Alternative Seating Systems for Students With Attention Difficulties: A Systematic Review

PURPOSE: Attention deficit hyperactivity disorder (ADHD) affects nearly 5% of school-age children, and this percentage continues to increase (Insel, 2010). Furthermore, research has demonstrated that a substantial percentage (40%–60%) of children with ADHD also have a sensory processing disorder such as a deficit in sensory modulation (Mangeot et al., 2001; Miller, Nielsen, & Schoen, 2012). A deficit in sensory modulation may cause a student to require additional sensory input, such as fidgeting, in order to respond to the appropriate stimulus in an adaptive manner (Ghanizadeh, 2011; Mangeot et al., 2001). By providing a student with an alternative seating device that allows for additional movement, students may be able to attend better to the appropriate task in the classroom. Whether or not children are diagnosed with ADHD or a sensory processing disorder, any student who experiences attention difficulties is at greater risk to underperform academically (Insel, 2010). Therefore, the purpose of this study was to determine the effectiveness of alternative seating systems in improving attention in students with attention difficulties.

DESIGN: A systematic review of the literature was performed. Studies were considered if they were published in a peer-reviewed journal between 2003 and 2016, recruited students with attention difficulty, evaluated the use of an alternative seating device, and had a randomized controlled trial, case–control, or single-subject design.

METHOD: Electronic databases searched included CINAHL, MEDLINE, JSTOR, PsycINFO, OTseeker, Cochrane Library, and Google Scholar. Medical Subject Heading (MeSH) terms included attention deficit disorder with hyperactivity (ADHD), attention, students, and child. Non-MeSH terms included attention deficit disorder (ADD), school age, seating, alternative seating, dynamic seating systems, therapy ball, therapy cushion, decreasing attention, and increasing concentration. Additionally, reference lists from identified studies were examined for potential articles. Studies meeting the above criteria were assessed by two authors for eligibility and methodological quality, and data were recorded in an evidence table.

RESULTS: Eight articles were included in this systematic review: one randomized controlled trial, one case–control study, and six single-subject studies. Articles were included specific to students identified as having attention difficulty rather than solely on the basis of a diagnosis such as autism spectrum disorder. All studies included in the review reported improvements in attention and behavior for students who used alternative seating devices. In addition, teachers generally reported strong support for the use of alternative seating devices.

CONCLUSION: The results of this review indicate that the use of alternative seating devices does increase attention for students. Larger sample sizes and wider age ranges are needed to fully determine the outcomes of using alternative seating devices in the school setting. It is hoped the results of this review of literature will contribute to evidence-based practice for occupational therapists in the school setting.

IMPACT STATEMENT: Generating evidence to support the use of alternative seating devices will enhance evidence-based occupational therapy practice in school-based therapy. Furthermore, the results of this study may have an impact on improving outcomes for this population.

References

Ghanizadeh, A. (2011). Sensory processing problems in children with ADHD, a systematic review. Psychiatry Investigation, 8, 89–94. https://doi.org/10.4306/10.4306/pi.2011.8.2.89

Insel, T. (2010). Post by former NIMH Director Thomas Insel: Attention on ADHD Awareness Week. Rockville, MD: National Institute of Mental Health. Retrieved from http://www.nimh.nih.gov/about/director/2010/attention-on-adhd-awareness-week.shtml

Mangeot, S. D., Miller, L. J., McIntosh, D. N., McGrath-Clarke, J., Simon, J., Hagerman, R. J., & Goldson, E. (2001). Sensory modulation dysfunction in children with attention-deficit–hyperactivity disorder. Developmental Medicine and Child Neurology, 43, 399–406. https://doi.org/10.1111/j.1469-8749.2001.tb00228.x

Miller, L. J., Nielsen, D. M., & Schoen, S. A. (2012). Attention deficit hyperactivity disorder and sensory modulation disorder: A comparison of behavior and physiology. Research in Developmental Disabilities, 33, 804–818. https://doi.org/10.1016/j.ridd.2011.12.005