# Exercise as it relates to Disease/The effect of physical activity on children with ADHD

This is an analysis of the journal article "Pilot Physical Activity Intervention Reduces Severity of ADHD Symptoms in Young Children" by Smith et. al. (2013)

## What is the background to this research?

Attention deficit hyperactivity disorder (ADHD) is the most diagnosed neurodevelopmental condition in children. ADHD is associated with developmental difficulties in sustaining attention, poor inhibitory control and a higher risk of mental health disorder. This disorder is usually present at 7 years of age and negatively influences their academic, social and family environments. There are numerous medical, therapeutical and behavioural management plans, however they have been shown to be ineffective in the long term. Physical activity is found to improve the neurocognitive function of children with ADHD, allowing them to concentrate more easily. Furthermore, physical activity has been shown to positively affect the behaviour of children, calming them so that they have less physical distractions or behaviour that is inappropriate to their age group.

## Where is the research from?

This study was conducted in a low socio-economic community in Vermont. The researchers were from the University of Vermont, Purdue and Columbia, the Cincinnati Children’s Hospital Medical Centre and a physical education teacher from Indiana.

## What type of research is this?

A case study approach was used to conduct this pilot research. A combination of qualitative and quantitative measures were used to assess the effectiveness of a physical activity intervention within a specific population (children exhibiting multiple symptoms of ADHD).

## What did the research involve?

17 children (grades K-3) were selected based on displaying a minimum of four symptoms of hyperactivity based on the Disruptive Behaviour Disorders Rating Scale, however only 14 participants completed the program. The participants undertook an 8-week intervention where they participated in 26 minutes of continuous moderate-to-vigorous physical activity before school on a daily basis. Examples of activities included: skipping, running and crab walking. Pre- and post program assessments were implemented to measure progress, inclusive of cognitive, motor, social and behavioural functioning (Table 1).
Table 1: Pre-Post Program Measures
| Test | Purpose | Description |
| Bruininks-Oseretsky Test of Motor Proficiency (BOT-2) | Age normed assessment of children’s motor proficiency for both gross and fine motor tasks | Series of mini tests: eg. Drawing to directions, copying images, jumping and tapping of limbs. |
| Motor Timing Task | Ability to synchronise a response with a given stimulus at a constant rate | Hitting the spacebar on a computer at a set rate (500ms) with a given stimulus. |
| Shape School | Assess the ability of cognitive processing through an increasingly difficult format. | 1. Name colours of figures 2. Name colours of happy figures 3. Name colours of figures with hats and their shapes Combination of 2 and 3 |
| Mazes | Assesses planning ability and perceptual organisation. | Create a path from the entrance to the exit of a maze. |
| Finger Windows | Evaluate the ability to remember sequences of increasing difficulty (number of options). | A cardboard piece with holes is used and a pencil is placed through the holes in a given sequence. The participant must attempt to recreate this sequence. |
| Sentence Memory | Assesses verbal working memory | Being read a sentence and then asked to repeat it. |
| Numbers Reversed | Working memory, mental manipulation and planning. | A sequence of numbers is read out and the participant must recite the numbers in reverse order. |
In addition to the pre and post program measures, weekly measures and daily observations of behaviour were also employed to monitor the progress and adherence to the intervention.
Parents, teachers and program staff were required to each rate the behaviour of each student, from a negative reaction to very much improved over six different categories. These categories were name calling/teasing/aggression, defiance/noncompliance, self-esteem, responsibility, social skills and following rules. The only recorded measure was whether or not the participant did improve (Table 2).

## What were the basic results?

Including moderate-to-vigorous activity into the daily routine of children who have been diagnosed with ADHD demonstrated statistically significant improvements from pre to post cognitive test measures BOT-2, Shape School and other weekly measures. Furthermore, there was an overall significant behavioural improvement (Table 2).
Table 2: Percentage of Participants Perceived as Improved by Adult Raters
| Measure | Parent | Teacher | Staff |
| Name Calling/Teasing/Aggression | 33 | 33 | 58 |
| Defiance/Noncompliance | 42 | 50 | 69 |
| Self-esteem | 67 | 54 | 71 |
| Responsibility | 58 | 31 | 29 |
| Social Skills | 67 | Not rated | 57 |
| Following Rules | 46 | 54 | 43 |
| Overall | 69 | 64 | 71 |
No more than two participants received a negative report as an indication of worsening behaviour for a given measure when rated by parents. Furthermore, no more than one child received a negative rating when rated by teachers.
There should be consideration for bias from the results of table 2, parents, teachers and staff who rated the behaviour of the participants were aware of the study and would most likely have had a bias for expecting positive results. This has the potential to skew in favour of positive results.

## What conclusions should be taken away from this research?

Increasing the amount of physical activity for children with ADHD may improve their ability to concentration, perform cognitive tasks and result in more positive behavioural actions and responses. Numerous studies on the effect of physical activity for children with ADHD support the notion that physical activity reduces the symptoms of ADHD.

## Practical advice

Parents of children with ADHD: Encouraging daily exercise for children with ADHD would enhance their ability to learn and their behaviour both at school and home. Examples of these activities include: participating in sports, swimming lessons or just general unscripted play. Teachers of children with ADHD: Increasing and encouraging all children to participate in physical activity during break periods such as recess, lunch, before and after school. Also to increase class time physical activity.

## Further reading

For further reading on children with ADHD and how exercise can affect them, as well as support groups and resources, click below.
Raising Children with ADHD - http://raisingchildren.net.au/articles/adhd.html
National Resource on ADHD - https://www.adhdaustralia.org.au/
Child Mind Institute: ADHD and Exercise - https://childmind.org/article/adhd-and-exercise/
The ADHD Exercise Solution - https://www.additudemag.com/the-adhd-exercise-solution/
Local ACT ADHD Support Group - https://www.addact.org.au/

## Reference list

* 1 2 3 4 5 6 7 8 9 10 Smith A, Hoza B, Linnea K, McQuade J, Tomb M, Vaughn A et al. Pilot Physical Activity Intervention Reduces Severity of ADHD Symptoms in Young Children. Journal of Attention Disorders. 2011;17(1):70-82.
* 1 2 3 Pontifex M, Saliba B, Raine L, Picchietti D, Hillman C. Exercise Improves Behavioral, Neurocognitive, and Scholastic Performance in Children with Attention-Deficit/Hyperactivity Disorder. 2017.
* 1 2 3 Azrin N. Physical Exercise as a Reinforcer to Promote Calmness of an ADHD Child. Behavior Modification. 2006;30(5):564-570.
* ↑ Pelham, W. E. (2002). Attention deficit hyperactivity disorder: Diagnosis, assessment, nature, etiology, and treatment. Buffalo, NY: University at Buffalo.
* ↑ Deitz J, Kartin D, Kopp K. Review of the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2). Physical & Occupational Therapy In Pediatrics. 2007;27(4):87-102.
* ↑ Zelaznik, H. N., Spencer, R. M. C., & Ivry, R. B. (2008). Behavioral analysis of human movement timing. In S. Grondin (Ed.), Psy- chology of time (pp. 233-260). Bingley, UK: Emerald Group.
* ↑ Espy, K. A. (1997). The Shape School: Assessing executive func- tion in preschool children. Developmental Neuropsychology, 13, 495-499. doi:10.1080/87565649709540690
* ↑ Espy, K. A., Bull, R., Martin, J., & Stroup, W. (2006). Measur- ing the development of executive control with the Shape School. Psychological Assessment, 18, 373-381. doi:10.1037/ 1040-3590.18.4.373
* ↑ Wechsler., D. (1989). Wechsler Preschool and Primary Scale of Intelligence–Revised. San Antonio, TX: Psychological Corpo- ration.
* 1 2 Sheslow, D., & Adams, W. (2003). Wide range assessment of memory and learning (2nd ed.). Los Angeles, CA: Western Psychological Services.
* ↑ McGrew, K. S., & Woodcock, R. W. (2001). Technical Manual. Woodcock-Johnson III. Itasca, IL: Riverside.