What is ADHD?
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder which often originates in childhood and is chronic. Symptoms manifest as hyperactivity, inattentiveness, and impulsivity.
People with ADHD often have difficulty transitioning between tasks, struggle with initiating and completing tasks, have working memory issues, and frequently lose or forget things. They may become distressed with small changes in routine or environment and can exhibit rigid thinking.
Executive functioning problems, hyper focus and time management issues are additional challenges with this diagnosis. ADHD can be treated with medication and/or behavioral therapy.
How is ADHD tied to repetitive behaviors?
A common symptom of ADHD is repetition of behavior performed in an effort to self regulate and cope with emotional or sensory challenges. Repetitive behaviors are known as stimming and can be carried out to self soothe or improve focus and attention in times of anxiety, stress or excitement. Repetitive movements can also help people process emotions or to self stimulate in times of boredom. Repetitive behaviors can be related to movements, sound, touch or visual stimulation. Repetitive behaviors that are associated with ADHD can be conscious or unconscious.
Examples include:
- finger tapping
- leg shaking
- fidgeting
- rearranging objects
- humming
- rocking
- swaying
- lip biting
- nose picking
- hair pulling
- skin picking
- making repetitive sounds
What triggers repetitive behaviors in ADHD?
Overstimulation:
Repetitive behaviors are often a self regulating mechanism used to achieve a sense of balance through routine and sameness. If a person is overstimulated due to stress, sensory overload, or excitement, they may find that repetition of motion shifts their focus away from the excitatory triggers and into a trancelike rhythmic state.
Understimulation:
It is common for people with ADHD to crave novelty and newness. When a person is understimulated due to boredom, lack of mental challenge, or absence of novelty, the rhythmic movements of their body can help awaken the senses and restore a sense of perceived balance.
Brain structure:
The distinct neurology of the ADHD brain can trigger repetitive movements due to structural differences, altered cerebral blood flow, and variations in brain activity. The brain anatomy influences a complex network of interconnected brain regions involved in motivation, reward seeking, learning, emotional regulation, and impulse control, each potentially related to increased motor restlessness.
The prefrontal cortex (PFC), located in the frontal lobe of the brain, is involved in the planning, sequencing and execution of motor activities. There is an activation of the PFC associated with repetitive movement. These repetitive movements can lead to flow states which are characterized by deep immersion in activity and often a lack of body awareness. It is a melting together of action and consciousness.
Reward Seeking:
The flow state that is evoked during the repetitive movement can be intrinsically rewarding, and the gratification and satisfaction that accompanies the reward can become habitual and automatic. People in this flow state often lose track of time.
Its self regulating function adds to the gratification. Repetitive motion reduces anxiety, releases excess energy, helps maintain focus, and provides added stimulation when bored.
In addition, an ADHD brain shows deficits in dopamine which is a crucial neurotransmitter for motivation, pleasure sensation and behavioral reinforcement. Too little dopamine results in reward seeking behavior which leads to impulsivity often seen in ADHD.
What is the treatment for ADHD and its accompanying repetitive behaviors?
Treatment options include cognitive behavioral therapy (CBT), medication management, sensory integration treatment, executive functioning training, and academic support. A combination of these strategies can help a person with ADHD manage their core symptoms and significantly improve the quality of their life.
Cognitive behavioral therapy can assist individuals in improving focus, organization skills and regulating emotional states. The cognitive component of the therapy focuses on reframing distorted thought patterns common to ADHD. Behavioral therapy helps manage the impulsivity and inattentiveness that comes along with ADHD. Some behavioral interventions include building structure and routine, teaching organizational skills and time management, and breaking down tasks into manageable steps.
Habit Reversal Therapy can help individuals reduce stimming behaviors and find alternative ways to self soothe. By providing other types of sensory input, the individual can self regulate without disturbing others.
Certain medications can assist in balancing the neurotransmitters in the brain, helping with focus and improving overall functioning. Both stimulants and non-stimulants are prescribed for ADHD. Some trial and error regarding dosing and medication type may be necessary to achieve the desired result.
Sensory integration therapy individually tailors treatment to assists individuals in processing, integrating and organizing sensory information. People with ADHD struggle to integrate sensory information from the environment and from their bodies, causing sensory overload or a lack of sensitivity to stimuli. Sensory integration therapy helps individuals with ADHD function better in every day life.
Schools can provide unique resources and strategies to help manage inattentiveness and hyperactivity. Extra time, a quiet classroom, note taking assistance, and reduced course load can all help to improve academic performance.
What are some examples of helpful strategies for people with ADHD and repetitive movements?
- Keep hands busy with fidgets, stress balls, putty, etc
- Engage in a craft like doodling, knitting, needlepoint, etc
- Equip yourself with textured or colorful stimuli that are interesting and satisfying
- Wear noise reducing headphones
- Change location to remove sensory or environmental triggers
- Take breaks to release excess energy through movement
- Practice breathing and meditation
- Engage in a regular a exercise routine
- Partner with someone to maintain accountability for task completion
- Break tasks into smaller, more manageable steps to increase confidence, focus and productivity
- Organize your environment to reduce clutter and distractions
- Keep a journal to help stay mindful of emotional or sensory triggers and to reflect on helpful strategies
If you or your loved one struggles with ADHD, reach out to Advanced Behavioral Health. The Director, Dr. Suzanne Feinstein is a Columbia University-trained Clinical Psychologist who helps people overcome increased motor restlessness associated with ADHD, emotional dysregulation, impulsivity, Body Focused Repetitive Behaviors, as well as the full spectrum of anxiety and mood disorders. Dr. Feinstein specializes in evidence-based treatments such as Habit Reversal and Stimulus Control Techniques (HRT), Exposure Therapy and Response Prevention (ERP), mindfulness, hypnotherapy, Acceptance and Commitment Therapy (ACT), Dialectic Behavioral Therapy (DBT), and other CBT techniques.