Attention Deficit Hyperactivity Disorder (ADHD)

Pathophysiology

Dopamine dysfunction: Problems with the production, transportation, and reabsorption of dopamine in the prefrontal cortex impair executive function, working memory, and reward processing — the core cognitive deficits that manifest as inattention and impulsivity
Noradrenaline signaling disruption: Noradrenergic pathways from the locus coeruleus to the prefrontal cortex are underactive, reducing the ability to sustain attention and regulate arousal states
Neuroanatomy: Imaging studies show reduced gray matter volume in the frontal cortex, basal ganglia (particularly the caudate nucleus), and cerebellum — areas responsible for decision-making, motor planning, and impulse regulation
Three presentations: Predominantly inattentive (difficulty filtering important from trivial stimuli), predominantly hyperactive-impulsive (motor restlessness and impulsivity), and combined type
Treatment: Psychostimulants (methylphenidate/Ritalin, dextroamphetamine/Adderall) increase dopamine and noradrenaline availability. Behavioral modification and meta-cognitive therapy are non-pharmacological approaches

Inattentiveness: Easily distracted by sights and sounds. Careless mistakes. Difficulty sustaining attention on tasks. Frequently loses or forgets tools, books, and appointments
Hyperactivity: Fidgeting with hands and feet. Squirming in seats. Inability to play or work quietly. A subjective sense of internal restlessness in adults that replaces the overt motor hyperactivity seen in children
Impulsivity: Blurting out answers. Difficulty waiting for a turn. Frequently interrupting conversations. Impulsive decision-making
Emotional dysregulation: Frustration intolerance, mood swings, and difficulty managing anger are increasingly recognized as core features rather than comorbidities
Sleep disturbances: Difficulty falling asleep due to racing thoughts. Poor sleep quality. Delayed sleep phase syndrome
Comorbidities: Anxiety disorders, depression, OCD, Tourette syndrome, and substance use disorders are common co-occurring conditions

Untreated ADHD increases risk for addictive behaviors (gambling, substance abuse, compulsive spending) as individuals may attempt to self-medicate the dopamine deficit
Stimulant medication side effects: Tachycardia, elevated blood pressure, appetite suppression, insomnia, and potential for misuse — monitor cardiovascular signs during intake
Comorbid depression or suicidal ideation: Screen for mood disorders, particularly in adolescents and adults with newly diagnosed ADHD
Oppositional or aggressive behavior in children: May indicate comorbid oppositional defiant disorder or conduct disorder requiring mental health referral

Primary challenge: The client's discomfort with being asked to remain still longer than their current capacity — this is a neurological limitation, not a behavioral choice
Session adaptation: Shorter sessions may be more effective than standard 60-minute treatments. Allow for movement breaks. Flexible positioning
Pressure preference: Firm pressure is generally preferred over light touch, which may be perceived as irritating or ticklish due to sensory processing differences
Environmental modifications: Reduce stimuli that compete for attention — turn off fans, dim lights, minimize background noise for overstimulated clients. Conversely, some clients focus better with rhythmic background sound
Children: Treat over clothing if the child is shy. Use firm, predictable strokes. Engage the child in the process to maintain cooperation
Bodywork benefits: Research associates massage with improvements in anger control, sleep quality, classroom behavior, and mood regulation
Medication awareness: Psychostimulants may cause elevated heart rate and blood pressure. Non-stimulant medications (atomoxetine) may cause drowsiness — assist with table transitions
Technique range: Ranges from rigorous sports massage for clients who crave deep sensory input to subtle energy work for those seeking stillness — let the client's nervous system guide the approach

Classified under neurological/mental health conditions. Recognize the three presentation subtypes (inattentive, hyperactive-impulsive, combined)
ADHD is a neurobiochemical disorder involving dopamine and noradrenaline — not a behavioral or parenting issue
Key comorbidities tested: anxiety, depression, OCD, Tourette syndrome, substance use disorders
Sensory processing differences determine whether deep pressure or lighter approaches are appropriate
Medication side effects (cardiovascular changes from stimulants, drowsiness from non-stimulants) modify treatment approach

ADHD is a neurobiochemical disorder involving dopamine and noradrenaline dysfunction in the frontal cortex, basal ganglia, and cerebellum — not a behavioral choice.
The primary massage therapy challenge is not physical safety but the client's neurological difficulty with remaining still. Session length and positioning must be adapted.
Firm pressure is generally preferred over light touch, which may be perceived as irritating due to sensory processing differences.
Environmental stimuli should be minimized to help overstimulated clients settle into the session.
Comorbidities (sleep disorders, depression, anxiety, OCD, Tourette syndrome) are common and require screening at intake.
Psychostimulant medications may cause elevated heart rate and blood pressure. Monitor cardiovascular signs.