Fidgeting is a common trait in people with ADHD (attention deficit hyperactivity disorder). Whether foot-tapping, twirling hair or clicking a pen, there is research to suggest that this sort of repetitive movement helps the ADHD brain focus on a task. Both adults and children with the disorder do better in cognitive tests performed while they are fidgeting. Meanwhile, sales of tools like kinetic desk toys and fidget spinners have risen, along with a rise in ADHD diagnoses.
In New Zealand, an estimated 280,000 people have ADHD and it is believed that the condition is under-diagnosed. Partly, this is because identifying it involves a lengthy specialist assessment. That will change in February next year when GPs and nurse practitioners will be able to begin assessing adults for ADHD and treating them. They will still have to rely on tools such as psychometric tests and behavioural checklists to identify the disorder in patients who come to them with symptoms including hyperactivity and a lack of control over attentiveness, focus and/or impulse.
Justin Fernandez is intent on providing medics with a new tool for diagnosis, linked to the common ADHD trait of fidgeting. Fernandez is a bioengineer from the University of Auckland who has long been interested in human motion.
“There are a lot of studies that show people with ADHD walk differently, at variable speeds or with more sway,” he says. “It appears to be an outward symptom but it is something that isn’t being used very much in diagnosis.”
Fernandez turned his attention to finer motions, such as fidgeting, and is using MRI (magnetic resonance imaging) to track what happens in the brain when people fidget.
Last time the Listener spoke to him, in 2021, he was collaborating with Mātai Medical Research Institute in Gisborne to do a small pilot study. Since you are not meant to move during an MRI, it presented challenges. Researchers placed foam supports under the elbows and knees so people could fidget – typically foot tapping and finger clicking – without it causing motion in the head for the hour they needed to be in the machine.
Since then, Fernandez has made progress, reducing the scan time to 20 minutes and working with larger numbers of ADHD and neurotypical participants. Close to 120 people have gone through now and the researchers are seeing a clear difference in the results.
“Those who fidget and have ADHD show an improved activation in the prefrontal cortex of their brain, which is associated with executive functioning. But the opposite was seen in people who are more neurotypical. They had a reduction in activity when they started to fidget, as if it was distracting.”
Fernandez and his team have now combined a range of scans measuring brain shape, structure, function and chemical signature to create an atlas of the ADHD brain.
“Clinicians will be able to scan a patient, map their brain onto [the atlas] and see how the patient compares. The more similar areas there are, the more likelihood there is that they have ADHD,” he says.
Fernandez has had no shortage of participants coming forward to take part in the trial and now hopes to expand it around the country. He continues to examine data from MRI scans done so far to look for more biomarkers and is seeing differences across age and gender that could lead to more personalised approaches to diagnosis and treatment.
“While other researchers have studied the ADHD brain far longer than me, no one has tried to get people to do these sorts of functional movements while scanning, and that’s when the brain kicks into action and you see these dynamic networks come into play, which you don’t see when they are still,” he says.
Fidgeting increases the dopamine levels in the brain, just as the commonly prescribed medication Ritalin does to relieve symptoms. “So, it all makes sense, it’s just that no one has ever tried to measure it before.”
