Up to 50% of children and adolescents with attention deficit/hyperactivity disorder (ADHD) exhibit motor abnormalities including altered balance. Results from brain imaging studies indicate that these balance deficits could be of cerebellar origin as ADHD children may show atrophy in those regions of the cerebellum associated with gait and balance control. To address this question, this study investigated postural and gait abilities in ADHD children and compared their static and dynamic balance with children with known lesions in the cerebellum. Children diagnosed with ADHD according to DSM IV-TR diagnostic criteria were compared with children with chronic surgical cerebellar lesions and age-matched controls. A movement coordination test was used to assess differences in motor development. Postural and gait abilities were assessed using posturography, treadmill walking and a paced stepping task. Volumes of the cerebellum and the cerebrum were assessed on the basis of 3D magnetic resonance images (MRI). Children with cerebellar lesions showed significant performance decrements in all tasks compared with the controls, particularly in the movement coordination test and paced stepping task. During dynamic posturography ADHD-participants showed mild balance problems which correlated with findings in cerebellar children. ADHD children showed abnormalities in a backward walking task and minor abnormalities in the paced stepping test. They did not differ in treadmill walking from the controls. These findings support the notion that cerebellar dysfunction may contribute to the postural deficits seen in ADHD children. However, the observed abnormalities were minor. It needs to be examined whether balance problems become more pronounced in ADHD children exhibiting more prominent signs of clumsiness.
"Methylphenidate (MPH) is frequently used as medication to treat ADHD patients (Wilens, Spencer, & Biederman, 2002) but little is known about its effect on postural and oculomotor performances. Leitner et al. (2007) have reported that children with ADHD under methylphenidate treatment show slight alteration/changes in walking with increased stride-to-stride variability that is not significantly different with respect to control children; Buderath et al. (2009) have also observed minor balance and stepping disorders in children with ADHD treated with methylphenidate at the time of testing, such impairment was similar to those reported in children with mild cerebellar dysfunction. Using the Movement Assessment Battery, Flapper, Houwen, & Schoemaker (2006) also found an improvement in the motor performances of children with ADHD after methylphenidate treatment. "
[Show abstract][Hide abstract] ABSTRACT: We compared the effect of oculomotor tasks on postural sway in two groups of ADHD children with and without methylphenidate (MPH) treatment against a group of control age-matched children. Fourteen MPH-untreated ADHD children, fourteen MPH-treated ADHD children and a group of control children participated to the study. Eye movements were recorded using a video-oculography system and postural sway measured with a force platform simultaneously. Children performed fixation, pursuits, pro- and anti-saccades. We analyzed the number of saccades during fixation, the number of catch-up saccades during pursuits, the latency of pro- and anti-saccades; the occurrence of errors in the anti-saccade task and the surface and mean velocity of the center of pressure (CoP). During the postural task, the quality of fixation was significantly worse in both groups of ADHD children with respect to control children; in contrast, the number of catch-up saccades during pursuits, the latency of pro-/anti-saccades and the rate of errors in the anti-saccade task did not differ in the three groups of children. The surface of the CoP in MPH-treated children was similar to that of control children, while MPH-untreated children showed larger postural sway. When performing any saccades, the surface of the CoP improved with respect to fixation or pursuits tasks. This study provides evidence of poor postural control in ADHD children, probably due to cerebellar deficiencies. Our study is also the first to show an improvement on postural sway in ADHD children performing saccadic eye movements.
Research in developmental disabilities 06/2014; 35(6):1292–1300. DOI:10.1016/j.ridd.2014.03.029 · 4.41 Impact Factor
"These findings demonstrate ADHD may influence postural control. The
results were consistent with the findings from most previous research that children with
ADHD show increased sway speed in the standing stability test under different conditions, or
fall during the more difficult tasks due to impaired balance management1, 5,6,7,8,9). "
[Show abstract][Hide abstract] ABSTRACT: [Purpose] To investigate how balance changes develop across time under different conditions (with or without a memory task) for children with Attention Deficit Hyperactivity Disorder (ADHD). [Subjects and Methods] The participants were 11 children with ADHD and 12 normal children. To determine their static balance ability, a force plate was used to measure the center of the pressure trajectory. [Results] The length of the sway path became slightly greater in both groups when an additional memory task was added, but the difference was not statistically significant. However, it was interesting to note a significant difference in memory task ability across groups with increasing time. The ADHD group showed a decrease sway path with increasing time for the memory task, but in the control group it increased. [Conclusion] At first, the memory task interfered with ADHD children's performance; however, the memory task may improve their performance after a few seconds.
"Up to 50% of children and adolescents with ADHD exhibit motor abnormalities including altered balance (Buderatha et al., 2009). Different studies report balance testing included a disruption of sensory signals. "
[Show abstract][Hide abstract] ABSTRACT: Neural circuits linking activity in anatomically segregated populations of neurons in subcortical structures regulate complex behaviors such as walking, talking, language comprehension, and other cognitive functions associated with frontal lobes. The basal ganglia are also crucial elements in the circuits that confer human reasoning and adaptive function and are key elements in the control of reward-based learning, sequencing, discrete elements that constitute complete motor acts, and cognitive function. Imaging studies of intact humans and electrophysiologic studies of the brains and behavior of other species confirm these findings. We know that the relation between the basal ganglia and the cerebral cortical region allows for connections organized into discrete circuits. Rather than serving as a means for widespread cortical areas to gain access to the motor system, these loops reciprocally interconnect a large and diverse set of cerebral cortical areas with the basal ganglia. Neuronal activity within the basal ganglia associated with motor areas of the cerebral cortex is highly correlated with parameters of movement. Neuronal activity within the basal ganglia and cerebellar loops associated with the prefrontal cortex is related to the aspects of cognitive function. Thus, individual loops appear to be involved in distinct behavioral functions. Damage to the basal ganglia of circuits with motor areas of the cortex leads to motor symptoms, whereas damage to the subcortical components of circuits with non-motor areas of the cortex causes higher-order deficits. In this report, we review some of the anatomic, physiologic, and behavioral findings that have contributed to a reappraisal of function concerning the basal ganglia and cerebellar loops with the cerebral cortex and apply it in clinical applications to ADHD with biomechanics and a discussion of retention of primitive reflexes being highly associated with the condition.
Frontiers in Systems Neuroscience 02/2014; 8:16. DOI:10.3389/fnsys.2014.00016
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