The Influence of Health Behaviours in Childhood on Attention Deficit and Hyperactivity Disorder in Adolescence

Associations between Dietary Intake and Attention Deficit Hyperactivity Disorder (ADHD) Scores by Repeated Measurements in School-Age Children

Attention deficit hyperactivity disorder (ADHD) is a common psychiatric disorder in school-age children and adolescents. However, the reported associations between ADHD and single nutrient intake are inconsistent. The aim of the study was to investigate the relationships between dietary intake changes and the prevalence of ADHD over time with repeat measurements using data from the Children Health and Environment Research (CHEER). To assess changes over time, we used data obtained in 2006 and 2008 (Phases ₁ and ₂). In this study, there were 2899 children aged 8 years or older in Phase ₁ and 2120 children aged 9 years or older in Phase ₂ from Korea, and the ADHD scores and dietary intake of 1733 children in Phases ₁ and ₂ were used in the final analysis. The YN group refers to children whose disease had improved in Phase ₂, and the NY group refers to children diagnosed with ADHD in Phase ₂. A notable within-group result was the increase in vegetable protein (p = 0.03) in the YN group. A between-group comparison showed that significant changes in nutrient intake could be confirmed most in the NY group, and the YN group tended to have a lower nutrient intake than the NY group. In the correlation of changes in nutrient intake and three subtypes (combined, AD, and HD), the total fat (p = 0.048) and animal protein (p = 0.099) showed a positive correlation with the prevalence of AD. Vegetable iron (p = 0.061 and p = 0.044, respectively), zinc (p = 0.022 and p = 0.007, respectively), vegetable protein (p = 0.074), and calcium (p = 0.057) had inhibitory effects on ADHD and its subtype. In conclusion, management of dietary and nutritional status should be considered to ameliorate ADHD and its subtypes in school-age children, and these relationships require further exploration in other settings.

How Are Attention-deficit Hyperactivity and Internet Gaming Disorders Related in Children and Youth?

OBJECTIVES

This review addresses important practical questions facing clinicians regarding internet gaming disorder (IGD) and attention-deficit/hyperactivity disorder (ADHD) in children and youth (C-Y). The authors investigated data concerning the risk that C-Y who have ADHD will develop IGD, whether effective treatment of ADHD positively influences the course of IGD in C-Y who have both, and other findings that might be of benefit to clinicians who treat C-Y with these conditions.

METHODS

We conducted a literature review using 4 databases: PubMed, Scopus, PsychInfo, and Embase.

RESULTS

C-Y with ADHD are at greater risk for developing IGD than those without ADHD. A close association exists between the severity of ADHD symptoms and the severity of IGD. It is unknown what proportion of C-Y with ADHD will develop IGD during their developmental trajectory; however, C-Y with IGD are at risk for developing ADHD, and ADHD can also increase the vulnerability of C-Y to IGD. Adolescents with ADHD and IGD have greater deficits in social skills than those with ADHD but no IGD. Lower parental occupational and socioeconomic status and poor family relationships are associated with more severe IGD symptoms. Atomoxetine and methylphenidate are equally effective in alleviating IGD symptoms comorbid with ADHD.

CONCLUSIONS

C-Y with ADHD are at increased risk for developing IGD compared with C-Y without ADHD, but it has not been determined at what developmental stage IGD is likely to emerge. Since IGD and ADHD are strongly associated, it is imperative to consider ADHD as a significant risk factor for IGD and vice versa, which can help psychiatrists be alert for early signs of IGD and manage them accordingly.

Diet, Physical Activity, and Screen Time to Sleep Better: Multiple Mediation Analysis of Lifestyle Factors in School-Aged Children with and without Attention Deficit Hyperactivity Disorder

OBJECTIVE

This study examined the mediation roles of multiple lifestyle factors in school-aged children. Structural equation modeling (SEM) tested how lifestyle factors play mechanism roles one another in the impact of ADHD to seek theoretical and intervention insights.

METHOD

An online survey assessed children's lifestyle factors including diet, physical activity, screen time, sleep difficulties, and having ADHD diagnosis. A multi-country sample from English speaking nations included 309 caregivers. Multiple regression and SEM were planned to identify significant correlates and mediators of ADHD in explaining lifestyle differences.

RESULTS

Preliminary multiple regression showed only sleep quality was significantly different between children with and without ADHD. Significant triple mediation effects suggested diet, physical activity, and screen time mediated the ADHD impact on sleep quality.

CONCLUSION

Researchers and practitioners may incorporate the findings to develop intervention models for children with ADHD attending to the mediational roles of lifestyle factors to improve sleep quality.

Children With ADHD Engage in Less Physical Activity

Background: Children with ADHD should engage in physical activity, given its known role as a treatment adjunct. Objective: The main objective of this study is to assess the relationship between ADHD diagnosis and physical activity among children in the United States. Methods: This retrospective population-based cross-sectional study used data from the 2016 caregiver reported, National Survey of Children's Health (NSCH). Results: In the adjusted binary model, children with an ADHD diagnosis had 21% lower odds of engaging in daily physical activity than their nondiagnosed counterparts. In the adjusted multinomial model, children with ADHD were increasingly unlikely to report additional days of physical activity as compared to those without a diagnosis. Conclusion: Given the known benefits of physical activity for those with ADHD, this study underscores the need for enhanced access to an important treatment adjunct for this population.

Health Behavior, Health-Related Quality of Life, and Mental Health Among Canadian Children: A Population-Based Cohort Study

Objective: Studies that have reported the associations of diet quality, physical activity (PA), sedentary behavior (SB), and health-related quality of life (HRQoL) with mental health among children and adolescents are predominantly cross-sectional in design. Very few studies have examined the longitudinal relationship of mental health with health behavior and HRQoL among children. This study aimed to investigate the associations of diet quality, PA, SB, and HRQoL among children with mental health disorders throughout childhood.

Methods: We linked data from grade five students aged primarily 10 and 11 years who participated in the Raising Healthy Eating and Active Living (REAL) Kids Alberta survey in 2012 in the Canadian province of Alberta with their administrative health care data from birth to 2012. Mental health outcomes included internalizing disorder and attention deficit and hyperactivity disorder (ADHD) defined by the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or Tenth Revision, Canadian version (ICD-10-CA). The HRQoL was measured by the EQ-5D-Y, a five-dimensional descriptive system for children and youth. We applied negative binomial regressions to examine the associations between health behaviors, HRQoL, and mental health.

Results: Of the 1,352 participating students, 12.31 and 8.32% had a diagnosis of internalizing disorders and ADHDs, respectively, during childhood from birth to the ages of 10–11 years. Students in the highest tertile for diet quality, relative to the lowest tertile, were 56% less likely to have diagnoses of internalizing disorders (incidence rate ratio, IRR = 0.44, 95% CI = 0.23–0.85). Students engaged in less PA (vs. more PA) were more likely to be diagnosed for internalizing disorders (IRR = 1.98, 95% CI = 1.19–3.30). Poorer diet quality, low PA, excessive use of computers/video games, and watching TV were significantly associated with more diagnoses of ADHDs. Children who experienced some or a lot of problems in “feeling worried, sad, or unhappy” and “having pain or discomfort” were more likely to receive diagnoses of internalizing disorders and ADHDs, respectively.

Conclusions: These observed associations suggest that health promotion programs targeting promoting diet quality, PA, and HRQoL and reducing SB among children may contribute to improving mental health.

Adherence to Life-Style Recommendations and Attention-Deficit/Hyperactivity Disorder: A Population-Based Study of Children Aged 10 to 11 Years

OBJECTIVE

The incidence of attention-deficit/hyperactivity disorder (ADHD) among children and youth is high, and temporal increases have been paralleled by deteriorating life-styles. Poor diet quality, physical inactivity, poor sleep habits, and sedentary behaviors have all been associated with ADHD. However, no earlier prospective study has examined the independent and combined importance of meeting established life-style recommendations in childhood for ADHD in adolescence. We examined the associations of adherence to life-style recommendations with the incidence of ADHD and the utilization of health services associated with ADHD.

METHODS

Life-style survey among 10- and 11-year-old students (N = 3436) was linked to administrative health data. Associations between adherence to nine established life-style recommendations with ADHD diagnosis and number of physician visits for ADHD until age 14 years were examined using Cox proportional hazard and negative binomial regression.

RESULTS

Before age 14 years, 10.8% of students received an ADHD diagnosis. Meeting recommendations for vegetables and fruit, meat and alternatives, saturated fat, added sugar, and physical activity was associated with fewer ADHD diagnoses. Compared with children who met one to three recommendations, meeting seven to nine recommendations was associated with substantially lower incidence of ADHD and fewer physician visits related to ADHD (hazard ratio = 0.42 [95% confidence interval = 0.28-0.61]; rate ratio = 0.38 [95% confidence interval = 0.22-0.65]).

CONCLUSIONS

Life-style recommendations exist to benefit development and physical health. Their promotion comes at no harm and may have benefits for ADHD. Experimental evidence is needed to clarify the potential bidirectional relationship between ADHD and adverse health behaviors.

Screen Time: The Impact of Digital Technology on Children and Strategies in Care

Media and digital devices are an integral part of the world today. Despite potential benefits of media time, excessive or inappropriate use of technology is having a significant impact on the development and health of children. There is a relationship between increased screen time and greater risk of physical health complications, mental health concerns, and negative outcomes on cognitive, language, social, and emotional development. Successful evidence-based interventions and screening initiatives are available for reducing unhealthy media use in children. Providers need to be aware of media-use guidelines, screen for at-risk media use, and provide parental education as well as recommend interventions when indicated. [Journal of Psychosocial Nursing and Mental Health Services, 57(11), 15-20.].

Does Diet Affect the Symptoms of ADHD?

INTRODUCTION

Attention deficit hyperactivity disorder (ADHD) is the most common psychiatric diagnosis in childhood and adolescence, with an estimated worldwide-pooled prevalence of 5,29%. The type of treatment depends on several factors. Psychopharmacological treatment entails undesirable side effects, with unclear long-term benefits, which has led the scientific community to investigate other therapeutic approaches, such as dietary interventions.

METHOD

The authors conducted a classical review on the current treatment recommended in individuals with ADHD diagnosis, their dietary patterns, as well as dietary factors possibly implicated in the etiology and treatment of this disorder. An extensive bibliographic research was carried out in the databases PubMed, The Cochrane Library and the National Guideline Clearinghouse.

DISCUSSION

The most common dietary interventions in the case of ADHD are food supplementation diets (e.g. PUFAs, vitamins) and elimination diets. Supplementation with omega-3 PUFAs lacks further studies that can validate them as an effective therapeutic approach in this disorder. Also, regarding vitamin supplementation, studies are not consistent as to their role in the etiology of ADHD. Elimination diets are unclear as to the benefits provided in individuals with ADHD. Children with ADHD are less likely to engage in healthy lifestyle behaviors than non-ADHD youth.

CONCLUSION

There is no clear evidence that supports dietary interventions for the treatment of ADHD. The effects of unhealthy diet patterns in ADHD individuals are not yet fully understood and, like the general population, children with ADHD may benefit from a healthy lifestyle.

The influence of diet quality and dietary behavior on health-related quality of life in the general population of children and adolescents: a systematic review and meta-analysis

OBJECTIVE

The association between diet quality, dietary behavior and health-related quality of life has been mostly examined in children and adolescents with specific chronic diseases. No systematic review has synthesized the influence of diet quality and dietary behavior on health-related quality of life in the general population of children and adolescents. The purpose of this study was to systematically review the primary studies that evaluated the association between diet quality, dietary behavior and health-related quality of life in the general population of children and adolescents and to synthesize the findings for the association.

METHODS

A computer search in the databases of MEDLINE, EMBASE and PSYCINFO was performed to retrieve English language studies that were published from 1946 up to April 8, 2018. We also screened the PubMed-related articles and the reference lists of the existing relevant literature to identify other eligible studies. We synthesized the association between diet quality, dietary behavior and health-related quality of life using both a qualitative method and meta-analysis. We reported the review following up the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline.

RESULTS

Seventeen studies were included in the synthesis including twelve cross-sectional studies and five longitudinal studies. We found that diet quality and dietary behavior were associated with health-related quality of life in children and adolescents. The positive effect of healthy diets on health-related quality of life was observed for multiple domains of health-related quality of life, including physical, school and emotional functioning, and psychosocial quality of life. We observed a dose-response relationship between the diet exposure and health-related quality of life, where an unhealthy dietary behavior or lower diet quality was associated with decreased health-related quality of life among children and adolescents.

CONCLUSION

The findings of the systematic review suggest the importance of promoting healthy diets and nutrition for good health-related quality of life among children and adolescents. Future research is needed to strengthen the evidence for prospective relationships and for the dose-response effect between diet quality, dietary behavior and health-related quality of life among children and adolescents.

Differences in Hyperactivity and Inattention between Adolescents Participating and Non-Participating in A National Polish After-School Athletics Program

Among the hyperactivity and inattention components, being predictors of the Attention Deficit Hyperactivity Disorder (ADHD) phenotype, there are restlessness, fidgeting, distractibility, lack of reflectiveness and lack of attention components. So far, it was observed that they may be associated with an excessive body mass in children. The aim of the study was to analyze differences of the hyperactivity and inattention between adolescents participating and non-participating in a national Polish after-school athletics program (12–13 years) in a case-control sample. The #goathletics study was conducted among a group of 1014 adolescents—507 representatives for the nationwide physical activity program “Athletics for All” and 507 pair-matched non-participating ones. Assessment of the hyperactivity and inattention was based on a Strengths and Difficulties Questionnaire—Hyperactivity-Inattention subscale (SDQ-HI). It was observed, that in spite of the fact, that the general frequency of hyperactivity and inattention did not differ between groups, the frequency of specific components differed. Especially in the case of girls, for adolescents participating in a national Polish after-school athletics program, the positive attention component was more often observed (39.7%) than for adolescents non-participating (30.0%). It may be concluded, that hyperactivity and inattention components may be less common in the case of active adolescents, than in the case of others.

Overweight in family members of probands with ADHD

The widely reported association between ADHD and overweight may be attributable to genetic and environmental factors also present in unaffected family members. Therefore, the purpose of this study was to examine the association between ADHD and overweight within families. A cohort was used of families with at least one member with ADHD, recruited as part of the Dutch node of the International Multicenter ADHD Genetics (IMAGE) study, with assessments taking place between 2003 and 2006, 2009 and 2012, and 2013 and 2015. The three assessment waves yielded N = 1828 youth assessments and N = 998 parent assessments from N = 447 unique families. Overweight was defined as a body mass index (BMI) ≥ 85th percentile for youth of the same age and sex; overweight in adults as a BMI ≥ 25. Effects of age, gender, and medication use (psychostimulants, antipsychotics, and melatonin) were taken into account. Generalized estimation equations were used to correct for within-family and within-subject correlations. There was no difference in risk between ADHD-affected youth and their unaffected siblings (OR 0.92, 95% CI 0.78-1.09). However, compared to population prevalence data, all ADHD family members alike were at increased risk for being overweight: ADHD-affected youth (OR 1.33, 95% CI 1.13-1.59), unaffected siblings (OR 1.73, 95% CI 1.45-2.08), mothers (OR 1.74, 95% CI 1.40-2.17) and fathers (OR 1.78, 95% CI 1.46-2.15). Parental overweight-but not parental ADHD-was predictive of offspring overweight (mothers OR 1.40; 95% CI 1.14-1.73, fathers OR 1.83; 95% CI 1.41-2.36). Being overweight runs in ADHD families, yet is not specifically linked to ADHD within families. Shared unhealthy lifestyle factors (including nutrition, sleep, exercise, stress) as well as genetic factors shared by family members likely explain the findings.

Influence of physical activity, sedentary behavior, and diet quality in childhood on the incidence of internalizing and externalizing disorders during adolescence: a population-based cohort study

PURPOSE

Studies among youth suggest that physical inactivity, sedentary behaviors, and poor diet quality are associated with poor mental health. Few population-based studies have investigated these relationships longitudinally. We examined the association between physical activity, sedentary behaviors, and diet quality in childhood and the incidence of internalizing and externalizing disorders throughout adolescence.

METHODS

We linked health behavior survey data from 2003 among 10- to 11-year-old children across Nova Scotia, Canada, with administrative health care data from 2003 to 2011. Students' diet quality was assessed using the Harvard Food Frequency Questionnaire. Physical activity and sedentary behaviors were self-reported, and internalizing and externalizing disorders were diagnosed by a physician. We applied Cox regression to examine the associations of the health behaviors with the incidence of internalizing and externalizing disorders between 2003 and 2011.

RESULTS

Of the 4861 participating students, 23.7% and 9.4% had a diagnosis of internalizing and externalizing disorders, respectively. The incidences of internalizing and externalizing disorders were higher among students who were less physically active and spent more time using computers and video games.

CONCLUSIONS

These findings suggest that promoting an active lifestyle in childhood may contribute to the prevention of both internalizing and externalizing disorders during adolescence.