OBJECTIVE. The purpose of this study was to investigate the effects of therapy balls as seating on in-seat behavior and legible word productivity of students with attention deficit hyperactivity disorder (ADHD). Additionally, social validity was assessed to evaluate teacher and student opinions regarding the intervention. METHOD. A single subject, A-B-A-B interrupted time series design was employed across 3 students (2 males, 1 female) with ADHD. The study was conducted in a 4th grade inclusive classroom during daily language arts. During phases 1 and 3, the 3 participants and all other class members sat on chairs (in-seat on chair); during phases 2 and 4, everyone sat on therapy balls (in-seat on ball). Dependent variables were in-seat behavior and legible word productivity. Data were graphed and visually analyzed for differences between phases. RESULTS. Results demonstrated increases in in-seat behavior and legible word productivity for the students with ADHD when seated on therapy balls. Social validity findings indicated that generally the teacher and students preferred therapy balls. CONCLUSION. This study provides evidence that use of therapy balls for students with ADHD may facilitate in-seat behavior and legible word productivity.

<h4>Introduction</h4>Children with developmental disorders often benefit from interventions supporting participation, including sensory interventions, which should be grounded and informed by evidence. The purpose of this systematic review was to evaluate and summarize current evidence on the effectiveness of sensory-based interventions (SBIs) on functional outcomes to guide interventions.<h4>Methods</h4>Searches were performed in Medline (OVID), CINAHL Complete, PsycINFO, OTSeeker, Cochrane Reviews, and ERIC. Inclusion criteria included the following: published in English between May 2015 and January 2024; participants aged 0-21 years with sensory integration/processing challenges; level I and II studies as classified by Johns Hopkins Nursing Evidence-Based Practice Model; functional outcomes indicated. The review followed the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses.<h4>Results</h4>Twenty-one studies were included. Strong strength of evidence supported use of deep pressure tactile input and caregiver training on the use of sensory strategies. Moderate strength of evidence supported that alternative seating did not improve attention. Additionally moderate strength of evidence supported targeting a variety of sensory systems is more effective than targeting only one system. There is a lack of evidence on the impact of sensory environmental modifications.<h4>Discussion</h4>SBIs may be useful for improving functional outcomes and participation. Further research is needed to clarify effectiveness for specific outcomes. The aim of this systematic review was to identify and examine literature on SBIs published between June 2015 and January 2024 and to answer the following question: What is the effectiveness of specific sensory-based interventions (including sensory techniques, caregiver-focused sensory interventions, and sensory environmental modifications) to support functioning and participation for children and youth (0–21 years old) with SI/SP challenges that interfere with everyday life participation? There is strong strength of evidence for deep pressure tactile input positively impacting functional outcomes ( 25 – 28 ). Four studies supported the use of deep pressure tactile stimulation, two of which examined weighted items and two of which examined massage. A Level I study ( 26 ) with moderate risk of bias demonstrated statistically significant improvements in motor skills for young children who Two studies focused on the outcome of sleep with both showing statistically significant improvements in sleep ( 25 , 28 ). The first Level II study ( 28 ) with a low risk of bias utilized massage with joint compressions prior to bedtime. Participants had significant improvements in overall sleep and a decrease in daytime sleepiness. Outcome measures for this study included Goal Attainment Scaling ( GAS ) ( 30 ) and the Child Sleep Habits Questionnaire ( 31 ) to assess sleep . The second study utilized a weighted blanket for sleep ( 25 ). This Level I study with a low risk of bias yielded statistically significant results for improved sleep for children with ADHD. The study used the PedsQL and Children's Global Assessment Scale ( 54 ) as outcome measures to assess quality of life and behavior and emotional function. Finally, another Level I study ( 53 ) with a moderate risk of bias indicated a program for children with ASD that focused on caregiver sensory knowledge, coaching, and support had statistically significant improvements in functional performance. This study used the COPM, GAS, and Parenting Sense of Efficacy Measure ( 55 ) as outcome measures to assess occupational performance and parent efficacy. There is not enough evidence to conclude the effectiveness of sensory environmental modifications. Nielsen and colleagues ( 27 ) noted improvements in areas such as learning, attention, and coping with the use of a vest for deep-pressure tactile stimulation, but results were not significant. All three of these studies focused on children with ADHD or SI/SP challenges, suggesting that deep-tactile pressure tactile stimulation may be a useful tool in supporting occupational outcomes with these populations. These findings are consistent with previous research findings supporting use of Qigong massage ( 14 , 15 ), suggesting that deep-pressure tactile stimulation should be included as part of intervention recommendations when indicated, such as for improving sleep and self-regulation, for children with SI/SP challenges. For the caregiver-focused interventions outcomes, this review builds on the emerging evidence found by Miller-Kuhanack and Watling ( 16 ) which supports group caregiver training on sensory processing and sensory motor strategies for children with ASD. Two studies in this current review evaluated caregiver-focused interventions for children with ADHD and SPD, providing additional evidence that group training in sensory–motor strategies can enhance caregiver awareness and their ability to implement these approaches effectively ( 50 , 51 ). Overall, the result of this systematic review supports the use of caregiver training to implement sensory strategies across populations of children with SI/SP challenges. However, the outcome measures across these studies varied. SBIs aim to alter the level of physiological arousal to provide a better match between the person and the task, thereby improving behavior and self-regulation ( 11 ). Many outcome measures on the effectiveness of SBIs focused on observable changes in behavior. Consequently, the outcome measures included in these studies relied on observable changes in behavior rather than considering internal physiological changes that might support occupational performance. While behavioral regulation requires the cognitive functions of attention, working memory, and inhibition ( 64 ), SBIs primarily focus on the organizing impact of sensory input to support modulation ( 11 , 65 ).

Many modern classrooms impose constraints on student movement, both physical (e.g. stable, upright chairs) and psychological (e.g. norms that "being still" signals paying attention).. We conducted two separate studies on 32 6^th grade (11-12 year old) and 43 7^th grade (12-13 year old) students, respectively. Study 1 was a within-subject design and compared students' creative ideation on the Alternate Uses Test and a verbal memory task through two conditions: Sit Still (on a regular chair with instructions to not move) or Freedom to Move (on a wiggle stool with ability to move as they wanted). There was a significant effect of condition on novel ideas, as well as number of novel ideas / total ideation (creativity ratio). There was no significant difference by condition on the verbal memory task. Study 2 was a within-subject design (due to the COVID-19 pandemic, each student completed 2 of 3 conditions): Sit Still, Freedom to Move, and Sit as Usual (on a regular chair with instructions to sit as if they were paying attention in class) and compared students' creative ideation and a focused attention task instead of Study 1's memory task. There was a significant effect of condition on novel ideas and creativity ratio, but pairwise comparisons were not statistically significant. There was no condition effect on focused attention. The Freedom to Move effects appear selective only for creative ideation. Implications for future research and small classroom changes to support natural movement are discussed.

Sedentary behaviour is increasingly common and is becoming a challenge to maintain the young population healthy. This scoping review aims to identify the existing literature on strategies for altering the classroom design to reduce sedentary behaviour in classroom settings during lessons and the impact of interventions. Three electronic databases (ERIC, PsycInfo, and Scopus) were searched for relevant literature. A total of 40 eligible articles from different countries published between January 2003 and April 2024 were included in the review, which was carried out to identify interventions to prevent sedentary behaviour by redesigning the classroom. The methodology was conducted by the framework presented by Arksey and O'Malley and is reported following the PRISMA-ScR guidelines. The findings reveal various approaches to preventing sedentary behaviour through active desks (e.g. standing desks, sit-to-stand desks, bicycling desks, and stability balls). Most studies focused on stand-biased desks, targeting students (9-12 years old) and were primarily from the USA. Since standing was voluntary, only minor bouts of standing and movement were typically achieved. Only a few studies included partial co-design elements. The thematic analysis identifies the impact of the different interventions. Five themes were found: impact on physical activity, classroom behaviour, cognitive performance, physical and/or mental well-being and challenges. The findings suggest that standing at standing desks while studying does not pose significant physical or mental challenges for students, although some physical fatigue was observed after prolonged standing up. However, a key gap was the absence of co-design in the intervention process. Trial registration: The scoping review protocol was not pre-registered.