This week’s question is from Jessica,
“My son struggles with sitting still at school and while doing homework. He is medicated (for ADHD) but his teacher and others at his school are recommending I increase his medication but I don’t know if I want to do that. What should I do?”
In this episode, I will address a number of things that I think will be helpful for all parents. Not just kids who have been diagnosed with ADHD. The number one takeaway here is that movement while learning is not only normal for all kids but it is essential for learning. Then I will give lots of helpful tips about things you can do to help your child learn in a way that works for them. Lastly, I will address medication and why it is not the teacher’s job to recommend medication.
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What the parents and teachers notice
- He is always fidgeting
- Does not stay in his chair while doing school online, in person, or while doing homework
- Difficulty regulating his movement
What they’ve tired
- Teachers and school authorities asking parent to increase his medication
Movement in this age is essential for development in all areas
- In fact, from infants all the way up to older kids – movement is critical to learning
- Movement helps to promote brain growth – physical activity is normal and important
- When kids move a lot, it might be signaling to us that they need a break to move their bodies
- Our school environment in the U.S. is very sedentary which is not a realistic expectation for kids who are learning
Strategies that can help…
- Make sure your child has a lot of time being active and playing outdoors, outside of school, and homework time
- It is developmentally inappropriate that a 7 yr old would have homework
- Opt-out if that’s best for him, talk with his teacher and the school about it
Setting up their environment for movement and learning
- Pace space – if your child likes to move or walk while learning, mark off a space on the floor with tape so they can move around in that space.
- Therabands – tie a band around the front two legs of the chair so they can use that to bounce their feet
- Ball chairs – gives the ability to stay in one spot and allows for lots of movement
- Sit disks – allows for kids to move back and forth while sitting on the chair
- DIY: Blow up a beach ball a quarter of the way, set it on their chair and they can sit and move on it
- Fidget toys – rubber bands, fidget spinners, squeeze ball, etc
- Alternate seating – propped up on their elbows, laying over a fitball
Weighted things can help with calming and regulating
- A weighted lap pad or stuffed animal
- Therapy putty or thick clay they can manipulate in their hands
- Water bottle or cup with a crazy straw – fill with something that has a thick consistency like a smoothie or applesauce
- Sucking is very calming
- Chewing on a cold chew toy or gum gives an organizing input to the brain
Breaks are important
- In general, we expect kids to learn and focus for too long
- 15-20 minutes of focus is the most we should expect at a time and then take breaks
- Talk to the teacher about allowing your child to take movement breaks
- An outside break is even better
- Take walks or do jumping jacks for 5 minutes
- Start the day with protein – eggs, sausage, almond butter on toast
- Keep blood sugar balanced – less sugary breakfast foods and snacks
- Add in a few nutrient-dense foods – avocado, salmon, cacao nibs, etc.
- Lots of water for hydration – always have a water bottle or cup available with water
- Speak with your doctor about checking iron level
- Magnesium can be helpful and calming for the brain
- It is not appropriate for school professionals to talk to parents about medication
- That should only be discussed with your medical provider
Connect with Dr. Nicole Beurkens on…
Episode Intro … 00:00:30
Movement while learning is normal and important … 00:02:10
Strategies that will help your child learn best … 00:07:57
Movement options while learning … 00:14:00
Help kids feel calm while learning …00:16:35
Give kids regular breaks … 00:18:10
What to look for with nutrition … 00:20:19
The conversation about medication … 00:22:00
Episode wrap up … 00: 25:25
Dr. Nicole Beurkens:
Hi everyone, welcome to the show. I am Dr. Nicole, and on today’s episode, I’m answering a question from a listener. I get so many questions each week, and this is a great way to provide answers that many of you might find helpful. If you have a question you’d like me to consider answering on a future episode, email it to firstname.lastname@example.org, and you just might hear it on an upcoming show. Now onto today’s question from Jessica. Jessica writes, “Dear Dr. Nicole. I’m really struggling with my 7 year old son in school activities, both the virtual classes and homework. This has been an ongoing problem all year, and our school isn’t going back to full-time in person until possibly next fall. My son has been diagnosed with ADHD and is very physically active. It’s tough to get him to sit still and stay in the same place for his teacher to see him during the online classes. He’s also always fidgeting in his chair, and trying to move all over during homework time. Honestly, this isn’t just an issue at home. His teacher complains about it in the classroom too. He takes medication to help with the ADHD, although I’m not sure how much it helps. The school keeps saying he needs more medicine or a different medicine, but I’m really not sure I want to do that. He’s a bright boy and can do the work, but it’s just helping him stay physically still that’s a problem. Any ideas that can help? Thank you. Jessica.”
Jessica, thank you for writing about this. I think that these are issues that many, many of our parent listeners face, so I hope that my response to your questions will be helpful to many of you who are listening.
Okay. So first, let’s start with the overarching idea here that we need to keep in mind when we are looking at what’s going on with a child’s physically active behavior and how that’s impacting them. So first of all, it is really important to remember that it is very developmentally appropriate for children, particularly younger children to move while they are engaged in thinking and learning kinds of activities. Movement is essential for development in all areas. And that’s the case for infants all the way up through older kids that brain growth and development, whether we’re talking bout development in the areas of motor skills or development in communication skills, relationship skills, thinking and cognitive skills, focus and attention skills, whatever area of development we’re talking about: Movement is a critical thing that drives that development, so that’s why we see in babies, in toddlers, in preschoolers, in elementary age kids, they’re moving their bodies a lot in different ways because they’re driven to do that, that’s how they are making sense of the world, it’s how they’re making sense of what’s going on inside them, and that movement is literally promoting brain growth, literally helping to promote the connections within and between the different parts of the brain that are essential for developing important skills in all of these areas. So movement, physical activity is natural, normal and important. So that’s the first thing we need to keep in mind. Now, movement can be at an extreme, and some kids, especially if they veer into the territory of what might truly be called hyperactive kinds of movement where they seem to be at a speed of 100 all the time and have difficulty regulating their activity level and their movement depending on the situation, then that can create some challenges, especially, depending on the activities or the situation or the environment. So it certainly can be the case that we need to give kids strategies and tools for learning how to regulate their movement needs and regulate their activity level, but within the overarching framework of understanding that movement is normal and important. And actually, I would argue that if a child is moving around a lot, that is telling us something about what their brain and body need. That’s giving us a clue about what their brain needs to function well, and what maybe isn’t working for them in that particular environment or situation. So that’s the first thing we need to keep in mind and I think that’s really important because so often, the thought process around what kids are expected to do in school or even what we expect young kids to do in general is we want them to sit still. We want them to focus and sit still or we want them to just calm down and sit still. And we forget, we look at that through the lens of our adult brain and we forget that movement is natural, physical activity is important for them. So we have a lot of unrealistic and actually developmentally inappropriate expectations for children, particularly of these younger ages, and our schools reflect that.
Unfortunately, our school system, at least her in the US, has really moved far, far away in many ways from what is developmentally-appropriate for kids, and that includes opportunities for lots of physical movement. More and more, we see even preschools that are moving towards kids sitting down at desks or at tables, doing a lot more sitting kinds of activities, not having near the amount of opportunities that they used to in my generation or for many of you listening, where we’d go outside, we’d have recess, we’d play, we’d have centers, lots of opportunities for movement, and unfortunately, in our schools today, that really has been taken away in many schools throughout the US, kindergarten is now an all-day everyday activity with a lot of focus on sitting, sitting, sitting, doing worksheets, doing sedentary kinds of things and that is not developmentally aligned with kids needs at that age and developmental level, and then we wonder why we run into this disconnect between what kids are expected to do for school and what their behavior is. And most of it revolves around, in my opinion, us having developmentally inappropriate expectations and environments for kids. So those are all things to consider when we are thinking about what is going on with a child and how to support them, because the vast majority at the time, in my experience, both working in schools as well as in private practice is that we need to change things in the environment. The environment is more the issue, there’s not something wrong with the child. Now again, I’m not saying that it isn’t beneficial and important to help kids learn skills and have tools for self-regulation, for managing their movement needs in appropriate ways, but we can do that the vast majority of the time by making environmental changes.
So let me share some ideas for you, some strategies that may be helpful. The first is to be proactive. That means making sure that your son has a lot of time for movement, for physical exploration, for being outside in nature, for just being active in his body outside of school and homework time. That is super, super important for these kids that need a lot of movement. I would argue for any child at that age, but especially kids who need a lot of movement. Give them lots of opportunities for movement when they’re not doing school kinds of activities. So that might mean building obstacle courses, it might mean him spending a lot of time outside, running around, riding his bike, climbing trees, depending on where you live, doing physically active things. Lots of opportunities for that. It’s super important, the most proactive thing that we can do.
Side note here because you mentioned that it’s difficult to get him to focus during homework time: What I want to say about that is that I find it really developmentally inappropriate that a 7-year-old would have homework. So that’s just maybe something to consider there. You know every parent certainly is welcome to have their opinions on that, professionals as well, but what I would say is that homework, in general, is not a research-based practice. I’ll say that again and maybe do a whole episode on this at some point: Homework has not been shown in the research that’s been done, to be an appropriate or necessary thing that we have kids do. And yet, it’s such a — I don’t know, it’s this thing that’s cemented in our school. It’s like this rite of passage like every kid needs to be having homework. It’s just silly and it’s not research-based and kids don’t need to be doing it. So if you’re in a school where your child is being assigned homework and it’s really a struggle and they’re tapped out by the end of the school day and it’s creating a lot of distress in the home environment to be doing that, I highly encourage parents to opt-out of it, and guess what? You have that option. And especially now, with virtual learning, if you have been working to help your child to stay focused and getting work done all day long on the computer, there is absolutely no need to spend one more moment sitting down then and doing something called “Homework” I mean think about how silly that even is. So I would say with a child like Jessica describes here, for any of you who have kids who this is a challenge with, opt out of the homework situation. Trust me, they’re not going to be any worse off for it, have a meeting with the teacher, talk with the school. It may be helpful for you to know that there are many more schools now going to policies, especially at the elementary level of not giving homework. Again, maybe I’ll do a whole other episode on homework if some of you would find that helpful, but just something to keep in mind here. Jessica, with your particular son and the challenges you’re noting, I would not spend a minute of time on homework. Instead, I would say, “You know what our homework is? Going outside and doing a scavenger hunt. You know what our homework is? Making sure that we’re taking a long bike ride together after dinner. You know what our homework is? Carrying the heavy laundry baskets up and doing the stairs for some heavy organizing input to our sensory system.” Those are the things we’re going to do as homework. So proactive, making sure there’s lots of time for movements, nature, physical activity.
Okay. Let’s talk about movement options during learning: Now this can be online if you’re having your child on the days that he is home and in front of the computer, but these can also be done in the classroom. Here are some specific strategies that I find really helpful. The first is a pace space. If your child is a pacer, a walker, likes to be moving around while he’s listening or doing things in front of the computer, tape off or mark off in some way on the floor this pace space, this space, it gives it some boundaries so he’s not walking or wandering all over the house or all over the room and the teacher is saying she can’t see him on the screen. Mark off this pace space on the floor and he can stand and move around as much as he wants in that space. It helps create some structure and some boundaries while still allowing movement. In the classroom, I will often tape off these pace spaces in the back of the room or on the side of the rooms so that kids can be up and using those and having those defined spaces and it’s not distracting or getting in the way of other kids being able to see. Another thought is to get some stretchy, what’s called TheraBand or those exercise bands, you can get them in different levels of resistance and tie a band around the front two legs of the chair. What this does is it gives your child something bouncy to bounce their legs or their feet against. It gives some resistance, they can bounce their legs there, it’s quiet but it gives them some resistance, some deep pressure and some opportunity to move there with their legs and get some physical input. Another option is a ball-chair. Some kids do okay with one of the big therapy balls or gym balls that they can just sit on and bounce on. They also make stands now or even whole chairs that have a ball or even bungee cords, I’ve seen chairs now with bungee cords, something that, again, gives that ability to stay in one spot but to get the physical movement that the brain and body are cravings. There are also things called sit discs that you can buy that sit on the chair that allow for movement back and forth and around while sitting on the chair. They’re not so much bouncy — a little bit, but they just allow for more fluid movements sitting on the chair. Honestly, a really cheap way to do that, you can go to the dollar store and get a midsize inflatable beach ball and blow it up just a little bit so there is air in it, so when your child sits on it, there’s like this movable surface. Not blowing it all the way up into a ball, just blowing it up maybe an eighth to a quarter of the way, so when they sit on it, they have this sort of movable pillow kind of surface on the chair. That can be helpful as well.
Fidget toys can be useful. So something that they can fidget with their hands. I had a kid in the clinic earlier today, we were working on some thinking kinds of activities and he chose a rubber band out of my little tool basket that I have of fidgets, and he was using that to fidget with. One of the things that teachers or parents often raise around these kinds of tools or allowing the movement is “Well, then he’s not going to be focused.” We need to remember that the opposite is true. Most kids, and especially kids with these kinds of movement needs and these kinds of challenges, need the movement to allow them to focus. So it’s not in the way that we’re thinking of it, if they’re moving they’re not focused. In fact, typically the opposite is true. They’re moving so that their brain can be more tuned in and focused. So even if it looks like they’re not paying attention, often they are. Now with fidget toys, whether it’s like a squeeze ball, stress ball, or rubber band, a little toy in their hands, whatever it might be, we need to have some limits and boundaries around that. Not appropriate to be throwing it, to be creating problems for other people, we can teach even really young kids how to use those things inappropriately, helpful ways. I would also encourage, during online lessons or even in the classroom, alternate kinds of seating. So sometimes, it works really well for these kids to be propped up on their belly on the floor, propped up on their elbows, that can help keep them stabilized in one spot, and it also gives them some good deep pressure input to their upper body by propping themselves up. Some kids do well lying over a gym ball or a therapy ball to have some movement and some pressure there. There’s nothing that says that that computer has to be sitting on a desk or a table surface with your child in the chair. Experiment with different things: Have them stand up, that can be helpful for some kids. I’ve got some kids who — a parent has a treadmill desk at home, and that can work really well for them. I’ve also seen in classrooms or in homes, you can get really inexpensively these little pedal exercisers, like little bike pedals you put on the floor under the desk, and some kids do great just being able to quietly pedal away while they’re working or while they’re listening. So the key here is to find space and movement options that are going to work and to experiment with that and to provide some choices for your son to make around what is going to be helpful to him during those times.
Now some other options that can be helpful: Some kids benefit from a weighted lap pad or a weighted stuffed animal, something that’s heavier on their lap that gives them some input and helps them to regulate their activity level and sort of calm their body. That can be helpful. Having something like Theraputty or thick playdough or clay that they can manipulate in their hands, that can be calming and regulating, again, can just help organize their brain and body when they’re not able to move around. Some other tools are giving a water bottle or a cup with a crazy straw, those straws that have lots of twists and turns in different shapes and things, and have them suck water through that or even a smoothie or a thicker liquid, even applesauce can work. Sucking, especially the harder a child has to suck through the straw, the more organizing and regulating that is for the brain and the sensory system, so that can be a great tool. Even a water bottle where they have to suck pretty strongly on the spout of the water bottle to get the water out, that can be a great, regulating, focusing, calming kind of tool. Some kids do well chewing gum or having a chewy toy or something that they can — again, that chewing gives and organizing input to the brain and can help them to regulate their movement and keep their brain focused. So a few other tools that can be helpful. Now I also think it’s really important to be giving kids regular breaks. That goes for at home with virtual learning and it also goes for their time in the classroom.
In general, I think we expect kids to focus and do learning kinds of activities for way longer than their brain is capable of. So, Jessica, you mentioned your son is 7. I would not expect more than 15-20 minutes tops of being able to stay focused on something before needing a break. So you try to work that in where you can with the virtual learning, in classrooms, there are lots of wonderful teachers now who are giving movement breaks regularly throughout the day, whether that’s a whole class movement break of doing some exercises altogether or allowing kids who need more breaks to do things like walk down to the drinking fountain, take a note to the office, help pass out papers, those kinds of things to give them some breaks for movement, but you want to look at scheduling those breaks throughout your day with your virtual learning and to take walks, do jumping jacks, go through an obstacle course, whatever it’s going to be, even just for 5 minutes, if you can go outside, that’s even better because then he gets the movement and the fresh air and nature, which is very regulating and focusing for the brain, but making sure that you’ve got regular breaks and that you’re not expecting him to sit and focus too long.
I think communication is important here. Talk with him about what he notices, what’s working and not working, make a plan at the start of the day, and say, “Okay, what do we think worked and what didn’t?” You can share your observations, he can share his, and you can kind of work together, recognizing that he has a goal of doing the right thing too. We often forget about that. We think for some reason that kids who are hyperactive and moving around a lot like they’re intentionally trying to cause problems. No! He wants to do well with this, he wants to be able to please other people. He wants to get his work done, he wants to be successful, so including him in the discussion of what’s helping, what’s not, what can we try that might work better?
From a nutrition standpoint, I would encourage you to think about just a few things: The first is starting the day with protein, which has been shown to be very helpful for regulating movement and hyperactivity, very helpful for just stabilizing the brain and helping with focus and attention, so starting the day with a good source of protein, making sure that you’re keeping blood sugar balance, not having a lot of sugary foods or snacks, focusing on good nutrient-dense foods when you can work those in, eating consistently throughout the school day is important. I recognize you have more control over that at home than you do in the school environment perhaps, and then also plenty of water for hydration, because kids, when they even get mildly dehydrated, it has a negative impact on their brain function, on their attention, so keeping water readily available and encouraging hydration throughout the school day. From a supplement perspective, lots of things that we can consider here, but particularly Jessica, with what you mentioned, I’d be interested in checking an iron level and just making sure with your primary care provider that the iron level is where it should be because suboptimal iron or even deficient iron and anemia can really be an issue with ADHD symptoms, with hyperactivity and those kinds of things, and then you may also want to talk with your healthcare provider about how magnesium can be helpful. That sometimes can be a very supporting, calming mineral for the brain and for the body, and so you may find that helpful. So those are some ideas there. Lots of other things that could be done, but hopefully that gives you some things to target.
I also, just as I’m wrapping up, want to touch base and spotlight something that you mentioned about the school telling you that your son should be taking more medicine or different medicine. I just really want to talk about that briefly before we close out here. It is not appropriate for school professionals to be talking with you about medication. That is not appropriate, school professionals are not educated around medications, are not educated and don’t have the credentials to be talking with parents about psychiatric medications or any medications for their child. It’s appropriate for educators to raise their concerns about what’s going on for a child in the classroom and how best that child can be supported from a developmental or an educational standpoint, not appropriate for them to be raising issues with you about medication. So I just want to be clear because I know that many of you listening may have similar kinds of things come up, and it’s just important for you to know that that’s not appropriate and that you need to make the decisions that you feel are best for your child, and I don’t ever want a parent to feel pressured by a child’s teacher or school administrators or whoever to put them on medication, to make medication changes. That certainly can be part of the discussion with healthcare providers around feedback that you’re getting from your child’s teacher and challenges that the school is noticing and what might be helpful there. So it’s appropriate for educators to raise their concerns about what they’re seeing in the classroom, not appropriate for them to be telling you to put him on different medication or increase his medication. What I would encourage is that you schedule a meeting. It might need to be online right now, still, or go into the school to discuss what’s happening. To provide suggestions to them about what you’re finding is working well at home, and to collaborate with them on a plan, we want to keep lines of communication open between home and school and have good collaborative communication and problem-solving. It might be helpful to meet regularly to talk about what’s working, what’s not working, what might be helpful when parents and school professionals are communicating well and collaborating together, that’s when we get the best outcomes for kids. And then also for you as the parent to determine, is this classroom teacher open to trying things? Are they open to viewing your son as a kid who is bright, who wants to be successful, who developmentally is struggling with some of these things but wants to do well and needs some different support? Is he or she open to that or not? That allows you to get a sense of what’s really happening there so that you can make the best decisions around what kind of environment is appropriate for your child, what different kinds of things might need to happen for school, those types of things. So I would definitely encourage you to schedule a meeting and just keep open collaborative communication and throw some of these suggestions out that I shared today and see what the feedback is and how those can be implemented. So I hope, Jessica, that this is helpful for you, and I hope that it’s helpful for any of you with kids who are physically active and need movement to focus and learn. Look for my next episode coming up, and I will be back next week with another Q&A for you.
Remember, if you have a question that you would like to hear answered on a future show, email it to us at email@example.com. Thanks as always for listening, and I’ll catch you back here next time.