Increased Postural Sway & ADHD

What is increased postural sway and how does it relate to people with ADHD?

Postural sway is the horizontal movement that a person makes when standing up.

Someone with low postural sway (which is the ideal here) will have no movement when standing and balanced. Someone with high postural sway will sway back and forth. They may be prone to bumping into things or losing their balance.

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This blog is for educational purposes only. This information is best case scenario, at least within the scope of my knowledge and experience at the time I write the post. Not only does everyone have different approaches to parenting and life- and my way may not be your cup of tea, but also- I am not perfect, nor do I want anyone to imagine that I am. Despite being a therapist and having a whole host of really cool techniques for all the mental health related things, I am constantly learning and trying to do better.

I’m hoping that this blog can help you. When we share what works for us, we can help others develop their own toolkit for improving their mental health.

Postural sway is based on where our center of balance is. In this photo, the people have a center of balance directly down the center of their body as they are standing with two feet on the ground, shoulder width apart. If they have high postural sway, they may move a bit, left to right, even though they’re in a balanced position.

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Our ability to stand up and maintain our balance is controlled by both our muscles and our brain. While many things impact our balance, people with high postural sway tend to have abnormalities in the cerebellum, the part of our brain responsible for balance, posture, motor learning, and speech. People with ADHD show reduced cerebellar volumes in neuroimaging so it makes sense that we see both issues in some people.

Only about 50% of people diagnosed with ADHD experience high postural sway. But the issue of postural sway isn’t exclusive to ADHD either- it can occur in those with anxiety and other disorders as well.

The important thing to remember is that high postural sway is relatively consistent through a person’s life: sudden balance issues could be caused by other health problems, including side effects from medication.

Impact of Increased Postural Sway

Increased postural sway can have an impact on your life, as well as your safety.

Here are some ways that increased postural sway may impact you:

  • Standardized field sobriety tests may conclude that someone with high postural sway is drunk, even if they haven’t been drinking.
  • Increased postural sway may impact driving ability and staying within the lines.
  • People who have high postural sway may be prone to breaking things and may have anxiety about being in places with lots of fragile objects.
  • Untreated high postural sway may make us prone to accidents, particularly if we work jobs where we are on ladders or other high objects.
  • Increased postural sway may cause us to have lots of small accidents and injuries that don’t hit the radar for medical treatment, but may be inconvenient: i.e.. the person may frequently covered in small cuts, bruising, etc.

I like to joke that I don’t have a fear of heights so much as I have a fear of falling. As a child, my nightmares often revolved around falling off a ladder. But I don’t get anxious when I see heights or ladders in a photo or from behind a protective barrier. If I’m properly secured (ie. on a ropes course), I’m confident and happy with heights. I also don’t get nervous seeing heights in movies, or 3D, or in photos.

I anticipate that many people with high postural sway may be similar to me and have a fear of heights and fear of crowds. These fears may not be based so much in the fear of the height per se, but of the fear of falling, particularly given historical data that says they tend to be a bit clumsy.

Similarly, being in crowds can cause some social anxiety as, with high postural sway, you may be prone to bumping into others. This is often not perceived kindly by strangers and could result in someone stopping to get angry with you, yelling at you, or even hitting or bumping you back.

Improving Postural Sway

While ADHD cannot be cured, we can work to improve executive function and improve postural sway. One way to do this is to stimulate and engage the cerebellum with exercise. Martial arts, dance, and yoga are thought to help, and it’s thought that exercise could improve attention and working memory for those with ADHD.

My understanding is that the best options for those with postural sway issues are activities that involve movement, preferably over unstable surfaces. I would guess that activities like walking on a balance beam (gymnastics), horseback riding (requires the development and improvement of balance), and hiking (movement on uneven ground) would also help.

As you might guess, sitting at a stable desk on a stable chair might not be helping improve postural sway. Substituting the chair for standing, a wiggle chair, or an exercise ball may be a good alternative.

The beautiful thing about ‘exercises’ for improving postural sway is that they do NOT have to be a bore. This is excellent news for children and adults with ADHD who may be prone to getting bored doing daily exercises. I am TERRIBLE at doing physical therapy exercises, but I LOVE doing sports like horseback riding, hiking through the woods, or just pretending to balance on a log as I’m walking around. I’d love to try aerial yoga.

  • DO NOT tell your ADHD person that they need to do exercises every day.
  • DO ask them what new physical activity they might enjoy trying or give them a list of potential activities. It could be riding a bike!
  • DO NOT pressure a person to do a group sport if they prefer something individual, or vice versa.

The important piece is to find what they’re passionate about because it is something they will have the drive to continue.

Personally, I like sports and activities where I can continue to learn and improve at a fairly quick pace. This doesn’t mean I do dangerous parts of my sport before I’m ready, but that I feel like I’m learning something new each time I participate.

It’s Not Just ADHD!

People with anxiety disorders and Autism also tend to experience high postural sway. It can also be a sign of a health issue, including a side effect of medication. If the increased postural sway is a new occurrence, you should see your doctor to ensure that nothing else is wrong.