Randomized Controlled Trial of Exercise for ADHD and Disruptive Behavior Disorders

Abstract

Purpose To test feasibility and impact of a 10-week after-school exercise program for children with ADHD and/or disruptive behavior disorders (DBD) living in an urban poor community. Methods Children were randomized to exercise (n=19) or a comparable but sedentary attention control program (n=16). Cognitive and behavioral outcomes were collected pre-post. Intent-to-treat mixed models tested group × time and group × time × attendance interactions. Effect sizes were calculated within and between groups. Results Feasibility was evidenced by 86% retention, 60% attendance, and average 75% maximum heart rate. Group × time results were null on the primary outcome, parent-reported executive function. Among secondary outcomes, between-group effect sizes favored exercise on hyperactive symptoms (d=0.47) and verbal working memory (d=0.26), and controls on visuospatial working memory (d=-0.21) and oppositional defiant symptoms (d=-0.37). In each group, within-group effect sizes were moderate-large on most outcomes (d=0.67 to 1.60). A group × time × attendance interaction emerged on visuospatial working memory (F[1,33]=7.42, p<.05), such that attendance to the control program was related to greater improvements (r=.72, p<.01) while attendance to the exercise program was not (r=.25, p=.34). Conclusions While between-group findings on the primary outcome, parent-reported executive function, were null, between-group effect sizes on hyperactivity and visuospatial working memory may reflect adaptations to the specific challenges presented by distinct formats. Both groups demonstrated substantial within-group improvements on clinically relevant outcomes. Findings underscore the importance of programmatic features such as routines, engaging activities, behavior management strategies, and adult attention; and highlight the potential for after-school programs to benefit children with ADHD and DBD living in urban poverty where health needs are high and services resources few.

Physical Activity and Adhd: Evidence on Developmental Trajectories, Transient and Durable Neurocognitive Effects, and Real-World Applications

“…Hence, preliminary evidence suggests that when PA groups are compared to active comparison groups, group x time effect sizes on symptom severity are small or near-zero, but when they are compared to no-intervention control groups they are often moderate-large. This hypothesis is also supported by the broad array of PA program formats demonstrating promise, traditional physical education games (Bustamante et al, 2016), distance running (Wendt, 2000), video games (Benzing & Schmidt, 2017), table tennis (Pan et al, 2016), mechanical horseback riding (Pan et al, 2017), swimming (Verret, Guay, Berthiaume, Gardiner, & Béliveau, 2012), sports therapy , yoga (Chou & Huang, 2017), and interactive cycling (Bowling et al, 2017), among others. If it is the case that the features of PA programs that are most important to improving behavior of children with ADHD are those associated with the environments in which the PA is taking place, this may reasonably be interpreted as a rationale for intentionally tailoring these factors to optimize impact.…”

“…A study of Taiwanese children (N=36, 7-14 year-old) found that those with ADHD completed 20 laps on the 20-meter PACER compared to 22 laps among TD peers (Pan et al, 2017). In a trial with African-American children with ADHD and/or Disruptive Behavior Disorders (N=35, 6-12 years-old), half of children were categorized by FitnessGram as "Needs Improvement" while the other half were categorized as "Needs Improvement -Health Risk" (Bustamante et al, 2016). Lastly, in a sample of 70 boys (aged M=9.7-years, SD=1.3), investigators found no differences in physical fitness between children with ADHD on medication, children with ADHD not on medication, and TD peers (Verret, Gardiner, & Béliveau, 2010).…”

“…The only way to disentangle the benefits of these non-PA components of programs from the unique benefits of PA is to provide a comparable but sedentary attention control program. At least three trials of children with ADHD have used this design finding few significant differences between groups despite strong within-group gains in PA conditions (Bustamante et al, 2016;Geladé et al, 2017;Hoza et al, 2015). The latter study, Hoza et al (2015), is the largest and amongst the most rigorous studies in the literature, including 94 children with ADHD.…”

Actividad física y TDAH: evidencia sobre el desarrollo, efectos neurocognitivos a corto y largo plazo y sus aplicaciones

“…Un estudio con niños y niñas taiwaneses (N = 36, entre 7 a 14 años) encontró que los niños con el TDAH completaron 20 vueltas en el PACER comparado con los niños aparentemente saludables, los cuales completaron 22 vueltas (Pan et al, 2017). Un estudio de intervención en niños y niñas afroamericanos con TDAH o con trastorno de conducta disruptiva (N = 35, entre 6 a 12 años), evidenció que la mitad de los niños fueron clasificados por FitnessGram como "necesita mejorar" mientras que la otra mitad fue clasificada como "necesita mejorar-riesgo a la salud" (Bustamante et al, 2016). Por último, en una muestra de 70 niños (edad promedio = 9.7 ± 1.3 años), los investigadores no encontraron diferencia en aptitud física entre los niños con TDAH bajo tratamiento farmacológico, niños con TDAH sin tratamiento farmacológico, y niños aparentemente saludables (Verret, Gardiner, & Béliveau, 2010).…”

Dropout from physical activity interventions in children and adolescents with attention deficit hyperactivity disorder: A systematic review and meta-analysis

“…Overall, 8 unique studies (Bustamante, et al, 2016;Chang, Hung, Huang, Hatfield, & Hung, 2014;Choi, Han, Kang, Jung, & Renshaw, 2015;Janssen, et al, 2016;Jensen & Kenny, 2004;Kang, Choi, Kang, & Han, 2011;Lee, Lee, & Park, 2015;Meßler, Holmberg, & Sperlich, 2016) were included in the meta-analysis. One study included two physical activity arms.…”