Like nose-picking and a preoccupation with feculence, the inability to sit still for long periods is a defining characteristic of childhood. But children with attention-deficit/hyperactivity disorder (ADHD) often squirm constantly, even when other kids can remain still. Many parents and teachers respond by trying to get ADHD kids, at any cost, to stop fidgeting. The assumption is that if they could just stop wriggling, they would be able to focus and learn.
But a new study suggests that a better approach for ADHD kids (at least those who are not hyperactive to the point of breaking things) is to let them move all they want. That's because many kids use their movements like swiveling in a chair or folding a leg underneath themselves and bouncing in a desk seat or repeatedly lolling and righting their head the way many adults use caffeine: to stay focused. In other words, it may be that excessive movement doesn't prevent learning but actually facilitates it. (See the top 10 medical breakthroughs of 2008.)
Longtime ADHD researcher Mark Rapport supervised the study, which is set to be published in the Journal of Abnormal Child Psychology. Rapport, a professor at the University of Central Florida (UCF) in Orlando, notes that our activity level how much we move around in everyday situations is one of the most fixed parts of our personalities. If you are a fidgety kid, you will be a fidgety adult, even if you learn to manage your movements with caffeine, stress-reduction, a personal trainer or other adult accoutrements.
The idea that stimulants like caffeine (or Ritalin or even something stronger like cocaine) can help you sit still and pay attention seems counterintuitive at first. But that surprising fact lies at the heart of Rapport's work: stimulants augment your working, or short-term, memory, where information is stored temporarily and used to carry out deliberate tasks like, say, solving a challenging math problem. ADHD kids have a hard time with working memory because they lack adequate cortical arousal, and Rapport believes that their squirms and fidgets help stimulate that arousal.
His study was small just 23 boys ages 8 to 12 participated but uncompromisingly meticulous; it took four years to recruit, screen and test the participants and to analyze the results. Twelve of the boys had an ADHD diagnosis. The other 11 were developing normally. All underwent a battery of tests at Rapport's lab over four consecutive Saturdays.
Since I've always been fidgety, I asked Rapport if he wouldn't mind putting me through the same tests he gave the boys. And so last week I found myself at the UCF Psychology Department, where a grad student affixed a device called an actigraph to my left wrist. Actigraphs look like digital watches and generate a signal each time they are moved, even slightly. They allow researchers to measure, quite precisely, a subject's kinetic activity. The boys in Rapport's experiments wore actigraphs on their ankles as well as their wrists because kids are often just as twitchy below the waist as above. (See the most common hospital mishaps.)
Wearing the actigraph, I sat before a computer in a small windowless room and took working-memory tests. For one test, I had to recite aloud a series of numbers that appeared on the screen. I was asked not only to remember the numbers but also to restate them in proper numerical order. So if I saw 4, then 3, then 1, then 8, I had to say, "One, three, four, eight." Each series of numbers also included a random letter, which I had to state at the end: "One, three, four, eight, D."
At first the test sounded simple, not least because I knew an 8-year-old could ostensibly complete it. But I found it quite difficult. Working-memory tests require intense concentration, and I was distracted because I was nervous. Rapport, several of his grad students, a UCF public relations official and a friend of mine were all watching me through an open doorway while I performed the tests. I ended up scoring worse than some of Rapport's kids.
My experience of being nervous was instructive because it mimicked, in a way, the cognitive strain under which an ADHD kid takes such tests. ADHD compromises the brain's executive functioning its ability to master unexpected exercises. The same way I got nervous, ADHD kids get momentarily lost, their attention fractured for a few seconds. Think about when you're reading and get to the end of a paragraph and realize you haven't been paying attention: that's what it's like for ADHD kids, all the time. My actigraph scores confirmed that I wasn't operating normally for a 38-year-old adult. Instead, during the experiment, I displayed the involuntary body movements of a typical 12-year-old boy. (See pictures of a diverse group of American teens.)
Rapport also conducted a control experiment with the boys in which they watched the pod-racing scene from Star Wars: Episode I The Phantom Menace. He showed me a video of a couple of the boys watching the scene, and I was shocked: even the ADHD kids who had spun around endlessly during their cognitive tests sat perfectly still while they watched the pod race. The film clip required almost no working memory, no concentrated effort. The scene simply washed over the passively watching boys, none of whom had to move around to stay alert.
Which suggests a classroom technique for ADHD kids: Don't overly tax their working memory. Rapport, who used to be a school psychologist, says the average teacher doesn't understand how ADHD kids process information. "If you go into a typical classroom," he told me, "you might hear, 'Take out the book. Turn to page 23. Do items 1 through 8, but don't do 5.' And you've just given them four or five directions. The child with working-memory problems has dropped three of them, and so he's like, 'Page 23 what I am supposed to do?' " Similarly, a parent might tell a kid, "Take my keys, go to the car, get your sister's toy, and before you go, take the trash with you." The ADHD kid will get to the car without remembering what else to do. Their instructions must be broken down carefully because their working memory is weak.
When I asked Rapport whether there's a cure other than breaking down instructions, his answer was a bit depressing: no. ADHD is incurable. Drugs like Ritalin are a common answer for controlling the condition, which affects about 3% to 5% of children, but Rapport notes that they have proven to be only a limited solution. In the short term, they can facilitate a child's ability to read undoubtedly a crucial benefit but Rapport says longitudinal studies have failed to show that Ritalin or other psychostimulants have consistent long-term behavioral effects. (Even if they did, another question would arise: Would you want to be dependent on a stimulant for the rest of your life?) Rapport hopes that his work will lead to the development of early behavioral and cognitive interventions that could help the youngest ADHD kids recognize, predict and somehow avoid ADHD's concentration gaps.
Such research is in its infancy, though, and if you have a child with ADHD, it's important to understand that he processes the world in a different way. He might be (literally) running circles around you, but that may be his way of paying attention.