Restless behaviors can be distracting and disruptive to family and classroom routines. There are many reasons a child might have trouble sitting still, and it is essential to determine if the cause is behavioral or sensory-based. It is also important to set realistic expectations about how long any child (or adult, for that matter) should be required to "sit still."

While sensory integration disorder and ADHD are very distinct, their problems and behaviors can look similar. As an occupational therapist certified in sensory integration, I like to consider what foundational issues, in addition to ADHD, might be contributing to the difficulties a child may have when required to sit in a desk chair or on the floor.

Is it ADHD or Sensory?

Sensory integration disorder is difficulty processing or organizing sensory information. Sensory information tells us about our bodies and how we interact with the world around us. If this information is distorted as it comes in or as we attempt to respond, the difficulties resemble those of children with ADD/ADHD. They can include poor attention span, difficulty learning certain subjects at school, messy handwriting, trouble following directions, inability to sit still during a lesson or a meal, lack of coordination, inability to make and keep friends, and sometimes, low self-esteem.

Hearing, sight, smell, and taste are the primary ways that we take in sensory information. There are three other less familiar, though critically important, sensory systems:

• The vestibular system (tells us where our head is in space and influences muscle tone, balance, and attention)
• The proprioceptive system (receptors located in our muscles and joints tell us where our arms and legs are in space and contributes to body awareness)
• The tactile system (our sense of touch which can be discriminative/ protective).

The Importance of Sensory Integration

Imagine the sensory nervous system as a super highway. If one road is blocked in either direction (sensory information going in or motor information going out), there can be a traffic jam, which prevents a person from responding well to everyday environmental demands and challenges. These systems must be well "integrated" to form a strong foundation for organized behavior.

If we think of our bodies like car engines, we want them to run just right, which relies on sensory integration. Think about times when you feel less alert, stressed, or overwhelmed. If your engine runs too fast or too slow, you may not be able to participate appropriately in your regular activities. In response to how we are feeling, we use our proprioceptive system to help us run "just right."

Poor sensory integration can make it difficult to modulate behaviors. So, when we feel sluggish, we get up and move; when stressed or overwhelmed, we may retreat to a safe place like a comfortable chair or under heavy blankets. This is our body's way of seeking an optimal level of arousal, that "just right" place that is not too high or not too low and where we can perform optimally when required.

Sometimes, children have difficulty sitting still because their body runs too high or too low, which may actually look the same in a restless child. Children with low levels of arousal may move to keep their arousal level just right; children with high levels of arousal may be seeking a level of intensity to organize their sensory nervous system better.

Another reason for shifting around while seated may include poor vestibular system integration, which influences muscle tone. A child with weak core muscle strength might need to alternate the use of different core muscle groups while seated to remain upright against gravity.

Sensory Strategies to Help Kids (and Adults) Sit Still

Here are some sensory strategies to try when your child has difficulties sitting still:

• Make sure the child is seated in a chair that fits the child, at the appropriate table height, and where the child's feet are flat on the floor.
• Provide the child with a chair that provides more support around the trunk, like a captain's chair.
• When sitting on the floor, let the child sit in a beanbag chair to give the body more "sensory input" while sitting. Or let the child lay on his tummy propped up on elbows to allow weight bearing through the upper body.
• At mealtimes, ensure that the child is sitting at an appropriate height at the table and that feet are supported (you can use a step stool or box under the feet).
• Make sure sitting times are realistic. Set time goals for the child to sit at the table. Start small, and increase this time frame gradually.
• Give the child many appropriate opportunities to move throughout the day. Use proprioceptive strategies (help unload groceries, push cart, open doors, etc.) to help the child return to the "just right" engine speed.

Finally, if you suspect your child may have a sensory integration problem in addition to ADHD, an occupational therapist certified in sensory integration can do a screening or an evaluation. This will help to determine which sensory systems are weak and how to support the child in achieving goals that will allow them to participate in life fully!