Expert: Christine D. DeLoatch, MA CCC-SLP - 10/29/2009

Question
My question is in regards to my 6 year old son. He just started Kindergarten this year and had previously been in a Pre-K program. We just had our first parent/teacher conference last night and it was brought to our (myself & my husband's) attention that our son had an issue with self control. His teacher stated that he literally 'flies' out of his chair at least 3 times a day during school. At first she thought it was for attention, however being with our son for a few weeks she now knows that is not the case. He becomes embarrassed when this happens during class. She also stated that it seems to be very difficult for him to 'sit still' for any period of time, that he is constantly moving. All of this I have noticed at home as well.  He has the ability to sit and listen when I am reading him a book, or when he is watching T.V.; however, he is constantly shuffling around and moving.  These issues are not currently affecting him academically.  The teacher stated he is doing great in school, he waits his turn, raises his hand and listens to what he is told. He just has a problem with sitting quietly or in one place. He is getting disciplined by his teachers for his behavior, but only when it has been an 'all day issue', as the teacher put it.  We do not believe it is ADHD or ADD, because he does not have a problem focusing and he has never been a child to throw tantrums or act without any inhibitions. But his ability to practice self-control is in question. The teacher suggested we bring this up to our doctor, and we will. But I am looking for some advice on how to handle, deal and assess this prior to his next doctor's appointment.  It seems that everything you search the internet for in regards to self-control, hyperactivity all leads back to ADHD and/or ADD.  Please provide your advise, I really appreciate it!  Thank you!!

Answer
Dear Cortney,

Thanks for asking me your question.  It is a very good one.  Let me first explain why the all your searches continue to come back with information related to ADD/ADHD.  

Often the reason that children or adults are so fidgety is because they're brains are less alert.  The constant movement increases bloodflow to the brain and helps the individual stay more alert and therefore 'able to concentrate and focus.'  Often, when these individuals are made to be still they will either become distracted, find it painful or very difficult to sit still or may even drift off to sleep.  

Many people think that if you 'can' concentrate sometimes and focus sometimes, then you can't have ADD/ADHD.  That is NOT true.  It is a myth.  Actually, we find that many people with ADD/ADHD can become hyper-focused at times, and don't shift their attention well.  Things that are mentally stimulating, such as televistion (with all the changes in colors and the quick shifts from scene to scene), and video games and even books for many of us, we are able to concentrate on.  But things that a redundant, like math, then that might be harder to focus on.  

The question about whether or not your son should be 'disciplined' is one up for discussion.  If he truly cannot help the fidgeting, then what are they trying to teach?  Discipline is about teaching.  If he needs to move to be alert, then the question becomes is the excess movement disturbing to the class?  If it is, then you may want to look into some options.  

An evaluation by an occupational therapist, might give you some insight into how you could help your son feel more alert without him having to do the moving around.  There are 'move and sit' cushions that may help your son feel more alert and hand fidgets that he could hold when he is supposed to be sitting quietly.  

Now, the first thing would be the OT evaluation, which the doctor could give you an 'order' for.  It would probably say a diagnosis of 'sensory integration disorder.'  You need a diagnosis in order to get the school to use the tools and techniques that will be suggested.  Some teachers will go along without any problems, but others may require you to go ahead and have a formal 504 plan in place that basically says that your son has a disability, and needs to use these things to 'access' the education he needs.  That he does not need any special instruction, but does need these tools or strategies.  A person with a wheel chair needs ramps and maybe a special desk to do her best work.  Your son might need some hand fidgets or a move and sit cushion to do his best work.  

I hope that makes sense.  It is not unusual for individuals with attention deficit disorder to have problems sitting still. It really should be called 'attention dys-regulation disorder.'  The problem is not that we can't pay attention, but often that we don't pay attention at the right times or pay enough attention.  Impulsivity is one of the hallmarks of ADD/ADHD. If you are not seeing signs of disorganization, (which are hard to see in kindergarteners, especailly if Mom is very organized) or forgetfullness, then you may only be looking at sensory issues. I would start with an OT evaluation, but don't be fearful of an ADHD diagnosis if it helps you and his teachers understand your son and tells them which box of tools/strategies to work out of.  

You may be interested in a book called, The Out-of-Sync Child.  Also, you may be interested to know, that when people with ADHD try to concentrate, they often get the opposite reaction.  They get less energy to concentrate.  They may even feel fatiqued or tired.

My suggestion - Discuss it with the doctor. Get an OT evaluation (they work on sensory issues). Share results and recommendations with the school.  See if the school will agree not to 'discipline' for fidgety behavior - and maybe try other methods, like movement breaks.  

I hope that I have been of some help.  

Many Blessings to you. I'm glad you are on top of this at the beginning.  The wait & see approach doesn't usually work.  

Christine