Associations of Meeting 24-hour Movement Behavior Guidelines with Cognitive Difficulty and Social Relationships in Children and Adolescents with Attention Deficit/Hyperactive Disorder
Authors: Taylor Alyx , Kong Chuidan , Zhang Zhihao , Herold Fabian , Ludyga Sebastian , Healy Sean , Gerber Markus , Cheval Boris , Pontifex Matthew , Kramer Arthur F , Chen Sitong , Zhang Yanjie , Müller Notger , Tremblay Mark S. , Zou Liye 
Published: January 2023

Abstract
Background: Evidence-based 24-hour movement behavior (24-HMB) guidelines have been developed to integrate recommendations for the time spent in the behaviors of physical activity, sedentary behavior, and sleep. For children and adolescents, these 24-HMB guidelines recommend a maximum of two hours of recreational screen time (as part of sedentary behavior), a minimum of 60 minutes per day of moderate to vigorous physical activity (MVPA), and age-appropriate sleep duration (9-11 hours for 5 to 13-year-olds; 8-10 hours for 14 to 17-year-olds). Although adherence to the guidelines has been associated with several positive health outcomes, the consequence of adhering to the 24-HMB recommendations has not been fully examined in children and adolescents with attention deficit/hyperactive disorder (ADHD). examine potential associations between meeting the 24-HMB guidelines and indicators of cognitive and social difficulties in children and adolescents with ADHD.
Methods: Cross-sectional data from the National Survey for Children’s Health (NSCH 2020) from 3470 children and adolescents with ADHD aged between 6 and 17 years were used. Adherence to 24- HMB guidelines comprised screen time, physical activity, and sleep. ADHD-related outcomes included four indicators; one relating to cognitive difficulties (i.e., serious difficulties in concentrating, remembering, or making decisions) and three indicators of social difficulties (i.e., difficulties in making or keeping friends, bullying others, being bullied). Logistic regression was performed to determine the above-presented associations while adjusting for co-founders.
Results: In total, 44.8% of participants met at least one movement behavior guideline, while only 5.7% met all three. Adjusted logistic regressions further showed that meeting all three guidelines was
associated with lower odds of cognitive difficulties in relative to none of the guidelines, but the strongest model included both screen time and physical activity as predictors (OR=0.26, 95% CI 0.12- 0.53, p<.001). For social relationships, meeting all three guidelines was associated with lower odds of difficulty keeping friends (OR=0.46, 95% CI 0.21-0.97, p =.04) in relative to none of the guidelines. Meeting the guideline for screen time was associated with lower odds of being bullied (OR=0.61, 95% CI 0.39-0.97, p =.04) in relative to none of the guidelines. While screen time only, sleep only and the combination of both were associated with lower odds of bullying others, sleep alone was the strongest predictor (OR=0.44, 95% CI 0.26-0.76, p=.003) in relative to none of the guidelines.
Conclusion: Meeting 24-HMB guidelines was associated with reduced likelihood of cognitive and social difficulties in children and adolescents with ADHD. These findings highlight the importance of adhering to healthy lifestyle behaviors as outlined in the 24-HMB recommendations with regard to cognitive and social difficulties in children and adolescents with ADHD. These results need to be confirmed by longitudinal and interventional studies with a large sample size.