Article

Postural and gait performance in children with attention deficit/hyperactivity disorder

Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany.
Gait & posture (Impact Factor: 2.3). 11/2008; 29(2):249-54. DOI: 10.1016/j.gaitpost.2008.08.016
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ABSTRACT 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.

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    • "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. "
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