Exercise and Attention-Deficit Hyperactivity Disorder: A Systematic Review

This study examined the role of exercise as a moderator of executive functioning for children with attention-deficit hyperactivity disorder (ADHD). Specifically, the hypothesis that exercise enhances the executive functioning of children with ADHD and promotes enhanced wellbeing was explored. Topics examined included the type of exercise, duration, severity, and other critical factors that play a role in the efficacy of exercise as a possible adjunct intervention for children with ADHD. A systematic review was utilized to identify literature from the SocINDEX and PsycInfo databases, with a variety of search terms utilized to identify articles exploring the impact of exercise on children with ADHD. Results from the study suggest that exercise may positively moderate inhibitory control and other key aspects of executive functioning to aid children with ADHD. EXERCISE AND ATTENTION-DEFICIT HYPERACTIVITY DISORDER 5 Exercise and Attention-Deficit Hyperactivity Disorder Data from the Centers for Disease Control and Prevention (CDC, 2016) paints a startling picture of the number of children who are affected by attention-deficit hyperactivity disorder (ADHD). More than six million children in the U.S. have been diagnosed with ADHD. The percentage of children who have been diagnosed with ADHD has increased substantially in recent years, from 7.8% in 2003 to 11% in 2011. Research suggests that boys are two times as likely as girls to have ADHD (American Psychiatric Association [APA], 2013). While the precise etiology of ADHD is not known (Black & Andreasen, 2014), it is described in the Diagnostic and Statistical Manual (DSM-5) as a neurodevelopmental disorder (APA, 2013). The primary DSM-5 criteria for a diagnosis of ADHD are “inattention and/or hyperactivity-impulsivity that interferes with functioning or development” (APA, 2013, p. 59). Attention, concentration, and impulse control are cognitive functions commonly associated with executive functioning (Piepmeier et al., 2015). Although many children have problems with attention and impulsivity, children with ADHD experience such problems with greater frequency and severity (National Institute of Mental Health [NIMH], 2013). Finding ways to effectively help children who have ADHD is critically important to social workers. School social workers, clinical therapists, skills workers, and other social work practitioners work daily on behalf of children who are facing challenges resulting from ADHD. Helping people who are vulnerable is a particular value of social workers that is mandated by the National Association of Social Work’s (NASW, 2016) EXERCISE AND ATTENTION-DEFICIT HYPERACTIVITY DISORDER 6 Code of Ethics. Children with ADHD are uniquely vulnerable because of their age and the symptoms of their disorder. Children with ADHD often face significant challenges and hardships. Children with ADHD are more likely to suffer from low self-esteem, depression, suicidal ideation, and substance use problems (Smith, Molina, & Pelham, 2002; The University of Chicago Medicine, 2010). In addition, children with ADHD often face greater scholastic challenges (e.g. diminished grades, standardized test scores) than children who do not have an ADHD diagnosis (NIMH, 2013). Despite these challenges, most children who have been diagnosed with ADHD can achieve success at school and enjoy productive lives with effective services and treatment (NIMH, 2013). Best practices for the treatment of ADHD currently call for a combination of medication and behavioral therapy (CDC, 2016). However, many children with ADHD are being treated exclusively with medication (CDC, 2016). In addition, medication has its limitations (Gapin & Etnier, 2010). The utilization of medication, duration of its impact, and extent of its efficacy show meaningful variation (Chang, Liu, Yu, & Lee, 2012; Hoza et al., 2015). Gapin and Etnier (2010) have noted, While stimulant medications have proven efficacious in treating the core symptoms of AD/HD in the short-term, there is little known about the long-term effects of medication and there is wide individual variation in therapeutic effectiveness, optimal dosage level, and side effects (p. 754). Accordingly, parents, teachers, social workers, and other concerned parties are searching for new ways to help children who have an ADHD diagnosis. EXERCISE AND ATTENTION-DEFICIT HYPERACTIVITY DISORDER 7 One possible alternative (or supplement) to ADHD medication that has been the subject of research is physical exercise (Piepmeier et al., 2015). An extensive body of research suggests that exercise enhances cognitive functioning (Barenberg, Berse, & Dutke, 2015; Chen, Yan, Yin, Pan, & Chang, 2014). In particular, some research has demonstrated that exercise helps to promote executive functioning (Chen et al., 2014). Accordingly, this study is conducted to examine whether exercise is an effective aid to children with ADHD.