Physical Activity, Affect, and Cognition in Children With Symptoms of ADHD

Acute aerobic exercise modulates cognition and cortical excitability in adults with attention-deficit hyperactivity disorder (ADHD) and healthy controls

Evidence suggests aerobic exercise has beneficial effects on cognitive performance in adults with attention-deficit hyperactivity disorder (ADHD). The underlying mechanisms might depend on mechanisms of exercise-mediated brain physiology. The study aims to investigate the effects of acute aerobic exercise on cortical excitability and cognitive performance, and the correlation between these phenomena in adults with ADHD. Twenty-six drug-naïve ADHD adults, and twenty-six age-, and gender-matched healthy controls were assessed with respect to cortical excitability and cognitive performance before and after acute aerobic exercise (a single session for 30 min) or a control intervention. The results show significantly enhanced intracortical facilitation (ICF) and decreased short intracortical inhibition (SICI) after aerobic exercise in healthy subjects. In contrast, SICI was significantly enhanced following acute aerobic exercise in ADHD. In ADHD, furthermore inhibitory control and motor learning were significantly improved after the acute aerobic exercise intervention. Alterations of SICI induced by aerobic exercise, and inhibitory control and motor learning improvement were significantly positively correlated in the ADHD group. Aerobic exercise had partially antagonistic effects in healthy controls, and ADHD patients. Furthermore, aerobic exercise-induced cognition-enhancing effects in ADHD depend on specific alterations of brain physiology, which differ from healthy humans.

Alternative Treatments to Pharmacological Therapy in Pediatric Populations With Attention-Deficit/Hyperactivity Disorder (ADHD): A Scoping Review

In recent years, there has been an increase in the prevalence of the diagnosis of attention-deficit/hyperactivity disorder (ADHD), a cognitive and behavioral disorder in which individuals present with inattention and impulsivity, in the pediatric population. With an increase in diagnoses, there is also increasing concern regarding overdiagnosis and overtreatment with medications for ADHD. The objective of this study was to map out and compile the recent literature pertaining to alternative therapies (e.g., physical activity, diet, mindfulness, and computer-based interventions) for children and adolescents diagnosed with ADHD in an attempt to reduce or replace the use of pharmacological therapy. This scoping review searched articles from multiple databases (PubMed, ScienceDirect, Web of Science, Directory of Open Access Journals, Scopus, and CINAHL). Using search terms "children with ADHD," "alternative treatment," and "cognitive behavioral therapy," articles were identified that were specific to the research question. The inclusion criteria were patients under the age of 18 with a previous diagnosis of ADHD, no other comorbid illnesses, alternative treatments, and was limited to studies published between 2012 and 2022. After removing duplicates, screening for eligibility criteria, and conducting a critical appraisal of the articles, 16 articles were retained for the final review. The main alternative therapeutic domains that emerged were (1) physical activity, (2) diet, (3) mindfulness, (4) computer-based interventions, and (5) miscellaneous interventions. Seven articles assessed the effect of physical activity on executive and cognitive function in children and adolescents with ADHD. Most findings showed improvement with increased physical activity. Two articles explored the effect of diet on the improvement of ADHD symptoms and reported a positive impact. The two articles that evaluated the effects of mindfulness on ADHD symptoms reported a reduction in ADHD symptoms. Two studies evaluated the use of computer-based interventions as an adjunct treatment in children and adolescents with ADHD; improvements in symptoms were reported. One study each evaluated interventions based on music and nerve stimulation. These showed an improvement in attention, memory, and executive function. With the increasing prevalence of ADHD diagnosis in children and adolescents, alternative and/or adjunctive treatments may be a viable and valuable alternative to pharmaceutical interventions. The findings from this review suggest that multiple non-pharmacological interventions effectively reduce symptoms of ADHD in children and adolescents, including diet, exercise, mindfulness, computer-based interventions, music, and nerve stimulation. While there are implications for alternatives to be used in the future, more research is warranted using larger samples with controlled trials.

Physical Activity and Mental Health in Children and Adolescents With Neurodevelopmental Disorders: A Systematic Review and Meta-Analysis

Importance

Children and adolescents with neurodevelopmental disorders experience mental health issues and are encouraged to be brought together in real-life treatment. However, physical activity, which is a promising method for boosting mental health, has only been examined in children and adolescents with certain types of neurodevelopmental disorders.

Objective

To examine the association of physical activity interventions with mental health (ie, cognitive function, psychological well-being, internalizing, and externalizing problems) in children and adolescents with neurodevelopmental disorders and to identify possible moderators.

Data Sources

Studies were searched from inception to May 2023 through Web of Science, PsycINFO, SPORTDiscus, MEDLINE, CINAHL, and ERIC.

Study Selection

Randomized clinical trials or nonrandomized designs applying physical activity interventions and reporting at least 1 mental health outcome in children and adolescents aged 5 to 17 years with neurodevelopmental disorders were included. Two independent reviewers selected and assessed the studies.

Data Extraction and Synthesis

Random multilevel meta-analysis using Hedges g was performed. Data extraction and risk-of-bias assessment were conducted by multiple reviewers. Heterogeneity, publication bias, sensitivity analysis, and moderator analysis were examined to substantiate the results.

Main Outcomes and Measures

The main outcomes were mental health related to cognitive function, psychological well-being, internalizing, or externalizing problems measured by neurocognitive tasks or subjective questionnaires.

Results

A total of 76 studies involving 3007 participants were included in systematic review, 59 of which were used for meta-analysis. The findings indicated that physical activity interventions were associated with significant benefits for overall mental health (g, 0.67; 95% CI, 0.50-0.85), cognitive function (g, 0.74; 95% CI, 0.53-0.95), psychological well-being (g, 0.56; 95% CI, 0.16-0.96), internalizing (g, 0.72; 95% CI, 0.34-1.10), and externalizing problems (g, 0.58; 95% CI, 0.28-0.89). Moderators were also identified: frequency, total sessions, and total duration for overall mental health; total sessions, and total duration for cognitive function; session duration and frequency for psychological well-being; physical activity type for internalizing problems; and session duration for externalizing problems. Moderator analyses showed that type of neurodevelopmental disorder did not modify the associations between physical activity and overall mental health or its subgroups.

Conclusions and Relevance

The findings in this study suggest that children and adolescents with different types of neurodevelopmental disorders may be grouped together when performing physical activity interventions, which were confirmed to be beneficial to overall mental health and its subgroups in this new diagnostic population, but that physical activity interventions should be tailored when targeting different mental health domains.

Treating Executive Function in Youth With Attention Deficit Hyperactivity Disorder: A Review of Pharmacological and Non-Pharmacological Interventions

INTRODUCTION

Executive function (EF) deficits are common in youth with ADHD and pose significant functional impairments. The extent and effect of interventions addressing EF in youth with ADHD remain unclear.

METHODS

We conducted a systematic literature review using PRISMA guidelines. Included studies were randomized controlled trials of interventions to treat EF in youth with ADHD.

RESULTS

Our search returned 136 studies representing 11,443 study participants. We identified six intervention categories: nonstimulant pharmacological (N = 3,576 participants), neurological (N = 1,935), psychological (N = 2,387), digital (N = 2,416), physiological (N = 680), and combination (N = 366). The bulk of the evidence supported pharmacological interventions as most effective in mitigating EF, followed by psychological and digital interventions.

CONCLUSION

A breadth of treatments exists for EF in youth with ADHD. Pharmacological, psychotherapeutic, and digital interventions had the most favorable, replicable outcomes. A lack of outcome standardization across studies limited treatment comparison. More data on the persistence of intervention effects are necessary.

Physical and mental health in adolescence: novel insights from a transdiagnostic examination of FitBit data in the ABCD study

Adolescence is among the most vulnerable period for the emergence of serious mental illnesses. Addressing this vulnerability has generated interest in identifying markers of risk for symptoms and opportunities for early intervention. Physical fitness has been linked to psychopathology and may be a useful risk marker and target for early intervention. New wearable technology has made assessing fitness behavior more practical while avoiding recall and self-report bias. Still, questions remain regarding the clinical utility of physical fitness metrics for mental health, both transdiagnostically and along specific symptom dimensions. The current study includes 5007 adolescents (ages 10-13) who participated in the Adolescent Brain Cognitive Development (ABCD) study and additional sub-study that collected fitness data from wearable technology and clinical symptom measures. Physical fitness metrics included resting heart rate (RHR- an index of cardiovascular health), time spent sedentary (associated with increased inflammation and cardiovascular disease), and time spent in moderate physical activity (associated with increased neurogenesis, neuroplasticity, and healthy neurodevelopment). Self-report clinical symptoms included measures of psychosis-like experiences (PLE), internalizing symptoms, and externalizing symptoms. Increased RHR- lower cardiovascular fitness- related only to greater internalizing symptoms (t = 3.63). More sedentary behavior related to elevated PLE severity (t = 5.49). More moderate activity related to lower PLE (t = -2.69) and internalizing (t = -6.29) symptom severity. Wearable technology fitness metrics linked physical health to specific mental health dimensions, which emphasizes the utility of detailed digital health data as a marker for risk and the need for precision in targeting physical health behaviors to benefit symptoms of psychopathology.

Impact of physical activity on executive functions: a moderated mediation model

Objective

To provide both empirical support and a theoretical framework for systematically improving and optimizing the cognitive capabilities of college students through physical activity, while considering the mediating and regulating impacts of self-efficacy and negative emotion.

Methods

The study employed an overall random sampling method, examining 500 college students from five universities in Jiangsu Province using the Physical Activity Rating Scale (PARS-3), Adult Executive Function Scale (ADEXI), Positive and Negative Emotion Scale (PANAS), and General Self-Efficacy Scale (GSES).

Results

The findings indicated that the average age of the participants was 18.41 ± 0.73 years, encompassing 215 male students (43%), and 185 female students (57%). Engagement in physical activity was significantly and positively correlated with executive function (β = 0.246, p < 0.01), inversely associated with negative emotion (β = -0.137, p < 0.01), and demonstrated a significant positive predictive impact on self-efficacy (β = 0.183, p < 0.01). Self-efficacy was observed to partially mediate the relationship between executive function and physical activity. In addition, negative mood was identified as playing a partial mediating and modifying role in the relationship between executive function and physical activity.

Conclusion

Increasing college students' daily physical activity participation not only benefits their executive function, self-efficacy, and confidence levels but also exerts a limited positive impact on negative mood, with the potential to regulate the intensity of negative emotion.

Physical and Mental Health in Adolescence: Novel Insights from a transdiagnostic examination of FitBit data in the ABCD Study

Adolescence is among the most vulnerable period for the emergence of serious mental illnesses. Addressing this vulnerability has generated interest in identifying markers of risk for symptoms and opportunities for early intervention. Physical fitness has been linked to psychopathology and may be a useful risk marker and target for early intervention. New wearable technology has made assessing fitness behavior more practical while avoiding recall and self-report bias. Still, questions remain regarding the clinical utility of physical fitness metrics for mental health, both transdiagnostically and along specific symptom dimensions. The current study includes 5007 adolescents (ages 10 to 13) who participated in the Adolescent Brain Cognitive Development (ABCD) study and additional sub-study that collected fitness data from wearable technology and clinical symptom measures. Physical fitness metrics included resting heart rate (RHR- an index of cardiovascular health), time spent sedentary (associated with increased inflammation and cardiovascular disease), and time spent in moderate physical activity (associated with increased neurogenesis, neuroplasticity, and healthy neurodevelopment). Self-report clinical symptoms included measures of internalizing symptoms, externalizing symptoms, and psychosis-like experiences - PLE). Increased RHR- lower cardiovascular fitness- related only to greater internalizing symptoms (t = 3.63). More sedentary behavior related to elevated PLE severity (t = 5.49). More moderate activity related to lower PLE (t=-2.69) and internalizing (t=-6.29) symptom severity. Wearable technology fitness metrics linked physical health to specific mental health dimensions, which emphasizes the utility of detailed digital health data as a marker for risk and the need for precision in targeting physical health behaviors to benefit symptoms of psychopathology.

Meta-analysis of the effects of physical activity on executive function in children and adolescents with attention deficit hyperactivity disorder

BACKGROUND

Executive function is a core deficit in children with attention deficit hyperactivity disorder (ADHD). This study systematically reviewed the evidence for the effects of physical activity (PA) interventions on executive function in children and adolescents with ADHD and explored the moderating effects of key variables of PA on executive function.

METHODS

Relevant literature in four electronic databases, Pubmed, Web of Science, Cochrane Library, and Embase, were systematically searched. Revman 5.4 was used for data analysis, and combined effect sizes, heterogeneity tests, subgroup analyses, and sensitivity analyses were calculated. Egger's test in Stata 15.0 was used for publication bias testing.

RESULTS

A total of 24 articles with 914 participants were included. Meta-analysis showed that PA interventions improved inhibitory control (SMD = -0.50, 95%CI [-0.71, -0.29], P < 0.00001), working memory (SMD = -0.50, 95%CI [-0.83, -0.16], P = 0.004) and cognitive flexibility in children and adolescents with ADHD (SMD = -0.45, 95%CI [-0.81, -0.09], P = 0.01). Subgroup analysis revealed a moderating effect of intervention intensity, motor skill type, sessions of PA, and weekly exercise volume on executive function.

CONCLUSION

PA interventions had positive effects on improvements in core executive functions in children and adolescents with ADHD and were influenced by intervention intensity, type of motor skill, sessions of PA, and amount of exercise. This has practical implications for the formulation of PA interventions programs.

Exploring the Relationship between Cardiorespiratory Fitness and Executive Functioning in Adults with ADHD

OBJECTIVE

Associations between measures of executive functioning (EF) and cardiorespiratory fitness (CRF) were examined for adults with and without ADHD.

METHOD

Measures of executive functioning including the Stroop task, Wisconsin Card Sorting task, and Operation Span Task were completed virtually (n = 36 ADHD; n = 36 Control). Participants completed the Six-Minute Walk Test to estimate CRF.

RESULTS

Mean performance measures of executive function did not differ by group. However, higher estimated CRF was associated with better Stroop task performance, and the association was strongest for individuals with ADHD.

CONCLUSION

In adults with ADHD, higher estimated CRF was associated with better inhibitory control, but not with other measures of executive functioning.

The mediating role of resilience in the association between MVPA and psychological ill-being in children with ADHD

PURPOSE

This study investigated the mediating role of resilience in the association between moderate-to-vigorous physical activity (MVPA) and psychological ill-being, as well as the moderating role of age in the direct and indirect relationship between MVPA and psychological ill-being in children with attention-deficit/hyperactivity disorder (ADHD).

METHODS

Eighty-five children aged 6-12 years (M_age  = 8.41 ± 1.44 years) diagnosed with ADHD were recruited. Participants wore an accelerometer on their non-dominant wrist for seven consecutive days to record MVPA. Resilience and psychological ill-being were assessed using self-reported questionnaires.

RESULTS

MVPA was positively associated with resilience but negatively related to depression and stress. Resilience was negatively correlated with depression and stress. Using the bootstrapping method, the indirect effect of resilience was found between MVPA and depression (-0.006%, 95% confidence interval [CI] = [-0.060, -0.020]) in children with ADHD, supporting partial mediation. Moderated mediation analysis further demonstrated that the indirect effect of MVPA on depression via resilience was stronger in older children (-0.008, 95% CI = [-0.023, -0.001]) than in younger children with ADHD.

CONCLUSION

The findings may inform future empirical studies on designing exercise interventions with MVPA levels that help to improve resilience and depression in children with ADHD.

Associations of meeting 24-h movement behavior guidelines with cognitive difficulty and social relationships in children and adolescents with attention deficit/hyperactive disorder

BACKGROUND

Evidence-based 24-h movement behavior (24-HMB) guidelines have been developed to integrate recommendations for the time spent on physical activity, sedentary behavior, and sleep. For children and adolescents, these 24-HMB guidelines recommend a maximum of two hours of recreational screen time (as part of sedentary behavior), a minimum of 60 min per day of moderate to vigorous physical activity (MVPA), and an age-appropriate sleep duration (9-11 h for 5 to 13-year-olds; 8-10 h for 14 to 17-year-olds). Although adherence to the guidelines has been associated with positive health outcomes, the effects of adhering to the 24-HMB recommendations have not been fully examined in children and adolescents with attention eficit/hyperactive disorder (ADHD). Therefore, this study examined potential associations between meeting the 24-HMB guidelines and indicators of cognitive and social difficulties in children and adolescents with ADHD.

METHODS

Cross-sectional data on 3470 children and adolescents with ADHD aged between 6 and 17 years was extracted from the National Survey for Children's Health (NSCH 2020). Adherence to 24-HMB guidelines comprised screen time, physical activity, and sleep. ADHD-related outcomes included four indicators; one relating to cognitive difficulties (i.e., serious difficulties in concentrating, remembering, or making decisions) and three indicators of social difficulties (i.e., difficulties in making or keeping friends, bullying others, being bullied). Logistic regression was performed to determine the associations between adherence to 24-HMB guidelines and the cognitive and social outcomes described above, while adjusting for confounders.

RESULTS

In total, 44.8% of participants met at least one movement behavior guideline, while only 5.7% met all three. Adjusted logistic regressions further showed that meeting all three guidelines was associated with lower odds of cognitive difficulties in relation to none of the guidelines, but the strongest model included only screen time and physical activity as predictors (OR = 0.26, 95% CI 0.12-0.53, p < .001). For social relationships, meeting all three guidelines was associated with lower odds of difficulty keeping friends (OR = 0.46, 95% CI 0.21-0.97, p = .04) in relation to none of the guidelines. Meeting the guideline for screen time was associated with lower odds of being bullied (OR = 0.61, 95% CI 0.39-0.97, p = .04) in relation to none of the guidelines. While screen time only, sleep only and the combination of both were associated with lower odds of bullying others, sleep alone was the strongest predictor (OR = 0.44, 95% CI 0.26-0.76, p = .003) in relation to none of the guidelines.

CONCLUSION

Meeting 24-HMB guidelines was associated with reduced likelihood of cognitive and social difficulties in children and adolescents with ADHD. These findings highlight the importance of adhering to healthy lifestyle behaviors as outlined in the 24-HMB recommendations with regard to cognitive and social difficulties in children and adolescents with ADHD. These results need to be confirmed by longitudinal and interventional studies with a large sample size.

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.

Effects of Physical Activity on Inhibitory Function in Children with Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis aimed to systematically evaluate the effect of physical activity (PA) on inhibitory function in children with ADHD. Experimental studies on the effect of PA on the inhibitory function of children with ADHD were retrieved. The data were obtained from PubMed, The Cochrane Library, Web of Science, EBSCO (MEDLINE, APA Psyclnfo, ERIC), Embase, Scopus, and ProQuest. The search period was from the date of inception of the respective databases to 4 May 2022, and Reviewer Manager software (version 5.3) was used for analysis. Eleven articles and 713 samples were included in the meta-analysis. Results revealed that PA can significantly improve the inhibitory function of children with ADHD (SMD = 0.78, 95% CI: 0.45−1.10, p < 0.001). Subgroup analysis showed that the effectiveness of PA as an intervention in improving the inhibitory function of children with ADHD was moderated by the frequency, intensity, duration, type, and length of intervention. Based on the findings, PA can effectively improve interference suppression inhibitory function in children with ADHD. Longitudinal open-skill exercise for 60 min or more, two times/week has the best effect on improving inhibitory function in children with ADHD.

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.

Acute effects of a motor coordination intervention on executive functions in kindergartners: a proof-of-concept randomized controlled trial

BACKGROUND

Executive functions are pivotal for future academic and social functioning. Causal effects of physical activity on executive functions have been shown in adults. The primary objective of this study was to test the proof-of-concept (i.e., feasibility of implementation and acceptance) of a motor coordination intervention and a sedentary control condition in kindergartners and its preliminary effectiveness on subsequent executive function performance.

METHODS

The study used a two-group post-test only design. All children aged between 4 and 7 years old were eligible. One hundred and three children (46% girls; age: M = 5.71 years, 95% CI = 5.50 to 5.92) recruited in a middle-sized town in Germany were randomly assigned to a 20-min motor coordination intervention (n = 51) or a sedentary control condition (n = 52), both of which were conducted in a one-on-one experimenter-child setting in the university or kindergarten. A second blinded-to-condition experimenter assessed the executive function outcomes directly following the conditions. Proof-of-concept criteria were the implementation of the intervention with a moderate-to-vigorous physical activity level assessed via heart rate sensors, and with motor coordination demands, analyzed via video recordings; children's acceptance via self-reported enjoyment of the conditions; and the post-assessments of executive functions with a behavioral and computerized task.

RESULTS

The motor coordination intervention and the control condition were feasible in a one-on-one setting with kindergartners. The intervention revealed heart rate increases and challenging motor coordination tasks. Children in both conditions indicated they enjoy them. Performance in the two executive function tasks did not differ between children in the motor coordination intervention and the control condition.

CONCLUSIONS

A one-on-one experimenter-child setting was feasible to deliver in kindergartners. Future intervention studies should consider pre-testing of executive functions and take into account children's characteristics as potential moderators, such as motor coordination 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.

Effects of Physical Activity, Exercise and Sport on Executive Function in Young People with Attention Deficit Hyperactivity Disorder: A Systematic Review

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that negatively affects the inattention, disorganization, and/or hyperactivity–impulsivity in children and adolescents who suffer from it, included cases being reported that continue into adulthood. This disorder impairs social, academic, emotional, psychological, and health system functioning due to its high cost of treatment. The present systematic review aims to analyze the effects of physical activity, exercise, and sports on the executive function in children and adolescents diagnosed with ADHD through the scientific literature. The results show that the practice of physical activity, exercise, or sport produces improvements in executive function in children and adolescents diagnosed with ADHD, mainly through aerobic exercise. A 20 min session of physical activity, sport, or exercise leads to improvements in executive functions in children and adolescents with ADHD. It can be concluded that the practice of physical activity, exercise, and sport generate improvements on executive functions in children and adolescents with ADHD, mainly through aerobic exercise.

The association between physical activity and mental health in children with special educational needs: A systematic review

The association between physical activity (PA) and mental health in typically developing children has been amply documented, but little is known about the corresponding association in children with special educational needs (SEN). This systematic review aimed to synthesize the evidence for the association between PA and mental health in children with SEN. A systematic literature search of five databases (PsycINFO, SPORTDiscus, PubMed, Web of Science, and CINAHL) was conducted, and the publication year was between October 2010 and February 2021. Two researchers performed abstract and full text screening and extracted the data independently. Inclusion and exclusion criteria followed the PICOS framework, and the quality of eligible studies was assessed using the McMaster critical review form. Eighteen studies that met the inclusion criteria and had quality ratings ≥ 60% were included in this review. PA was positively associated with overall psychological well-being and its subtypes (including enjoyment, self-worth, self-competence, mental wellness, and quality of life), and negatively associated with anxiety and fatigue. Body composition, age, and sex were moderators of the association. The findings of this review indicated that PA was consistently associated with mental health in children with SEN. These associations were the most powerful when PA was conducted in unstructured types such as free play and recess activities. Structured types including physical education classes were more strongly related to mental health than overall PA (combined structured and unstructured types). Future PA interventions are needed to promote mental health in children with SEN.

Dose-Response Effects of Acute Aerobic Exercise Intensity on Inhibitory Control in Children With Attention Deficit/Hyperactivity Disorder

The present study aimed to examine whether the effect of acute aerobic exercise on inhibitory control of children with attention-deficit/hyperactivity disorder (ADHD) is moderated by exercise intensity. Using a within-subjects design, 25 children with ADHD completed a flanker task with concurrent collection of electroencephalography (EEG) data after three different intensities of treadmill running. The results showed that low- and moderate-intensity exercises resulted in shorter reaction times (RTs) relative to vigorous-intensity exercise during the incompatible condition of the flanker task regardless of task congruency. A P3 congruency effect was observed following low- and vigorous-intensity exercises but not after moderate-intensity exercise. The mean alpha power, a measure of cortical arousal, increased following low- and moderate-intensity exercises but decreased following vigorous-intensity exercise. In addition, the change in arousal level after moderate-intensity exercise was negatively correlated with RT during incompatible flanker tasks. The current findings suggest that children with ADHD have better inhibitory control following both low- and moderate-intensity exercises relative to vigorous aerobic exercise, which could be characterized by an optimal state of cortical arousal.

The impact of exercise interventions concerning executive functions of children and adolescents with attention-deficit/hyperactive disorder: a systematic review and meta-analysis

Background

Previous studies found that exercise interventions have positive effects on executive functions of the general population. However, studies seldom target executive functions of children and adolescents with attention-deficit hyperactivity disorder (ADHD). This study aimed to synthesise empirical studies regarding the effects of exercise interventions on executive functions of children and adolescents with ADHD.

Methods

A systematic search of the relevant literature was conducted in March 2020 through six electronic databases: CINAHL Complete, Eric, MEDLINE, PsychINFO, SPORTDiscus with Full Text, and Web of Science. Randomised controlled trials/quasi-experimental designs that applied exercise interventions and assessed executive functions through neurocognitive tasks among children and adolescents with ADHD were included. Altogether, 314 studies were identified, from which 31 full texts were independently assessed by two authors for eligibility. Finally, 21 studies underwent systematic reviews and 15 were selected for meta-analysis. Data extraction procedures and risk of bias analysis were conducted by two independent authors using the Physiotherapy Evidence Database (PEDro) scale.

Results

The findings indicated that exercise interventions improved overall executive functions of children and adolescents with ADHD (SMD = 0.611, 95% CI [0.386 to 0.836], p < 0.01). Exercise interventions had a moderate-to-large positive effect on inhibitory control (g = 0.761, 95% CI [0.376 to 1.146], p < 0.01) and cognitive flexibility (g = 0.780, 95% CI [0.331 to 1.228], p < 0.001). Likewise, during the subgroup analysis, intervention intensity and sessions of exercise (acute vs chronic) significantly moderated exercise intervention rather than intervention type.

Conclusions

Chronic sessions of exercise interventions with moderate intensity should be incorporated as treatment for children with ADHD to promote executive functions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01135-6.

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.

The relationship between screen-based sedentary behaviors and symptoms of depression and anxiety in youth: a systematic review of moderating variables

Background

To elucidate the populations and conditions where screen-based sedentary behaviors (SB) and internalizing symptoms are coupled, this review synthesized the evidence for factors that may moderate the associations between screen-based SB, depressive symptoms, and anxiety symptoms among youth.

Methods

Two independent researchers conducted a systematic literature search of the Medline, psycINFO, and Scopus electronic databases in late 2018 for observational studies assessing moderators of the association between screen-based SB and depressive and anxiety symptoms. Studies among children and adolescents were eligible if moderation was assessed by statistical test (interaction) or stratification; and a narrative synthesis of eligible studies was conducted in accordance with PRISMA guidelines.

Results

Seventy empirical studies (46 cross-sectional, 19 longitudinal, and 5 both) of 13 different moderating variables of screen-based SB-internalizing symptom associations met the eligibility criteria. Of these, 40 studies were of depressive symptoms, 2 were of anxiety symptoms, and 28 studies assessed symptoms of both. The most consistent evidence of moderation was for screen-type, such that TV viewing was not as strongly associated with internalizing symptoms compared to other forms of screen-based SB. There was also inconsistent evidence for physical activity buffering screen-based SB-internalizing symptom associations and for female sex amplifying screen-based SB-internalizing symptom associations. In general, the body of evidence for anxiety symptoms was more limited than that for depressive symptoms, and were therefore more inconsistent.

Conclusions

Screen-type, physical activity, and sex may influence the magnitude of screen-based SB-internalizing symptom coupling; highlighting potential sources of heterogeneity of screen-based SB-internalizing symptom associations. Additional studies aimed at understanding potential mechanistic explanations for the above moderators are needed prior to the development of tailored intervention strategies designed to decouple screen-based SB and internalizing symptoms among youth.

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.

Comparison of aural rehabilitation outcomes in presence and absence of back ground noise in hearing impaired children with and without attention deficit hyperactivity disorder (ADHD)

OBJECTIVE

We sought to understand the extend of improvement in seven major skills to determine the best rehabilitation approach in hearing impaired young children with and without attention deficit and hyperactivity disorder (ADHD).

METHODS

Newsha developmental scale was assessed in 40 hearing impaired children with and without ADHD in two conditions, in which seven major skills (hearing, speech, receptive language, expressive language, cognition, social communication, and motor skills) were evaluated. Two separate analyses were conducted, each after six months of rehabilitation. The first six months rehabilitation was done by controlling background noise level, while the other six months rehabilitation was performed with background multi talker babble noise, and ADHD and non ADHD children performance were compared.

RESULTS

After the first six months of rehabilitation there were no significant difference in improvement in any of the major skills except for motor and cognition skills between hearing impaired ADHD and non ADHD children. After the second six months of rehabilitation the extend of improvement was equal in both groups.

CONCLUSION

The equal improvement of hearing impaired ADHD and non- Children with ADHD support the benefits of rehabilitation program in both groups. In addition, it seems background multi talker babble noise can facilitate the process of rehabilitation in ADHD group. As a result, it is important to understand the specific needs of hearing impaired children with ADHD in rehabilitation program to provide the best services and increase the chance for success.

Acute Physical Activity Enhances Executive Functions in Children with ADHD

Acute physical activity of moderate to vigorous intensity has been shown to improve cognitive functions in children. However, the empirical evidence associated with Attention Deficit Hyperactivity Disorder (ADHD) in children is still limited, in particular regarding which specific cognitive functions benefit. This study investigated the effects of an acute bout of physical activity on multiple aspects of executive functions (inhibition, switching, and visual working memory) in children with ADHD. Forty-six children (8-12 years old; 82.6% boys) were randomly assigned to either 15 minutes of acute exergaming (physical activity of moderate intensity) or to a control condition (sedentary). Executive function performance in inhibition, switching and visual working memory were assessed before and after each condition, using a modified version of both the Flanker and the Color Span Backwards Task. The results revealed that participants in the exergaming group performed significantly faster than those in the control group in terms of both inhibition and switching, but there was no significant difference in the accuracy of the two tasks nor in visual working memory performance. These findings suggest that acute physical activity utilizing exergaming has the potential to improve specific aspects of executive functions (reaction times in inhibition and switching) in children with ADHD.

Physical Activity Interventions for Children with Social, Emotional, and Behavioral Disabilities-A Systematic Review

OBJECTIVE

Perform a systematic review of the available literature regarding the effectiveness of exercise interventions on children with any type of social, emotional, or behavioral disability (SEBD), with attention to a range of physiological, behavioral, and mood outcomes.

METHODS

Six databases were searched using a systematic methodology. References of included studies, as well as relevant reviews, were also examined. The review was limited to studies published since 2000 reporting a quantitative analysis of the effects of a physical activity (PA) intervention on at least 1 behavioral, psychological, or cognitive outcome in children aged 21 and under, diagnosed with a SEBD. Only studies with a control group were included.

RESULTS

We identified 24 eligible studies. Studies varied in design, participant characteristics, and intervention characteristics (single-bout vs repeated exposure, duration, intensity level, mode of exercise). Of the 20 behavioral outcome assessments, there was 1 negative finding, 12 null findings, 5 positive findings, and 2 mixed findings. For the 25 executive functioning outcome assessments, there were 5 null findings, 18 positive findings, and 2 mixed findings. For the remaining outcome domains, 1 of 2 studies looking at academic performance, 3 of 6 studies looking at objective neurological measures, and 1 of 3 studies looking at affect outcomes found positive results. All other results were null or mixed.

CONCLUSION

Although additional research is warranted to further understand the mechanisms by which PA affects behavioral and cognitive outcome measures in children with SEBDs, PA offers a safe and alternative form of treatment for this population.

Mood Dimensions Show Distinct Within-Subject Associations With Non-exercise Activity in Adolescents: An Ambulatory Assessment Study

Physical activity is known to preserve both physical and mental health. However, the physical activity levels of a large proportion of adolescents are insufficient. This is critical, since physical activity levels in youth have been shown to translate into adulthood. Whereas in adult populations, mood has been supposed to be one important psychological factor that drives physical activity in everyday life, this issue has been poorly studied in adolescent populations. Ambulatory Assessment is the state-of-the-art approach to investigate how mood and non-exercise activity fluctuate within persons in everyday life. Through assessments in real time and real life, this method provides ecological validity, bypassing several limitations of traditional assessment methods (e.g., recall biases). To investigate whether mood is associated with non-exercise activity in adolescents, we equipped a community-based sample comprising 113 participants, aged 12–17 years, with GPS-triggered e-diaries querying for valence, energetic arousal, and calmness, and with accelerometers continuously measuring physical activity in their everyday lives for 1 week. We excluded all acceleration data due to participants' exercise activities and thereafter we parameterized non-exercise activity as the mean value across 10-min intervals of movement acceleration intensity following each e-diary prompt. We used multilevel analyses to compute the effects of the mood dimensions on non-exercise activity within 10-min intervals directly following each e-diary prompt. Additionally, we conducted explorative analyses of the time course of the effects, i.e., on different timeframes of non-exercise activity up to 300 min following the mood assessment. The results showed that valence (p < 0.001) and energetic arousal (p < 0.001) were positively associated with non-exercise activity within the 10 min interval, whereas calmness (p < 0.001) was negatively associated with non-exercise activity. Specifically, adolescents who felt more content, full of energy, or less calm were more physically active in subsequent timeframes. Overall, our results demonstrate significant associations of mood with non-exercise activity in younger ages and converge with the previously observed association between mood and physical activity in adults. This knowledge on distinct associations of mood-dimensions with non-exercise activity may help to foster physical activity levels in adolescents.

Managing childhood and adolescent attention-deficit/hyperactivity disorder (ADHD) with exercise: A systematic review

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is one of the most common neuropsychiatric disorders affecting some 8-10% of children worldwide. Increasing research has shed light on the life course of the disorder, suggesting that majority of children with ADHD will continue to have persistent symptoms into adulthood. The mainstay of ADHD management has been pharmacologic and behavioural/psychological interventions, with little attention paid to exercise as a potential management strategy. A systematic review, examining both the short-term and long-term effects of exercise on children with ADHD, is timely and necessary to guide further research in this area.

METHODS

Using the keywords [exercise OR physical OR activity OR sport] AND [attention deficit hyperactivity disorder OR ADHD OR ADDH], a preliminary search on the PubMed and Ovid database yielded 613 papers published in English between 1-Jan-1980 and 1-July-2016. Full articles were also reviewed for references of interest.

RESULTS

A total of 30 studies were included in this systematic review. Both short-term and long-term studies support the clinical benefits of physical activity for individuals with ADHD. Cognitive, behavioural and physical symptoms of ADHD were alleviated in most instances, and the largest intervention effects were reported for mixed exercise programs. No adverse effects arising from physical exercise were reported in any of the studies, suggesting that exercise is a well-tolerated intervention.

CONCLUSION

Physical activity, in particular moderate-to-intense aerobic exercise, is a beneficial and well-tolerated intervention for children and adolescents with ADHD. Future research should include more adequately-powered trials and investigate the ideal exercise prescription.

Zooming into daily life: within-person associations between physical activity and affect in young adults

OBJECTIVE

Negative affect in daily life is linked to poorer mental and physical health. Activity could serve as an effective, low-cost intervention to improve affect. However, few prior studies have assessed physical activity and affect in everyday life, limiting the ecological validity of prior findings. This study investigates whether daily activity is associated with negative and positive evening affect in young adults.

DESIGN

Young adults (N = 189, Mdn = 23.00) participated in an intensive longitudinal study over 10 consecutive days.

MAIN OUTCOME MEASURES

Participants wore accelerometers to objectively assess moderate-to-vigorous physical activity continuously throughout the day and reported their affect in time-stamped online evening diaries before going to sleep.

RESULTS

On days when participants engaged in more activity than usual, they reported not only less depressed and angry evening affect but also more vigour and serenity in the evening.

CONCLUSION

Young adults showed both less negative and more positive affect on days with more activity. Physical activity is a promising health promotion strategy for physical and mental well-being.

Within-Person Link between Depressed Affect and Moderate-to-Vigorous Physical Activity in Adolescence: An Intensive Longitudinal Approach

BACKGROUND

During adolescence, young women and men frequently show low physical activity and elevated depressed affect. This study aimed to examine the within-person link between moderate-to-vigorous physical activity (MVPA) and depressed affect in everyday life.

METHODS

Within an intensive longitudinal approach, adolescents (N = 72; 37% young women; M age = 17.36 years; age range: 12-26 years; mid-90% age range: 13-22 years) wore accelerometers to assess their daily MVPA and reported next-morning and same-evening depressed affect in diaries over eight consecutive days. The within-person link between MVPA and depressed affect on the next morning (time-lagged prediction) and the same evening (same-day link) was analyzed with mixed-effects models.

RESULTS

More-than-usual MVPA significantly predicted less next-morning depressed affect on weekdays in young women, to the extent that a 60-min increase in MVPA over the person mean significantly predicted 50 per cent lower next-morning depressed affect.

CONCLUSIONS

This study encourages the development of individually tailored physical activity interventions that could help adolescents enhance their daily amount of unstructured, self-initiated MVPA to reduce depressed affect. This approach may be particularly suitable for young women who have the highest risk for an inactive lifestyle and elevated depressed affect.

Hyperactivity and Motoric Activity in ADHD: Characterization, Assessment, and Intervention

The aim of the present literature review is threefold. (1) We will review theories, models, and studies on symptomatic hyperactivity and motoric activity in attention-deficit/hyperactivity disorder (ADHD). (2) Another focus will be on assessment methods that have been proven to be effective in the detection of hyperactivity and motoric activity in children, adolescents, and adults with and without ADHD and emerging areas of research in the field of ADHD. We will compare subjective methods (i.e., rating scales) and objective methods (i.e., accelerometers). (3) Finally, physical activity intervention studies aiming at a modification of activity and overactive behavior will be summarized that seem to be promising candidates for alleviating hyperactivity symptoms in children, adolescents, and adults with ADHD.