There is nothing worse than using a scientific study that correlates two variables and assuming causation. Translation: If behaviors typical of disorder “A” are seen in a lot of people with problem “B”, we cannot assume that “A” is the cause of their behavior. But we do it all the time. People who love coffee adore studies that say coffee drinkers seem to live longer. People who hate to exercise are validated by reports that find the number of heart attacks after exercise “is increasing”.
When it comes to labeling children’s behavior, we should take a couple of big steps back with our erroneous reasoning. And when the label is ADHD, take three more. Not because ADHD isn’t a big issue for families. The struggles of kids, parents and educators shouldn’t be minimized. We should be cautious with labels when two situations occur: very young ages and multiple diagnoses that are determined largely by clinical observation, not testing. Seeing ADHD in a child with hypermobility is one of those situations.
Hypermobility without functional problems is very common in young children. Super-bendy kids that walk, run, hit a ball and write well aren’t struggling. But if you have a child that cannot meet developmental milestones or has pain and poor endurance, that is a problem with real-life consequences. Many of them are behavioral consequences.
Yes, I said it. Hypermobility is a motor problem that has a behavioral component. I don’t know why so little has been written on this subject, but here it is: hypermobile kids are more likely to fidget while sitting, more likely to get up out of their chairs, but also more likely to stay slumped on a couch. They are more likely to jump from activity to activity, and more likely to refuse to engage in activities than their peers. They drape themselves on furniture and people at times.
Why? Hypermobility reduces a child’s ability to perceive body position and degree of movement, AKA proprioception and kinesthesia. It also causes muscles to work harder to stabilize joints around a muscle, including postural muscles. These muscles are working even when kids are asleep, so don’t think that a good rest restores these kids the same way another child gets a charge from a sit-down.
When a hypermobile child starts to move, the brain receives more sensory input from the body, including joints, skin and muscles. This charges up a sensory system that was virtually starving for information. Movement from fidgeting and movement by running around the house are solutions to a child’s sense that they need something to boost their system. But fatigue can set in very quickly, taking a moving child right back to the couch more quickly than her peers. It looks to adults like she couldn’t possibly be tired so soon. If you had to contract more muscles harder and longer to achieve movement, you’d be tired too! Kids develop a sense of self and rigid habits just like adults, so these “solutions” get woven into their sense of who they are. And this happens at earlier ages than you might think.
Then there is pain. Some hypermobile kids experience pain from small and large injuries. They are more likely to be bruised, more likely to fall and bump into things, and more likely to report what pediatricians may call “growing pains”. Sometimes the pain is the pull on weak ligaments and tight muscles as bones grow, but sometimes it isn’t. Soreness and pain lead some kids right to the couch. After a while, a child may not even complain, especially if the discomfort doesn’t end. Imagine having a lingering headache for days. You just go on with life. These kids are often called lazy, when in truth they are sore and exhausted after activities that don’t even register as tiring for other children their age.
How can you tell the difference between behaviors from ADHD and those related to hypermobiilty? I think I may have an idea.
When a hypermobile child is given effective and consistent postural support, is allowed to rest before becoming exhausted (even if they say they are fine), and any pain issues are fully addressed, only then can you assess for attentional problems. Occupational therapists with both physical medicine and sensory processing training are skilled at developing programs for postural control and energy conservation, as well as adapting activities for improved functioning. They are capable of discussing pain symptoms with pediatricians and other health professionals.
I think that many children are being criticized for being lazy or unmotivated, and diagnosed as lacking attentional skills when the real cause of their behaviors is right under our noses. It is time to give these kids a chance to escape a label they may not have.