Attention-Deficit/Hyperactivity Disorder (ADHD)

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About ADHD

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that affects how a child’s brain functions, particularly in areas related to attention, self-control, and activity level. Children with ADHD may experience challenges with maintaining focus, impulsivity, and/or hyperactivity, which can impact learning, social relationships, and everyday activities at home and school.

Common Challenges Experienced by Children with ADHD

Children with ADHD may experience a wide range of challenges. Many of these challenges are related to executive functions, which include:

Working memory – holding, manipulating, and using information in your mind to complete a task
Planning and organization – setting goals, organizing materials, and identifying steps needed to complete a task
Task initiation – starting a task independently without delaying
Sustained attention – maintaining focus over time
Cognitive flexibility – adjusting to changes, switching between tasks, or trying a new approach to a task
Emotional regulation – managing emotional responses appropriately
Self-monitoring – recognizing and adjusting one’s own behaviour
Inhibitory control – thinking before acting and resisting impulses

Children with ADHD may experience challenges with one or more of the above executive functions. In daily life, these executive functioning challenges may present as:

Forgetting instructions or only completing part of a multi-step task
Requiring frequent reminders to complete familiar daily routines
Having difficulty starting tasks, even when it is something they enjoy
Under- or over-estimating the amount of time a task will take to complete
Difficulty organizing thoughts into verbal or written output (e.g., paragraph writing)
Making mistakes because they overlook details, particularly when rushing or losing focus
Frequently losing personal belongings, such as water bottles or clothing
Having difficulty completing or handing in schoolwork on time
Challenges transitioning between activities
Frequently interrupting others or blurting out answers in class
Finding it difficult to take turns or manage frustration

Some children with ADHD may also experience fine motor, visual-motor, or coordination difficulties that may affect handwriting, cutting with scissors, or participating in sports and playground activities. While these features are not considered core features of ADHD, they commonly occur alongside ADHD.

What is Occupational Therapy?

Occupational therapists (OTs) support children to develop the skills and strategies needed to successfully participate in everyday activities, also known as “occupations”. For children, these activities may include self-care tasks, such as eating, bathing, getting dressed, brushing their teeth, and sleeping; school-related tasks, such as completing schoolwork, staying organized, and paying attention in class; social participation and emotion regulation; and participating in leisure activities.

Rather than focusing solely on ADHD symptoms, OT focuses on helping children participate more fully and independently in their everyday activities. OTs work collaboratively with children and their families to build skills, adapt tasks and environments, and provide practical strategies to support executive functioning and increase independence in daily activities through individualized, evidence-informed supports.

OT Assessment

An OT assessment begins with developing an understanding of a child's strengths, interests, daily routines, and the challenges they experience across home, school, and community settings. OTs gather this information through interviews with the child and their caregiver(s), direct observation, review of relevant reports (e.g., psychoeducational assessments), collaboration with other professionals involved in the child’s care (e.g., speech-language pathologists, social workers, psychologists) and standardized assessment tools.

The standardized assessment tools selected are based on the specific challenges a child experiences. Depending on these challenges, an OT may assess areas such as executive functioning, sensory processing, fine and gross motor skills, handwriting, self-care skills, or sleep. These assessments help an OT understand how a child’s strengths and challenges affect their participation in daily activities and provide the foundation for collaborative goal setting and intervention planning.

Depending on the level of observation needed and the standardized assessments chosen to administer, an OT assessment may take between 1-2 hours to complete.

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OT Support and Intervention

For children with ADHD, OT may involve providing age-appropriate education about ADHD and executive functioning to help them better understand their strengths, challenges, and how their brain works. This understanding can foster self-awareness, build self-efficacy, and support children to identify and work toward goals that are important to them. OTs also provide education, coaching, and practical strategies to caregivers, educators, and other professionals involved in the child’s care. By developing a shared understanding of ADHD and its impact on a child’s everyday life, everyone can work together to create consistent, supportive environments that help the child succeed across all settings.

OTs may also support children and families to explore sensory strategies that can promote attention, regulation, and participation in daily activities. For children who experience challenges with emotional regulation, OTs may support them to build their emotional vocabulary, increase awareness of their thoughts, feelings, and body cues, and to develop individualized strategies to recognize, manage, and respond to emotions effectively.

OTs may support the development of routines that reduce the cognitive demands placed on a child to promote greater independence in their daily activities. OTs work collaboratively with families to develop, implement, and maintain routines that fit within their family life. OTs may also provide task-specific strategies for activities that are particularly challenging for a child, such as getting dressed, brushing their teeth, completing homework, or transitioning between activities.

If a child experiences specific challenges at school, OTs can recommend strategies and environmental adaptations to support participation and learning in the classroom. Adaptations may include visual schedules, visual timers, written and verbal instructions, task checklists, movement breaks, flexible seating options, and assistance with breaking larger assignments into smaller, more manageable steps. These supports help to reduce cognitive demands and promote increased independence in a school setting. OTs can suggest these accommodations while simultaneously supporting a child to develop related skills – ensuring that adequate support is in place as the child increases their competence and confidence.

Please note that within Nova Scotia, privately funded OTs cannot physically enter schools for the purpose of observing or providing support to children within a school context. With family consent, privately funded OTs can communicate with educators and support persons via email, phone, or video conference to gain further information about the strengths and challenges a child exhibits within a school setting.

When Should OT Services be Initiated?

OT is not necessary simply because a child has an ADHD diagnosis. OT services may be warranted when a child has difficulty doing the things they need or want to do in everyday life. If challenges are infrequent or do not impact daily functioning, then OT is likely not necessary.

OT services may be beneficial for children who experience ongoing challenges with age-appropriate skills that affect their daily activities at home, school, or in the community. Children may benefit from OT services if they experience:

Challenges with fine motor skills, such as handwriting, using scissors, buttoning clothing, or tying shoelaces
Difficulties with executive functioning skills, such as planning, organization, memory, time management, and problem solving, that impact their participation in daily activities
Difficulty with emotion regulation, such as becoming frustrated or upset easily, or having challenges calming down after experiencing big emotions
Difficulty completing daily routines independently, for example, requiring frequent reminders or help with brushing their teeth, getting dressed, packing their backpack, bathing, or preparing for school
Challenges with attention and completing tasks, such as not finishing schoolwork, or challenges paying attention in class
Challenges with impulse control that affect social interactions with peers, participating in class, or safety during everyday activities.
Difficulty transitioning between activities, adapting to changes in routine, or coping with unexpected situations

Please note that these are simply examples of common challenges that children with ADHD may experience and are not an exhaustive list. If you are unsure whether your child would benefit from OT services, Shoreline Therapy offers free 15-minute consultations with an OT who can answer questions you may have about OT support for your child.

Frequently Asked Questions

Can OTs Diagnose ADHD?

No, OTs cannot diagnose ADHD. OTs are not diagnosticians and cannot diagnose any condition. The following healthcare professionals can diagnose ADHD in Nova Scotia:

Psychologists
Medical doctors (e.g., family doctor, psychiatrist, pediatrician)
Nurse practitioners

Assessments to diagnose ADHD may be accessed through publicly funded health services (e.g., IWK, Nova Scotia Health, Regional Education Centres), or through private practices. There are pros and cons to each. Assessments through the public health system are covered by MSI; however, wait times can range from 1-3 years, and typically require a referral from a family doctor or other healthcare provider. Private assessments can cost between $1500-$3000 which may be partially covered by your own private insurance; however, wait times are generally shorter, and parents can initiate the referral.

For a list of private psychology services in the HRM, click here.

Does OT Support for ADHD Just Focus on School?

No, OTs can support children with ADHD to engage in any daily activities that are challenging for them. In addition to school-related support, OTs may support children to engage in their morning or nighttime routines, improve sleep hygiene, or support emotional self-regulation in the context of home or social environments (e.g., while playing with friends, or participating in organized sport).

What Sensory Strategies Are Beneficial for Children with ADHD?

For many children with ADHD, sensory strategies can support regulation of bodies and minds – making it easier to stay focused, regulate their emotions, and participate in their daily activities. The type of sensory input, and thus the sensory strategies that may be beneficial, are dependent on the needs of the specific person, and can vary depending on the situation. For example, different types of movement may help one child stay focused but may cause more distraction for another child; or access to a fidget may help a child stay focused in class but may not support emotion regulation at home.

Sensory strategies are not a ‘one size fits all’ approach. An OT can help children and their caregivers identify specific sensory strategies that support regulation across settings and situations.

Are Fidgets/Sensory Toys Beneficial for Children with ADHD?

Access to fidget toys can be beneficial for children with ADHD; however, the effectiveness of fidgets often depends on the type of fidget, and the situation in which the fidget is being used.

There is an important difference between a ‘fidget toy’ and a ‘fidget tool’. ‘Fidget toys’ are items that are used for fun/play and may be a distraction if used while participating in an activity that requires greater focus, such as while completing schoolwork or their morning routine. ‘Fidget tools’ are used to support regulation, increased attention, and increased focus while participating in daily activities. OTs can support children to identify ‘fidget toys’ vs ‘fidget tools’, and to determine what types of fidgets or other sensory strategies may be effective in different situations.

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