# Exercise as it relates to Disease/Exercise As A Tool For Managing ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is a neurobehavioral disorder that typically presents in childhood, and is caused by an imbalance of central catecholamines (norepinepherine and dopamine) identified by biochemical, physical and cognitive tests. ADHD has 3 subtypes:
* Attention Deficit/ Hyper Activity Disorder Predominantly Inattentive Type
* Attention Deficit/ Hyper Activity Disorder Predominantly Hyperactive-Impulsive Type
* Attention Deficit/ Hyper Activity Disorder Combined Type

#### Prevalence

ADHD is the most common behavioural disorder in children and is more prevalent in boys than girls. It is estimated a worldwide prevalence of 5.29% in those aged 18 years or under with significant variability.

## Symptoms/Diagnosis

ADHD is characterised by a certain behaviour pattern that is present in more than one environment and creates social issues for those with the disorder. Symptoms include:
* Inattentiveness
* Hyperactivity
* Impulsivity
* Social Difficulty
* Forgetfulness/Disorganisation
* Lack of Self Control
* Pre Frontal Cortex Abnormalities
Patients are diagnosed by the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and must meet a minimum six persistent symptoms from the last six months, that are more severe than normally observed in that developmental stage.

## Treatment
##### Pharmacotherapy

ADHD is primarily managed by a range of prescription drugs that are controlled, administered and managed by a referring doctor or psychiatrist. ADHD drugs can be classified into two categories, stimulants and non stimulants with stimulants being the most common type to prescribe, however different drugs can be prescribed depending on the age and developmental status of the patient.
| Drug Type | Effect on the Body | Common Pharmaceutical Drugs |
| Stimulant | Increase concentration of dopamine and norepinepherine into prefrontal cortex Block dopamine transporter Promote dopamine release from the presynaptic neuron | Methylphenidate Amphetamine Dextroamphetamine Adderall |
| Non-Stimulant | Inhibits presynaptic norepinepherine uptake Increases synaptic norepinepherine and dopamine | Strattera Intuniv Kapvay |

##### Psychotherapy

Psychotherapy can be used in conjunction with drug therapy, and is generally conducted by a psychologist. There have been successful studies conducted using Cognitive Behaviour Therapy (CBT) for management, but were not sustainable for longer durations. Using this technique on children also has proved validity by the therapist working on creating and developing a connection with the patient, and then focusing on changing the mental process used by the child.

##### Exercise

Using exercise as management for ADHD has been praised by many researchers due to the success it has seen through various studies. It has been shown that aerobic exercise can improve inhibition in children, which results in improved behavioural self-regulation. Furthermore, some longitudinal studies have seen improvements through frequent exercise and social interaction in reducing deviant behaviour and improving social interactions. Further benefits of exercise for those with ADHD include:
* Improved physical fitness
* Increased levels of norepinepherine, dopamine and serotonin in Pre Frontal Cortex and Hippocampus
* Increased levels of attention and focus and reduced distractibility
* Decreased aggressive behaviour
* Increased feeling of well being due to endorphins
* Assistance in goal setting
* Reduced symptoms of anxiety and depression

## Recommendations

It is important for those with ADHD to follow daily physical activity guideline which recommends a minimum 60 minutes of moderate to vigorous intensity exercise every day, with a combination of aerobic and strength exercises. Studies conducted involving exercise for ADHD patients have returned positive findings for mostly aerobic exercise, mainly due to the exercise induced release of dopamine. It is also beneficial for ADHD patients to be involved in team based exercise to enhance social skills and discipline control in an exercise and sport setting and give them a non-academic related goal setting task to work towards.

##### Further reading

* Australian Guidelines on Attention Deficit Hyperactivity Disorder - http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/ch54_draft_guidelines.pdf

## References

* 1 2 3 4 Berger, F.K. (2014). Attention Deficit Hyperactivity Disorder. MedlinePlus. September 2014. http://www.nlm.nih.gov/medlineplus/ency/article/001551.htm
* ↑ Nigg, J.T. (2006). What Causes ADHD?. The Guilford Press. United States of America
* 1 2 Medina, J. A. et al. (2010). Exercise impact on sustained attention of ADHD children, methylphenidate effects. Attention Deficit Hyperactivity Disorder, 2(1), 49-58.
* 1 2 3 4 MSU. (n.d.). DSM-IV Definition Attention-Deficit/Hyperactivity Disorder. September 2014. https://www.msu.edu/course/cep/888/ADHD%20files/DSM-IV.htm
* ↑ Polanczyk, G. (2007). The Worldwide Prevalence of ADHD: A Systematic Review and Metaregression Analysis. The American Journal of Psychiatry, 164(6),
* ↑ American Psychiatric Association. (2013). Attention Deficit/ Hyperactivity Disorder. September 2014. http://www.dsm5.org/documents/adhd%20fact%20sheet.pdf
* ↑ Goldburg, G. (2014). ADHD in Adults. September 2014. http://www.webmd.com/add-adhd/ss/slideshow-adhd-in-adults
* 1 2 3 4 Wigal, S. et al. (2012). Exercise: Applications to Childhood ADHD. Journal of Attention Disorders, 17(4) 279–290
* ↑ Royal Australasian College of Physicians. (2009). Draft Australian Guidelines on ADHD. Australian Government: National Health and Medical Research Council. September 2014. http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/ch54_draft_guidelines.pdf
* 1 2 3 4 5 6 7 8 9 Wilens, T. E. et al. (2011). An update on the pharmacotherapy of attention-deficit/hyperactivity disorder in adults. Expert Review of Neurotherapeutics, 11(10), 1443-1465
* 1 2 3 4 5 Arnsten, A. (2006). Stimulants: Therapeutic Actions in ADHD. Neuropsychopharmacology, 31, 2376–2383
* ↑ Hesslinger, B. et al. (2002). Psychotherapy of attention deficit hyperactivity disorder in adults. European Archives of Psychiatry and Clinical Neuroscience, 252(4), 177-184
* 1 2 Conway, F. et al. (2012). Psychodynamic psychotherapy of ADHD: A review of the literature. Psychotherapy, 49(3), 404-417
* ↑ Verret, C. et al. (2010). A Physical Activity Program Improves Behavior and Cognitive Functions in Children With ADHD: An Exploratory Study. Journal of Attention Disorders, 6(1) 71–80
* ↑ Sattelmair, J. (2009). Physically Active Play and Cognition An Academic Matter?. American Journal of Play,
* ↑ Department of Health. (2014). Australia's Physical Activity and Sedentary Behaviour Guidelines. September 2014. http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines#apa1317
* ↑ Chang, Y. et al. (2012). Effect of Acute Exercise on Executive Function in Children with Attention Deficit Hyperactivity Disorder. Archives of Clinical Neuropsychology, 27(2), 225-237
* ↑ CHADD. (n.d.). Sports, Exercise, and ADHD. September 2014. http://www.chadd.org/Understanding-ADHD/Parents-Caregivers-of-Children-with-ADHD/Behavior-and-Social-Skills/Sports-Exercise-and-ADHD.aspx
* ↑ Sampson, K. (2009). On the Move. September 2014. http://www.chadd.org/LinkClick.aspx?fileticket=3FguUggGkjM%3d