The Differential Impact of Acute Exercise and Mindfulness Meditation on Executive Functioning and Psycho-Emotional Well-Being in Children and Youth With ADHD

A brief bout of moderate intensity physical activity improves preadolescent children's behavioral inhibition but does not change their energy intake

Children in rural communities consume more energy-dense foods relative to their urban peers. Identifying effective interventions for improving energy intake patterns are needed to address these geographic disparities. The primary aim of this study was to harness the benefits of physical activity on children's executive functioning to see if these improvements lead to acute changes in eating behaviors. In a randomized crossover design, 91 preadolescent (8-10y; M age = 9.48 ± 0.85; 50.5% female; 85.7% White, 9.9% Multiracial, 9.9% Hispanic) children (86% rural) completed a 20-minute physical activity condition (moderate intensity walking) and time-matched sedentary condition (reading and/or coloring) ~ 14 days apart. Immediately following each condition, participants completed a behavioral inhibition task and then eating behaviors (total energy intake, relative energy intake, snack intake) were measured during a multi-array buffet test meal. After adjusting for period and order effects, body fat (measured via DXA), and depressive symptoms, participants experienced significant small improvements in their behavioral inhibition following the physical activity versus sedentary condition (p = 0.04, Hedge's g = 0.198). Eating behaviors did not vary by condition, nor did improvements in behavioral inhibition function as a mediator (ps > 0.09). Thus, in preadolescent children, small improvements in behavioral inhibition from physical activity do not produce acute improvements in energy intake. Additional research is needed to clarify whether the duration and/or intensity of physical activity sessions would produce different results in this age group, and whether intervention approaches and corresponding mechanisms of change vary by individual factors, like age and degree of food cue responsivity.

Hyperactivity in ADHD: Friend or Foe?

BACKGROUND

Hyperactivity may play a functional role in upregulating prefrontal cortical hypoarousal and executive functioning in ADHD. This study investigated the neurocognitive impact of movement during executive functioning on children with ADHD.

METHODS

Twenty-four children with and without ADHD completed a Stroop task and self-efficacy ratings while remaining stationary (Stationary condition) and while desk cycling (Movement condition). Simultaneous functional near-infrared spectroscopy (fNIRS) recorded oxygenated and deoxygenated changes in hemoglobin within the left dorsolateral prefrontal cortex (DLPFC).

RESULTS

Among children with ADHD, the Movement condition produced superior Stroop reaction time compared to the Stationary condition (p = 0.046, d = 1.00). Self-efficacy improved in the Movement condition (p = 0.033, d = 0.41), whereas it did not in the Stationary condition (p = 0.323). Seventy-eight percent of participants showed greater oxygenation in the left DLPFC during the Movement condition vs. the Stationary condition. Among children without ADHD, there were no differences in Stroop or self-efficacy outcomes between Stationary and Movement conditions (ps > 0.085, ts < 1.45); 60% of participants showed greater oxygenation in the left DLPFC during the Movement vs. the Stationary condition.

CONCLUSIONS

This work provides supportive evidence that hyperactivity in ADHD may be a compensatory mechanism to upregulate PFC hypoarousal to support executive functioning and self-efficacy.

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.

Cognitive strengths in neurodevelopmental disorders, conditions and differences: A critical review

Neurodevelopmental disorders are traditionally characterised by a range of associated cognitive impairments in, for example, sensory processing, facial recognition, visual imagery, attention, and coordination. In this critical review, we propose a major reframing, highlighting the variety of unique cognitive strengths that people with neurodevelopmental differences can exhibit. These include enhanced visual perception, strong spatial, auditory, and semantic memory, superior empathy and theory of mind, along with higher levels of divergent thinking. Whilst we acknowledge the heterogeneity of cognitive profiles in neurodevelopmental conditions, we present a more encouraging and affirmative perspective of these groups, contrasting with the predominant, deficit-based position prevalent throughout both cognitive and neuropsychological research. In addition, we provide a theoretical basis and rationale for these cognitive strengths, arguing for the critical role of hereditability, behavioural adaptation, neuronal-recycling, and we draw on psychopharmacological and social explanations. We present a table of potential strengths across conditions and invite researchers to systematically investigate these in their future work. This should help reduce the stigma around neurodiversity, instead promoting greater social inclusion and significant societal benefits.

Experiences of children and young people with attention deficit hyperactivity disorder (ADHD) during COVID-19 pandemic and lockdown restrictions

PURPOSE

To explore the experiences of children and young people (CYP) with attention deficit hyperactivity disorder during the COVID-19 pandemic and lock down restrictions.

METHODS

Semi-structured, online interviews were conducted with 17 children and young people from the UK, Northern Ireland, aged 10-14 years with ADHD. Over half the participants had a co-existing diagnosis, such as autism spectrum disorder. Interviews were recorded and transcribed verbatim before being subjected to thematic analysis.

RESULTS

Four themes were identified; the emotional impact of the pandemic, adjustments to daily living, impact of remote learning and the effect on relationships. Many CYP citied feelings of sadness, loneliness and anxiety, others found the reduction in social demands favourable.

CONCLUSIONS

As one of few studies to capture the experiences of children and young people with ADHD during the COVID-19 pandemic, this research highlights the potential negative long-term impact on emotional welfare, schooling and relationships.Implications for rehabilitationHealth care professionals should be aware of the overall impact on health and well-being for children and young people with ADHD following the COVID-19 pandemic and lockdown restrictions to ensure that the effect of these are minimised and managed in the future.Educators and clinicians should be cognisant of the long term consequences of poor mental health during the COVID-19 pandemic and should put in place pro-active strategies to support children and young people with ADHD.Children and young people with ADHD may suffer greatly from reduced access to sports and leisure facilities. Policy makers should be conscious of the potential negative consequences of placing limitations on access to such facilities.

Single Exercise for Core Symptoms and Executive Functions in ADHD: A Systematic Review and Meta-Analysis

OBJECTIVES

A systematic review and meta-analysis of studies of single exercise on core symptoms and executive function in adolescents with ADHD.

METHODS

Four databases were searched for studies of the effects of single exercise on core symptoms and executive functioning in adolescents with ADHD.

RESULTS

Thirteen studies were included, and a single session of exercise had small effect-size improvements in core symptoms and executive function in adolescents with ADHD: 10 to 13 year olds in the early adolescent-elementary school years and 18 to 24 year olds in the late adolescent-college years. Moderate-intensity continuous training, high-intensity interval training, single sessions of less than 30 minutes, and single sessions of 30 minutes and more significantly improved cycling training, attention, inhibition, substance use, and pre-study abstinence.

CONCLUSIONS

A single session of exercise had an overall ameliorative effect on core symptoms and executive function in adolescents with ADHD.

Mindfulness induction and executive function after high-intensity interval training with and without mindful recovery intervals

OBJECTIVES

Determine the effect of incorporating mindfulness-based activities into the recovery intervals of high-intensity interval training (HIIT) on mindfulness induction and subsequent executive function performance.

DESIGNS

A within-subject crossover trial.

METHODS

Forty adults participated in two experimental conditions, including a 30-min bout of HIIT involving mindfulness recovery intervals (Mindful) and a 30-min bout of HIIT without mindfulness recovery intervals (Non-mindful), on two separate days in counterbalanced order. Before and after each condition, participants completed the flanker task, switch-flanker task, and n-back task to measure inhibitory control, cognitive flexibility, and working memory, respectively.

RESULTS

A higher level of mindfulness state was observed following the Mindful condition than the Non-mindful condition. Dispositional mindfulness was positively correlated with the level of the mindful state only during the Mindful condition but not the Non-mindful condition. The switch-flanker response accuracy was improved from the pretest to posttest during the Non-mindful condition but remained unchanged over time during the Mindful condition. Time-related improvements in the flanker and n-back task outcomes were observed for both the Mindful and Non-mindful conditions and did not differ between conditions.

CONCLUSION

Although incorporating mindfulness-based activities during the recovery intervals of HIIT successfully led to greater state-related mindfulness, such a heightened mindful state did not correspond with additional modulation in inhibitory control and working memory performance while attenuating HIIT-related positive changes in task performance requiring cognitive flexibility.

Digital Cognitive Training for Children with Attention Deficit Hyperactivity Disorder

The present article used a pilot study to determine the effectiveness of digital cognitive mindfulness training developed based on dialectical behavioral therapy (DBT) in reducing attention deficit hyperactivity disorder (ADHD) symptoms in children. The sample consisted of 90 children (8-10 years old) diagnosed with ADHD. The participants were randomized into two groups: an experimental group (n = 45) and a control group (n = 45). Results were assessed at three time points: before, after the study, and one month after the end of the study. Regarding ADHD symptoms, the ANCOVA results showed that there were no statistically significant differences between the study groups for inattention and hyperactivity/impulsivity after testing. One month after completion of the program, there was a significant alleviation in symptoms of inattention, executive functioning, learning problems, aggression, and peer relationships. Hyperactivity was the only variable that showed a decrease both post-test and during follow-up. These results suggest that a DBT-based mindfulness program is a promising method of reducing ADHD symptoms in children.

How Self-Regulation and Executive Functions Deficits Affect Quality of Life of Children/Adolescents with Emotional Regulation Disorders

BACKGROUND

Deficits in self-regulation and executive functions (EFs) frequently characterize children/adolescents with emotional regulation disorders and restrict their daily function and quality of life (QOL). These deficits are mainly manifested by neuropsychological measures in laboratory settings. This study aimed to compare self-regulation and EFs by ecological measures to reflect the implications in daily life between children with emotional regulation disorders and healthy controls and examine the relations between self-regulation, EFs and QOL in the study group.

METHODS

the participants were 49 children aged 8-18: 25 children/adolescents with emotional regulation disorders and 24 healthy children. The parents completed a socio-demographic questionnaire, the Child Behavior Checklist (CBCL), the Behavior Rating Inventory of Executive Functions (BRIEF) and the Pediatric Quality of Life Inventory (Peds-QL).

RESULTS

The study group had greater self-regulation difficulties (internalization and externalization problems), executive dysfunctions (EFdys) (including metacognition difficulties) and a lower QOL. Their internalization and externalization problems correlated with reduced EFs and QOL. Internalization predicted the physical and emotional QOLs, while metacognition predicted social and school-related QOLs.

CONCLUSIONS

Deficits in self-regulation and EFs are prevalent in children/adolescents with emotional disorders and restrict their daily function and QOL. Therefore, they should be routinely evaluated by ecological instruments to reflect daily restrictions.

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.

A Systematic Review of Yoga and Meditation for Attention-Deficit/Hyperactivity Disorder in Children

With attention-deficit/hyperactivity disorder (ADHD) being a prevalent disorder in childhood, it is essential to acknowledge the different adverse effects the disorder can have on the quality of life in children. Therefore, this systematic review focuses mainly on children. Medical therapy, especially stimulants, can have many side effects. Our systematic review aims to evaluate the potential of other non-medical treatment options for ADHD, such as yoga or meditation. We used PubMed and Google Scholar as databases for this systematic review. Using different combinations of medical subheadings (MeSH) and key terms, followed by the application of several inclusion/exclusion criteria and filters to narrow down our search. From an initial 51,675 articles, we selected 10 papers that passed our screening process and quality check to analyze in depth. Yoga and meditation positively affect various symptoms in children with ADHD, including attention, hyperactivity, and impulsive behavior. If done in family group sessions, it also benefited the parents and family dynamics, suggesting a potential option for family therapy. Furthermore, other psychological symptoms, such as anxiety or low self-esteem, appeared to be positively impacted by these interventions. Although yoga and meditation positively influenced children with ADHD, a more in-depth research is necessary with a more significant number of participants and over a more extended period of time. The results of the included studies suggest a substantial benefit. Nonetheless, as the number of studies is limited, at present yoga and meditation could be beneficial as supplemental therapy rather than being used alone as a therapy for ADHD.

The Effects of Different Exercise Approaches on Attention Deficit Hyperactivity Disorder in Adults: A Randomised Controlled Trial

Attention deficit hyperactivity disorder (ADHD) results in significant functional impairment. Current treatments, particularly for adults, are limited. Previous research indicates that exercise may offer an alternative approach to managing ADHD, but research into different types of exercise and adult populations is limited. The aim of this study was to examine the effects of acute exercise (aerobic cycling vs mind-body yoga exercises) on symptoms of ADHD in adults. Adults with ADHD (N = 82) and controls (N = 77) were randomly allocated to 10 min of aerobic (cycling) or mind-body (Hatha yoga) exercise. Immediately before and after exercise, participants completed the Test of Variables of Attention task, Delay Discounting Task, and Iowa Gambling Task to measure attention and impulsivity. Actigraphy measured movement frequency and intensity. Both groups showed improved temporal impulsivity post-exercise, with cycling beneficial to all, whilst yoga only benefited those with ADHD. There were no effects of exercise on attention, cognitive or motor impulsivity, or movement in those with ADHD. Exercise reduced attention and increased movement in controls. Exercise can improve temporal impulsivity in adult ADHD but did not improve other symptoms and worsened some aspects of performance in controls. Exercise interventions should be further investigated.

The Effect of a Single Bout of Chinese Archery on Core Executive Functions in Preadolescent Children in Shanghai

BACKGROUND

Recent literature has demonstrated that acute physical activity benefits the transfer of executive functions. However, further studies indicated the type of variability in the effect of physical activity on executive functions. Therefore, this study initially explored the effect of a single bout of Chinese archery on subdomains of core EFs in preadolescent children; Method: Eligible participants were allocated either an intervention group (n = 36) or a control group (n = 36). The subjects in the intervention group received a 45-min Chinese archery session. The primary outcomes were the performance of core EFs (inhibition control, working memory, and cognitive flexibility) in preadolescent children, assessed with psychological paradigms (Fish Flanker Task, N-Back Task, and DCCS (Border version), respectively). Paired t-test and ANCOVA were used to analyze the mean difference in the performance of core EFs within and between subjects, respectively; Results: Considering reaction time and accuracy, we explored the impressive performance in three cognitive tasks with acute Chinese archery; Conclusion: The finding suggests that a single bout of Chinese archery benefited three subdomains of core EFs in healthy preadolescent children.

Acute effects of mindful interval exercise on cognitive performance in a higher education setting

Interval exercise (IE) has been shown to have acute facilitating effects on cognition; however, the existing literature has been limited to laboratory settings and has focused on manipulating the parameters of exercise bouts during IE. This study included two classroom-based experiments to (1) investigate the effect of an acute bout of IE delivering mindfulness activity during its recovery intervals (mindful IE) on cognitive performance, and (2) compare cognitive performance following acute bouts of mindful IE with non-mindful IE. Experiment 1: Using a class-based within-subject crossover design, 59 participants completed the Stroop, d2, and trail-making tests to measure inhibitory control, attention, and cognitive flexibility, after a 30-min non-exercise or mindful IE session on separate counterbalanced days. Experiment 2: Using a similar design, 70 participants were assigned to two groups to receive a non-exercise and an IE session with (mindful) or without (non-mindful) mindfulness-based recovery intervals on separate counterbalanced days. Results from Experiment 1 showed superior d2 performance following the mindful IE than the non-exercise session. Although Experiment 2 found exercise-related decreases in commission error rate during the d2 test in both groups, the non-mindful group showed additional decreases in omission and total error rates. Further, higher scores on the nonreactivity facet of dispositional mindfulness were correlated with larger decreases in omission and total error rates during the d2 test for the mindful IE group. No exercise-related effect was found for outcomes of the Stroop and trail-making tests in both experiments. These findings in the selective improvements in d2 test performance are the first to suggest the feasibility of integrating mindfulness activity into the recovery intervals of IE for enhanced cognitive performance that may depend on individual differences in dispositional mindfulness.

A mixed method investigation of teacher-identified barriers, facilitators and recommendations to implementing daily physical activity in Ontario elementary schools

Background

Fewer than 17% of children worldwide are meeting the international recommendations for daily physical activity. Since most children are in school for the bulk of their day, the classroom has been identified as an ideal space to incorporate physical activity opportunities. In Ontario (Canada), the Daily Physical Activity (DPA) policy aims to ensure all elementary school children receive a minimum of 20 min of moderate to vigorous physical activity each school day during instructional time. However, a 2015 evaluation found that only half of Ontario teachers were meeting this expectation; this work advocated for additional research to monitor implementation and its predictors and to further identify fidelity recommendations. Thus, the current study investigated contemporary factors influencing DPA fidelity in Ontario elementary schools and provides teacher-identified recommendations to support DPA implementation.

Methods

The first part of the study was a quantitative approach surveying 186 elementary school teachers across Ontario. Descriptive statistics including frequencies and means were used to characterize barriers, facilitators, and recommendations to DPA implementation. Spearman’s correlations were used to assess the relation between the likelihood of DPA implementation and intrapersonal factors of gender, teaching experience, prior DPA training and personal physical activity participation. The second part of the study consisted of a qualitative approach using teacher interviews to explore in-depth teachers’ recommendations to support DPA implementation. A thematic analysis was used to analyze the transcripts and identify recommendations for DPA.

Results

Survey results showed that only 23% of teachers met the mandated 20 min of DPA per day. Barriers to implementation included space and time constraints, inadequate training, student behavioural issues and low self-efficacy. Gender, teaching experience and prior DPA training were not related to the likelihood of DPA implementation. Teachers who rated themselves as more physically fit were more likely to implement DPA. Teacher interviews elucidated key areas for improving DPA implementation including greater DPA training opportunities, resources, community partnerships, accountability and strategies that support school-wide implementation.

Conclusion

The current study demonstrated that fidelity to the DPA policy in Ontario elementary schools is on the decline. This work highlights unique factors implicated in DPA fidelity and brings to the forefront teacher recommendations to improve DPA implementation.

Psychotherapy for Adult ADHD

The adult patient who presents for psychiatric evaluation with symptoms of attention deficit hyperactivity disorder (ADHD) poses specific challenges to the treating psychiatrist. Symptoms include trouble focusing, hyperactivity, and impulsive behavior. Patients may experience behavioral, mood, and cognitive issues. Co-occurrence of anxiety, boredom, sleep deprivation, or mood dysregulation may be reported. In addition, patients may have associated learning disabilities, either identified or undiagnosed. Symptoms can range from mild to severe. Many adults are unaware that they have ADHD, but they are acutely aware that they have everyday challenges. This article reviews the treatment dynamics created by the adult patient with a diagnosis of ADHD, as well as the evidence-based approaches that the psychiatrist can utilize in a psychotherapy setting.

Convergence mechanism of mindfulness intervention in treating attention deficit hyperactivity disorder: Clues from current evidence

This paper reviews the underlying evidence for various aspects of the convergence mechanism of mindfulness intervention in attention deficit hyperactivity disorder (ADHD). There may be compatibility among various ADHD remission models and the therapeutic mechanism of mindfulness intervention in ADHD may be mainly via the convergence mechanism. However, neuroimaging-based analysis of the mechanisms of mindfulness intervention in treating ADHD is lacking. Differences in the efficacy of various subtypes of mindfulness intervention, and corresponding specific imaging changes need further investigation. Future research may focus on the neuroimaging features of specific mindfulness intervention subtypes.

Mindfulness Practice with a Brain-Sensing Device Improved Cognitive Functioning of Elementary School Children: An Exploratory Pilot Study

This is the first pilot study with children that has assessed the effects of a brain-computer interface-assisted mindfulness program on neural mechanisms and associated cognitive performance. The participants were 31 children aged 9-10 years who were randomly assigned to either an eight-session mindfulness training with EEG-feedback or a passive control group. Mindfulness-related brain activity was measured during the training, while cognitive tests and resting-state brain activity were measured pre- and post-test. The within-group measurement of calm/focused brain states and mind-wandering revealed a significant linear change. Significant positive changes were detected in children's inhibition, information processing, and resting-state brain activity (alpha, theta) compared to the control group. Elevated baseline alpha activity was associated with less reactivity in reaction time on a cognitive test. Our exploratory findings show some preliminary support for a potential executive function-enhancing effect of mindfulness supplemented with EEG-feedback, which may have some important implications for children's self-regulated learning and academic achievement.