The assessment tool MFNU (Motor Function Neurological Assessment) was developed at the Sørlandet Competence Center (Statped) in the 1990s. The idea for the tool emerged after observing “dyspraxic” difficulties in the most restless children—difficulties that appeared during everyday activities but were often not detected through standard motor or neuropsychological assessments. These difficulties could be alleviated with relatively simple interventions, provided that the child and the surrounding environment were made aware of them. MFNU was constructed to identify and make these difficulties visible.
The manual can both read as a book with updated information about the method, and as a manual for performing the assessment.
Research Support
MFNU has been the subject of research for the past 20 years. Findings indicate that both children and adults with ADHD primarily struggle in two motor domains. The first, and perhaps most important, concerns difficulties regulating and adjusting the force and flow of movements. This may result in movements that are jerky, abrupt, and uneven, particularly when repeated over time. The second domain concerns challenges with regulating tension (muscle tone) in the large movement muscles of the back, shoulders, and hips (for example, the erector spinae, latissimus dorsi, and iliopsoas). These muscles are often used compensatorily to maintain an upright posture when the deep stabilizing muscles around the spine require assistance. Individuals with ADHD also have difficulties regulating muscle tension in the lower legs and feet. This can cause walking and running to become stiff and “stomping.” When muscle tone is high in the large hip flexor (iliopsoas), hip mobility is reduced.
Muscular regulation difficulties do not necessarily represent motor problems in the traditional sense and are often not detected through standard motor tests. These difficulties are frequently seen even in motorically proficient individuals with ADHD, such as dancers and highly trained athletes.
Research projects conducted at Sørlandet Hospital found that around 80% of both children and adults with ADHD had difficulties regulating muscular tension. Individuals in the control group without ADHD showed these problems only in rare cases. Muscular regulation difficulties typically do not make a person appear clumsy or awkward. In fact, some may function well in activities such as snowboarding, diving, climbing, and dance. Because children with ADHD often perform well in such activities, teachers and parents may overlook more fundamental muscular difficulties.
One study of adults found that 80% of the ADHD group reported widespread muscular pain, compared to 17.4% in the control group.
Increased tension in the major movement muscles of the shoulder area can also affect handwriting by reducing mobility in the shoulder region, which causes difficulties regulating pressure on the pencil or pen. The writing becomes heavy, angular, and uneven.
Children and adolescents with ADHD will often show associated movements in the hands when they move their feet.
Research conducted at the Sørlandet Competence Center also showed that children and adolescents with ADHD who had significant muscular regulation difficulties experienced better effects of stimulant medication on attention and behavior than children with the same diagnosis who had fewer motor regulation difficulties. It has not yet been confirmed through controlled studies whether this also applies to adults with ADHD.
These muscular regulation problems typically become less visible with age and are compensated for through alternative muscle use. Problems in adulthood appear largely related to the development of muscular pain due to long-term high tension. For both children and adults, stimulant medication may have a relieving effect on the pain. The same applies to regular stretching exercises.
Videos demonstrating examples of these stretching exercises can be found on YouTube.
Recent research from 2024 Ph.D. project from Udal also confirm the relevance of the method and knowledge today: The Utility of Neuromuscular Assessment to Identify ADHD Among Patients with a Complex Symptom Picture – PubMed
The research articles can be found by searching our names on www.researchgate.net.