The Effects of Functional Power Training in Children With Attention Deficit Hyperactivity Disorder

Study Overview
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Brief Summary
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This study is aimed to investigate the effectiveness of functional power training on attention, gross and fine motor skill, participation and quality of life in children with attention deficit hyperactivity disorder (ADHD) by comparing traditional strength training and their healthy peers. In the literature, there are limited studies that investigate the effect of power exercise in children with ADHD. But there is no randomized controlled trial include power exercises which is designed to the National Strength and Conditioning Association (NSCA) criteria and investigate the effects on attention, gross and fine motor skill, participation and quality of life in children with ADHD. This study hypothesizes that power exercises could improve attention, gross and fine motor skill, participation, and quality of life better than traditional strength training in children with ADHD.

Detailed Description
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Attention Deficit Hyperactivity Disorder is a neurodevelopmental disorder characterized by inattention, impulsivity, and hyperactivity. These core symptoms cause poor gross and fine motor skills. Recent critical review results suggest that motor performance not only consists of motor response activation. It also includes mental representation of activity, attention, memory, makes decisions, and control over preponderant responses. These findings support that ADHD symptoms could affect motor performance negatively. DSM-V (The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) also specifies the relationship between ADHD symptoms and poor motor performance. DSM-V pointed out motor difficulties that occur in ADHD are caused by inattention and impulsivity rather than neurological origin. In the literature, Tseng et al. investigated ADHD symptom's negative effect on motor performance in 42 school-aged children with ADHD. Tseng et al.'s study was shown that inattention and impulsivity were determinative symptoms for motor difficulties. Because of the ADHD's symptoms' effect on the motor skill, children with ADHD have poor fine manual control, manual coordination, body coordination, strength, and agility when they are compared with health peers. These motor difficulties affect the academic, social, and daily life of children with ADHD. They have many restrictions on participation of daily living activities, school, social and sport activities and have decreased quality of life scores. It is considered that these symptoms of ADHD related to catecholamine systems. Jeyanthi et al. suggest that exercises both directly and indirectly affects catecholamine systems. In the literature, there are many studies that was included different exercise interventions involving children with ADHD. Many of the studies were shown that exercise had positive effects on ADHD symptoms. However, there is not enough information about the type, duration, intensity, and frequency of appropriate exercises. Power exercises can be an appropriate approach given the previously reported problems in children with ADHD. This type of exercise shown positive effects on the other populations (CP). The aim of the study is to investigate the effect of power exercises on children with ADHD by comparing these effects with traditional strength training and their healthy peers.

Official Title
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The Effects of Functional Power Training on Attention, Gross and Fine Motor Skills, Participation and Quality of Life in Children With Attention Deficit Hyperactivity Disorder

Conditions
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Attention Deficit Hyperactivity Disorder, Child Mental Disorder

Intervention / Treatment
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* Other: traditional strength training
* Other: Power training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: • age between 6 years and 12 years; Diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) by a child and adolescent health psychiatrist, regardless of subtype, according to DSM-V criteria Have cognitive ability to follow instructions for assessment measures and exercise intervention Exclusion Criteria: • Children have any other psychiatric diagnosis like autism spectrum disorder, psychotic symptoms, depression, etc. Children have any neurological or orthopedic disorders like head injury, cerebral palsy, epileptic seizure, visual and speech disorder. Inclusion Criteria for Healthy Children: Healthy children aged 6-12 years old Children without a psychiatric and neurological diagnosis Exclusion Criteria for Healthy Children: Children got medical treatment for a neuropsychiatric disorder Children whose parents or themselves refused to participate

Ages Eligible for Study
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Minimum Age: 6 Years
Maximum Age: 12 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Traditional strength training group<br>traditional strength training (running, jumping forward over a barrier with one leg and two legs, heel-rise, push up and ball throw with load, bench press, and flexion-abduction-external rotation pattern with theraband) | Other: traditional strength training<br>* traditional strength training (running, jumping forward over a barrier with one leg and two legs, heel-rise, push up and ball throw with load, bench press, and flexion-abduction-external rotation pattern with theraband). Participation in the traditional strength training group will complete these exercises with a load and without time limitations and speed.<br>|
| Experimental: Power Training group<br>progressive functional strength training protocol (running, jumping forward over a barrier with one leg and two legs, heel-rise, push up and ball throw with load, bench press, and flexion-abduction-external rotation pattern with theraband) | Other: Power training<br>* progressive functional strength training protocol (running, jumping forward over a barrier with one leg and two legs, heel-rise, push up and ball throw with load, bench press, and flexion-abduction-external rotation pattern with theraband)<br>|
| No Intervention: Control group<br>no intervention Typically developing children | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Conners' Teacher Rating Scale (CTRS) | CTRS is a reliable and valid 59-item teacher self-report form designed to identify children with ADHD and associated behavioral difficulties. Each item can be scored from 0 to 3; where 0 represents an item is not present and 3 represents an always or definitely present symptom. | change from baseline to end of the 8 weeks | 
| Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2) to measure motor proficiency. | Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2) is norm referenced and designed to measure gross and fine motor skills in youth 4 to 21 years of age. Standard scores 40 are considered below average, whereas those >40 range from average to above average. | change from baseline to end of the 8 weeks | 
| Evaluation of muscle power of lower extremity | Muscle Power Sprint Test (MPST) will be used to assess lower extremity muscle power.Peak power and Mean Power (watts) were also calculated and used as markers of anaerobic power in the MPST. Power output for each sprint was calculated using body mass and running times, where power = (body mass Å  distance2)/time. Peak power was defined as the highest calculated power, while Mean Power was defined as average power over the 6 runs. | change from baseline to end of the 8 weeks | 
| Evaluation of muscle power of upper extremity | Throw Basketball Test will be used to assess upper extremity muscle power. The distance from the starting line to where the ball landed was recorded in centimetres. | change from baseline to end of the 8 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The 30 seconds Repetition Maximum test | The 30 seconds Repetition Maximum test was used to assess functional muscle strength of the lower extremities. The three closed kinetic chain exercises of lateral step-up test, Sit To Stand and attain stand through half knee were used. The children were instructed to perform as many repetitions as possible in 30 seconds for each of the exercises. Lateral step-up and attain stand through half knee were evaluated bilaterally. The repetition maximum for each side was used to calculate total scores for the left and right side and thus ﬁve ﬁnal scores were obtained. | change from baseline to end of the 8 weeks | 
| walking speed | 1 Minute Walk Test (1 MWT) will be used to assess walking speed. | change from baseline to end of the 8 weeks | 
| Evaluation of participation | Participation and Environment Measurement Child & Youth (PEM-CY) is a parent-report questionnaire to assess participation and environment factors in the home, at school and within community Settings. The participation sections included 10 activities in the home setting, five activities in the school setting and 10 in the community setting. For each activity, parents are asked to determine the participation frequency (how frequently has the child participated with eight options: daily to never), participation involvement (how involved the child is while participating the activity rated on a five-point scale: very involved to minimally involved) and whether change is desired (do the parents want to see change in the child's participation in this type of activity: no or yes, with 5 different types of change). | change from baseline to end of the 8 weeks | 
| Evaluation of quality of life | The Pediatric Quality of Life Inventory (PEDS-QL) is a generic health related quality of life measure consisting of 4 core scales, physical function (8 items), emotional function (5 items), social function (5 items) and school function (5 items) that is intended for use in healthy and patient populations. Respondents are asked to recall the last month and indicate how frequently - from never to almost always - they have experienced specific phenomena. Item responses (0-100) are averaged to form total and core scores; higher scores indicate higher functioning. | change from baseline to end of the 8 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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hyperactivity disorder, power, attention deficit, strength, training