This post is part of a series of guest posts on GPS by the graduate students in my Psychopathology course during Spring 2014. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Mental Health.” To that end, each student has to prepare two 1,000ish word posts on a particular class of mental disorders, with one of those focusing on evidence-based treatments for those disorders and the other focused on a particular myth or misunderstanding about mental illness.
Can Exercise & Physical Activity Cure ADHD? by Stephanie Cole
Recently an article published in the Washington Post was circulating around the ever-popular Facebook. It may come as a shock to some of you, but the things we read on Facebook often have to be taken with a grain of salt and examined and researched for accuracy. This particular article by Angela Hanscom, who is a pediatric occupational therapist and founder of Timbernook, discussed shortened recess and the amount of time children are asked to sit still in school these days as being possible contributors to the rise we have seen in the last several decades in the prevalence of ADHD. The problems the article addresses is that Kindergarteners are being asked to sit still in story time for 30 min, which is nearly impossible for someone that age, and children are having to be in an upright position for long periods of time. Children should be climbing trees, rolling down hills, and spinning in circles instead of being asked to sit still for 8 hours a day in a desk. Another problem according to the article is that children are walking around with an underdeveloped vestibular system due to restricted movement. The answer, this author says, is hours of outdoor play everyday. The article caught the attention of many people, as it was shared and viewed thousands of times. The article was well written and informative…but there did not appear to be any scientific evidence directly linked to this particular article. So, the question presents itself: Will more hours of outdoor play or regular exercise help cure and prevent ADHD?
There are currently two evidence-based treatments for ADHD – pharmacological and behavior based psychosocial treatments. Pharmacological treatments have been shown to be very effective in reducing inattention and hyperactivity but often come with harmful side effects. The psychosocial treatments, which consist of, parent management training and organization and also school based behavioral management programs also have positive effects on ADHD symptoms. What has been found with most treatments is that they are short term and mostly only treat the symptoms and not the underlying brain dysfunctions. Many health professionals and parents of children with ADHD are desperate for answers and are looking for new intervention strategies (including a number that have been shown to be bunk).
Interestingly, there was a study published in the Journal of Pediatrics in 2014 that describes elementary aged children who were a part of an afterschool fitness program called FITKids,. These children exercised for an hour everyday after school and they were compared to a control group who did not exercise. The children who exercised had better brain function and had improved executive control, working memory, and cognitive flexibility. This particular study was not directly linked to children with ADHD, but instead overall brain health in general and executive control. Now, brain health is obviously a good thing and there is no question that children of all ages and backgrounds need more exercise given the obesity epidemic in the US.
All of this is great news for a lot of children who are struggling with fidgeting, and who are having a hard time paying attention, but ADHD symptoms can be so much more than that. Can more movement and play outside help anyone who is struggling with ADHD? Are there any studies done that directly correlate exercise with improved ADHD functioning?
It turns out that there actually have been quite a few studies done to test the benefits of exercise in treating ADHD symptoms. One article published in The Journal of Pediatrics found that short bouts of moderately intense aerobic exercise produced greater response accuracy and stimulus-related processing and also exhibited selective enhancements in regulatory processes. The exercise group was compared with a similar duration, seated group of readers. Another article published in American Journal of Lifestyle Medicine did pharmacological and physiological comparisons between ADHD medications and exercise. It states that aerobic exercise can improve the symptoms of ADHD because of increased releases and adequate regulation of both dopamine and norepinephrine. The benefit shows up immediately and can last from 60-90 minutes.
A major review article, the research of which was funded by the National Institute of Mental Health, states that physical exercise may be more powerful for brain function and development than previously believed. According to the article there is experimental evidence, experimental data, and preliminary evidence suggesting that exercise improves behavior in children with ADHD symptoms. In this article they reviewed six experimental studies that examined the effects of physical exercise on executive functioning in school-aged children. All six studies found at least some improvements in executive function and brain development for short-term and long-term treatment. This article concludes that research that has been conducted on both animals and humans shows evidence that aerobic exercise can promote growth and development in the brain and improve executive function and thereby ADHD symptoms. The study authors conclude by stating that “data are promising and support the need for further study, but are insufficient to recommend widespread use of such interventions for children with ADHD.”
The tentative takeaway of the research to this point is that physical exercise does appear to help alleviate some of the symptoms of ADHD and could have some possible long-term lasting effects. It is very unlikely that a lack of exercise and movement is a cause of ADHD, however. Many of the studies done that tested ADHD symptom improvement in children due to exercise, are preliminary and need more research and study before these types of programs can be implemented. At this time any exercise intervention programs for children with ADHD need to be combined with evidence based treatments. There is hope, though, that there will be more studies and research done in the future to help support exercise as (at least) an adjuvant intervention and treatment for ADHD. As a cure, though, as Ms Hanscom appears to claim? That seems unlikely at this point.