a through physical and history is taken to help rule out physical conditions that may look like ADHD. Family history is assessed as well, since ADHD is highly heritable and tends to run in families. Scientific validated rating scales for things like ADHD, Executive Functioning and any other suspected mental health conditions should or are typically be collected (especially before, during and post medication trials). For the ADHD diagnosis, symptoms have to be present in at least 2 environments (home & work or school) and assessed in an unmitigated state. Brain scans, MRI’s, etc… are rarely part of an ADHD work up for diagnosis due to the expense and lack of definitive diagnosis from tests like that. It will be interesting to see how things change in the diagnostic process over time.

    It’s amazing we can find a needle in haystack, but trip over the large boulder right in front of our face. I’m giggling about this right now because both of my sons (each of whom have ADHD) just ran into a metal rack holding napkins at a Party Store. The one son responded by getting mad and throwing the napkins on the shelf and the other didn’t notice what his bother did and proceeded to do the same thing. Too funny.

    1. Hi Gwen,

      Oh, I hate to laugh….I hope your boys weren’t hurt…but that IS pretty funny. Especially the different reactions from two boys who both have ADHD.

      Absolutely, we cannot attribute all ADHD-related “clumsiness” to cerebellar function. Distractibility, hyperfocusing on one thing (needle) and missing the other things (e.g. haystack…the rack!)…all that can play a role.

      Yes, it will be interesting to see how the diagnostic process changes over time.

      I suspect it will be many years before Machine Learning/AI can be more accurate than a good clinician who knows how to take a thorough history, ask the right questions, and piece it all together.

      Not even genetic study will be diagnostic, at least at this point. It’s thought that 100s of genes are associated with ADHD, and they are not exclusive to people with ADHD. It’s the number of genes, in the presence/absence of other genes, that can create the syndrome we know as ADHD. 🙂

      Thanks for your comment.

  16. I read this thinking, “Wow, what other actions controlled by the Cerebellum could ADHD affect?”

    Then I read through the comments and saw my own from 4 years ago, lol!!
    Yeah, I was waaaaaaaaaaay improperly medicated back then.
    And I was moving then too! Go figure! 😉

  17. Grendel’s Mom

    I am reading this while lying on the couch with a broken leg, a broken wrist, and a broken elbow, as a result of a bicycle accident running into a traffic calming pole 10 days ago.

    I figured this was ADHD related in that I was probably Momentarily distracted just before I ran into the pole.

    But I now recall that it did take me two years of daily practice, enforced by my mother every day in the summer while I wept and begged her not to make me do it, to learn how to bicycle. I kept falling off. I hated it so much. And I have never been good at sports and I can’t catch things and I am not graceful.

    So maybe I just wobbled where a normal person wouldn’t wobble and that’s why I now have enough titanium in my femur and tibia to set off metal detectors in the next airport. And maybe I should be taking my stimulant medication even though it is a summer holiday. But come to think of it I did take it that morning.

    I guess it doesn’t make any difference then and I just can’t ever do anything fun for the rest of my life. I am feeling very sorry for myself right now

    1. Aww nooooo. Poor baby! I’m so sorry to hear this. Leg, wrist, AND elbow. Gah!

      My rule when I am sick or injured is: DON’T THINK. 🙂

      The inflammatory healing response can make our brains go screwy and we’re more vulnerable to depression. So I try to push off any “Big Thoughts” and distract myself with movies or books.

      Who knows. Maybe it was distraction. There is so much on the roads these days to distract us. So much activity. And cars going too fast.

      Or maybe poor coordination, visual distortion, slow response time, etc. — all the things that can be fallout from ADHD.

      Maybe your medication could be improved, or maybe it wore off by that time.

      But maybe, hey, bicycles are not your thing, and that is perfectly okay! Lots more fun to be had in the world.

      I hope you are being cared for and resting comfortably.


    2. Look into Developmental Coordination Disorder (often called Dyspraxia). It is a brain-based movement disorder and very often is a comorbid condition with ADHD. Kids with this disorder typically struggle to climb stairs, use scissors, hold a pencil, button and zip clothes, play sports, etc. There is often a maturational lag with fine-motor and/or gross motor movements, because the brain struggles to choose, plan and coordinate those movements. Balance is typically , but not always, a big problem, and might be the “sway” this study refers to. Speech can also be affected, in terms of making certain sounds, modulation of volume, etc. Like ADHD, there is a great deal of individual difference with DCD.

    3. Hi M.B.,

      Thanks for mentioning dyspraxia. I struggle to keep my blog posts short—while writing on complex topics. 🙂

      But I should have at least made a mention. I did look for research on the connection between dyspraxia and ADHD but found no authoritative scientific papers but found none.

      I find this sentence of yours very helpful in particular in making the connection to core ADHD neurobiology: There is often a maturational lag with fine-motor and/or gross motor movements, because the brain struggles to choose, plan and coordinate those movements.

      My understanding of dyspraxia is that, as with so-called Central Auditory Processing Disorder (CAPD), it is more of a “side effect” of ADHD rather than a standalone condition. That is, it’s what some allied specialties (learning specialists, occupational therapists, etc.) call a certain presentation of ADHD neurophysiology. Perhaps as a holdover from earlier times when we knew less about the brain. Perhaps simply the lack of cross-disciplinary understanding.

      The last I researched CAPD, I found there’s little evidence that it exists except as secondary to ADHD. Moreover, the research shows that methylphenidate, a stimulant, is typically helpful. Yet, if you ask some speech therapists, they do not know this. A family member who recently graduated as a speech therapist from a top school said her professor said that CAPD resolves by age 12. Yikes.

      With both conditions, along with dyslexia, dyscalculia, etc., the list of symptoms often are almost exactly the same as ADHD.

      I see so many parents of children with ADHD become confused and overwhelmed by the string of terms. Each field has a different term to describe various ADHD-related phenomena and often a different treatment, too. But some of those treatments are more effective than others. In my observation, treating the ADHD first can go a long way toward resolving many “dys” conditions.

      thanks for your comment,

  18. Lorraine Hopkins

    Great article! I am also left-handed which seems to add another level to my clumsiness – perpetually bruised!

  19. Wow. This one really hits home. I have bruises upon bruises on my shins and thighs, most of these I attribute to my (injury-caused) blindness in one eye and lack of depth perception. But I do tend to sway, rock back and forth when not in motion. I’ve always assumed it is a stimulant-related side effect of my medication. Food for thought. Speaking of stimulants, I usually need to take one to sleep, to turn my brain off. My doc said that is rare, but I wonder… anyone else?
    I have developed quite good balance though, using little tricks, like bending the knee of the supporting leg a bit more when balancing on one foot (lowers your center of gravity) in the shower.
    This blog has helped me understand my condition so much. Thanks for sticking with it!

    1. Hi Nathan,

      Thank you so much! The only reason I keep going after 20 years is because of feedback such as yours. 🙂

      re: stimulant helping sleep. You are NOT rare. I’ve offered this strategy for at least 15 years. At least as something to try — on a night when it won’t matter the next day if you’re sleep deprived, and perhaps a lower-than-average dose of your stimulant. I mostly get quizzical looks of disbelief.

      One guy at my Palo Alto face-to-face group finally tried it. It worked! But he stopped it, because he found it so paradoxical. lol

      For some people, it definitely can help to “organize” the brains so you can sleep. I’ve written a few articles on ADHD and sleep that mentions this. I need to post them here.

      For other people, poorly managed anxiety can make it impossible to use this strategy. It’s always hard to know, though, what is anxiety caused by ADHD fallout and what is brain-based-neurobiological anxiety. It takes some trial and error.

      Sometimes Adderall won’t work so well in this regard, though.

      I’ve met late-diagnosis old-timers (in their 50s, 60s and even 80s) who their entire lives have used coffee at bedtime to promote sleep. Won’t work for everyone. But it did for them.


  20. Interesting! I have always had problems with coordination of movements and balance, but never thought it could relate to adhd. On certain days it appears to be more prominent than on others. Putting my pants on while standing can be a challenge.I broke an unnumbered amount of glasses .I am used though to make a special effort of concentration while handling valuable objects. It didn‘t outgrow and clumsiness remains to be my middlename- but not when I hyperfocus. Thanks for the article, Pera.

    1. Hi Gert,

      I’m happy to have provided a possible clue!

      Yes, it makes sense that some days are worse than others when it comes to maintaining balance.

      Poor sleep, stress, etc…..can affect all of us humans with coordination, cognition, etc. So it makes sense that balancing might be more challenging on some days than on others.


  21. 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.

    1. Hi Heather,

      Wow! I did not think of that, but you are absolutely right! Sheez!

      Thanks for your comment.


  22. Omg I have this issue and I have tested myself over the years before diagnosis with ADHD I have always been clumsy but I thought it was I moved to quick before brain could catch up. I now do my walks close my eyes and see how straight I can walk. Well its never straight I always tend to go to one side and I can feel it. Weird thing.

    1. Hi Kim,

      That does sound like a weird thing to experience. You better not get pulled over for drunk driving. 😉

      Have you tried stimulant medication, and, if so, have you noticed an improvement?

      Thanks for your comment,

  23. Gina, that is insane–I went through some ROTC training (never entered the military) and was told that I could trip over my own two feet on a flat surface. I had so much trouble with basic drill and parade exercises. Not to mention the endless physical training! I didn’t go into the military because of an unrelated illness that wasn’t discovered until after I finished ROTC. However, I can never wear high heels, and right now I have two huge bruises on my shins from bumping into our coffee table. It’s so good to see these relationships!

  24. So interesting. When my stepson (who is a young adult with ADHD) was living at home, we had so many broken dishes. It was uncanny, as least that is what I thought at the time.

    1. I hear you, Cheri. My husband seemed to break whatever dish was sitting on the counter.

      He did have “insight” into this. He said, “Don’t leave anything around that you value.” 🙂

      He thought it was because he is of a rather “lumberjack” build.

      It took me a few years to make the connection to ADHD.

      He hasn’t broken anything in years. 😉


  25. OMG! I have always had this problem. I never knew it had anything to do with my ADHD.
    My son is constantly bumping into objects/furniture too.
    Oh man…something else for me to research.
    Thanks Gina!

    1. Oh, interesting, Liz. I hadn’t thought about that angle. I wonder how many parents have been thought guilty of abuse, due to unusual bruising.


    2. Hi Liz,

      Yay! Glad to shed some light on this.

      My husband has gotten much more coordinated over the years (thanks to medication) and also more aware of “where he is in space.

      Drives me nuts when these platitudes about ADHD surface that it makes people great athletes. There are too many children with unrecognized ADHD whose neurospatial difficulties and motor coordination problems make it hard for them to play team sports — or even ride a bicycle.

      Parents have a right to know this is an issue and that medication might help.


    3. You know what is even more crazy?
      I have been told that he has sensory processing disorder, which I know is a common comorbidity.
      I just wonder if he really does have a sensory issue, or he just has my ADHD genes.
      He went to OT for a while, and a play therapist. He seems to be self-regulating pretty well right now.

      I run my knees/elbows into things a lot. I have not dropped anything in a long time.

      thanks again for the info!

    4. Hi Liz

      What I’ve learned is that, with ADHD and its many co-existing conditions (depression/anxiety, etc. but also auditory processing, sensory processing, dysgraphia, etc.), the “label” depends on the specialist. There are many “silos.”

      If your son is doing well, great. But I’ve seen so many kids who first saw an OT and had the therapy, and might have experienced benefit sensory-wise (or aged out of it) but still had ADHD symptoms.

      ADHD has many physical manifestations, but this is not widely known.


  26. hi Gina,

    I really love your posts! Not only the informative subject matter (for ex ‘postural sway’ but also for your great illustrations, graphics, etc really terrific!


  27. Hi, I wonder if the sample people had also been tested for hypermobility. I don’t have a link to the site but last week I read about a study showing a correlation between hypermobility and anxiety. So, in addition to neurological factors, there could also be a linked physiological factor, as in laxity of joints.

    Kind regards
    Marianne Doczi

    1. Hi Marianne,

      Fascinating. It’s past time that we learn about the various physiological effects of “brain” conditions — especially since the brain is the body’s headquarters. No pun intended. 😉

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