# Exercise as it relates to Disease/Physical Activity as an intervention to ADHD in children

This is a critic of a paper discussing physical activity and how it assists with ADHD. It has been written as part of an assignment for the unit Health, Disease and Exercise at the University of Canberra.
Paper: Claudia Verret, Marie-Claude Guay, Claude Berthiaume, Phillip Gardiner and Louise Béliveau. ‘A Physical Activity Program Improves Behaviour and Cognitive Functions in Children With ADHD: An Exploratory Study’.

## What is the background to this research?

Statistics acquired from the National Survey of Children’s Health 2003-2011 state that 5.1 million children between the ages of 4-17 in the U.S are currently diagnosed with ADHD; which is an 8.8% or 1 in 11 ratio of children in this age group across the nation. Worldwide statistics further suggest that there is a 5.29% prevalence of ADHD in children under the age of 18.

### What is ADHD?

ADHD is a behavioural disorder that is characterised by symptoms of inattention and hyperactivity, where the individual has difficulty staying focused and controlling their behaviour., There are 3 sub-types of ADHD:
* Predominantly hyperactive-impulsive: children display signs of hyperactivity and fewer symptoms of inattention.
* Predominantly inattentive: children predominantly display signs of inattention and less of hyperactivity. They are less likely to have outbursts and will interact more fluently with other children and teachers.
* Combined hyperactive-impulsive and inattentive: children demonstrate a combined form of ADHD.
Physical activity has been suggested to be beneficial in improving cognitive function and behavior in children with ADHD. This study aimed to determine whether there was any correlation between exercise, specifically moderate-high intensity exercise and improvements in cognitive function and behavior in children with ADHD.

## Where is the research from?

This study was conducted using 21 participants from the specialized ADHD clinic of the ‘Rivière-des Prairies Hospital’ and a local school in Montreal, Quebec. This study was conducted via the Department of Kinesiology at the University of Montreal.

## What kind of research was this?

This study was a longitudinal, cohort study involving 2 groups of children diagnosed with ADHD. One group was assigned physical activity as a form of treatment, whilst the other ‘control’ group used stimulant medication as a form of treatment.
* Advantages: Cohort studies clearly indicate the relationship between exposure/treatment method and the outcome.
* Disadvantages: Cohort studies can be time consuming as they can be measured for long periods of time and they can be expensive.

## What did the research involve?

21 participants were recruited from the ‘Rivière-des Prairies Hospital’ and a local school in Montreal. Children were evaluated individually in neuropsychology and psychiatry in order to confirm the initial ADHD diagnosis. Children displaying the inattentive ADHD sub-type were excluded from the study as were children displaying other learning disorders. 2 groups were then formed, one being a physical activity intervention group and the other being a control medication group.

## What were the basic results?

The physical activity intervention group showed no significant improvements in fitness parameters except in muscular endurance, where children in the physical activity group were able to perform more push-ups than those in the control group at the time of post testing. Based off CBCL (child behavior checklist) results from parents and teachers, physical activity had a positive effect on behavior; with post-test scores indicating decreases in:
* Social, thought and attention problems
* Somatic complaints
* Aggressive behaviours
* Internalised and externalised problems
* Anxiety-depression scores
* Withdrawn-depression scores.
| | | Physical Activity Group n=9 | Control Group n=9 |
| Variables | Pre-test grand mean | Post test adjusted mean | Post test adjusted mean |
| Anxiety-depression | 84.2 | 71.4 | 82.8 |
| Withdrawn-depression | 81.8 | 79.9 | 87.2 |
| Somatic complaints | 72.9 | 66.1 | 72.1 |
| Social problems | 83.8 | 74.2 | 84.1 |
| Thought problems | 81.8 | 67.8 | 85.9 |
| Attention problems | 92.6 | 83.3 | 96.0 |
| Aggressive behaviours | 90.9 | 82.9 | 89.4 |
| Internalised problems | 84.6 | 75.9 | 76.0 |
| Externalised problems | 89.7 | 83.7 | 87.2 |
The physical activity intervention group also displayed significant improvements for 2 neuropsychological variables in their post test results in comparison to pre-test results and results produced by the control group. The group showed improvements in information processing via their ‘time-to-target pondered’ score and also produced a higher ‘attention pondered' score result which suggests the physical activity intervention assisted in better auditory, sustained attention.
| | | Physical Activity Group n=10 | Control Group n=11 |
| Variables | Pre-test grand mean | Post test adjusted mean | Post test adjusted mean |
| Time-to-target pondered | 8.1 | 10.3 | 8.8 |
| Attention pondered | 7.9 | 10.0 | 9.6 |
There may be some limitations with the study as the small sample group of 21 participants and missing data limited the statistical power of the study. Children who displayed the Inattentive sub-type diagnosis of ADHD were left out of the research and the severity of symptoms of ADHD displayed by the children affected the adherence of parents to ensure medication was taken by the children.
The research does indicate that physical activity does have a positive impact on ADHD related behaviour and cognitive function in children.

## How did the researchers interpret the results?

Researchers found a high correlation between physical activity and reduced problems in a social sense and at the conclusion of the program, suggesting that exercise has a positive effect in producing improved social behaviour in children with ADHD- which will be beneficial as children with ADHD often have to deal with social difficulties and isolation. (,)
Researchers also found a positive relationship between physical activity and improved cognitive function in children with ADHD, with the physical activity experimental group showing improved scores in their information processing and sustained attention scores.

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

The study provided strong correlations between physical activity and positive effects on behaviour and cognitive functions in children with ADHD. It has produced important clinical implications that suggest children with ADHD should look to maximise structured physical activity to help improve with their symptoms.
However, as this is recent research and the first to look at the relationship between physical activity and ADHD, further research is required and additional therapies need to be included in order to have a greater understanding of how physical activity can be implemented as a strategy to combat ADHD.

## What are the implications of this research?

The research implies that physical activity has been shown to be beneficial to improving cognitive function and behavioural attitudes in children with ADHD. However, as it is the first study conducted concerning the effect of exercise on ADHD, further research is required before it can be considered an effective and definite form of treatment.

## References

* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Verret, C. et al. (2012) 'A Physical Activity Program Improves Behavior and Cognitive Functions in Children With ADHD: An Exploratory Study'. Journal of Attention Disorders vol 16 no.1 pp 71-80
* ↑ National Resource Center on ADIHD, Statistical Prevalence of ADHD. help4adhd.org [Online].2014 [cited 2015 09 21]. Available from: http://www.help4adhd.org/about/statistics
* ↑ Polanczyk, G. et al. (2007) 'The Worldwide Prevalence of ADHD: A Systematic Review and Metaregression Analysis'. The American Journal of Psychiatry vol 164 no. 6 pp 942-948
* ↑ Faraone, S. (2003) 'The worldwide prevalence of ADHD: is it an American condition?'. World Psychiatry: The Official Journal of the World Psychiatric Association vol 2 no.2 pp 104-113
* 1 2 3 4 National Institute of Mental Health, Attention Deficit Hyperactivity Disorder (ADHD). [Online]. 2015 [cited 2015 09 21]. Available from: http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml
* 1 2 Introduction to Evidence-based Practice, Type of Study: Cohort (2015) [Online] [cited 2015 09 22]. Available from: http://guides.mclibrary.duke.edu/c.php?g=158201&p=1036068
* ↑ Antshel, K. et al. (2003) 'Socials skills training in children with attention-deficit hyperactivity disorder: A randomized-controlled clinical trial'. Journal of Clinical Child and Adolescent Psychology vol 32 no.1 pp 153-165