Why ADD and ADHD are not always the answer…
As a school year begins in the US, teachers meet their new students and settle into their routines as they bravely tackle a year’s worth of curriculum. Inevitably, it doesn’t take very long for many teachers to start to look at some of their students more closely and wonder if there is something they are missing. Often times, we as educators turn to the “go-to” answers. Do they have ADD? ADHD? Learning Disability? Counseling? Speech? Separation Anxiety? We try to make the symptoms fit. But sometimes the go-to list does not have the right answer.
While some studies show that a child with ADHD may have RLS and a child with RLS may have ADHD, medical professionals are still not sure if they are linked. That said, RLS and ADHD can look very similar in a child in a classroom. Ever have a student who just gets up and walks around or is constantly fidgeting in their seats or can occasionally have random outbursts or may appear to be tired or seems too distracted? Or ever have a child that is all of those things? It is very easy as educators to think, “I wonder if he/she has been tested for ADHD?…”
As a parent of an 8 year old with Restless Leg Syndrome, when I encounter a child with those symptoms I also think, “I wonder if he/she has RLS…?” But I consider myself fortunate. When my daughter starts a new school year I do not give my daughter’s teachers a chance to ask those questions. I am fortunate to have the answer for them, but it is easy to see why, after explaining her symptoms her teachers inevitably ask, “are you sure she does not have ADHD?” And it is even easier to find yourself dealing with a parent who looks exhausted, feels helpless and is turning to their child’s teacher for help. I personally know how desperate someone can feel when their 8 year old is going on her 6th night strait of four broken hours of sleep!
What is Restless Leg Syndrome (RLS)?
The National Institute of Neurological Disorders and Strokes classifies Restless
Leg Syndrome as a neurological disorder characterized by throbbing, pulling, creeping, or other unpleasant sensations in the legs and an uncontrollable, and sometimes overwhelming, urge to move them. Symptoms occur primarily at night when a person is relaxing or at rest and can increase in severity during the night. Moving the legs relieves the discomfort. Often called paresthesias (abnormal sensations) or dysesthesias (unpleasant abnormal sensations), the sensations range in severity from uncomfortable to irritating to painful. NINDS goes on to say that, Childhood RLS is estimated to affect almost 1 million school-age children, with one-third having moderate to severe symptoms.
In other words, there is a chance that at some point you will probably work with a student that has Restless Leg Syndrome (whether or not they have been diagnosed or not). While there is growing evidence that children with ADHD have RLS and vice versa, it is important to note that not all children with RLS have ADHD and not all children with ADHD have RLS. Recent research by sleep specialists indicates that at least 25% of the children who have a diagnosis of ADHD may truly have Restless Legs Syndrome or Periodic Limb Movements or a combination of the two. That said, all children with RLS have an overwhelming desire to move in an effort to reduce the symptoms.
It is also important to know that children with RLS often have broken sleep and can often be tired and cranky during the day. This can be very frustrating for everyone involved in that child’s life. Living this first hand, I can attest to how difficult it can be for an 8 year old to function on four broken hours of sleep a night. So much so that after many years of varying treatment plans, I vividly remember calling my daughter’s second grade teacher and asking her to tell me what my she was like in school as we were finally getting to meet her for the first time as she was starting to sleep for more than 4 hours a night consistently (and so were we!). For more specifics on RLS symptoms and sleep check out Cleveland Children’s Clinic.
RLS in Kid Speak
For many children with RLS, explaining what is happening to them can be difficult. Often times, they will try to hide it (like my daughter) or be so uncomfortable that they have to move and will use different words (that may seem crazy). Those words include;
- Pins and Needles
- Burning (nothing worse then a child telling you they feel like their legs are on FIRE!)
- Coca Cola in the viens
They may also describe the feeling as numb, hot, or cold. Sometimes they cannot even explain it other than having an overwhelming desire to move. In my experience RLS can make a child hot one minute and cold the next. My daughter often wears layers as she is freezing in the morning, hot in the afternoon and cold again at night.
But articulating that can be a challenge and often takes some detective work on the part of the adults. When my daughter was really young, she would cry and grab her legs. As she learned to speak, we found it easier for her to point on a drawing or draw the feelings herself. During her pre-school age, she would often refer to her pain as spiders, creepy crawlies, or just cry in pain. Now she is able to articulate a pain scale, specific feelings and the severity of them. She is even learning ways to self control her symptoms and knows is getting better at communicating that with her teachers.
What to do for wiggles, squiggles, spiders, creepy-crawlies, pins, needles, heeby jeebies, and ouchies…
There is a lot you can do for a child with RLS (or one that has similar symptoms) without anyone in the class ever knowing. This can include;
- Let them be the messenger and run an errand
- Having them walk to what they need supplies wise instead of bringing it to them
- Let them be the teacher’s helper
- Let them stand, or sit, or move to the carpet area depending on what they need
- Additionally the following “tools” have a big impact without a lot of investment;
- Balance balls are always a great way to let them move without being a distraction
- Bouncy Bands around the desk for them to put their feet in is also a great way to get they “worms” out
- Free-choice seating is another way to create an inclusive classroom
- A contract for students and parents for free choice seating can be found here
- A video on seating choices can be found here
- Pins on free-choice seating can be found here
The Restless Leg Foundation has a tremendous amount of resources to help people gain a deeper understanding of what RLS is, why people get it, and how to live with it. Their work towards awareness and advocacy is my inspiration for this post. As educators I believe it is important to always be learning. This site can provide you with far more resources as well as answer specific questions about RLS.
Other Helpful Sites
While RLS has a wealth of knowledge, there are some other sites that are useful in helping to gain a deeper understanding of RLS. They include;
Often times the key is knowing the signs as to not make it worse for the child. Telling a child to sit still may have long term negative effects.While some children may be very vocal about their symptoms, others, like my daughter, go out of their way to try to make sure no one knows that she needs to move. Her only giveaway is her toes curling all day long in her shoes! That said, regardless of what it is that a child may be dealing with I firmly believe that an inclusive classroom is critical to having a positive learning environment..
Disclosure – I am not a doctor, nor am I an expert on Restless Leg Syndrome. That said, I am a mother of an 8 year old who was diagnosed with RLS and childhood insomnia at the age of 4. There is no question that my daughter has been living with RLS since birth, it just took 4 years and a lot of doctors to get to that answer.