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

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

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.