Wednesday, March 16, 2011

When a Child Can't Sit Still

One of the most common reasons why a child is initially referred for occupational therapy is that he can't sit still in class.  When a child simply can't stay put, it's vitally important for the grown ups to play detective and figure out why.  Children who can't sit still are children who are driven to move. Before we try to force them to be still, we need to find out what is behind their restlessness so that we can begin to help them, either by fixing the problem that is driving the behavior or by providing them with safe, appropriate opportunities to supply them with the movement experiences they need.


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Many of the children I treat can't sit still simply because they need to move their bodies.  In big cities like Manhattan, children don't have the opportunity to run around freely, and their overscheduled parents don't make the time to take them to the park.  It often takes much convincing on my part that regular unstructured time spent out of doors, either at a park, beach, or playground, is an essential priority for children, and that constantly strapping children into strollers, car seats, high chairs, play pens, and anything else that prevents them from moving and exploring freely is impeding their neurological and cognitive development.

I often go to schools for observations and leave with the feeling that the adults who are responsible for planning the children's days don't always schedule activities with a realistic view of what is possible and what is not.

  I recently observed a second grade classroom in which the children were required to sit quietly for 90 minutes and write without a break.  After about 30 minutes had gone by, the teacher was expending a lot of energy trying to get her class to stay seated and focused.  Ninety minutes for a group of seven year olds is a long, long time to sit still.  Another time I observed a classroom of six year olds being given a highly structured, rather uninteresting craft activity to do.  After about fifteen minutes, the teacher was working mighty hard to maintain decorum.   The majority of the children had long since finished their task, and were more than ready to move on, but they were required to sit there for ten more minutes.  The children got more and more restive and bored, and the teacher became sterner and sterner as she tried to force the children to sit.  It would have been much less toxic to give them a second task or to give everyone a one minute structured movement break.

 Something else I frequently observe is that circle time tends to go on and on and on.  After about five or ten minutes of sitting on the floor with nothing to do, the children are clearly restless and bored.  The teacher is unable to do any teaching  at that point.  All of her energy is directed towards trying to trying to convince them to sit still, when they are obviously dying to get up and move their bodies.

When children don't have good, solid strength in their trunks due to low muscle tone, sitting in a chair is a struggle.  If a child is constantly rocking in his chair, wrapping his legs around the furniture, leaning his upper body against his desk,  or falling out of his chair during class, he does not have the strength to support himself, and is trying to manufacture it by using the furniture.

 Children who have a clinical condition known as auditory defensiveness, which is oversensitivity to noise, have a hard time in school because they can't tolerate the noise levels.  Their ears don't filter and dampen noise effectively, and the sound waves from the other children's high pitched voices build up in their eardrums and can be quite painful.  A young child who moves around and around the periphery of a noisy classroom, can't settle down or demonstrate any goal oriented behaviors during unstructured play or work time, is having difficulty coping with the sound levels.

If the child's eyes are sensitive to light, he is probably quite uncomfortable, especially if he is in an interior classroom with fluorescent lighting.  I see this quite often in New York:  children in brightly lit classrooms painted a glaring, flat white, with no natural lighting or ventilation.  After a few minutes, I'm feeling sweaty and dull headed, and dying to get out of there myself.

Tactile defensiveness, a condition where the skin is overly sensitive,  can make it very difficult for a child to sit still when his socks are bothering him, his underwear is bothering him, the tag in his shirt is bothering him, and other children are sitting too close to him.

 A child who is restless and reluctant to do table top tasks like writing, puzzles, coloring, or cutting may have weak eye muscles.  He may have quite a bit of difficulty controlling them to do things like copy from the board or pulling in them in close enough to read or write.  This is painful and uncomfortable and makes it extra challenging to attend to close work.  If a child squirms in his chair, rubs his eyes, and is resistant to close work, he may have trouble seeing what he's doing.

Children who have a hard time sitting  are often poor, shallow breathers.  Chronic shallow breathing causes anxiety by flooding the system with adrenaline and forcing the child to exist in a chronic low level fight or flight mode.  Don't believe me?  Try panting shallowly for a minute, and notice the beating of your heart and the restlessness in the rest of your body.  The resulting agitation compels the body to get up and move, partly to survey the environment for predators, and partly to discharge the large amounts of nervous energy that the floods of adrenaline cause in the body.

A child who constantly seeks movement, spinning his body while standing in line, twirling around every light post he passes, jumping on every bench and curb, very likely has an under responsive vestibular system.  The vestibular nerve is responsible for our levels of alertness and uprightness based in part on information it receives as the child's body moves.  When it isn't working right, the child is driven to move more frequently and intensely to make up for the lack of nerve's ability to respond.  His arousal levels are too low, and he's doing whatever he can instinctively do in order to bring them to the level where he can focus and attend.

If a child has a very hard time falling asleep, and doesn't sleep well, his ability to sit and focus is greatly diminished.  If he is a seriously picky eater and subsists on junk food, he won't have the fuel necessary to help him keep centered and focused.  He may be suffering from gut problems, like undetected food allergies or yeast.

8 comments:

reCREATEdonna said...

Thank you for this informative post. My daughter's teacher keeps their kindergarten class in circle for far too long. She is convinced my daughter is ADHD...I completely disagree, as her behavior at home doesn't reflect it. After reading this I think she possibly has auditory issues. Her hands are quick to cover her ears and she constantly complians it is too loud in her class.

Anonymous said...

Hi There, we have just been told that our son (3 years 10 months) does not stay still in class and is always running around. The teacher has also indicated that he is very itelligent and can do activities very easily. He is very active at home as my husband takes him out to the Park for an hour. At home as well we cant get him to sit in one place and focus on sitting activity for more than 10 mins (like painting or colouring or drawing, etc). Please do give me some pointers on how I may help my son. Thank you

Anonymous said...

Thanks for the info! I can probably narrow it down to tactile defensiveness or poor shallow breathing for my daughter. Both of those things fit my daughter. She said that she can't sit still cause she feels like things are crawling on her so probably sensitive skin. I knew there was a reason for it but couldn't pin point it. Very informative!

Anonymous said...

This was very informative. I have a meeting with my 4 year old's teacher in the morning concerning her inability to sit still at rug time and constantly moving around. She is not a bad child and is disciplined at home. Thank you for your article. This will definitely help me tomorrow.

Anonymous said...

I can't sit still for hours! I need to move around, by spinning, rocking, or jumping. My vestibular sense is under-sensitive, and I never get dizzy. I have tactile defensiveness, visual defensiveness, and auditory defensiveness.

I can't detect the motion of swinging on the swing, because it doesn't go high enough for me. I like to spin around for 15 minutes or so (If I can stand the texture of the floor).

ADHD No More said...

Want to Change your Child’s ADHD behavior? READ ON… I had these same issues with my son. But I discovered clearly by accident that he is allergic to food dyes. We were playing with face painting crayons. My son decided to draw a target on his stomach with the yellow. The next morning he asked me to check out his stomach. I was shocked. His skin was raised with red welts and tiny scabs everywhere he used the yellow crayon. After extensive research, I discovered that, although not clinically tested (AND why not?), children can be allergic to food dyes. Reds and yellows are very common and found in too many foods to mention. We cut all food dyes out of his diet and my son was a totally different kid. He stopped sitting on his head when we would watch a movie, stopped fighting with everyone he came in contact with, and stopped disrupting his classmates every 5-10 minutes. His teacher actually contacted me to tell me whatever I was doing with my son, that I should keep it up. She thought I put him on an ADHD medication – NOT!!! What is wrong with our government that allows this garbage to be put in foods? FYI, Red food dye comes from “Coal Tar”. There are many more stories I could share but I thought this was the most important. Cut out food dyes in your Child’s diet and you may find that is all it takes to make you child “Normal”.

Paula Anderson said...

I have a 4 year old that is not hyper, but has a very hard time sitting still. Constantly sqwerming, and rolling. She can color for long periods of time, and can be very focused. She is very smart, but can't seem to sit still.. any thoughts as to what I should do? At first I thought it was cause she was tired, but she is like this more often than not.

Anonymous said...

I have the same issue with my Kindergarten son as Paula does with her daughter. "Squirmy" and "restless" have been my go-to words whenever I have tried to describe my child's behaviors when he is made to stay to in one place. Like Paula's child, mine is also very intelligent and can focus when necessary, though he almost seems to hyperfocus, as though he forgets that he exists when he is trying to observe something. As a result, he doesn't participate when he is in a group or circle even if they are doing a physical activity, and he doesn't seem to be able to watch and listen at the exact same time, but rather seems to just rapidly switch between the two senses in an attempt to compensate and his struggle to do so leads him to get frustrated and subsequently antsy. Any ideas on how to teach him how to balance it all?