I am interested in the role of attention in gait disorders. Do kids with ADD have gait changes? What did you use to analyze their gait?

No sure ly its a very interesting and rare field as much i know as an occupational therapist if we cal know the ratio of energy produced n used in them in al activity it ll be a great help to handale teheir situation..

The lab I work at is very interested in the relationship between motor control and ADHD (http://lnir.kennedykrieger.org/publications.html) . We use the PANESS a lot, which has worked well. It doesn't really measure gait per se, but gets at a lot of things that I would imagine are gait-related.

Not familiar with gait disorders. Often observed in children with cerebral Palsy .Please post your results. Currently doing a case study on a learner with ADD. If anyone has some interesting information please forward.

I am not aware of any gait difficulties in children with adhd. Children who have difficulties focusing in class, might excel in sports. I understand that Michael Phelps suffers from adhd. I suppose he doesn´t have problems to walk .

I never have heard something like that, it doesn´t make me sense

I work with adult ADHD. Reprorts for balance disturbances among ADHD children have been reported in the bibliography. I am interested for methods that help to assess gait disturbances in both children and adults with ADHD.

This paper sprang immediately to my mind when reading this post; hope it helps!

Leitner Y, Barak R, Giladi N, Peretz C, Eshel R, Gruendlinger L, Hausdorff JM.(2007) Gait in attention deficit hyperactivity disorder : effects of methylphenidate and dual tasking. J Neurol. 254(10):1330-8.

Hi all.

I agree with Stephen concerning the difficulties in the nosological classification of ADHD; I guess this is also why it is defined as a syndrome (a collection of symptoms that appear to occur often together) and not a disease (whereas, e.g., Schizophrenia is a "mental disorder").

On my side, I come from the world of animal studies, and we have recently published two papers on the problem of hyperactivity:

Brain distribution of genes related to changes in locomotor activity. Mignogna P, Viggiano D. Physiol Behav. 2010 Apr 19;99(5):618-26

Viggiano D. The hyperactive syndrome: metanalysis of genetic alterations, pharmacological treatments and brain lesions which increase locomotor activity. Behav Brain Res. 2008 Dec 1;194(1):1-14.

We postulate that the hyperactive symptoms are rather aspecific and emerge as soon as a delicate brain network is altered either pharmachologically either genetically.

As for the comment of Gisela and Barros, there are papers suggesting modifications of gait in ADHD children (thanks to Sjoerd for the citation and to Artemios), and several papers that suggest a subtle link between attention and gait pattern in normal subjects.

Other useful papers are:

Buderath et al 2009 Gait Posture. 2009 Feb;29(2):249-54

Hausdorff JM. Hum Mov Sci. 2007 Aug;26(4):555-89

Thanks all!

D

mmm... thanks John. I suspect that dividing the sample into subsamples would reduce too much the sample size in each set; moreover, much often the cause of ADHD is unknown at the time of the diagnosis.

In any case, although I like you idea that the cause of ADHD may have effects on gait networks, I was rather thinking that hyperactivity and intattention per se would modify gait control.

But you made a good point: even if we can demostrate that a child with ADHD has subtle modifications in gait patterns, it is difficult to understand if this is linked to the pathogenesys of ADHD or simply to the inattention/hyperactivity of the subject (I am including now this discussion point in the MS).

I work with ADHD children and have observed that there is a certain pattern in their gait, especially when on an onset of an activity or while beginning to start activities which involve coloring or clay work. They also have a special way of standing with their feet outward in two directions. They are also much more receptive to the instructions when they are standing or sitting with both their hands on the chin.

Just do keep in mind that the DSM does not offer an appropriate means of distinguishing ADHD and gifted - and you'd better dig deeply into research on the gifted because there is a tremendous number of gifted that are (a) under achievers, (b) twice exceptional (i.e. gifted but with dyslexia or dyscalculia), (c) gifted but suffering from depression (they have huge challenges with idealism and social noncomformity), (d) may not be detected via IQ tests ("gifted" may be musically, artistically, athletically, etc.).

If you are going to study ADHD - make very certain that you can defend your approach to classification that distinguishes from gifted.

Hi Jeffrey,

I am not sure whether I understand your point about the distinction between ADHD and gifted; possibly this is due to the difference in the educational system in Italy. Here we have not a very strong pressure at school until the age of 18: your grading has no effect at this stage has on your following career. Therefore, here there is no link between ability and inattention at school. And after this age, usually symptoms of ADHD are fainter, as far as I know (although it does exist adult ADHD).

In any case, how would you measure gifted quality in a person? IQ is not good... so maybe scores at school?

Hello Davide,

I'm really interested by what you say in your previous post on the fact that there is no link between inattention and inability in Italy. I just published an article (cf. below) that reports such a link in Quebec. I would really appreciate if you sent me references showing this absence of association ? Regarding your topic, you might want to make a distinction between hyperactivity and inattentive symptoms. As you mentioned symptoms of ADHD vary with age but, while hyperactivity symptoms tend to decrease, it is not necessarily the case for inattention (references in my article). So maybe, depending of age at assessment, you might find a stronger association with hyperactivity or inattentive symptoms.

Am J Psychiatry. 2011 Nov;168(11):1164-70.

Childhood trajectories of inattention and hyperactivity and prediction of educational attainment in early adulthood: a 16-year longitudinal population-based study.

http://www.ncbi.nlm.nih.gov/pubmed/21799065

Dear Jean-Baptiste, thanks for the citation (could you send me the paper?).

I do not think you will find a formal publication on that, although in general you may find something about the discrepancies on the diagnosis of ADHD from nation to nation which are likely to depend on the educational setup. This is supported by two informations (i) The incidence of ADHD looks quite different among nations (compare to schizophrenia, which is much more consistent) (ii) the diagnosis is influenced by the perception of child behavior from their families and the teachers.

Therefore, you may expect that in a less 'pushing' educational system some grade of hyperactivity/inattention may be more acceptable than in highly 'selective' systems, and you should note lower incidenceof ADHD; take into consideration that even the introduction of Ritalin in Italy also occurred somehow late compared to other countries.

Hi Stephen. Well, please take into consideration that Ritalin is a psychostimulant; it is a bit counterintuitive, but the medication for hyperactivity and inattention is not a sedative. Think that Ritalin is used even by adults and students to improve attention (and some people talk about cognitive enhancement). One side effect, in fact, is that it may induce sleeplessness.

I do understand concerns, but I would not use the term catatonic or mediocre spirit induced by the medication.

Abstract

The misdiagnosis issue, of the gifted as having ADHD, has been described as an overseas concern

(i.e., predominantly American). However, in New Zealand psychologists and paediatricians,

perhaps without knowledge of the gifted, utilise the same diagnosis process outlined within the

Diagnostic and statistical manual of mental disorders-text revision (American Psychiatric Association,

2000) to identify those with ADHD. This article addresses the most significant reasons why

misdiagnosis of the gifted as having ADHD could be occurring, such as how the ADHD

characteristics within the DSM-IV (APA, 2000) relate very closely to both gifted and creatively

gifted characteristics. The purpose of this article is to inform educators, with a brief overview, of

such similarities so they can recognise when misdiagnosis has occurred. Teachers can then talk

to parents about the possible misdiagnosis and provide education that is appropriate for the

gifted rather than that which is fitting for those with ADHD.

Hi Davide,

I sent you several links to quite a few articles, but here is another:

http://www.giftedchildren.org.nz/apex/pdfs15/Edwards%20K.pdf

Being "gifted" does not mean having an intellectual advantage (which is why I wrote of musically, artistically, and even athletically gifted). A good way of thinking about the gifted population is to suggest that gifted kids typically ask "why" questions (thus branded as somewhat defiant by certain teachers) whereas bright students ask "what" questions (favored by teachers). Bright kids quickly learn and easily navigate the social rules and become very popular whereas the gifted kids experience asynchronous development and do not mature emotionally and socially at the same rate as the other children (and therefore become labeled as the "geeks", the "freaks", "book worms", "nerds", etc.). The bright kids get very high grades in all classes, but many of the gifted get perfect grades in some classes while fail in others - not because they cannot learn but because they are bored, uninterested, or have fallen behind. This last point often confuses many; how do gifted kids become under achievers and fall behind? When they come into school, they often do very well, but sometimes get a little lazy and become disruptive, pay less attention, act out ... and the next thing you know, they have fallen behind and cannot easily catch up. Still others simply do not want to move on - sometimes (because they tend to be highly idealistic and powerfully driven) they wish to remain where they are in school because they want to study that topic more. Here are some examples of gifted students in class:

- He brings to class the heart from the deer his father shot while hunting over the weekend for Show and Tell in 3rd grade ... but brings it pre-sliced to highlight each ventricle and valve.

- She decides to stay in during recess to organize the art supplies in your classroom by color, type, texture, size, and availability.

- He can explain in detail everything there is to know about different types of stars, but he can't find the pencil on the floor beneath his feet - even when you point directly to it.

- She is failing math, plays the violin beautifully, and befriends the lonliest student because she doens't want to turn him away like all of the other kids do.

- His brain and his body are moving 100 miles an hour morning to night, 24 hours a day, seven days a week, and hasn't figured out how to slow down, sit down, or even remain still when it's necessary to do so.

- She gets perfect scores on tests but won't raise her hand in class because she doesn't want the other kids to know how smart she is.

- He volunteers at the local nursing home where he reads to elderly patients, but he won't sign up for credit for his volunteer hours because he doesn't want other kids to know what he's doing for fear they will say he is "soft" or a "sissy".

- Her vocabulary is as extensive as yours - or more so - though she cannot remember the facts to regurgitate on tests.

- His imagination runs wild, especially when he creates constructions with K'NEX sets. He's been sleeping on the couch lately because his bedroom is filled floor to ceiling with his designs, some of which move and do incredible things, but cannot read and is very clumsy playing outside.

- She has a secret notebook filled with poety and short stories that she has illustrated, and she only showed it to you because you mentioned that you like to draw.

- He cannot read or write, cannot do math, and doesn't really care ... he can draw amazing images and that is all that he wants to do.

"Gifted" children might be academically gifted, but they may be exceptional in different ways; empathy or concern for a cause (highly idealistic and passionate at a very young age - which is often seen as defiant by adults); special interest or ability/talent in narrowly defined areas (young PhDs ... they want to know everything about something and will ignore school studies to pursue their own interests - and often fall behind); they may dominate classroom discussions yet fail tests and do no homework (I call it "empty grade book syndrome"); when forced to do school work they find dull, boring, repetitive, or below their achievement level they often resist and fall into power struggles with teachers and parents.

Unfortunately, if you divide children into groups and can differentiate between the 'bright' and the 'gifted', you find that the gifted are overwhelmingly dealing with depression (most of the "goth" and "emo" kids dressed all in black are powerfully gifted underachievers). You will also find that the rate of high school and college suicide is highest amongst the gifted.

We fail to think about "the rest of life" for these kids. Why would they become depressed? Why would they struggle socially? Because they don't fit in well with their peers - and often do not fit in well with their own families - thus are social outsiders even in their own homes. Further, gifted kids appear in all homes - including bad ones - and abuse within the home can have even worse effects on a child whose emotional and social deveopment is already asynchronous.

The diagnosis of ADD and ADHD was very suspect in the beginning, but became an immediate favorite amongst psychiatrists because they didn't know how to handle a "gift" after spending all of their professional careers looking for problems. If you go back to the earliest literature covering the topic - it was highly controversial and remains so. Medications designed to treat other disorders fell into fashion and an industry of research and pharmaceutical design was born ... without ever clarifying *why* an ADD or ADHD child exists. To date, there are no appropriate diagnostic approaches to state clearly, "this child is ADD or ADHD" and not simply a gifted kid in a bad place in life. Further, not once as a study every bothered to look at how a child's brains are impacted developmentally when placed on the medications during neurologically sensitive stages of growth. We have no idea - and no one can claim that they do - to what extent brain DNA is methylated inappropriately, what kind of epigenetic circumstances result, or even what kinds of changes are induced on a gross morphologic scale ... the studies simply have never been done. Why? It's not often that you get a kid taking ADHD medications long term who ends up in a car wreck and dies from a ruptured spleen and so has an intact brain to autopsy. Further, imaging studies are interesting, but cannot demonstrate the difference between a BOLD response indicating a causitive circumstance or a resulting one.

I know. I deal with these things all day, read all of the literatue, and teach the gifted.

...and I am one. I grew up going through all of the things I described. When I was a child, the ADD / ADHD diagnosis did not exist and so I was lucky. I spent my first 8 years in school with my desk facing the back wall because I was "too talkative", "could not sit still", "was disruptive (i.e. asked too many questions), and "never paid attention in class." When I got to high school, I got 'A' grades and I also got 'F' grades and so graduated with exactly a 2.0 grade point average. Fortunately, my family did not have a lot of money and I had to use the military to pay for college - it was fortunate because I acquired the discpline and self motivation I did not find at home or in school. Since that time I have completed training in the US Navy as a nuclear engineer, and 5 university degrees - now finishing my 6th.

For most kdis, the ADD / ADHD diagnosis is a myth. If you'd like some evidence to support that claim ... take a good look at the ADHD literature and examine the prevalence in America, the UK, Australia ... what you'll find is that diagnosis of ADHD increases the closer the child lives to a center of high academics. In America, this moves from the West to the East ... few on the West coast, but the rate increases as you approach the East coast where acadmics become very competitive and the so-called "Ivy League" schools predominate. For some of the ADHD diagnoses, you simply have to feel sorry - we now live in the most stimulus driven time in all of human civilization, continually bombarded with data-driven stimulation arriving with digital speed and intensity, and our brains did not evolve for the tasks some of our kdis as asked to manage. We will allow them to play blistering fast computer games for half the night (don't forget that brain plasticity will redefine aspects of the brain under these conditions) while he is on his cell phone, or suring the net on his iPad. The kid comes to school texting and Facebooking while riding on the bus or walking down the street, steps into a classroom, and is told to put away all electronic devices so that they can stare blankly at a dull teacher who will assail them with boring lectures for the next 8 hours and they had better sit still and do so quietly until it is time to fill out another worksheet with infomation presented two days ago that was no more relevant to their lives then as it is now.

What?

A recent study in Science has found defective inner ear genes in ADHD. Inner ear dysfunction, particularly if intermittent, is likely to lead to auditory inattention, and vestibular disorders, especially in balance and hence gait.