Associations of Meeting 24-hour Movement Behavior Guidelines with Cognitive Difficulty and Social Relationships in Children and Adolescents with Attention Deficit/Hyperactive Disorder

Abstract

Background: Evidence-based 24-hour movement behavior (24-HMB) guidelines have been developed to integrate recommendations for the time spent in the behaviors of 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 minutes per day of moderate to vigorous physical activity (MVPA), and age-appropriate sleep duration (9-11 hours for 5 to 13-year-olds; 8-10 hours for 14 to 17-year-olds). Although adherence to the guidelines has been associated with several positive health outcomes, the consequence of adhering to the 24-HMB recommendations has not been fully examined in children and adolescents with attention deficit/hyperactive disorder (ADHD). examine 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 from the National Survey for Children’s Health (NSCH 2020) from 3470 children and adolescents with ADHD aged between 6 and 17 years were used. 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 above-presented associations while adjusting for co-founders. 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 relative to none of the guidelines, but the strongest model included both 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 relative 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 relative 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 relative 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.

MVPA and Motor Proficiency between Children with ADHD and Typical Development: Associations with Sleep Quality

“…Our study found that, compared with children with TD, children with ADHD engaged less time in MVPA daily (101.00 min·d −1 vs 84.19 min·d −1 ) and had a lower proportion to meet the MVPA guidelines (93% vs 78%). It was noted that previous findings on accelerometer-measured MVPA and subjective reports on 60 min of MVPA guideline attainment on children with ADHD are mixed (38.47, 51.75, and 27.57 min·d −1 ) (10,19,31,32), and MVPA disparities in children with ADHD warrant further investigation. Moreover, the 2020 WHO Guidelines on Physical Activity and Sedentary Behaviours recommended that children and adolescents with living disabilities engage in at least 60 min of MVPA daily, including children with ADHD (33).…”

“…The multitude of biopsychosocial risk factors that caused sleep problems in children with ADHD has been proposed, including biological (e.g., sleep-wake cycle and circadian rhythm), psychological (e.g., co-occurring mental health problems), and contextual factors (e.g., PA levels) (11). One recent cross-sectional study in 3470 children with ADHD using the National Survey for Children's Health (NSCH 2020) reported that only 4.9% of participants met 60 min of MVPA guidelines and that 26.9% of participants had sufficient sleep (19). Although the emerging associations between higher daytime MVPA and minor sleep latency (20), short sleep duration and severe ADHD symptoms (21), and lower motor proficiency and severer sleep problems (11) in children with ADHD have been reported, little research has examined the relationships among MVPA, motor proficiency, and sleep quality in children with ADHD.…”

Recent Trends and Disparities in 24-hour Movement Behaviors among US Youth with Mental, Behavioral and Neurodevelopmental Conditions

“…Particularly, a better understanding of meeting 24-HMB guidelines among youth with MBD conditions represents a critical step before strategies for this disadvantaged population can be developed and implemented. Meeting 24-HMB guidelines among youth have been documented in parts of Korea, China, Australia and the U.S. [14,15,23,24], but U.S.-based studies have thus far been limited to either only single conditions of MBD[18, 24,25] or the majority of data among youth have relied on cross-sectional designs [15,19,26]. Recent trends in meeting 24-HMB guidelines among youth with MBD conditions have not been well described.…”

Evaluation of a pilot physical activity intervention for children with ADHD symptoms and reading difficulties

“…Furthermore, the prevalence of obesity is very high (Faraone et al, 2021), with some studies reporting an increased prevalence of 40% compared to children without ADHD (Cortese et al, 2016). There is therefore a need to support increases in MVPA for children with ADHD (Taylor et al, 2023).…”