A randomized trial examining the effects of aerobic physical activity on attention-deficit/hyperactivity disorder symptoms in young children

Modernizing behavioral parent training program for ADHD with mHealth strategies, telehealth groups, and health behavior curriculum: a randomized pilot trial

OBJECTIVE

Parent behavior management training (BMT) is an evidence-based yet underutilized tool to treat children with ADHD and address related health disparities. This pilot study investigated the acceptability and feasibility of a novel, health behavior-, and technology-adapted BMT (LEAP) vs. standard BMT.

METHODS

The weekly 9-session LEAP telemedicine group program is based on a standard BMT curriculum enhanced with strategies for supporting optimal child sleep, problematic media use (PMU), and physical activity, including wrist-worn activity trackers. Children ages 6-10 years with ADHD and their caregivers were randomized to LEAP or standard BMT. Acceptability and feasibility were tracked. Caregivers completed standardized measures, and children wore hip-worn accelerometers for 1 week at baseline, postintervention (10 weeks), and follow-up (20 weeks).

RESULTS

84 parent/child dyads were randomized to LEAP or standard BMT, with high and comparable acceptability and feasibility. Both treatment groups demonstrated decreased ADHD symptoms and improved executive functions postintervention (p < .0001), maintained at follow-up. Average accelerometer-measured MVPA decreased and sleep duration remained unchanged, while PMU and bedtime resistance improved for both groups.

CONCLUSIONS

LEAP is highly feasible and acceptable, and yielded similar initial clinical and health behavior improvements to standard BMT. Innovative and targeted supports are needed to promote healthy behaviors in children with ADHD.

Optimal exercise intensity for improving executive function in patients with attention deficit hyperactivity disorder: systematic review and network meta-analysis

This study aimed to compare and rank the effectiveness of optimal exercise intensity in improving executive function in patients with ADHD (Attention deficit hyperactivity disorder, ADHD) through a comprehensive comparison of direct and indirect evidence. A systematic search was performed in five electronic databases to explore the optimal exercise intensity for improving executive function in patients with ADHD by directly and indirectly comparing a variety of exercise intervention intensities. In addition, the isolated effects of exercise on improving executive function in patients with ADHD were explored through classical meta-analysis of paired direct comparisons. Twenty-nine studies were retrieved and included in this study. Classical paired meta-analysis showed that for the patients with ADHD in the age group of 7-17 years, statistical difference was observed for all the parameters of exercise interventions (intensity, frequency, period, and training method), the three dimensions of executive function, the use of medication or not, the high and low quality of the methodological approach. Network meta-analysis showed that high-intensity exercise training was optimal for improving working memory (97.4%) and inhibitory function (85.7%) in patients with ADHD. Meanwhile, moderate-intensity exercise training was optimal for improving cognitive flexibility (77.3%) in patients with ADHD. Moderate to high intensity exercise training shows potential for improving executive function in these patients. Therefore, we recommend applying high-intensity exercise intervention to improve executive function in patients with ADHD to achieve substantial improvement.

[Sports and Physical Exercise Therapy in the Treatment of Mental Health Issues in Children and Adolescents]

Sports and Physical Exercise Therapy in the Treatment of Mental Health Issues in Children and Adolescents Abstract: Mental disorders are among the most common chronic diseases in childhood and adolescence in Germany and worldwide. The health benefits of a physically active lifestyle during adolescence are well documented. Furthermore, a growing body of evidence suggests a positive impact of physical activity on mental health and emotional well-being. Longitudinal studies also show an association between physical activity and reduced risk of developing a mental disorder. Therefore, therapeutic exercise plays an important role in child and adolescent psychiatry. High-quality randomized-controlled trials are needed to substantiate the described effects.

[Attention deficit hyperactivity disorder in children and adolescents: lessons from the COVID-19 pandemic]

To limit the spread of the coronavirus infection COVID-19, which has received the status of a pandemic, a lockdown was temporarily introduced. In conditions of isolation, children and adolescents suffering from attention deficit hyperactivity disorder (ADHD) were faced with forced changes in their daily routine in the form of a transition to distance learning, a decrease in physical activity, an increase in time in front of TV screens/computer monitors/tablets, etc. The review provides current evidence on the associations between social restrictions caused by the COVID-19 pandemic and behavioral problems in children and adolescents with ADHD. The main factors that can influence the severity of the disease in children and adolescents are analyzed. Particular attention is paid to the role of parental behavior and its influence on the manifestations of ADHD in children in isolation. The results of numerous observations and online surveys of relatives and children suffering from ADHD have demonstrated a multidirectional trajectory of the disease depending on numerous factors, including relationships with parents and immediate family. Despite the end of the COVID-19 pandemic, the effects of isolation during critical periods of childhood have the potential to increase the burden of mental illness. Treatment of children and adolescents with ADHD during the COVID-19 pandemic should be pathogenetic, taking into account the main symptoms of the disease. When choosing pharmacotherapy, priority should be given to drugs with verified effectiveness and a reliable safety profile.

Associations of ADHD-Risk and Motor Competence With School Functioning

OBJECTIVES

This study investigated the unique associations of motor competence and ADHD risk status on school functioning. Additionally, this study examined the factor structure of the Bruininks-Oseretsky Test of Motor Proficiency, Short Form (BOT2-SF).

METHODS

Participants included early elementary school children (N = 202, Mage = 6.83, SD = 0.96, Male = 53.5%, ADHD-risk = 46.5%). Child assessments of motor competence and teacher and parent reports of school functioning were used.

RESULTS

A two-factor model of the BOT2-SF with correlated fine and gross motor factors and correlated residuals best fit the data. Fine and gross motor competence were unique positive predictors of academic performance, after accounting for the effects of ADHD-risk on academic performance. ADHD-risk was the only unique predictor of adaptive school behavior.

CONCLUSION

Findings suggest that assessing for ADHD and motor competence in children demonstrating school functioning problems may better allow for targeted intervention in school.

Effect of physical activity on attention in school-age children with ADHD: a systematic review and meta-analysis of randomized controlled trials

Background: Attention problems are one of the core symptoms of Attention-deficit/hyperactivity disorder (ADHD) in children. Previous studies have shown that physical activity intervention has a positive impact on executive function in children and adolescents with ADHD, but there is limited research on attention problems in school-aged children with ADHD. There are still uncertainties about the appropriate physical activity interventions to improve attention problems in this population. This study conducted a Meta-analysis of randomized controlled trials (RCTs) related to physical activity intervention for attention problems in school-aged children with ADHD, providing a certain reference for precise intervention in attention problems for this population. Methods: We systematically searched the following databases up to October 2022: PubMed, Embase, Web of Science, and Cochrane Library, to identify RCTs that investigated the effects of physical activity interventions on children with ADHD. Two investigators independently conducted literature screening, extraction, and quality assessment. We performed a meta-analysis using Stata 15.1. Results: In total, we included 10 studies in this meta-analysis. The results indicated that physical activity intervention had a moderate effect in improving attention problems in school-aged children with ADHD (SMD = -0.48, 95% CI: 0.85, -0.07, p < 0.05). Furthermore, subgroup analysis showed that the effect of physical activity intervention was moderated by intervention type, frequency, and period, rather than the physical activity environment or single intervention time. Conclusion: Our study suggests that cognitively engaging exercise is more effective in improving attention problems in school-aged children with ADHD. Specifically, when cognitive-engaging exercise is used as the type of physical activity and the intervention frequency is less than 3 times per week, with an intervention period of less than weeks, it is most beneficial for improving attention problems in school-aged children with ADHD. However, we should also consider individual differences in children with respect to their ADHD symptoms and accurately evaluate each child's specific symptoms before intervention. Systematic Review Registration: identifier (CRD42022363255).

Feasibility and Efficacy of the Alert Program® for Children with Attention-Deficit/Hyperactivity Disorder

This study explored the feasibility and initial efficacy of a sensorimotor intervention to improve symptoms of attention-deficit/hyperactivity disorder (ADHD). Twenty-seven children (ages 8-12 years) with ADHD and their parents participated in an 8-week group intervention based on The Alert Program® for Self-Regulation (AP). Families were taught to recognize child arousal states and to use sensorimotor strategies to manage levels of alertness. Parent and teacher reports of child attention symptoms were collected at baseline, before and after intervention. Objective ratings of child problem behaviours and use of sensorimotor strategies during computerized tasks of visual and auditory attention were also coded before and after intervention. Parents and children endorsed high acceptability and satisfaction for the AP treatment. Parental ratings indicated increased knowledge and use of sensorimotor strategies, and decreased child ADHD symptoms at home from pre-AP to post-AP. However, no significant changes in child outcomes were reported by teachers. Unexpectedly, observed child problem behaviours during the visual attention task increased from pre-AP to post-AP. The AP was received positively by parents and children with improvements in regulation strategies and child attention at home, but more work needs to be done to generalize the effects to school and other peer settings.

Effects of different physical activity interventions on children with attention-deficit/hyperactivity disorder: A network meta-analysis of randomized controlled trials

Background

Previous studies have shown that physical activity interventions positively affect core symptoms and executive functioning in children with attention-deficit/hyperactivity disorder (ADHD). However, comparisons between different physical activity interventions still need to be made. This study is the first to analyze the effects of 10 different types of physical activity on children with ADHD through a network meta-analysis.

Methods

PubMed, Embase, Web of Science, and Cochrane Library databases were searched for randomized controlled trials on the effects of physical activity interventions on children with ADHD. The search time frame was from database creation to October 2022. Two investigators independently performed literature screening, extraction, and quality assessment. Network meta-analysis was performed with Stata 15.1.

Results

A total of 31 studies were included, and the results indicated that perceptual-motor training was the most effective in terms of motor ability and working memory (SUCRA = 82.7 and 73.3%, respectively). For attention problems and cognitive flexibility, aquatic exercise was the most effective (SUCRA = 80.9 and 86.6%, respectively). For social problems, horsemanship was the most effective (SUCRA = 79.4%). For inhibition switching, cognitive-motor training was the most effective (SUCRA = 83.5%).

Conclusion

Our study revealed that aquatic exercise and perceptual-motor training had a superior overall performance. However, the effects of various physical activity interventions on different indicators in children with ADHD can vary depending on the individual and the intervention's validity. To ensure an appropriate physical activity intervention is selected, it is important to assess the severity of symptoms exhibited by children with ADHD beforehand.

Chronic Exercise for Core Symptoms and Executive Functions in ADHD: A Meta-analysis

BACKGROUND AND OBJECTIVES

The effects of chronic exercise interventions (CEIs) on core symptoms and executive functions (EFs) of attention-deficit/hyperactivity disorder (ADHD) and how different characteristics of CEIs could modify the effect remain unclear. We synthesized the current evidence on the effects of CEIs on core symptoms and EFs in children and adolescents with ADHD.

METHODS

Data sources include PubMed, Embase, Web of Science, Cochrane Library, and China National Knowledge Infrastructure from database inception to July 31, 2022. Study selection includes randomized controlled trials that reported on the effects of CEIs on core symptoms and/or EFs in ADHD aged 6 to 18 years.

RESULTS

Twenty-two randomized controlled trials were included. CEIs had a small beneficial effect on overall core symptoms (standardized mean difference [SMD] = -0.39, 95% confidence interval [CI]: -0.64 to -0.14), as well as inattention (SMD = -0.32, 95% CI: -0.63 to -0.004) among children and adolescents with ADHD. Closed-skill exercise showed a large improvement in core symptoms (SMD = -0.83, 95% CI: -1.30 to -0.35), whereas open-skill exercise did not. Additionally, CEIs had a moderately beneficial effect on overall EFs (SMD = -0.68, 95% CI: -0.91 to -0.45) and a moderate-to-large effect on the specific domains of EFs. The pooled effects on overall core symptoms and EFs were not significantly modified by study population (children or adolescents), exercise session duration (≤50 or >50 minutes per session, median), or total exercise sessions (<24 or ≥24 sessions, median).

CONCLUSIONS

CEIs have small-to-moderate beneficial effects on overall core symptoms and EFs in children and adolescents with ADHD.

The effect of physical activity on quality of life and parenting stress in children with attention-deficit/hyperactivity disorder: A randomized controlled trial

BACKGROUND

Poorer quality of life (QoL) is commonly observed in children with Attention-deficit/Hyperactivity Disorder (ADHD). Parents of children with ADHD also perceived elevated levels of parenting stress. Previous research has documented the positive effects of physical activity (PA) on managing ADHD symptoms. It is critical to implement ADHD management with broader functioning from both children's and parents' perspectives.

OBJECTIVE

This study aimed to examine whether PA would exert an influence on the QoL of children with ADHD and parenting stress of their parents.

METHODS

Forty-three children with ADHD (6-12 years) were randomly assigned to the PA intervention and waitlist control groups. Children in the intervention group participated in a 12-week PA program. Parent-reported QoL and parenting stress were assessed before and immediately after the intervention. Analysis of covariance with a mixed factorial design of 2 (time: before vs. after intervention) × 2 (group: PA intervention vs. waitlist control) was conducted to examine changes in QoL and parenting stress over the 12 weeks.

RESULTS

Compared to the control group, parents of children in the intervention group reported significant reduced overall parenting stress (p = .021, η² = 0.142) and child domain of parenting stress (p = .024, η² = 0.138) after the intervention. No significant improvement in QoL was documented in either group.

CONCLUSIONS

The participation of PA intervention positively impacts parenting stress perceived by parents of children with ADHD, which provides further evidence of the family-wide benefits of the PA intervention.

Comparative effectiveness of various physical exercise interventions on executive functions and related symptoms in children and adolescents with attention deficit hyperactivity disorder: A systematic review and network meta-analysis

Background

Physical exercise has been recommended as an important nonpharmacological therapeutic strategy for managing attention deficit hyperactivity disorder (ADHD). We conducted a network meta-analysis (NMA) to assess the comparative impact of different physical exercise modalities on enhancing executive functions (EFs) and alleviating symptoms in children and adolescents with ADHD.

Methods

We searched Web of Science, PubMed, Embase, Cochrane Central Register of Controlled Trials, SPORTDiscus, PsycINFO, CNKI, and clinical trials databases from inception to October 20, 2022. Randomized controlled trials (RCTs) and quasi-experimental studies investigating physical exercise for ADHD-related symptoms of hyperactivity/impulsivity and inattention, and executive functions were included. The frequentist random-effect NMA method was applied to pool the results.

Results

A total of 59 studies (including 39 RCTs, 5 quasi-RCTs, and 15 self-controlled trials) published between 1983 and 2022 were incorporated into the systematic review, of which 44 studies with 1757 participants were eligible for meta-analysis. All types of physical exercise were effective in improving EFs (SMD = 1.15, 95% CI: 0.83 to 1.46), and open-skill activities which require participants to react in a dynamically changing and externally paced environment induced the most incredible benefits for executive functions (SUCRA = 98.0%, SMD = 1.96, and 95% CI: 1.15 to 2.77). Subgroup analyses for EFs revealed varied findings that open-skill activities were the most promising physical exercise type for improving inhibitory control (SUCRA = 99.1%, SMD = 1.94, and 95% CI: 1.24 to 2.64), and closed-skill activities dominated by aerobic exercises had a slightly higher probability of being the most promising physical exercise intervention for working memory (SUCRA = 75.9%, SMD = 1.21, and 95% CI: -0.22 to 2.65), and multicomponent physical exercise tended to be the most effective in cognitive flexibility (SUCRA = 70.3%, SMD = 1.44, and 95% CI: -0.19 to 3.07). Regarding ADHD-related symptoms, closed-skill activities dominated by aerobic exercises might be more advantageous for hyperactivity/impulsivity (SUCRA = 72.5%, SMD = -1.60, and 95% CI: -3.02 to -0.19) and inattention (SUCRA = 96.3%, SMD = -1.51, and 95% CI: -2.33 to -0.69) improvement.

Conclusion

Physical exercise can significantly help to alleviate the symptoms of ADHD and improve executive functions in children and adolescents with ADHD. Most of all, to promote adherence to treatment, they should be encouraged to perform the physical exercises that they enjoy most.

Dimensions of physical activity as related to child attention-deficit/hyperactivity disorder symptoms and impairment

In efforts to explore adjunct/alternative treatments for ADHD, this study investigated the associations between dimensions of physical activity (PA) and children's ADHD symptoms and impairment. Current evidence-based treatments include medication and behaviour management, but there is widespread consensus that more treatment options are desirable. Although there is increasing support for PA as an adjunct/alternative to existing treatment for ADHD, the interplay of specific dimensions of PA has not been studied. Fifty-one parents of children aged 6-12 years with ADHD filled out questionnaires. Hierarchical regression analysis indicated that only some dimensions of PA explained a statistically significant portion of the variance in ADHD symptoms, beyond that explained by typical demographic variables. PA dimensions did not account for a statistically significant portion of ADHD impairment. Refining the measurement of how long children have engaged in PA is a key step in generating evidence for PA as an adjunct or alternate treatment for ADHD, and developing guidelines to manage parental expectations for this treatment in the benefit of their children.

Effects of physical exercise on attention deficit and other major symptoms in children with ADHD: A meta-analysis

PURPOSE

To explore the effects of physical exercise intervention on the cardinal symptoms, motor skills and executive function among children with attention deficit hyperactivity disorder (ADHD).

METHODS

Literature searches for randomized controlled trials (RCTs) were performed in PubMed, The Cochrane Library, Web of Science, Embase, CNKI, CBM, VIP and Wanfang databases from the time of database construction to March 28, 2021. Screening was conducted based on inclusion and exclusion criteria. The Cochrane bias risk assessment tools were used to evaluate methodological quality. Relevant data were analyzed with RevMan5.3.5 software, and Stata16.0 was used for publication bias tests.

RESULTS

A total of 15 RCTs with 734 subjects were included. The meta-analysis showed that physical exercise can improve the attention of ADHD children (standardized mean difference [SMD] = -0.60, 95% confidence interval [CI] [-1.10, -0.11], p < 0.01), executive function (SMD = 1.22, 95% CI [0.61, 1.82], p < 0.01), and motor skills (SMD = 0.67, 95% CI [0.22, 1.12], p < 0.01). There were no significant effects on hyperactivity (SMD = 0.06, 95% CI [-0.26, 0.37], p = 0.72), depression (SMD = -0.72, 95% CI [-1.55, 0.11], p = 0.09), social problems (SMD = -0.27, 95% CI [-0.64, 0.09], p = 0.14), or aggressive behavior (SMD=-0.24, 95% CI [-0.69, -0.21], p = 0.30). Intervention duration and frequency might be the source of heterogeneity.

CONCLUSION

Physical exercise can help alleviate the symptoms of ADHD in children. Specifically, it can improve attention, executive function, and motor skills.

The dynamical association between physical activity and affect in the daily life of individuals with ADHD

Exercise interventions in mental disorders have evidenced a mood-enhancing effect. However, the association between physical activity and affect in everyday life has not been investigated in adult individuals with ADHD, despite being important features of this disorder. As physical activity and affect are dynamic processes in nature, assessing those in everyday life with e-diaries and wearables, has become the gold standard. Thus, we used an mHealth approach to prospectively assess physical activity and affect processes in individuals with ADHD and controls aged 14-45 years. Participants wore accelerometers across a four-day period and reported their affect via e-diaries twelve times daily. We used multilevel models to identify the within-subject effects of physical activity on positive and negative affect. We split our sample into three groups: 1. individuals with ADHD who were predominantly inattentive (n = 48), 2. individuals with ADHD having a combined presentation (i.e., being inattentive and hyperactive; n = 95), and 3. controls (n = 42). Our analyses revealed a significant cross-level interaction (F(2, 135.072)=5.733, p = 0.004) of physical activity and group on positive affect. In details, all groups showed a positive association between physical activity and positive affect. Individuals with a combined presentation significantly showed the steepest slope of physical activity on positive affect (slope_inattentive=0.005, p<0.001; slope_combined=0.009, p<0.001; slope_controls=0.004, p = 0.008). Our analyses on negative affect revealed a negative association only in the individuals with a combined presentation (slope=-0.003; p = 0.001). Whether this specifically pronounced association in individuals being more hyperactive might be a mechanism reinforcing hyperactivity needs to be empirically clarified in future studies.

The Efficacy of Physical Activity for Children with Attention Deficit Hyperactivity Disorder: A Meta-Analysis of Randomized Controlled Trials

BACKGROUND

This systematic review and meta-analysis assesses the efficacy of regular, moderate to vigorous physical activity (MVPA) for attention deficit hyperactivity disorder (ADHD) in children and adolescents in randomized controlled trials (RCTs).

METHODS

RCTs including children and adolescents with clinically diagnosed ADHD, implementing regular MVPA, and assessing ADHD core-symptoms on a valid rating scale post-intervention (primary outcome) were included. Outcomes were pooled through random-effects meta-analysis. Prospero registration: CRD42019142166.

RESULTS

MVPA had a small effect on total ADHD core symptoms (n = 11; g = -0.33; 95% CI [-0.63; -0.02]; p = .037).

CONCLUSIONS

MVPA could serve as an alternative treatment for ADHD. New RCTs are necessary to increase the understanding of the effect regarding frequency, intensity, type of MVPA interventions, and differential effects on age groups.

Acute Effects of Physical Exercise on Cognitive and Psychological Functioning in College Students with Attention-Deficit/Hyperactivity Disorder

We sought to elucidate the acute effects of high-intensity interval training (HIIT) among college students with and without attention-deficit/hyperactivity disorder (ADHD). Participants were age- and sex-matched across ADHD (n = 18) and non-ADHD groups (n = 18) and both groups completed baseline (non-HIIT) and experimental sessions (HIIT). We examined within- and between-subject effects on a continuous performance task (CPT) and self-reported ADHD and internalizing symptomatology. We found that the degree of improvement on ADHD and depressive symptomatology, as well as processing speed and response variability following HIIT was significantly greater for the ADHD group than the comparison group. Further investigations such as randomized controlled trials focusing on the chronic effects of sustained HIIT interventions are needed to substantiate the potential feasibility and efficacy of HIIT as an intervention. HIIT may be a useful adjunct to psychosocial and/or pharmacological treatments for college students with ADHD because it: (a) yields immediate, acute improvements in executive functioning, ADHD, and mood; (b) promotes improved physical and mental health; (c) poses a relatively low risk of deleterious effects in apparently healthy college students. Even with the need for additional research, current data suggest a single, brief, high-intensity bout of aerobic exercise can yield immediate significant short-term improvements. These improvements may enhance functioning and improve outcomes for college students with ADHD.

Effects of school-based before-school physical activity programmes on children's physical activity levels, health and learning-related outcomes: a systematic review

OBJECTIVE

To review and evaluate the impact of school-based, before-school physical activity (PA) programmes on children's PA levels, health and learning-related outcomes.

DESIGN

Systematic review.

DATA SOURCES

PubMed, PsycINFO, Scopus, Embase and ERIC were searched in January 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: (1) Original research published in English, (2) sample included typically developing school-age children and/or adolescents, (3) examined school-based PA programmes delivered before school, (4) included a comparator and (5) reported associations with PA, physical health, learning-related and/or psychosocial outcomes. Studies examining before-school active transport or sport were excluded.

RESULTS

Thirteen articles representing 10 studies were included (published 2012-2020); seven conducted in primary schools. Programmes ranged between 3 weeks and 6 months, primarily operating daily and for 25-40 min. One study examined a programme informed by theory; six incorporated fidelity measures. Data synthesis, considering consistency of findings, showed indeterminate associations for the domains of physical health, learning-related and psychosocial outcomes. Among subdomains, synthesis showed positive associations with before-school and daily PA, cardiorespiratory and muscular fitness, readiness to learn and an inverse association with adiposity. Risk of bias was high/serious or insufficiently detailed across studies and outcome domains, except PA, which included moderate-risk studies.

CONCLUSION

There is limited available evidence on school-based, before-school PA programmes, with some positive associations at domain and subdomain levels. Continued research is justified to understand the role of before-school programmes for facilitating PA. Future research should follow recommended practice for intervention design and process evaluation, and address under-represented contexts, including secondary schools.

PROSPERO REGISTRATION NUMBER

CRD42020181108.

Evaluating the Feasibility and Acceptability of the Lifestyle Enhancement for ADHD Program

OBJECTIVE

To evaluate the feasibility and acceptability of the Lifestyle Enhancement for Attention Deficit Hyperactivity Disorder (ADHD) Program (LEAP), a novel parent behavior management training program that promotes physical activity (PA) and positive health behaviors and is enhanced with mobile health technology (Garmin) and a social media (Facebook) curriculum for parents of children with ADHD.

METHODS

The study included parents of children ages 5-10 years diagnosed with ADHD who did not engage in the recommended >60 min/day of moderate to vigorous PA based on parent report at baseline. Parents participated in the 8-week LEAP group and joined a private Facebook group. Children and one parent wore wrist-worn Garmin activity trackers daily. Parents completed the Treatment Adherence Inventory, Client Satisfaction Questionnaire, and participated in a structured focus group about their experiences with various aspects of the program.

RESULTS

Of 31 children enrolled, 51.5% had ADHD combined presentation, 36.3% with ADHD, predominately inattentive presentation, and 12.1% had unspecified ADHD (age 5-10; M = 7.6; 48.4% female). Parents attended an average of 86% of group sessions. On average, parents wore their Garmins for 5.1 days/week (average step count 7,092 steps/day) and children for 6.0 days/week (average step count 9,823 steps/day). Overall, parents and children were adherent to intervention components and acceptability of the program was high.

CONCLUSIONS

Findings indicate that the LEAP program is an acceptable and feasible intervention model for promoting PA among parents and their children with ADHD. Implications for improving ADHD symptoms and enhancing evidence-based parent training programs are discussed.

Balance-based Attentive Rehabilitation of Attention Networks (BARAN) improves executive functions and ameliorates behavioral symptoms in children with ADHD

INTRODUCTION

Balance as a motor activity requires integrating different sensory information to maintain the center of gravity above the base of support through proper motor strategies in the light of cognitive processing.

METHODS

In the present study, twenty-nine children with attention deficit- hyperactivity disorder (ADHD) were recruited in a random clinical trial design in two intervention and active control groups. The N-Back, Wisconsin Card Sorting, Go/No-Go tasks, and Conners' Teacher and Parent Rating Scales were performed in baseline, post-intervention, and follow-up sessions. The intervention group received balance-based attentive rehabilitation of attention (BARAN), and the active control group received aerobic exercise and running in 12-15 sessions.

RESULTS

BARAN improves working memory (P < .05), cognitive flexibility (P < .01), and inhibitory control (P < .05) and ameliorates ADHD symptoms at home (P < .01) and school (P < .05).

CONCLUSION

Dual-balance and cognitive tasks improve executive functions and ameliorate symptoms in children with ADHD.

Training Executive, Attention, and Motor Skills (TEAMS): a Preliminary Randomized Clinical Trial of Preschool Youth with ADHD

This preliminary randomized controlled trial compared Training Executive, Attention and Motor Skills (TEAMS), a played-based intervention for preschool children with attention-deficit/hyperactivity disorder (ADHD), to an active comparison intervention consisting of parent education and support (ClinicalTrials.gov Identifier: NCT01462032). The primary aims were to gauge preliminary efficacy and assist in further development of TEAMS. Four- and 5-year-old children with ADHD were randomly assigned to receive TEAMS (N = 26) or the comparison intervention (N = 26) with blinded assessments by parents, teachers and clinicians ascertained pretreatment, post-treatment, and 1- and 3-months post-treatment. Changes in ADHD severity, impairment, parenting factors, and neuropsychological functioning over time as a function of treatment condition were assessed using the PROC MIXED procedure in SAS. Across most measures, significant main effects for Time emerged; both treatments were associated with reduced ADHD symptoms that persisted for three months post-treatment. There were no significant Treatment effects or Time x Treatment interactions on symptom and impairment measures, suggesting that the magnitude of improvement did not differ between the two interventions. However, significant correlations emerged between the magnitude of behavioral change, as assessed by parents and clinicians, and the amount of time families engaged in TEAMS-related activities during treatment. Across a wide array of parenting and neuropsychological measures, there were few significant group differences over time. TEAMS and other psychosocial interventions appear to provide similar levels of benefit. Play-based interventions like TEAMS represent a potentially viable alternative/addition to current ADHD treatments, particularly for young children, but more research and further development of techniques are necessary.

Fine and gross motor skills predict later psychosocial maladaptation and academic achievement

BACKGROUND

Difficulties in fine and gross motor skills are often overlooked as developmental problems, although approximately 6-13% of all school-age children have poor motor coordination. Understanding motor coordination is important from the perspective of school adaptation. This longitudinal cohort study aimed to determine whether fine and gross motor skills in preschool children predict later academic achievement and psychosocial maladaptation.

METHODS & PROCEDURES

Participants were 2,501 children from nursery and elementary schools (5-13 years old). The motor skills of preschool children were assessed by their nursery teacher immediately before entering elementary school. The Strengths and Difficulties Questionnaire and a standardized Japanese test were administered annually throughout elementary school.

RESULTS

Early motor difficulties in preschool children had significant effects on their academic achievement and psychosocial maladaptation up until the sixth grade. Gross motor difficulties in preschool were associated with the later peer problems and worsened emotional symptoms.

CONCLUSIONS

Motor skills in preschool children are useful as a predictor of later psychosocial maladaptation and academic achievement.

The effect of physical activity with and without cognitive demand on the improvement of executive functions and behavioral symptoms in children with ADHD

Background: Purposeful physical activities improve cognitive functions. Two possible mechanisms are available for this intervention including the impact of the physical component of exercise and goal-directedness as a cognitive component. In the present study, we aimed to compare the effect of physical activity with and without cognitive demand on executive functions and behavioral symptoms in children with ADHD.Methods: Thirty children with ADHD were randomly assigned to two equal groups of physical activity training with and without cognitive demand. Exercise for cognitive improvement and rehabilitation (EXCIR) or running, as an aerobic exercise, were used for intervention in two groups. Executive functions and ADHD symptoms were measured in three sessions including baseline, post-intervention, and follow-up assessments, using 1-back, Wisconsin Card Sorting, and Go/No-Go tests and Conner's Teacher and Parent Rating scales. Repeated measures ANOVAs were used for analysis.Results: The results showed physical activity with cognitive demand, compared to the physical activity without cognitive demand, has a better and longer impact on the improvement of executive functions and ADHD symptoms.Conclusions: Cognitive rehabilitation with combined physical and cognitive tasks has a beneficial and lasting impact on impaired executive functions and behavioral symptoms in children with ADHD.

Physical Activity Improves Mental Health in Children and Adolescents Irrespective of the Diagnosis of Attention Deficit Hyperactivity Disorder (ADHD)-A Multi-Wave Analysis Using Data from the KiGGS Study

Physical activity (PA) may have positive effects on mental health in children and adolescents. This post hoc study aimed to further investigate the relationship between different frequency levels of PA and general mental health as well as specific hyperactivity/inattention symptoms in children and adolescents.

METHODS

The analyses were based on data drawn from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) study, a regularly conducted large-scale, epidemiological investigation of somatic and mental health of children and adolescents in Germany. Parents were asked about their children's attention deficit hyperactivity disorder (ADHD) records and answered questionnaires concerning any mental health problem behavior of the children and adolescents using the Strengths and Difficulties Questionnaire (SDQ). The overall problem score as well as the hyperactivity/inattention symptoms subscale (SDQ-H/I) were entered as outcomes in a regression model controlling for parental socio-economic status and participants' sex, age, and body mass index (BMI). Cross-sectional analyses were conducted at three time points of the KiGGS study (baseline, wave 1, and wave 2) using general linear models (GLM). This was performed for different age groups (4-5, 6-9, 10-17 years).

RESULTS

Significant negative relationships were found between PA and general mental health problems. For the relationship between PA and SDQ-H/I, different patterns emerged at the three time points. There was no interaction between PA frequency levels and diagnosis of ADHD (ADHD vs. non-ADHD controls) regarding the SDQ total score.

CONCLUSION

This study underlines the importance of a high frequency level of PA for a good mental health status among children and adolescents, irrespective of the diagnosis of ADHD.

Effectiveness of Physical Activity Intervention on ADHD Symptoms: A Systematic Review and Meta-Analysis

Objective: To assess the effectiveness of physical activity (PA) intervention on attention-deficit/hyperactivity disorder (ADHD)-related symptoms. Method: Studies that investigated PA intervention for ADHD-related symptoms were identified through searching PubMed, Web of Science, Cochrane Library, and Embase databases from inception through June 2021. Standardized mean difference (SMD) with 95% confidence interval (CI) was used to assess the effectiveness of PA intervention on improving ADHD-related symptoms. The meta-analyses were conducted using fixed-effect or random-effect models according to the heterogeneity of the studies. Results: Nine before-after studies (232 participants) and 14 two-group control studies (162 participants/141 controls) were included in this meta-analysis. Combined results for before-after studies indicated significant improvements on all studied ADHD-related symptoms (inattention: SMD = 0.604, 95% CI: 0.374-0.834, p < 0.001; hyperactivity/impulsivity: SMD = 0.676, 95% CI: 0.401-0.950, p < 0.001; emotional problems: SMD = 0.416, 95% CI: 0.283-0.549, p < 0.001; behavioral problems: SMD = 0.347, 95% CI: 0.202-0.492, p < 0.001). Meta-analyses for two-group control studies further confirmed that PA intervention significantly improved the inattentive symptom (SMD = 0.715, 95% CI: 0.105, 1.325, p = 0.022). Subgroup analyses suggested significant beneficial effect on inattention symptoms in children. Moreover, closed motor skills were beneficial for hyperactive/impulsive problems (SMD = 0.671, p < 0.001), while open motor skills were beneficial for attention problems (SMD = 0.455, p = 0.049). When excluding studies with combined medication, the studies in unmedicated participants in before-after studies still showed significant results in all studied ADHD-related symptoms as in the overall analysis. Given the limited sample size, the best frequency and intensity of PA intervention need further investigation. Conclusion: Our results suggested that PA intervention could possibly improve ADHD-related symptoms, especially inattention symptoms. Closed-skill and open-skill activities could be beneficial for hyperactivity/impulsivity and inattention symptoms, respectively. Further high-quality randomized clinical trials with large sample size are needed.

Moderate-to-vigorous physical activity and processing speed: predicting adaptive change in ADHD levels and related impairments in preschoolers

BACKGROUND

Preschool ADHD symptoms have predictive utility for later presence of ADHD diagnoses (Harvey, Youngwirth, Thakar, & Errazuriz, 2009, Journal of Consulting and Clinical Psychology, 77, 349; Lahey et al., 2004, American Journal of Psychiatry, 161(11), 2014), yet some level of inattention, hyperactivity, and impulsivity are present even in typically developing preschoolers. Physical activity (PA) is known to have a broad spectrum of positive effects on the brain in school-age typically developing children (Centers for Disease Control and Prevention, 2010, The association between school based physical activity, including physical education, and academic performance. Atlanta, GA: U.S. Department of Health and Human Services), including functions impaired by ADHD (Halperin, Berwid, & O'Neill, 2014, Child and Adolescent Psychiatric Clinics of North America, 23, 899), yet links between PA and ADHD levels and impairments have rarely been studied in either typically developing or at-risk preschool children. Importantly, impaired processing speed (PS), though not a symptom of ADHD, is a robust neuropsychological correlate (Willcutt & Bidwell, 2011, Treating attention deficit hyperactivity disorder: Assessment and intervention in developmental context. Kingston, NJ: Civic Research Institute) that may indicate additional risk for ADHD. Hence, we examined whether baseline PS moderates the association between preschoolers' PA, specifically moderate-to-vigorous PA (MVPA), and changes in ADHD levels and related behaviors.

METHOD

Eighty-five preschoolers (49.4% female; M_age  = 4.14, SD_age  = .64) were drawn from a larger study of the effects of the Kiddie Children and Teachers (CATs) on the Move PA program on school readiness. The sample was largely Head Start eligible (68.2%) and ethnically diverse. Hierarchical regressions were utilized to examine links between MVPA, averaged over a school year, and changes in inattention (IA), hyperactivity/impulsivity (HI), oppositional behaviors, moodiness, and peer functioning, and whether these associations varied based on baseline PS.

RESULTS

Results indicated that for IA, HI, and peer functioning, higher amounts of MVPA were associated with greater adaptive change for those with lower (but not higher) levels of PS.

CONCLUSIONS

Preschool MVPA may be a viable method of reducing ADHD levels and impairments for those with lower PS.

Development and pilot evaluation of a mobile app on parent-child exercises to improve physical activity and psychosocial outcomes of Hong Kong Chinese children

BACKGROUND

Parent-child exercises involve children and parents to do workout together and have positive effects on physical and mental health. We developed a mobile app on parent-child exercises called Family Move, which combines coaching videos with game features such as points and level system to enhance the health and wellbeing of both children and parents through parent-child exercises. This pilot pre-post study investigated whether the Family Move app-based intervention had a positive effect on children's health-related quality of life (HRQOL), psychosocial wellbeing, and physical activity (PA) level.

METHODS

We recruited 67 parent-child pairs. During the 8-week intervention, these pairs were invited to perform parent-child exercises using the Family Move app. Points were automatically added to the user account after viewing a coaching video. In-game ranking was available to enhance user engagement. Parent proxy-report questionnaires on children's HRQOL, psychosocial wellbeing, and PA were administered at baseline and 1- and 6-month follow-up. Paired samples t-tests were conducted to evaluate post-intervention changes in child outcomes (HRQOL, psychosocial wellbeing, and PA). Multiple linear regressions were used to examine these changes as a function of in-game ranking.

RESULTS

52 (78%) viewed at least one coaching video in the Family Move app. Children's PA level significantly increased at 1-month (d = 0.32, p = 0.030) and 6-month (d = 0.30, p = 0.042) follow-up, whereas their psychosocial problems declined at 6-month follow-up (d = 0.35, p = 0.005). Higher in-game ranking was significantly associated with fewer psychosocial problems at 1-month follow-up (β = - 0.15, p = 0.030).

CONCLUSIONS

Our findings suggest that the Family Move app could be a possible intervention to increase children's PA level and psychosocial wellbeing through parent-child exercise.

TRIAL REGISTRATION

ClinicalTrials.gov number, NCT03279354 , registered September 11, 2017 (Prospectively registered).

Comparison of the effects of treadmill and vibration training in children with attention deficit hyperactivity disorder: A randomized controlled trial

OBJECTIVE

The aim of this study was to compare the effects of treadmill training (TT) and whole body vibration training (WBVT) on attention, severity of attention deficit hyperactivity disorder (ADHD) symptoms and impairment of executive function behaviors, and quality of life in children with ADHD.

METHODS

Thirty children (7-11 years of age) with ADHD were randomly assigned to either the 'TT' group or the 'WBVT in addition to TT' group (TT + WBVT). Both groups received TT for 8 weeks (3 days/week). The TT + WBWT group also received WBVT for 15 minutes. Stroop Test TBAG form, Behavior Rating Inventory of Executive Function (BRIEF), Conners' Rating Scale (CRS) and Pediatric Quality of Life Inventory (PedsQL) were applied at baseline and after 8 weeks of training.

RESULTS

All assessment results significantly improved in both groups at the end of the program compared to baseline values (p < 0,05). There were significant differences between groups regarding improvements in CTRS-R/L and BRIEF-Teacher form in favor of the TT + WBVT group.

CONCLUSIONS

The findings suggest that exercise training including TT and WBVT might be used in the treatment of ADHD but further research is required to provide evidence of the effectiveness of the whole body vibration training in the management of ADHD.

Moderate-to-vigorous physical activity and behavioral outcomes in adolescents with attention deficit and hyperactivity disorder: The role of sleep

BACKGROUND

Attention deficit and hyperactivity disorder (ADHD) is a neurodevelopmental disorder that has a worldwide prevalence of 7.2%. Individuals with ADHD often have sleep and behavioral problems.

OBJECTIVE

This cross-sectional survey aims to investigate the relationships between moderate-to-vigorous physical activity (MVPA), sleep, bullying, and school engagement in adolescents with ADHD.

METHODS

Data were obtained from the 2011-2012 National Survey of Children's Health. A subsample (n = 272) that fit the inclusion criteria was included. Path analysis was used to test the hypothesized model (i.e., MVPA → sleep → bullying/school engagement).

RESULTS

The proposed model fit the data well. MVPA was found to be associated with sleep, bullying, and school engagement. In addition, sleep mediated the relationship between MVPA and bullying/school engagement.

CONCLUSIONS

MVPA and sleep play an important role in understanding behavioral outcomes in adolescents with ADHD. Longitudinal or intervention studies are needed to support the present findings.

Working Memory and Increased Activity Level (Hyperactivity) in ADHD: Experimental Evidence for a Functional Relation

OBJECTIVE

Converging evidence indicates large magnitude deficits in the "working" component of working memory for children with ADHD. However, our understanding of the relation between these central executive deficits and ADHD behavioral symptoms remains limited due to problems with several commonly used working memory tests.

METHOD

Children with ADHD (n = 25) completed a counterbalanced series of working memory tasks that differed only in memory set predictability.

RESULTS

Results indicated that central executive demands increased when memory set was unpredictable, as evidenced by moderate performance decreases (d = 0.22-0.56) and large changes in performance variability (d = 0.93-3.16) and response times (d = 1.74-4.16). Activity level remained relatively stable when memory set was unpredictable but decreased significantly over time when memory set was predictable.

CONCLUSION

Results suggest that altering memory set predictability is a feasible method for increasing/maintaining central executive demands over time, and suggest a positive association between working memory demands and gross motor activity for children with ADHD.

Exercise and Academic Performance Among Children With Attention-Deficit Hyperactivity Disorder and Disruptive Behavior Disorders: A Randomized Controlled Trial

PURPOSE

To examine effects of a 10-week after-school physical activity (PA) program on academic performance of 6- to 12-year-old African American children with behavior problems.

METHODS

Participants were randomized to PA (n = 19) or sedentary attention control (n = 16) programs. Academic records, curriculum-based measures, and classroom observations were obtained at baseline, postintervention, and/or follow-up. Mixed models tested group × time interactions on academic records and curriculum-based measures. One-way analysis of variance or Kruskal-Wallis tested for differences in postintervention classroom observations.

RESULTS

Intent-to-treat analyses demonstrated a moderate effect within groups from baseline to postintervention on disciplinary referrals (PA: d = -0.47; attention control: d = -0.36) and a null moderate effect on academic assessments (PA: d = 0.11 to 0.36; attention control: d = 0.05 to 0.40). No significant group × time interactions emerged on direct academic assessments (all Ps ≥ .05, d = -0.23 to 0.26) or academic records (all Ps ≥ .05, d = -0.28 to 0.16). Classroom observations revealed that intervention participants were off-task due to moving at twice the rate of comparative classmates (F = 15.74, P < .001) and were off-task due to talking 33% more often (F = 1.39, P = .257).

CONCLUSION

Academic outcome improvements were small within and between groups and did not sustain at follow-up. Academic benefits of after-school PA programs for children with attention-deficit hyperactivity disorder and/or disruptive behavior disorders were smaller than neurobiological, behavioral, and cognitive outcomes as previously reported.

Identification and evaluation of risk of generalizability biases in pilot versus efficacy/effectiveness trials: a systematic review and meta-analysis

BACKGROUND

Preliminary evaluations of behavioral interventions, referred to as pilot studies, predate the conduct of many large-scale efficacy/effectiveness trial. The ability of a pilot study to inform an efficacy/effectiveness trial relies on careful considerations in the design, delivery, and interpretation of the pilot results to avoid exaggerated early discoveries that may lead to subsequent failed efficacy/effectiveness trials. "Risk of generalizability biases (RGB)" in pilot studies may reduce the probability of replicating results in a larger efficacy/effectiveness trial. We aimed to generate an operational list of potential RGBs and to evaluate their impact in pairs of published pilot studies and larger, more well-powered trial on the topic of childhood obesity.

METHODS

We conducted a systematic literature review to identify published pilot studies that had a published larger-scale trial of the same or similar intervention. Searches were updated and completed through December 31st, 2018. Eligible studies were behavioral interventions involving youth (≤18 yrs) on a topic related to childhood obesity (e.g., prevention/treatment, weight reduction, physical activity, diet, sleep, screen time/sedentary behavior). Extracted information included study characteristics and all outcomes. A list of 9 RGBs were defined and coded: intervention intensity bias, implementation support bias, delivery agent bias, target audience bias, duration bias, setting bias, measurement bias, directional conclusion bias, and outcome bias. Three reviewers independently coded for the presence of RGBs. Multi-level random effects meta-analyses were performed to investigate the association of the biases to study outcomes.

RESULTS

A total of 39 pilot and larger trial pairs were identified. The frequency of the biases varied: delivery agent bias (19/39 pairs), duration bias (15/39), implementation support bias (13/39), outcome bias (6/39), measurement bias (4/39), directional conclusion bias (3/39), target audience bias (3/39), intervention intensity bias (1/39), and setting bias (0/39). In meta-analyses, delivery agent, implementation support, duration, and measurement bias were associated with an attenuation of the effect size of - 0.325 (95CI - 0.556 to - 0.094), - 0.346 (- 0.640 to - 0.052), - 0.342 (- 0.498 to - 0.187), and - 0.360 (- 0.631 to - 0.089), respectively.

CONCLUSIONS

Pre-emptive avoidance of RGBs during the initial testing of an intervention may diminish the voltage drop between pilot and larger efficacy/effectiveness trials and enhance the odds of successful translation.

Non-pharmacologic management of attention-deficit/hyperactivity disorder in children and adolescents: a review

Attention-deficit/hyperactivity disorder (ADHD) is a very common neurobehavioral disorder that affects children and adolescents with impact that persists beyond adolescence into adulthood. Medication and non-pharmacological treatments are evidence-based interventions for ADHD in various age groups, and this article will elaborate on the psychosocial, physical and integrative medicine interventions that have been studied in ADHD.

Sensory processing and organisational abilities in children with inattentive-hyperactive behaviours

Background/Aims

Sensory processing has been theorised to contribute to object and temporal organisation. Sensory processing and organisational abilities in children with inattention-hyperactivity was assessed, and investigated if there was a relationship between the two.

Methods

A community sample of children aged 9–12 years was categorised into inattentive-hyperactive (n=20) and non-inattentive-hyperactive groups (n=56) using the Vanderbilt Attention Deficit Hyperactivity Disorder Parent and Teacher Rating Scales. The Sensory Profile, Child Organisation Scale and Child Organisation Parent Perception Scale were used to collect additional data.

Results

Sensory processing and organisational abilities differed significantly between the groups. Object organisation correlated significantly with multisensory processing; temporal organisation failed to correlate with sensory processing.

Conclusions

Results suggest there is a need to screen children with informant-reported inattention-hyperactivity for sensory processing differences and organisational deficits. Sensory processing and object organisation may be associated; further research on potential factors underlying this association is needed.

Physical exercise in attention deficit hyperactivity disorder - evidence and implications for the treatment of borderline personality disorder

A growing body of literature indicates a potential role for physical exercise in the treatment of attention deficit hyperactivity disorder (ADHD). Suggested effects include the reduction of ADHD core symptoms as well as improvements in executive functions. In the current review, we provide a short overview on the neurophysiological mechanisms assumed to underlie the beneficial effects of exercise. Further, we review the current evidence from experimental studies regarding both acute exercise and long-term interventions in ADHD. While the positive effects observed after acute aerobic exercise are promising, very few well-designed long-term intervention studies have been conducted yet. Moreover, although exercise effects have not yet been studied in borderline personality disorder (BPD), in the end of this paper we derive hypotheses why exercise could also be beneficial for this patient population.

Using Repeated-Measures Data to Make Stronger Tests of the Association between Executive Function Skills and Attention Deficit/Hyperactivity Disorder Symptomatology in Early Childhood

Theoretical models of Attention deficit/hyperactivity disorder (ADHD) have long implicated executive function (EF) skills as contributing to the etiology, maintenance, and changes in ADHD symptomatology over time. Although there is interest making within-person inferences (i.e., deficits in EF skills give rise to ADHD behaviors), most of the evidence has been derived from studies that conflated between- and within-person sources of variance. Here, we use repeated-measures data to test within-person association between EF skills and ADHD behaviors. Participants included 1160 children from the Family Life Project, an ongoing prospective longitudinal study of child development in low-income, nonmetropolitan communities. We tested the magnitude of the association between EF skills and ADHD behaviors when children were 3, 4, and 5 years old. Consistent with meta-analyses, unadjusted bivariate associations between EF and ADHD (which reflect combined between- and within-person variation) were of moderate magnitude (rs = -0.20 to -0.30). However, after controlling for all time-invariant, between-person sources of variation, the within-person associations between EF skills and ADHD behaviors were weak (βs - 0.04 to -0.05, ps = 0.01). These results suggest that EF skills may contribute less prominently to ADHD behaviors in early childhood than is commonly assumed and provoke broader questions about developmental models of ADHD.

Impact of physical exercise on children with attention deficit hyperactivity disorders: Evidence through a meta-analysis

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) which is characterized by developmentally inappropriate levels of attention, hyperactivity and impulsivity, is considered as the most common neurodevelopmental disorder in childhood. Physical exercise has shown to have several benefits in the improvement of children with ADHD. In this meta-analysis, we aimed to systematically show, with evidence, the impact of physical exercise on children with ADHD.

METHODS

Web of Science, MEDLINE, EMBASE, Google Scholar, Cochrane Central and http://www.ClinicalTrials.gov were the searched sources for studies which were based on the impact of physical exercise on children with ADHD. Relevant endpoints were assessed. This evidence based meta-analysis was carried out by the most relevant RevMan 5.3 software. Due to the involvement of continuous data (mean and standard deviation), weight mean difference (WMD) with 95% confidence intervals (CI) were used to represent the final analysis. A significant level of P ≤ .05 was set and a fixed statistical effect model was used throughout the analysis.

RESULTS

Fourteen studies with a total number of 574 participants with ADHD were included in this evidenced based meta-analysis. Two hundred and seventy six (276) participants were assigned to the physical activity group whereas 298 participants were assigned to the control group. Results of this analysis showed that anxiety and depression were significantly improved with physical activity in these children with ADHD (WMD: -1.84; 95% CI: [-2.65 - (-1.03)], P = .00001). Hyperactive/impulsive symptoms (WMD: -0.01; 95% CI: [-0.32 - 0.29], P = .93) and inattention symptoms (WMD: -0.22; 95% CI: [-0.51 - 0.08], P = .15) were also improved with physical exercise but the results were not statistically significant. This evidence based analysis showed thought problems (WMD: -3.49; 95% CI: [-5.51 - (-1.47)], P = .0007), social problems (WMD: -5.08; 95% CI: [-7.34 - (-2.82)], P = .0001), and aggressive behaviors (WMD: -3.90; 95% CI: [-7.10 - (-0.70)], P = .02) to have significantly been improved in participants with ADHD who were assigned to physical activity group.

CONCLUSIONS

This current meta-analysis showed with evidence, that physical exercise has a major contribution owing to significant improvement in anxiety and depression, aggressive behaviors, thought and social problems among children suffering from ADHD. Therefore, physical exercise should be incorporated in the daily life of children with ADHD. Further future research should be able to confirm this hypothesis.

An Exercise Program Designed for Children with Attention Deficit/Hyperactivity Disorder for Use in School Physical Education: Feasibility and Utility

Moderate to high intensity exercise can improve cognitive function and behavior in children including those with attention-deficit/hyperactivity disorder (ADHD). However, exercise with long periods of the same activity, or inactivity can fail to engage or maintain their attention. This study examined the effect of exercise sessions developed to engage children with ADHD. Twelve children (10-11 years), six with a diagnosis of ADHD and six with no diagnosis, undertook 40-minute sessions of short-duration, mixed activities bi-weekly for eleven weeks. ADHD symptoms and exercise enjoyment were recorded before six and eleven weeks of intervention. Teacher-reported data showed ADHD symptoms were significantly decreased in the children with ADHD, with a moderate to large effect size. There were no changes in the control group. All children indicated equal enjoyment of the exercise sessions. Specially designed exercise sessions stimulate and maintain engagement by children with ADHD and may reduce ADHD symptom levels in the school environment. The method that supports inclusive practice in physical education (PE) was successfully transferred to the study school and led by the usual class teacher. Children evaluated the exercises as acceptable and enjoyable for those with and without ADHD. This inclusive exercise method might help children manage ADHD symptoms.

Moderating Effect of Motor Proficiency on the Relationship Between ADHD Symptoms and Sleep Problems in Children With Attention Deficit Hyperactivity Disorder-Combined Type

OBJECTIVES/BACKGROUND

A high proportion of children with Attention Deficit Hyperactivity Disorder- Combined type (ADHD-CT) experience sleep and motor problems. This study investigated (a) whether motor proficiency moderated the relationship between ADHD symptoms and sleep problems in children with and without ADHD-CT and (b) whether this moderation differed as a function of ADHD diagnosis.

PARTICIPANTS

A sample of 70 primary school male children between 8-15 years were recruited; children with ADHD-CT (n = 38; mean age 10 years, 2 months [SD = 1 year, 6 months]) and a typically developing (TD) (n = 32; mean age 9 years, 6 months [SD = 1 year, 5 months]) group.

METHODS

Motor proficiency was measured using the Movement Assessment Battery for Children-2nd Edition (MABC-2), ADHD symptoms were measured using the Conners' Parent Rating Scale (CPRS) and parent reported sleep problems were measured using the Children's Sleep Habits Questionnaire (CSHQ).

RESULTS

Children who reported higher ADHD symptoms and lower motor proficiency scores reported more sleep problems. The moderation effect only held in children with a diagnosis of ADHD-CT and not in the typically developing group.

CONCLUSIONS

These findings indicate that children who experience greater severity of ADHD symptoms who also have lower motor proficiency may be at increased risk of experiencing sleep problems. These findings also illustrate the importance of considering motor proficiency when exploring risk factors for sleep problems in children with ADHD-CT as well as sleep interventions.

Effects of Exercise on Cognitive Performance in Children and Adolescents with ADHD: Potential Mechanisms and Evidence-based Recommendations

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder with a complex symptomatology, and core symptoms as well as functional impairment often persist into adulthood. Recent investigations estimate the worldwide prevalence of ADHD in children and adolescents to be ~7%, which is a substantial increase compared to a decade ago. Conventional treatment most often includes pharmacotherapy with central nervous stimulants, but the number of non-responders and adverse effects call for treatment alternatives. Exercise has been suggested as a safe and low-cost adjunctive therapy for ADHD and is reported to be accompanied by positive effects on several aspects of cognitive functions in the general child population. Here we review existing evidence that exercise affects cognitive functions in children with and without ADHD and present likely neurophysiological mechanisms of action. We find well-described associations between physical activity and ADHD, as well as causal evidence in the form of small to moderate beneficial effects following acute aerobic exercise on executive functions in children with ADHD. Despite large heterogeneity, meta-analyses find small positive effects of exercise in population-based control (PBC) children, and our extracted effect sizes from long-term interventions suggest consistent positive effects in children and adolescents with ADHD. Paucity of studies probing the effect of different exercise parameters impedes finite conclusions in this regard. Large-scale clinical trials with appropriately timed exercise are needed. In summary, the existing preliminary evidence suggests that exercise can improve cognitive performance intimately linked to ADHD presentations in children with and without an ADHD diagnosis. Based on the findings from both PBC and ADHD children, we cautiously provide recommendations for parameters of exercise.

Physical Activity, Screen Time, and Sleep in Children With ADHD

Background: Children with attention deficit hyperactivity disorder (ADHD) are at increased risk for poor health and obesity. The authors describe obesity-related movement behaviors in children with ADHD, determine higher risk groups, and compare with children with other disorders. Methods: Physical activity (PA), sleep, and screen time of children with ADHD (aged 6-18 y) were compared with recommendations and with behaviors of children with autism, asthma, and a normative group using 2011 National Survey of Child Health data. Results: Approximately one-third of children with ADHD participated in daily PA and half in sports in the past year. Older children with ADHD were less likely to get daily PA, get enough sleep, and limit screen time to <2 hours per day. Obese children had lower odds of daily PA. Children who had lower socioeconomic status, or severe ADHD, had lower odds of sports participation. Children with ADHD had 50% lower odds of sports participation than children with asthma. Conclusions: Children with ADHD did not engage in recommended amounts of PA, sleep, and screen time. Children with ADHD who are older, poor, obese, and/or with more severe symptoms are at higher risk for suboptimal movement behaviors. These domains represent novel treatment targets in ADHD youth.

Applying a Cognitive Neuroscience Perspective to Disruptive Behavior Disorders: Implications for Schools

A cognitive neuroscience perspective seeks to understand behavior, in this case disruptive behavior disorders (DBD), in terms of dysfunction in cognitive processes underpinned by neural processes. While this type of approach has clear implications for clinical mental health practice, it also has implications for school-based assessment and intervention with children and adolescents who have disruptive behavior and aggression. This review articulates a cognitive neuroscience account of DBD by discussing the neurocognitive dysfunction related to emotional empathy, threat sensitivity, reinforcement-based decision-making, and response inhibition. The potential implications for current and future classroom-based assessments and interventions for students with these deficits are discussed.

Effect of physical exercises on attention, motor skill and physical fitness in children with attention deficit hyperactivity disorder: a systematic review

Children with attention deficit hyperactivity disorder (ADHD) are educated in classrooms along with typically developing children. Those with ADHD, however, find it difficult to participate in routine educational and recreational activities as they encounter problems associated with behaviour, attention, motor skills and physical endurance. Traditionally, the management of children with ADHD has focussed primarily on problems with cognition and has been heavily dependent on pharmaceutical interventions and, to a lesser extent, on non-pharmaceutical measures. More recently, experts have increasingly advocated the use of exercises in alleviating symptoms associated with ADHD. The primary objective of this review was to summarize research that examined the role of exercises on deficits related to attention, motor skills and fitness in children with ADHD. A search of the available literature was conducted using a combination of relevant key words in the following databases: PubMed, MEDLINE, Google Scholar, Embase and Cochrane review. The search filtered 3016 studies of potential relevance, of which 2087 were excluded after screening titles and abstracts as per the inclusion criteria. Thirty-four (34) studies were analysed in greater depth, and 16 were excluded after detailed consideration as they did not match the inclusion (PEDro score > 4) and exclusion criteria. Three (3) additional studies were excluded as they lacked exercise prescription details such as intensity, duration and frequency of exercise. Finally, 15 studies were analysed with a focus on the effects of physical exercises on attention, hyperactive behaviour, motor skills and physical fitness in ADHD children. Overall, the studies reviewed were of moderate-to-high quality and reported benefits of a variety of exercise programmes in improving motor skills, physical fitness, attention and social behaviour in children with ADHD. However, there was limited information regarding school-based programmes, the effects of structured exercise programmes independently or in combination with cognitive-based therapies, and the long-term benefits of exercises in alleviating behavioural problems in these children.

Acute and chronic effect of physical activity on cognition and behaviour in young people with ADHD: A systematic review of intervention studies

BACKGROUND

Young people with attention deficit hyperactivity disorder (ADHD) often have learning and behavioral control difficulties.

AIM

The aim of this review is analyse the acute and chronic effect of physical activity (PA) on the cognition and behaviour of children and adolescents with ADHD.

METHODS

Studies were identified in five databases (PubMed, SPORTDiscus, ProQuest, Web of Science, and SCOPUS), from January 2000 through to January 2017. A total of 16 interventional studies met the inclusion criteria.

RESULTS/CONCLUSIONS

PA practice of 20-30 min (intensity 40-75%) produces a positive acute effect on processing speed, working memory, planning and problem solving in young people with ADHD. However, these effects on behaviour are contradictory and vary depending on age. Chronic PA practice (≥30 min per day, ≥40% intensity, ≥three days per week, ≥five weeks) further improves attention, inhibition, emotional control, behaviour and motor control. The results must be treated with caution, because only 25% of the studies used confounders.

IMPLICATION

More research is needed to justify the causes of these effects. It is necessary to establish programs with regard to the duration, intensity, kind of exercise, and time of PA to improve cognition and behaviour in young people with ADHD taking into account potential confounders.

Docosahexaenoic acid supplementation for children with attention deficit hyperactivity disorder: A comprehensive review of the evidence

Attention deficit hyperactivity disorder (ADHD) is considered the most common behavioural disorder in school-age children. ADHD is a complex and multifactorial disorder characterised by a variety of symptoms, including concentration problems, excessive motor activity and impulsivity which interferes with execution of simple school tasks. Diagnosis has been essentially subjective, since no specific laboratory tests are available. However, ADHD remains overdiagnosed, probably due to social pressures for children to be successful in school from an early age, which leads parents to seek medical support. Although therapeutic approaches for ADHD have been essentially pharmacologic, in recent years several studies were performed to investigate the role of nutrition, especially omega 3 polyunsaturated fatty acid (omega 3-PUFA), in the development and treatment of this disorder. In this review, the authors gathered the most relevant evidence regarding omega 3-PUFA, mainly docosahexaenoic acid, as coadjutant or as a single therapy, in the management of ADHD symptoms. The authors also reviewed this disorder's current medical and therapeutic features.

Effects of Before-School Physical Activity on Obesity Prevention and Wellness

INTRODUCTION

The effects of Build Our Kids Success-a 12-week, 1-hour before-school physical activity program-on BMI and social-emotional wellness among kindergarten to eighth grade students was examined.

STUDY DESIGN

This was a nonrandomized trial.

SETTING/PARTICIPANTS

Participants were from 24 schools in Massachusetts; there were 707 children from kindergarten to eighth grade.

INTERVENTION

Children registered for Build Our Kids Success in 2015-2016 participated in a 2 days/week or 3 days/week program. Nonparticipating children served as controls.

MAIN OUTCOME MEASURES

At baseline and 12 weeks, study staff measured children's heights/weights; children aged ≥8 years completed surveys. Main outcomes were 12-week change in BMI z-score, odds of a lower BMI category at follow-up, and child report of social-emotional wellness. Analyses were completed in March-June 2017.

RESULTS

Follow-up BMI was obtained from 67% of children and self-reported surveys from 72% of age-eligible children. Children in the 3 days/week group had improvements in BMI z-score (-0.22, 95% CI= -0.31, -0.14) and this mean change was significantly different than the comparison group (-0.17 difference, 95% CI= -0.27, -0.07). Children in the 3 days/week group also had higher odds of being in a lower BMI category at follow-up (OR=1.35, 95% CI=1.12, 1.62); significantly different than the comparison group (p<0.01). Children in the 2 days/week program had no significant changes in BMI outcomes. Children in the 3 days/week group demonstrated improvement in their student engagement scores (0.79 units, p=0.05) and had nonsignificant improvements in reported peer relationships, affect, and life satisfaction versus comparison. The 2 days/week group had significant improvements in positive affect and vitality/energy versus comparison.

CONCLUSIONS

A 3 days/week before-school physical activity program resulted in improved BMI and prevented increases in child obesity. Both Build Our Kids Success groups had improved social-emotional wellness versus controls.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT03190135.

Behavioral Effects of a Locomotor-Based Physical Activity Intervention in Preschoolers

BACKGROUND

Poor adaptive learning behaviors (ie, distractibility, inattention, and disruption) are associated with behavior problems and underachievement in school, as well as indicating potential attention-deficit hyperactivity disorder. Strategies are needed to limit these behaviors. Physical activity (PA) has been suggested to improve behavior in school-aged children, but little is known about this relationship in preschoolers. This study examined the effects of a PA intervention on classroom behaviors in preschool-aged children.

METHODS

Eight preschool classrooms (n = 71 children; age = 3.8 ± 0.7 y) with children from low socioeconomic environments were randomized to a locomotor-based PA (LB-PA) or unstructured free playtime (UF-PA) group. Both interventions were implemented by classroom teachers and delivered for 30 minutes per day, 5 days per week for 6 months. Classroom behavior was measured in both groups at 3 time points, whereas PA was assessed at 2 time points over a 6-month period and analyzed with hierarchical linear modeling.

RESULTS

Linear growth models showed significant decreases in hyperactivity (LB-PA: -2.58 points, P = .001; UF-PA: 2.33 points, P = .03), aggression (LB-PA: -2.87 points, P = .01; UF-PA: 0.97 points, P = .38) and inattention (LB-PA: 1.59 points, P < .001; UF-PA: 3.91 points, P < .001).

CONCLUSIONS

This research provides promising evidence for the efficacy of LB-PA as a strategy to improve classroom behavior in preschoolers.