Heidi Allen
University of Puget Sound
December, 2003

Increase Attention: Use of Therapy Balls as Classroom Seating for Children with Attention Deficit Hyperactivity Disorder

Occupational therapists have become experts in the field of sensory-based therapy for children with special needs. Sensory processing delays are often the basis for many treatments of children with Attention Deficit Hyperactivity Disorders (ADHD), especially when addressing attention within the classroom. Differential seating, specifically therapy balls or inflatable discs, is often implemented as a means to increase attention within the classroom. Currently there is only one published study that examines this issue, therefore, this report will attempt to address the rationale behind using a therapy ball or inflatable disc to increase attention.

Evidence Based Practice Question:
For school aged children, diagnosed with Attention Deficit Hyperactive Disorder, does the use of therapy balls or inflatable discs as classroom seating increase attention within the classroom?

Criteria for Evidence Selection:

Types of Participants:
Infants to elderly adults
With and without disabilities, specifically postural control and attention

Types of Interventions:
Postural control
Alternative forms of seating

Types of Studies:
Randomized Control Trials (definitive and non definitive), cohort studies, case control, case report
Levels of evidence I-V

Table Summarizing the Evidence:




Level of


Sample Size


Summary of Results

Schilling et al. (2003)

Single Case Design

Level III

24 students in 4th grade: 3 children with ADHD

Chair and ball phases of in class seating. Measured within context of study: seating behavior, word legibility, social validity.

When children were seated on balls, there was an increase in seated behavior, word legibility, comfort, ability to listen and attend, finish class work, and calm and focus body.

Washington et al. (2001)


Level II

4 infants unable to sit independently

5 minutes of data recorded in each of 3seating conditions (highchair, highchair with foam liner, highchair with contoured foam seats (CFS)).

CFS improved postural alignment for all children, 80%-100% from baseline. CFS increased arm use when playing with toys.

Dault et al. (2001)


Level III

24 typically developing adults 20-40 years old

Stood on 3 different supports while measuring 3 levels of cognitive difficulties.

As postures became more difficult and novel, cognitive tasks became more difficult, which decreased postural stability.

Redfern et al.  (2001)


Level III

18 healthy young adults and 18 healthy older adults with normal vestibular function

4 postural challenges (sways) and the attention required within sensory system in context of 4 cognitive challenges.

Young adults showed no attention effects on sensory system as posture was challenged. Older adults displayed sensory integration problems when postures were challenged. Balance is required for postural control, and is related to attention and sensory integration.

Dunn et al.  (1997)


Level III

1115 parents of children 3-10 years old without disabilities

Parents reported how often their children displayed 125 different behaviors.

Know child’s threshold to sensory information to decide if sensory processing delays are due to intensity of behaviors. Children without disabilities displayed similar Sensory Profile patterns as some with disabilities.

Dunn (1997)

Literature Review

Level V


Neuroscience and behavioral science

Background for sensory receptors and transmitters are grounded in neuroscience. The ability to learn is affected by the CNS and sensory processing. Low and high thresholds respond to sensory stimuli differently.

Case-Smith (1997)

Literature Review

Level V


Sensory Profile

Understanding the sensory profile of a child is necessary for understanding functional performance. A child must keep attention to make social connections. A therapist must know child’s thresholds to find best treatment.
























Summary of Evidence:

Implications for Consumers:

Implications for Practitioners:

Implications for Researchers:

Recommendations for Best Practice: