# Exercise as it relates to Disease/Improving behavior and cognitive functions in children with ADHD with a physical activity program

The article being critiqued is. This is for an university assignment

## What is the background to this research?

* ADHD children have been known to struggle with academics and socializing in schooling environments so a paper by Claudia Verret etal, called "A physical activity program improves behavioral and cognitive functions in children with ADHD: an exploratory study" in 2012 was done to see if exercise could help. The small intervention looked at the kids behaviours, social interactions, how they felt, their physical performance and intellectual performance to see if the exercise had any effect.
* While other studies had been done to look at the relationship between ADHD and cognitive abilitythis study was one of the first ones to look into a wider range of effects exercise can have on ADHD children.
* While this was only a small study it allowed other researchers to use its information to give reason to look more deeply into this topic and the paper can be found being used by other papers years after its release.

## Where is the research from?

* The group of researchers were from Québec Montréal Canada with 4 of the 5 of them holding a PHD most relating in different ways to the research and the other had a masters in science, most taking an interest in how physical activity can help ADHD children. The journal the paper is in is called "The Journal Of Attention Disorders" which has an impact factor of 2.826 according to web of science group and 3.044 from scopus, when 3 is considered a good impact factor this puts it just on the line of being a good reliable journal. The paper would have been an exciting one to have in their Journal with it being one of the first of its kind, especially with positive outcomes making it more desirable to have, as positive reliable results in this area were uncommon at the time.

## What kind of research was this?

* The study was a randomized control trial with the two groups, one doing the experiment while the other group is there for control, the children were selected by finding children in the local area of Québec Montréal to met a criteria set by the local hospital 'Rivière-des Prairies Hospital'. When split into two groups the experiment group was all from the same school and the control group was all on medication compared to the 30% in the experiment group, so there were some things that could have been better tested if more randomized.
* With lots more research coming out there is stronger support to agree with the evidence of physical activity supporting, ADHD symptoms and some help with social and behavioural problems compared to this paper where there wasn't as much strong effects to support the findings.

## What did the research involve?

* In the study both groups ( Refer to the previous paragraph for the selection process) started off by going through different types of testing, fitness and motor skills tests like the test of gross motor development 2 and the Bruce treadmill protocol along with other body measurements. There was a child behaviour check list done by parents and teachers for behaviour. Attention and response inhibition was measured using the test of everyday attention for children. These tests were done 10 days before the experimental group started the exercise program. Then 3 times each week for 10 weeks the children would spend 45 minutes doing an exercise program that was made to work them from moderate to vigorous intensity using team sports tag games and exercise circuits to keep the sessions entertaining to the children. After the 10 weeks both the experimental group and the control group were tested again through the same tests to see if there were any differences.
* Because of the way this test was run there could have been places of bias. For example putting all the children from one school together and the children with medication together doesn't give much randomization making the source less reliable. If there was a chance to prevent teachers, parents and information gatherers from knowing which child was in which group for testing and surveys then we could reduce that chance of bias even further. But besides these few things the method of the randomized control trial was successful with its use of defining ADHD and way of programing and testing, including their use of t tests and one tailed testing was all used effectively.
* Their one biggest let down is the limited participants in the study which makes it hard to be a reliable source with such low numbers. With data collection from teachers and parents it can be heavily biased especially with qualitative data.

## What were the basic results?

* The important findings in this research were that there was improved motor skills and locomotion scores, as well as improved social, depression scores, impulse and inattentive component scores. However the scores for most behavioural changes tended to not reach a significant difference standard besides rule breaking tendencies. For intellectual there were findings with improved information processing and visual research.
* The way the researches interpret these results seem to make it sound much more significant, while they do say their research can't hold much power they still infer that all these finding are a very positive step forward for physical programing with ADHD children.

## What conclusions can we take from this research?

* My personal take on the research is that it provides some evidence that exercise can have a positive effect on ADHD children but with the lack of power this research can provide with its limitations it can only be used to encourage more research to be done in the area which in its own way is useful to the research community.
* As found in later research papers there are many that agree with the findings of this paper with stronger correlations with cognitive function and behaviour.

## Practical advice

* From this paper while the results weren't majorly significant it can still show that ADHD children can benefit from physical activity, but more specifically doing it with other children.
** As the study found there was social benefits along with behavioural ones its likely team sports or games with other people involved is effective to improve lots of symptoms of ADHD while also improving their interaction skills with other people.
* Important things readers should know is that exercise is far from a cure for ADHD but it can help a lot with some of the symptoms and social anxieties that usually come with it.

## Further information/resources

* Here's a list of a few difference resources depending on how would like to learn more about ADHD children exercising
* For those who are interested in looking at more resent research in a similar area there's a study done by Narkeesh Arumugam just this year looking at exercise programs but with more modern research knowledge and equipment.
* For those more interested in getting their own children involved in exercise here's a website by Rae Jacobson about how to help kids get into exercise and how and also a page from the NDIS on how you can get your child into sport programs with them.

## References

* 1 2 3 4 5 6 7 Verret et al, (2012) Exploratory Study A Physical Activity Program Improves Behavior and Cognitive Functions in Children With ADHD: an exploratory study, Journal of Attention Disorders 16(1) 71–80, DOI: 10.1177/1087054710379735
* 1 2 3 4 Gawrilow et al(2013), Physical Activity, Affect, and Cognition in Children With Symptoms of ADHD, Journal of Attention Disorders, 1–12, DOI: : 10.1177/1087054713493318
* 1 2 3 Smith et al(2013), Pilot Physical Activity Intervention Reduces Severity of ADHD Symptoms in Young Children, Journal of Attention Disorders 17(1) 70–82, DOI: 10.1177/1087054711417395
* ↑ Tomporowski et al (2003), Effects of acute bouts of exercise on cognition, PMID: 12595152, DOI: 10.1016/s0001-6918(02)00134-8
* 1 2 3 Hoza et al(2016), Using Physical Activity to Manage ADHD Symptoms:The State of the Evidence, Current Psychiatry Reports volume 18, Article number: 113
* 1 2 3 4 5 Arumugam et al(2021)Effectiveness of structured exercises on motor skills, physical fitness and attention in children with ADHD compared to typically developing children-A pilot study, PMID: 34345720, DOI: 10.1016/j.ensci.2021.100357
* ↑ https://journals.sagepub.com/home/jad
* ↑ https://www.scijournal.org/impact-factor-of-j-atten-disord.shtml
* ↑ https://www.scijournal.org/articles/good-impact-factor
* 1 2 3 Hariton et al(2018), Randomised controlled trials—the gold standard for effectiveness research, PMID: 29916205, DOI: 10.1111/1471-0528.15199
* ↑ NJIT(20201),https://researchguides.njit.edu/evaluate
* ↑ Ziereis et al(2015), Effects of physical activity on executive function and motor performance in children with ADHD, Research in Developmental Disabilities Volume 38, Pages 181-191
* 1 2 Jacobson, https://childmind.org/article/adhd-and-exercise/
* ↑ NDIS, https://dsr.org.au/ndis-sports-guide/