Jul 29, 2020
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ADHD Treatment Options: How are Weighted Blankets Effective?

ADHD and ADHD-like symptoms are a growing problem in our society. There are many ADHD treatment options to consider such as...

What are you focused on right now? Is it this article that you’re about to read, or is it the never-ending to-do list that acts as a dark cloud, hovering over all of your thoughts? In today’s society, most brains are like the latter, but this isn’t our fault or the fault of mental illness. Society has adapted to move fast-paced, and our workloads have exponentially increased. It’s no wonder our brains drift off into the comfort of planning every chance it can. 

Despite the normalcy of distraction, there is a level where the distractibility becomes a clinical issue that needs intervention –aka ADHD or ADD. How do weighted blankets play into ADHD treatment options and the treatment of nonclinical inattention? Spoiler alert, they can help! If you’ve come all this way for a short, concise answer, there you have it. For the rest of you, we will review the diagnostic breakdown, areas of the brain affected by ADHD. Finally, we will get into why a heavy blanket can alleviate symptoms of inattention and hyperactivity.

Feel free to scroll around to get the information you’ve come for, no hard feelings. Our brains get distracted! 

What is ADHD, really?

The obvious signs and symptoms of ADHD are those that are stereotyped with the disorder: inattention and hyperactivity and ADD is marked by just distractibility.  However, some inattention and hyperactivity are “normal” in people, as described in the compelling intro to this article! When these symptoms are severe and frequently occur, which then obstructs the ability to function in social, academic, and/or occupational settings, there is a justified diagnosis of ADHD or ADD.

Unlike other mental health disorders, ADHD and ADD are classified as a neurodevelopmental disorder, meaning that the cause can be traced to brain development. The exact cause of ADHD is undetermined, but scientists have guessed at the factors that may play a role such as genetics, prenatal alcohol, and drug exposure, lead exposure, brain injury, and low birth weight (NIMH, 2016). (Ahem, as if we need more evidence not to use alcohol and drugs while carrying life!) 

When scientists examined the brain of a child who meets the diagnostic criteria of ADHD, they found similarities in brain size amongst those observed; specifically, they found that areas such as the frontal lobe, temporal lobe, parietal lobe were much smaller than their typical peers (Pratt, 2018). Scientists do not well understand the cause and relationship effects from these smaller brain sizes, but the connection is apparent (Kim et al., 2010) 

Another area of difference in the brain of a person with ADHD comes from blood flow –an indicator of brain activity. A person with ADHD has less blood flow to areas in the prefrontal cortex, which holds the tasks of organization, attention, memory, emotions, and planning, all of which are areas that people with ADHD struggle with. Another malfunction stems from dopamine; at times, there is not enough dopamine, or there are not enough receptors to use dopamine, which is available (Campo, Chamerlain, Sahakian, & Robbins, 2011). The lack of serotonin and ADHD also have been theorized to play a role. 

Essentially, what this all boils down to, is that ADHD is not a choice; it is a neurological condition. (But what mental health issue is a choice honestly?)

How ADHD Makes you Inattentive

Every person has a different experience with ADHD and ADD; some may have more severe symptoms, which prevent them from performing what seems like simple tasks (like laundry or getting to work on time). Others manage their symptoms reasonably well and can get things done. Therefore, the differences in brain make-up and chemistry highlighted above may vary. Despite the level of symptoms, the inability to focus can be both frustrating and debilitating when trying to perform day-to-day tasks, so an easy to implement intervention –such as a weighted blanket –could provide quick relief so that people who struggle with either clinical or non-clinical inattention and hyperactivity can focus.

Summary of ADHD Therapeutic Weighted Blanket Research

Weighted blankets are a form of deep pressure stimulation, which is pressure against the skin that causes changes in bodily and emotional response, in short. Weighted vests –another form of deep pressure stimulation –precede weighted blankets. Thus in the past 20 years, there is much more research on the weighted vest as a therapeutic intervention compared to weighted ADHD blankets. While they are both similar in principle (applying pressure against the skin), there are apparent differences such that a weighted blanket is typically heavier and is a compression blanket to more areas of the body. The therapeutic benefits associated with weighted blankets and ADHD work better under more pressure. 

To be blunt, there isn’t a single study discerning the two methods. I’ve scoured the internet to see if anyone had hypothesized or put to the test the clinical differences between the two and came up with nothing. Therefore, I’m left to speculate on my own.

Both weighted blankets and weighted vests have the same principle component called deep pressure stimulation, so logically it would make sense that if a weighted vest produces an effect, then a weighted blanket –being much more massive and proving more pressure – would also elicit a similar, if not more of an impact. However, it may boil down to preference.

 If you are someone who is stuck at an office and needs to focus at your desk where other people are surrounding you, then a weighted vest underneath your clothing may be a more discreet way to obtain pressure benefits. However, if you’re someone who works from home or has an office to themselves, draping a blanket over your shoulders, or your lap, maybe the better option. Think about practicality that will suit your situation. 

With this being said, there are five studies that involve a deep pressure stimulation method (i.e., weighted vests and weighted blankets) and that have participants with an ADHD diagnosis. For this article, and based on the hypothesis stated above, I will be generalizing the weighted vest results to apply to weighted blanket use.


Study Citation
What Did They Do?AgeMethod of DPS and specsOutcome
Lindstedt & Umb-Carlsson, 2013Researchers test to see which type of cognitive assistive technology would help with adults who have debilitating ADHD.
18-65
Weighted BlanketWeighted Blanket was the preferred item to use for ADHD symptom management.
VandenBerg, 2001Used to see if on-task behavior in a classroom setting would improve5-6Weighted Vest – 5% of body weight, with weight placed on shouldersOn task behavior increased by 18% – 25% in all four students who used the vest.
Hvolby & Bilenberg, 2011Sought to determine if weighted blankets could remedy sleep issues in ADHD8-1315.43 lb weighted blanketFell asleep faster and had a minor amount of sleep increase
Collin and Dworkin, 2011
Used to determine if a weighted vest would improve attention in a classroom setting; different in that there was a control and kids weren’t compared against themselves in this study. 
7-10Weighted VestTeachers reported an increase in attention for 4 out of 7 children; Visual observation from researchers determined only two participants had improved attention with a weighted vest
Lin, Lee, Chang, and Hong (2014)Tested if weighted blankets would improve attention for children with ADHD in a classroom setting.6 – 12Weighted vests with weight distributed on shoulders, back and front. Weight was 10% of body weight.Improved on-task and attention overall.
Buckle et al. (2011)Determined if weighted vests improve in-seat behavior, task completion speed, and attention to a task.6-9Weight distributed on shoulders, chest, and back; the vests weighted 10% of the child’s body weightSignificant improvements were seen in in-seat behavior, task completion speed, and attention to a task.
Weighted Blanket and ADHD Research Review

I fully recognize that the above chart does not get into many details, and you may be left wondering about some of the more nitty-gritty details of each of the studies presented. Head over to our blog articles to read more information and our opinions on each of the studies presented above. 

ADHD Treatment Options: 3 Ways Weighted Blankets can Help

I sound like a broken record in most of the articles I write, but weighted blanket research is a niche field and still relatively novel. Due to this factor, and compared to other evidenced-based interventions, there are very minimal studies that explore the efficacy of a deep pressure stimulation intervention and even fewer that use a weighted blanket. A good portion of the research on deep pressure stimulation overall is flawed in that the sample sizes are petite, and most of the research is considered pilot studies with few follow-ups found. Despite these challenges, the studies highlighted above have provided similar results, which can help us build hypotheses on weighted blankets for ADHD and begin to bridge the gap between what is known and what is questioned.

At this stage in the research, I believe weighted blankets are best used as a complementary treatment –one that is used in part of a greater treatment plan. With different severities of ADHD and the lack of data on lasting effects of brief weighted blanket use, weighted blankets have promising data that can amplify the treatment of behavioral therapy and medication-assisted treatment. As we get closer to developing an appropriate protocol for weighted blanket treatment, it may eventually serve as a standalone treatment option. 

1. Relief from Comorbid Anxiety

One thing has remained relatively consistent throughout weighted blanket literature, and that is that weighted blankets –and other deep pressure stimulation interventions –heighten parasympathetic activity and reduce sympathetic activity. These findings have been documented throughout the literature but have primarily been looked at through the lens of anxiety as a standalone disorder. Comorbid diagnoses are common, and stress –a cause and result of a heightened sympathetic nervous system response — is a primary underlying condition for most mental health conditions, including ADHD. A researcher found that 93% of adult participants who had ADHD also had at least one comorbid disorder, such as depression or generalized anxiety disorder. 

The comorbid stats for ADHD aren’t surprising; think about someone in your life who struggles with inattention and disorganization. Often, it’s frustrating to sit down to do homework only to have your mind hyper fixate on anything but that homework assignment, or it’s frustrating to be “that late friend” because time management is a challenge. Over time these occurrences can deteriorate one’s self-esteem and create symptoms of depression and/or anxiety. The cycle of being unfocused that then results in anxiety, which then fuels the inattention can be detrimental to one’s mental health.  For this particular “side-effect” of ADHD, there is documented evidence to support that weighted blankets can mitigate symptoms of anxiety and thus break the cycle of dysfunction (at least the dysfunction caused by anxiety). 

2. Neurological Relief

 A person who has ADHD has a deficiency in norepinephrine, which is a neurotransmitter in the brain. Norepinephrine is like adrenaline in the sense that it gets the body ready for action. When there is a deficiency in norepinephrine, you will experience lethargy and lack of focus (Silver, 2020). In addition to a deficiency in this neurotransmitter, there are also malfunctions noted in the frontal cortex, the limbic system, the basal ganglia, and the reticular activating system (Silvers, 2020). 

From the studies summarized above, there is a clear connection between the pressure against the skin and the brain’s ability to focus. While we aren’t confident about what that connection is, we know that weighted blankets increase serotonin levels and dopamine levels, which are neurotransmitters that affect our mood (Williams, 2019). Dopamine is used to create norepinephrine; therefore, we can presume that when weighted blankets are applied, there is an increase in norepinephrine, which can reduce the symptoms of inattention and lack of concentration associated with norepinephrine deficiency (Eske & Moawad, 2019). 

3. Sensory Input to Reduce Restlessness

There is a strong link between ADHD and sensory processing problems. People with sensory processing deficits can result in either too high or too low thresholds to sensory inputs, which translates in the academic settings as slow to initiate engagement in activities or responding too quickly to instruction and thus appearing hyperactive. It is theorized that the sensory input of a weighted blanket assists with these issues by allowing the person to organize the stimuli better and therefore adjust better to environmental stimuli. 

Another sensory response associated with ADHD is an overarching sensory is proprioceptive dysfunction; proprioception is our ability to know where our body is in space without actually looking at the body part. This article does an excellent job explaining proprioceptive input. It is theorized that the weight of weighted blankets provides proprioceptive input information, which can reduce the restlessness of seeking proprioceptive input and allowing the person to engage more on the task at hand. 

References

Campo, N., Chamerlain, S., Sahakian, B., & Robbins, T. (2011). The roles of dopamine and noradrenaline in the pathophysiology and treatment of attention-deficit/hyperactivity disorder. Biological Psychiatry, 69(12), e145-e156. DOI:10.1016

Collin, A., & Dworkin, R. (2011). Pilot study of the effectiveness of weighted vests. American Journal of Occupational Therapy, 65(6), 688 – 694. DOI:10.5014/ajot.2011.000596 

Hvolby, A., & Niels, B. (2010). Use of ball blanket in attention-deficit/ hyperactivity disorder sleeping problems. Nordic Journal of Psychiatry, 65(2), 89-94. DOI:10.3109/08039488.2010.501868.

Lin, H., Posen, L., Chen, W. (2014). Effects of weighted vests on attention, impulse control, and on-task behavior in children with attention deficit hyperactivity disorder. American Journal of Occupational Therapy, 68(2), 149 – 158. DOI:10.5014/ajot.2014.009365

Lindstedt, H., & Umb-Carlsson, O. (2013). Cognitive assistive technology and professional support in everyday life for adults with ADHD. Disability Rehabilitation Assistive Technology, 8(5), 401 – 408. DOI:10.3109/17483107.2013.769120

Eske, J., & Moawad, H. (2019). Dopamine and serotonin: Brain chemicals explained retrieved from https://www.medicalnewstoday.com/articles/326090.php

National Institute of Mental health (2016). Attention-deficit/hyperactivity disorder (ADHD): The basics. Retrieved from https://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder-adhd-the-basics/index.shtml

Pratt, E. (2018). ADHD may affect certain brain regions in kids. Retrieved from https://www.healthline.com/health-news/adhd-may-affect-certain-brain-regions-in-kids#The-future-of-ADHD-research

Silver, L. (2020). The neuroscience of the ADHD brain retrieved from https://www.additudemag.com/neuroscience-of-adhd-brain/

VandenBerg, N. (2001). The use of a weighted vest to increase on-task behavior in children with attention difficulties. American Journal of Occupational Therapy, 55(6), 621 – 628. DOI:10.5014/ajot.55.6.621

Williams, V. (2019). Mayo clinic minute: How weighted blankets may lift anxiety retrieved from https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-minute-how-weighted-blankets-may-lift-anxiety/

Veronica THWB
Veronica

Veronica is a mental health professional who is pursuing a doctorate in Clinical Psychology. She has earned her master’s degree in Clinical Mental Health Counseling and now provides therapy to children and youth in the community agency setting. She has been a part of several studies withiфn the field of psychology, including cognitive psychology, sports psychology, and health psychology. Her current research interests revolve around utilizing mindfulness meditation techniques and how they can impact the health of individuals in various socio-economic settings. She also has research interests revolving around developing and implementing interventions to aid in recovery from substance abuse within the primary care setting.

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