ADHD

ADHD brains are wired for creativity and high energy—channelled well, they become superpowers.

Anonymous

Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder was once diagnosed as ADD or ADHD. Previously, hyperactive and impulsive symptoms were associated with the term “ADHD,” while inattentive symptoms like trouble listening or managing time were diagnosed as “ADD.” Today, the condition is simply called ADHD — according to changes in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V)1 — and patients are diagnosed with one of three presentations.‍

Types of ADHD Differences

Hyperactive and Impulsive Type ADHD

People with hyperactive ADHD feel the need for constant movement. They often fidget, squirm, and struggle to stay seated. Children often appear to act as if “driven by a motor” and run around excessively. People of all ages may talk non-stop, interrupt others, blurt out answers, and struggle with self-control. This type of ADHD is more recognizable and more often diagnosed in children and men.

Inattentive Type ADHD

People with inattentive ADHD make careless mistakes because they have difficulty sustaining attention, following detailed instructions, and organizing tasks and activities. They have weak working memory, are easily distracted by external stimuli, and often lose things. This type of ADHD is more commonly diagnosed in adults and girls, and was formerly known as ADD.

Combined Type ADHD

People with combined-type ADHD demonstrate six or more symptoms of inattention, and six or more symptoms of hyperactivity and impulsivity.

ADHD brings creativity, high energy, and a knack for big-picture thinking; strengths that drive innovation and fast problem-solving. Many people with ADHD are resilient, hyperfocused on passions, and skilled at multitasking and spotting novel connections others miss. With supportive environments and strategies that harness these traits, ADHD can be a powerful asset in work, learning, and relationships.

Overlap of ADHD and Sensory Processing Differences

ADHD and Sensory Processing Disorder (SPD) frequently co-occur, with up to 60% of individuals with ADHD also experiencing sensory processing challenges. ADHD and sensory processing differences commonly overlap; many people with ADHD also experience sensory sensitivities or under-responsiveness, which can amplify distractibility, impulsivity, and difficulties with emotional and self‑regulation. Sensory over‑responsivity such as sensitivity to noise, touch, or light can trigger avoidance or meltdowns, while under‑responsivity may look like inattention or low motivation. Sensory processing disorder symptoms are more prevalent in children with ADHD, leading to more difficulties in social and educational settings (Adra et al., 2021).ADHD (attention‑deficit/hyperactivity disorder) and sensory processing differences (SPD/atypical sensory modulation) frequently co‑occur and interact, producing overlapping functional challenges in attention, behaviour, motor skills and emotional regulation.

Co-occurrence & Overlap

Attention & arousal dysregulation: sensory overload or under‑responsivity alters arousal, worsening inattention or hyperactivity.
Distractibility: sensory distractions (noise, lights, textures) mimic or amplify ADHD inattentiveness.
Impulsivity & motor restlessness: sensory seeking (need for movement/pressure) appears like hyperactivity or impulsive behaviour.
Poor task tolerance & fatigue: sensory overload leads to quicker mental and physical exhaustion, reduced task persistence.
Emotional dysregulation: sensory stress increases anxiety, meltdowns or low frustration tolerance common in ADHD.
Motor coordination impact: proprioceptive and vestibular differences can contribute to clumsiness often seen with ADHD.

Therapy

Bottom Up Approaches: These aim to regulate arousal and sensory systems to improve readiness for attention which includes sensory integration therapy, sensory lifestyle, vestibular and proprioceptive input, deep pressure and heavy work, gross‑motor or oral‑motor activities. Expected outcomes are regulated arousal, improved motor control and greater classroom participation, organisation of behaviour and reduced meltdowns.
Top‑down approaches teach cognitive strategies to plan, initiate, sustain, monitor and complete tasks by targeting executive functions such as initiation, working memory, planning, inhibition, flexibility. Occupational therapy strategies include visual schedules, task chunking, timers, checklists, cueing systems, rehearsal scripts, self‑monitoring charts, goal‑setting and graded scaffolding. Expected outcomes are better task follow‑through, reduced prompt dependence, and improved time management and organisation.

Neurological difference

ADHD involves atypical frontostriatal and executive‑control network function with dysregulated dopaminergic and arousal systems affecting attention and inhibition, whereas sensory processing differences reflect altered sensory‑pathway and multisensory integration (thalamic, somatosensory, vestibular) processes which are often overlapping but neurobiologically distinct.

Bottom up and Top down intervention

Physiological state and cognitive control are interdependent: bottom‑up regulation sensory and motor integration stabilizes arousal and reduces noise in the nervous system, creating the receptive state in which top‑down executive strategies can be learned and used.‍

Executive Functions

Executive functions (EF) are the brain’s management skills that enable goal-directed behavior: planning, organizing, starting tasks, sustaining attention, controlling impulses, adapting to change, and monitoring performance. They develop through childhood into early adulthood and underpin learning, self‑care, social skills, and workplace success.

Core types of executive functions

Inhibition (self‑control)

Resist impulses, pause before acting, manage emotional reactions.

Working memory

Hold and manipulate information in mind (e.g., follow multi‑step instructions).

Emotional control

The capacity to manage and regulate your feelings in a way that is appropriate for the current time and place.

Cognitive flexibility (set‑shifting)

Switch between tasks, perspectives, or rules; adapt when plans change.

Planning & organization

Break goals into steps, sequence actions, and organize materials and time.

Task initiation & motivation

Begin tasks without excessive delay and maintain momentum.

Sustained attention

Maintain focus on a task despite distractions.

Self‑monitoring & error correction

Track performance, recognize mistakes, and adjust strategies

Time management & prioritisation

Estimate time, meet deadlines, and choose what to do first.

Occupational therapy interventions for children and adults with ADHD target sensory processing, motor skills, and executive functioning to support both bottom‑up and top‑down development. By addressing sensory modulation and motor planning (bottom‑up strategies) alongside goal‑directed behavior, self‑regulation, and cognitive control skills (top‑down strategies), OT promotes integrated neural and functional gains that improve attention, adaptive participation, and daily living performance.