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Objective: Physical activity associates with mental health and neurocognitive function, showing potential for addressing ADHD symptoms. As a preliminary assessment of this potential, the authors piloted a before-school physical activity intervention for young children. Method: Seventeen children (Grades K-3) exhibiting four or more hyperactivity/impulsivity symptoms on the Disruptive Behavior Disorders Rating Scale (Pelham, 2002) completed about 26 min of continuous moderate-to-vigorous physical activity daily over eight school weeks. The authors administered cognitive, motor, social, and behavioral functioning measures at pre- and postprogram, assessed response inhibition weekly, and coded negative behaviors daily. Results: Several measures showed significant or marginally significant change over time (effect size = 0.35-0.96) with additional measures showing meaningful effect size values (≥ 0.20). Response inhibition effects were most consistent. Most participants (64% to 71%) exhibited overall improvement according to postprogram parent, teacher, and program staff ratings. Conclusion: Physical activity shows promise for addressing ADHD symptoms in young children.
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Journal of Attention Disorders
17(1) 70 –82
© 2013 SAGE Publications
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DOI: 10.1177/1087054711417395
http://jad.sagepub.com
Research Brief
417395JAD17110.1177/108705471141739
5Smith et al.Journal of Attention Disorders
© 2013 SAGE Publications
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1Purdue University, West Lafayette, IN, USA
2University of Vermont, Burlington, USA
Corresponding Author:
Alan L. Smith, Department of Health and Kinesiology, 800 West Stadium
Avenue, Purdue University, West Lafayette, IN 47907-2046, USA
Email: alsmith7@purdue.edu
Pilot Physical Activity Intervention
Reduces Severity of ADHD Symptoms
in Young Children
Alan L. Smith1, Betsy Hoza2, Kate Linnea2, Julia D. McQuade2, Meghan Tomb2,
Aaron J. Vaughn2, Erin K. Shoulberg2, and Holly Hook1
Abstract
Objective: Physical activity associates with mental health and neurocognitive function, showing potential for addressing
ADHD symptoms. As a preliminary assessment of this potential, the authors piloted a before-school physical activity
intervention for young children. Method: Seventeen children (Grades K-3) exhibiting four or more hyperactivity/
impulsivity symptoms on the Disruptive Behavior Disorders Rating Scale (Pelham, 2002) completed about 26 min of
continuous moderate-to-vigorous physical activity daily over eight school weeks. The authors administered cognitive,
motor, social, and behavioral functioning measures at pre- and postprogram, assessed response inhibition weekly, and
coded negative behaviors daily. Results: Several measures showed significant or marginally significant change over time
(effect size = 0.35-0.96) with additional measures showing meaningful effect size values (0.20). Response inhibition effects
were most consistent. Most participants (64% to 71%) exhibited overall improvement according to postprogram parent,
teacher, and program staff ratings. Conclusion: Physical activity shows promise for addressing ADHD symptoms in young
children. ( J. of Att. Dis. 2013; 17(1) 70-82)
Keywords
ADHD treatment, attention, exercise, school-based intervention
ADHD is a chronic health condition that is considered the
most common neurobehavioral disorder experienced by
children (American Academy of Pediatrics, 2000). Present
in 3% to 7% of the school-aged population, ADHD is
expressed in inattentive, hyperactive/impulsive, and com-
bined forms (American Psychiatric Association, 2000). The
key features of inattention and/or hyperactivity/impulsivity
are generally present by the age of 7 and foster impairments
across at least two settings, most often home and school.
Such impairments include academic and social difficulties,
family distress and dysfunction, and challenges in various
extracurricular settings such as sports (Hoza, Owens, & Pel-
ham, 1999). Difficulties often persist and expand (e.g., driv-
ing accidents, illicit drug use, school dropout) over the
adolescent and adult years (Mannuzza & Klein, 2000), mak-
ing chronic management of the disorder essential. In light of
the chronic nature of ADHD and the substantial economic
impact of ADHD in children and adolescents, estimated to
be US$36 to US$52.4 billion annually (Pelham, Foster, &
Robb, 2007), it is recognized as a major public health issue
(National Institutes of Health, 2000).
The primary treatment approaches for ADHD are medi-
cation management, behavioral treatment, or a combination
of the two. The National Institute of Mental Health
Multimodal Treatment Study of Children with ADHD
(MTA; MTA Cooperative Group, 1999a, 1999b; Richters
et al., 1995) significantly extended the database on long-term
treatment and serves as a benchmark for research quality
(Schachar et al., 2002). The MTA findings suggest that a
rigorously monitored medication management plan offers
meaningful benefits to school-aged children, whether alone
or in combination with behavioral treatment. Medication
and combined treatments show an advantage over behav-
ioral and community care for ADHD outcomes. However,
when extending assessment beyond ADHD symptoms to
other functional outcomes (e.g., academic performance,
aggression, internalizing, social skills/relationships), com-
bined approaches may be preferred (MTA Cooperative
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Smith et al. 71
Group, 1999a). Consistent with this conclusion, secondary
analyses involving a composite outcome variable demon-
strated a small benefit of combined treatment over medica-
tion management and moderate to moderately large benefit
over behavioral treatment and community care (Conners et al.,
2001). Anchoring these outcomes to clinical relevance,
additional secondary analyses indicated that 68% of those
receiving combined treatment achieved parent and teacher
average symptom ratings of “just a little” or below, consid-
ered a threshold for successful treatment, followed by medi-
cation management (56%), behavioral treatment (34%), and
community care (25%; J. M. Swanson et al., 2001).
Despite these documented benefits, MTA follow-up
assessments show reduction of effects by 10 months post-
treatment (MTA Cooperative Group, 2004) and no detect-
able treatment group differences 22 months after completion
of study treatment (Jensen et al., 2007). Moreover, there are
a variety of challenges associated with ADHD treatment. As
evident in the MTA findings, there is substantial discrep-
ancy between what is offered to children in community care
settings and what yields greatest success. Demands associ-
ated with most successful treatment such as frequent visits
to the physician and/or therapist, taking medicine one or
more times daily, and chronic behavioral management are
onerous. Moreover, parents may be hesitant to pursue stim-
ulant medication management, especially in young children,
because of tolerability (T. Wigal et al., 2006), documented
side effects such as trouble in sleeping and reduced growth
rate (J. Swanson et al., 2006; T. Wigal et al., 2006), and extant
debate on cardiovascular risk (Biederman, Spencer, Wilens,
Prince, & Faraone, 2006; Nissen, 2006). Thus, additional
intervention options are needed that are amenable to long-
term maintenance and more easily incorporated into the life-
styles of children. In this pilot work, we explore the potential
for physical activity to serve as such an option.
Physical activity is any movement produced by skeletal
muscles and resulting in energy expenditure (Caspersen,
Powell, & Christenson, 1985). For children this can come in
the form of active transport (e.g., walking or biking to
school), informal play, sports, physical education, and delib-
erately structured activity to promote fitness components
(i.e., exercise). Though the bulk of work examining physical
activity and health has focused on adults, emerging evi-
dence shows an association between physical activity and a
host of physical and mental health markers in young people
(Stensel, Gorely, & Biddle, 2008). The indicators of mental
health that are most extensively examined in the youth phys-
ical activity literature are self-concept, depression, and anxi-
ety. The extant literature suggests that physical activity
involvement positively associates with various components
of self-concept and negatively associates with anxiety and
depression (for reviews, see Calfas & Taylor, 1994; Strong
et al., 2005). Specifically examining children aged 6 to 14
years with ADHD, a recent study by Kiluk, Weden, and
Culotta (2009) showed greater sport involvement to be asso-
ciated with lower anxious-depressed, internalizing prob-
lems, and affective T-scores on the Child Behavior Checklist
(Achenbach, 1991). Such associations were not observed
for a comparison sample of children with learning disabili-
ties, suggesting that youth at risk for mood problems may
particularly benefit from physical activity. Moreover, for
both boys and girls with ADHD, those engaging in three or
more sports showed significantly lower anxious-depressed
T-scores than those engaging in two or fewer sports. Thus,
consistent involvement in physical activity may be an impor-
tant matter when considering physical activity as a strategy
for addressing ADHD symptoms.
Beyond the link to mental health described above, physi-
cal activity also shows associations with neurocognitive
function. Early interest in this connection was largely
focused on later adulthood, where physically active life-
styles and aerobic physical activity interventions have been
linked to the preservation and enhancement of cognitive
function, particularly executive control processes (Hall,
Smith, & Keele, 2001; Kramer et al., 1999). Extant animal
and human work suggests that such physical activity affects
the brain in ways that would be expected to impact executive
function. For example, animal studies suggest that, in
rodents, aerobic physical activity benefits learning and
memory, plasticity in the hippocampal formation, neurogen-
esis, and neurotrophin expression (see Cotman, Berchtold, &
Christie, 2007; Olson, Eadie, Ernst, & Christie, 2006). Also,
recent human studies suggest that aerobic physical activity
enhances frontal brain function (Colcombe et al., 2004),
affects frontal brain structure (Colcombe et al., 2006),
increases serum levels of brain-derived neurotrophic factor
(BDNF; Ferris, Williams, & Shen, 2007; Tang, Chu, Hui,
Helmeste, & Law, 2008), and promotes hippocampal neu-
rogenesis (Pereira et al., 2007). Such findings are relevant
to ADHD in that executive control deficits, in particular
behavioral inhibition challenges, are core impairments asso-
ciated with ADHD (Barkley, 1997).
Importantly, ADHD symptoms extend beyond executive
function deficits. Indeed, it appears that multiple brain
regions and neurochemical pathways are implicated in the
disorder (see Nigg, 2006). Compared with typically devel-
oping individuals, those with ADHD have been shown to
have less brain volume not only in frontal regions associ-
ated with executive function but also in the cerebellum and
other cortical regions (Halperin & Healey, 2011; Seidman,
Valera, & Makris, 2005). Moreover, despite children with
hyperactive/impulsive and combined-type ADHD ostensi-
bly being quite active as a function of hyperactivity, chil-
dren with ADHD are at risk for movement skill deficits and
motor problems as well as poor levels of physical fitness
(Diamond, 2000; Harvey & Reid, 2003; Nigg, 2006).
Patterns of chronic physical activity engagement of chil-
dren with ADHD have not been examined, though the
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72 Journal of Attention Disorders 17(1)
documented movement skill and fitness deficits suggest
that hyperactivity in itself does not yield movement and fit-
ness outcomes consistent with typically developing chil-
dren. Thus, exposing children with ADHD to consistent,
deliberately structured physical activity may help accom-
modate for observed motor and fitness deficits associated
with the disorder as well as other cognitive, behavioral, and
social deficits. In light of its broad ranging effects on the
brain, physical activity may be well suited for addressing a
disorder such as ADHD, which is characterized by impre-
cise etiology and broad neurocognitive effects.
More recently, attention has been paid to the potential
link of physical activity with cognitive function and aca-
demic performance in children (see Best, 2010; Centers for
Disease Control and Prevention, 2010; Tomporowski,
Davis, Miller, & Naglieri, 2008). Sibley and Etnier (2003)
conducted a meta-analysis of initial efforts exploring the
activity to cognitive function link, including 44 studies (125
effect sizes) in their analysis. The overall effect size was
0.32, and moderator analyses showed that middle school–
aged children (effect size = 0.48 ± 0.27) followed by young
elementary children (effect size = 0.40 ± 0.26) showed the
largest effect sizes. The authors speculated that findings for
young elementary-aged children may be explained by the
importance of movement to young children’s cognitive
development. This is an interesting consideration in light of
the above-described movement challenges experienced by
many children with ADHD and recent animal work address-
ing physical activity and neurogenesis. Kim et al. (2004)
demonstrated age-related differences in the effect of tread-
mill exercise on cell proliferation within the dentate gyrus of
rats. Specifically, they found treadmill exercise to increase
cell proliferation of 4-, 8-, and 62-week-old rats, with the
most active proliferation in the youngest rats and less active
proliferation with increasing age. This work suggests that
employing physical activity as an intervention to address
ADHD may be especially beneficial during young
childhood.
The association of physical activity with positive men-
tal health and neurocognitive function in children, the rela-
tively broad ranging effects of physical activity, and the
plasticity of the young brain point to physical activity as a
potentially valuable intervention for children with ADHD
symptoms. Aside from descriptive work on physical activ-
ity and cognitive function (Gapin & Etnier, 2010) and
research examining the impact of acute physical activity
bouts (Tantillo, Kesick, Hynd, & Dishman, 2002; S. B.
Wigal et al., 2003) on children with ADHD, we located no
published investigations of an extended aerobic physical
activity protocol for the management of ADHD symp-
toms. An extended protocol presumably would be neces-
sary for effective ADHD management and to afford any
benefits to brain development. The present study was
designed as a preliminary effort to address the viability of
such a protocol. Specifically, the purpose of the present
study was to pilot a before-school physical activity inter-
vention for reducing ADHD symptoms in young children.
We hypothesized that completing physical activity before
each school day over a 9-week time frame would foster
adaptive change in cognitive, behavioral, motor, and social
symptoms associated with ADHD.
Method
Participants
Eligible participants (N = 17) were identified using parent
and teacher ratings on the Diagnostic and Statistical
Manual of Mental Disorders (4th ed.; DSM-IV) version of
the Disruptive Behavior Disorders (DBD) Rating Scale
(Pelham, 2002; Pelham, Gnagy, Greenslade, & Milich,
1992). The DBD is comprised of the DSM-IV symptoms of
ADHD, oppositional defiant disorder (ODD), and conduct
disorder (CD); however, CD items were not used given the
ages of participants. Kindergarten through third graders in
a diverse, low-SES Vermont community (54% of students
on free or reduced lunch) with parental consent were screened.
We sought children at risk for ADHD and set four or more
symptoms of hyperactivity/impulsivity as a requirement for
eligibility. The mean number of symptoms endorsed was
7.1 for hyperactivity/impulsivity (SD = 1.9), 5.6 for inatten-
tion (SD = 2.7), and 4.9 for ODD (SD = 2.6). Participants
were 5.2 to 8.7 years of age at entry (M = 6.7, SD = 1.0).
Three children dropped out in the first 2 weeks and 14
completed the program; data from these 14 children, all
medication naïve, are summarized in the “Results” section.
Six boys and 8 girls comprised the completers. In the final
sample, 12 participants were White and the 2 remaining
participants were Black.
Procedure
The physical activity program was designed to maximize
participant involvement in continuous moderate-to-vigorous
physical activity (MVPA) within an engaging, before-
school setting. Each day the program was for 30 min, with
participants completing four stations within small groups
(about five children) that each lasted 6 min. Stations were
designed to foster sustained MVPA within the context of
games and activities that required participants to employ a
variety of motor skills (e.g., moving objects to different
locations in the activity area, various forms of locomotion—
skipping, running, hopping, crab walking). Staff members
were trained to limit the provision of verbal instructions
with the children being sedentary. Instead, staff members
modeled desired behaviors and provided instruction while
the children were moving. One staff member supervised
each station. In addition to these stations, one large-group
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Smith et al. 73
“warm-up” aerobic running activity (e.g., tag) was com-
pleted in 1 to 2 min each day following review of program
rules (i.e., keep your hands and feet to yourself, wait your
turn to speak, speak nicely to others, and follow directions
the first time) and prior to breaking into the stations.
Therefore, a total of about 26 min of MVPA was scheduled
on a given program day. The balance of time was used for
transitions (e.g., removing coats, changing activity sta-
tions).
Program staff received approximately 20 hr of training
and practice in the implementation of the program prior to
program initiation to ensure reliable administration of the
intervention and assessment procedures. Most of the staff
who ran the physical activity program had previous experi-
ence working with youth with ADHD or teaching physical
activity skills in camp settings, and all were undergraduate
or graduate students in psychology.
Preassessments listed in the “Pre-Post Program Meas-
ures” section were completed the week immediately before
the start of the program. Eight weeks of physical activity
were then completed over a 9-week period. Two weeks (9
school days) of the intervention were conducted, followed
by the participants’ 1.5-week spring break, a partial (2 days)
week of intervention, and then five full intervention weeks.
In addition to the pre–post measures, various weekly and
daily ecological/behavioral assessments were completed
(described below). Postassessments were completed the
week immediately following the program; teachers, par-
ents, and staff also provided global improvement ratings
(described below) at the end of the program.
Children were provided school bus transportation to the
program. Participants were not compensated monetarily,
but attendance was tracked daily and children were given a
star on a chart for each day they attended. Children with
good attendance received good attendance certificates peri-
odically throughout the program and an attendance award
(a small trophy) on the last day of the program. Rates of
attendance were high, with 86% (12 of 14) of children
meeting or exceeding 75% attendance. A problem arose
partway through the program with children sitting down to
rest as soon as they got tired or out-of-breath; hence, a sys-
tem was initiated whereby children who “kept moving” the
entirety of at least three of the activity stations earned a
small trinket from a grab bag that day. This was contingent
only on movement, not any other behavior(s). To avoid
confounds, no formal behavior management system was in
place and staff were instructed to handle negative behavior
as best they could; they were not permitted to use time out
or other behavioral strategies for negative behavior.
Measures
Given the preliminary nature of this pilot work, and the
absence of prior studies indicating what measures may be
sensitive to physical activity effects on ADHD symptoms,
a broad range of measures was employed. Direct measures
of motor, cognitive, social, and behavioral capacities were
used, as well as behavioral and improvement ratings by
multiple informants. We report results of all measures
described below, emphasizing effect sizes rather than sig-
nificance of comparisons, in the hope that these preliminary
data are useful to future investigators exploring physical
activity effects across a variety of outcome domains.
Pre–Post Program Measures
Bruininks–Oseretsky Test of Motor Proficiency, 2nd edition
(BOT-2). The BOT-2 (Bruininks & Bruininks, 2005) is a
widely used, reliable, valid, and age-normed assessment of
children’s motor proficiency, including both gross-motor
and fine-motor tasks. The short form of the BOT-2 was
administered in the present study. It consists of the follow-
ing fine-motor tasks: drawing lines through crooked paths
on a sheet of paper, folding paper on lines, copying a square,
copying a star, and transferring pennies one at a time from
one hand to the other (and then placing in a box) for 15 s,
and the following gross-motor tasks: synchronized jumping
in place, synchronized tapping of fingers and feet, walking
forward on a line, standing on one leg on a small beam for
10 s (eyes open), hopping on one foot for 15 s, dropping and
catching a tennis ball after one bounce using both hands,
dribbling a tennis ball (alternating hands), knee push-ups
for 30 s, and sit ups for 30 s. The short form of the BOT-2
produces a single score standardized to a mean of 50 and
standard deviation of 10, on which higher scores index
greater motor proficiency. The norm sample for the BOT-2
consisted of randomly selected individuals from ages 4
through 21 years, stratified within age groups by sex, race/
ethnicity, socioeconomic status, and disability status
(including ADHD; Bruininks & Bruininks, 2005). For the
short form of the BOT-2 with knee push-ups, the 5- through
8-year-old children in the norm sample exhibited internal
consistency reliability values ranging from 0.75 to 0.86. Test–
retest reliability for a subgroup of 4- through 7-year-old
children was 0.86. Interrater reliability was 0.98 (see Bruin-
inks & Bruininks, 2005).
Motor timing task. Each child completed a motor timing
task (Zelaznik, Spencer, & Ivry, 2008) that purportedly
reflects cerebellar function. Specifically, participants
attempted to synchronize pressing the space bar on a com-
puter keyboard to a metronome set at a rate of 2 Hz (500 ms
period). Following 10 s (19 intervals) of synchronization,
participants continued to press without the metronome for
about 20 s, attempting to maintain the rate. Participants
completed 15 to 20 trials of this task. The time series of
intertap intervals from the continuation (i.e., no metronome)
portion of the task were detrended and the coefficient of
variation was calculated. The coefficient of variation is
defined as the standard deviation of the time series divided
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74 Journal of Attention Disorders 17(1)
by the average intertap interval, converted to a percentage.
The best six trials (i.e., smallest coefficients) were averaged
and used in the primary data analysis. Using best trials lim-
its the degree to which timing variability stems from chang-
ing participant tapping strategies within and across trials
(see Zelaznik, Spencer, & Ivry, 2002).
Shape School. The Shape School (Espy, 1997; Espy, Bull,
Martin, & Stroup, 2006) assesses set shifting and response
inhibition in young children using a storybook format that
presents tasks of increasing difficulty. Condition A assesses
cognitive-processing speed, where children are asked to
name the colors of the depicted figures. The subsequent
conditions assess executive function. Condition B requires
children to name colors of “happy-faced figures” and inhibit
naming “sad-faced figures”; Condition C requires naming
the colors of figures without hats and naming the shapes of
figures with hats; Condition D requires children to name the
colors of happy-faced figures without hats, inhibit naming
sad-faced figures without hats, name the shapes of happy-
faced figures wearing hats, and inhibit naming sad-faced
figures with hats. In the present study, the efficiency scores
(number correct divided by time to completion) for Condi-
tions A through D were analyzed. Espy et al.’s (2006) vali-
dation sample for the Shape School was 219 typically
developing preschoolers, 54% girls, 85% White, and
described as possessing varied vocabulary skills. Executive
conditions of the Shape School (i.e., all conditions except A)
had internal consistency reliability values exceeding 0.70
and showed significant correlations with other measures
purported to assess executive function (see Espy et al., 2006).
Moreover, recent work shows inattention/hyperactivity to
correspond with lower inhibitory efficiency on the Shape
School (Pritchard & Woodward, 2011).
Mazes. The Mazes subtest from either the Wechsler Pre-
school and Primary Scale of Intelligence–Revised (WPPSI-
R; Wechsler, 1989) or the Wechsler Intelligence Scale for
Children–III (WISC-III; Wechsler, 1991) was administered
depending on the child’s age. Mazes assesses “the child’s
planning ability and perceptual-organizational ability—that
is, the ability to plan and follow a visual pattern” (Sattler,
2001, p. 294). In the present study, age-normed scaled scores
(M = 10, SD = 3) were derived and analyzed with higher
scores indexing more advanced planning ability. The stan-
dardization sample for the WPPSI-R was 1,700 children
ranging in age from 3 years to 7 years 3 months; the stan-
dardization sample for the WISC-III was 2,200 children
ranging in age from 6 to 16 years (Sattler, 2001). The mean
internal consistency reliabilities for the WPPSI-R and WISC-
III Mazes, respectively, are 0.77 and 0.70 (Sattler, 2001).
Finger Windows. The Finger Windows subtest from the
Wide Range Assessment of Memory and Learning–second
edition (WRAML-2; Sheslow & Adams, 2003) was
employed as a measure of spatial working memory. Specifi-
cally, children are shown an 8 × 11 in. card that has nine
holes cut in various locations. The examiner puts a pencil
through the holes in various prespecified sequences of
increasing difficulty and the child is required to correctly
replicate each one using her or his index finger. Scores are
derived based on the number of sequences correctly repli-
cated and are converted to scaled scores (M = 10, SD = 3)
based on age norms. The standardization sample for the
WRAML-2 was 1,200 individuals, ranging in age from 5 to
90 years (Sheslow & Adams, 2003). Higher scores indicate
better spatial working memory. As reported in the test man-
ual, the coefficient alpha reliabilities of the Finger Win-
dows subtest ranged from 0.76 to 0.83 across the 5-to 8-year
-11-month age range (Sheslow & Adams, 2003).
Sentence Memory. The Sentence Memory subtest, also
from the WRAML-2 (Sheslow & Adams, 2003), was
employed as a measure of verbal working memory. Specifi-
cally, children are read a series of sentences of increasing
difficulty and asked to recall each one exactly as stated.
Points are deducted for each error of omission, commission,
or change of a word (e.g., tense, contracting two words).
Scores are derived based on the degree of correct recall and
are converted to scaled scores (M = 10, SD = 3) based on
age norms. Higher scores indicate better verbal working
memory. As reported in the test manual, the coefficient
alpha reliabilities of the Sentence Memory subtest ranged
from 0.69 to 0.78 across the 5-to 8-year-11-month age
span (Sheslow & Adams, 2003).
Numbers Reversed. The Numbers Reversed subtest from
the Woodcock–Johnson III Tests of Cognitive Abilities
(WJ-III; Woodcock, McGrew, & Mathur, 2001) was admin-
istered, which requires children to listen to sequences of
number digits read by the examiner and then to reproduce
them in reverse order. This task measures working memory
skills that require mental manipulation and also has been
shown to assess planning (e.g., Schofield & Ashman, 1986).
Scores are derived based on the degree of correct perfor-
mance and are converted to standard scores (M = 100, SD =
15) based on age norms. The standardization sample for the
WJ-III included 8,818 individuals selected to be representa-
tive of persons aged 2 to 90+ years from 100 different com-
munities spanning the Northeast, Midwest, South, and West
portions of the United States (McGrew & Woodcock,
2001). Higher scores indicate better verbal working mem-
ory. According to Appendix A of the technical manual reli-
ability coefficients for the Numbers Reversed subtest
ranged from .84 to .92 across the 5- to 8-year-old age range
in the standardization sample.
Weekly Measures
Simon Says. The proportion of inhibition failures during
the popular children’s game Simon Says was used as a
weekly ecological measure of response inhibition. This task
has been used previously in research (Strommen, 1973) to
assess inhibition errors in young children. In a given
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Smith et al. 75
administration of the task, 30 commands were provided
with 10 instances absent the preliminary statement “Simon
Says.” These 10 instances were coded for inhibition failure,
and were differently sequenced from week to week to pre-
vent improvements stemming from memory of a command
pattern. Timing of commands was constant across an
administration of the task. Interrater reliability (agreements
divided by the sum of agreements and disagreements) was
assessed on detection of inhibition errors beginning in
Week 2 and averaged 0.94 over the remainder of the
program.
Red Light/Green Light. Similarly, the proportion of inhibi-
tion errors during a weekly Red Light/Green Light game
was used as an ecological measure of response inhibition.
Specifically, children were permitted to take one step fol-
lowing a “red light” call, and any additional steps or loss of
balance involving touching the ground (with any body part
except one’s feet) were coded as inhibition errors. In a
given administration of the task, 27 commands were pro-
vided with 15 instances being a “red light” and coded by
observers. The command sequence was changed from week
to week and the length of “green light” portions varied,
ranging from 1 to 4 s, within a session to prevent improve-
ments stemming from memory of the command pattern.
Interrater reliability was assessed on detection of inhibition
errors beginning in Week 2 and averaged 0.95 over the
remainder of the program.
Pittsburgh Modified Conners Teacher Rating Scale. Teacher
ratings of behavior on the Pittsburgh Modified Conners
Rating Scale (Pelham, 2002), which includes the widely
used 10-item Abbreviated Conners (Goyette, Conners, &
Ulrich, 1978) and Iowa Conners scales (Loney & Milich,
1982), as well as a Peer Interaction Scale developed by Pelham
(2002), were collected on at least a weekly basis. For chil-
dren with more frequent teacher ratings, items were aver-
aged to produce a weekly item score. Teachers rated on a
4-point scale (ranging from not at all to very much) the
extent to which each problem behavior was present. Scale
scores were derived separately for the Abbreviated Con-
ners, the inattention/overactivity and oppositional/defiant
subscales of the Iowa Conners, as well as the Peer Interac-
tions Scale, by averaging the computed item scores com-
prising each scale. Higher scores on these scales indicate
more problematic behavior. Pelham and colleagues (Pelham,
2002; Pelham, Milich, Murphy & Murphy, 1989) reported
means and standard deviations (n > 600) for boys and girls
in Kindergarten through fifth grade. As reported by Pelham
et al. (1989), coefficient alphas for the inattention/overac-
tivity and oppositional/defiant subscales, respectively, were
0.89 and 0.92.
Daily Observations of Behavior.
Trained behavioral observers recorded frequencies of the
following negative behaviors nicely, interrupting, intentional
aggression, unintentional aggression, and not following adult
directions. Observational methods were derived specifically
for this study to fit the ages of participants and the research
goals but were modeled after established procedures (Pelham
& Hoza, 1996). Observers received approximately 20 hr of
training and practice with the observational procedures prior
to commencing the program. Because of limited resources
and the staffing demands required to administer this pilot
program, only sporadic checks of the reliability of the obser-
vation system could be conducted. There was inconsistency
of interrater reliability values (complete disagreement
through complete agreement) across these spot checks. This
in part is likely because the checks covered short periods of
time and were infrequent, meaning a low number of overall
behaviors would be observed (i.e., any rater disagreement
would substantially impact reliability). Accordingly, results
pertaining to behavioral observations should be interpreted
with caution.
Post Program Only Improvement Ratings.
Ratings of perceived degree of improvement were com-
pleted by teachers, parents, and program staff at post pro-
gram following procedures used extensively in prior work
by Pelham and colleagues (Hoza & Pelham, 1995; Pelham
et al., 2000; Pelham & Hoza, 1996). Global ratings of over-
all improvement as well as ratings in specific areas (see
Table 2) were assessed on a 7-point scale (1 = very much
worse; 7 = very much improved). Consistent with prior
work, children for whom raters did not perceive a problem
in a given area were rated as “no problem” and not included
in analyses for that domain. In addition, both teachers and
program staff completed end-of-program ratings indexing
the degree to which each child’s behavior with (a) peers and
(b) adults was “like that of a normal child” (0 = very much
like a normal child; 6 = not at all like a normal child).
Finally, teachers and staff rated the degree to which they
found interacting with the child pleasant by the end of the
program (0 = very pleasant; 6 = very unpleasant). Parent
and teacher ratings were each provided by a single infor-
mant. As there were multiple program staff providing rat-
ings of each child, a single score for each child was derived
by averaging across raters.
Data Analysis
Dependent t tests were employed to test change over the
program on pre -post program measures, weekly measures,
and daily observations of behavior. For weekly measures,
averaged data over the first half of the program were com-
pared with averaged data over the second half of the pro-
gram. Similarly, the averaged frequency of observed
behaviors per program station over the first half of the
program was compared with the averaged frequency over
the second half of the program. In light of the relatively
limited power to detect statistically significant change over
time, effect size values were calculated and interpreted.
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76 Journal of Attention Disorders 17(1)
Table 1. Descriptive Statistics, Dependent t-Values, and Effect Size Values for Pre–Post and First Half–Second Half Comparisons
Preprogram
or first half
Postprogram
or second half Effect
sizeb
Measure M (SD)M (SD)nat p
Pre-post program measures
BOT-2 short formc40.77 (3.35) 44.00 (5.97) 13 -3.27 <.01 0.96
Continuation timing 15.68 (9.55) 14.21 (6.47) 12 0.72 .49 0.15
Shape School, Condition A 1.25 (0.29) 1.22 (0.43) 10 0.31 .76 -0.10
Shape School, Condition B 0.75 (0.23) 0.83 (0.25) 12 -3.06 <.05 0.35
Shape School, Condition C 0.48 (0.19) 0.54 (0.18) 11 -1.78 .11 0.32
Shape School, Condition D 0.37 (0.11) 0.41 (0.16) 12 -1.42 .18 0.36
Mazesc8.43 (2.56) 9.00 (2.08) 14 -0.87 .40 0.22
Finger Windowsc8.07 (2.84) 8.29 (3.02) 14 -0.26 .80 0.08
Sentence Memoryc10.38 (3.28) 10.85 (3.08) 13 -0.79 .45 0.14
Numbers Reversedc99.50 (10.59) 104.08 (15.22) 12 -1.23 .25 0.43
Weekly measures
Simon Says 0.29 (0.22) 0.33 (0.29) 13 -0.51 .62 -0.18
Red Light/Green Light 0.33 (0.15) 0.24 (0.14) 14 2.42 <.05 0.60
PMCTRS—Abbreviated Conners 0.94 (0.53) 0.62 (0.42) 14 2.18 <.05 0.60
PMCTRS—Iowa I/O 1.20 (0.53) 0.83 (0.51) 14 2.23 <.05 0.70
PMCTRS—Iowa O/D 0.67 (0.54) 0.45 (0.44) 14 2.66 <.05 0.41
PMCTRS—Peer interactions 0.46 (0.43) 0.29 (0.31) 14 2.03 .06 0.40
Daily observational measures
Not speaking nicely 0.15 (0.12) 0.17 (0.18) 14 -0.70 .50 -0.18
Interrupting 0.23 (0.14) 0.12 (0.09) 14 4.10 <.01 0.78
Intentional aggression 0.27 (0.21) 0.30 (0.34) 14 -0.44 .67 -0.12
Unintentional aggression 0.26 (0.13) 0.21 (0.12) 14 1.96 .07 0.40
Not following adult directions 1.31 (0.86) 1.32 (0.75) 14 -0.27 .79 -0.02
Notes: PMCTRS = Pittsburgh Modified Conners Teacher Rating Scale; I/O = inattention/overactivity; O/D = oppositional/defiant.
aReduced n for some analyses because of missing data, administrator/recording error, and/or participant failure to understand directions.
bEffect size calculated by dividing pre-post difference by preprogram standard deviation (positive value assigned to finding in expected/adaptive
direction).
cScaled/standard scores.
Effect size was calculated by dividing the pre -post
program difference by the standard deviation at prepro-
gram. A positive sign was assigned to values corresponding
to change in an adaptive direction and a negative sign was
assigned to values corresponding to change in a maladap-
tive direction. Values of 0.2, 0.5, and 0.8 were interpreted
as small, medium, and large effect sizes, respectively
(Cohen, 1988).
Results
Mean and standard deviation values for pre -post program
measures, weekly measures, and daily observational mea-
sures are found in Table 1. Statistically significant pre-to-
post (or first half-to-second half) program changes were
observed for BOT-2, Shape School Condition B, Red
Light/Green Light, Abbreviated Conners, Iowa Conners
(both inattention/overactivity and oppositional/defiant sub-
scales), and Interrupting scores (see Table 1). All signifi-
cant changes were in adaptive directions. The associated
effect sizes were of small or medium magnitude, with the
exception of the BOT-2, which had a large effect size. The
BOT-2 effect size would be expected in light of the nature
of the program and provides support for the efficacy of the
physical activity intervention. Six additional measures
yielded positive effect sizes greater than 0.20, indicating
improvement that did not reach statistical significance.
Overall, the relatively larger positive effect size values
tended to correspond with measures ostensibly assessing
response inhibition/impulsiveness. There was no evidence
of an adverse effect of the program, with all negative effect
sizes being less than 0.20 in magnitude.
Table 2 shows the percentage of parents, teachers, and
staff rating participants as “somewhat,” “much,” or “very
much” improved by the program. Depending on rater and
the focal domain, from 29% to 71% of participants were
rated as exhibiting some degree of improvement. The great-
est proportions of improvement were reported for the over-
all rating. Never did more than two participants receive
parent ratings that indicated worsening on a given domain.
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Smith et al. 77
Table 2. Percentage of Participants Perceived as Improved by
Adult Raters
Rater
Measure Parent Teacher Staff
Name calling/teasing/aggression 33 33 58
Defiance/noncompliance 42 50 69
Self-esteem 67 54 71
Responsibility 58 31 29
Social skills 67 Not rated 57
Following rules 46 54 43
Overall 69 64 71
Note: Rater indicated “somewhat improved,” “much improved,” or “very
much improved.
For teacher ratings, on no occasion did more than one par-
ticipant receive such a rating. Normalization ratings for
behavior with peers (teacher rating: M = 2.00, SD = 1.52;
staff rating: M = 1.77, SD = 0.90) and with adults (teacher
rating: M = 2.07, SD = 1.54; staff rating: M = 1.77, SD =
0.88) corresponded to participants behaving more “like a
normal child” than not. Finally, teachers (M = 2.07, SD =
1.64) and staff (M = 1.56, SD = 0.96) rated participants
overall as relatively more pleasant than not to interact with
by the program end.
Discussion
The data obtained in the present study suggest that there is
potential value in exploring regular physical activity as a
management tool for ADHD. Specifically, our preliminary
work suggests that sustained involvement in structured
physical activity may offer benefits to motor, cognitive,
social, and behavioral functioning in young people exhibit-
ing ADHD symptoms. Almost half of the measures showed
significant or marginally significant change over the pro-
gram, with effect sizes of mostly small to medium magni-
tude. Measures of response inhibition showed the most
consistently favorable findings, suggesting that physical
activity may be especially helpful in addressing this core
manifestation of ADHD. Moreover, key informants per-
ceived some degree of improvement in overall functioning
for about two thirds of the participants. No outcomes of
meaningful effect size were in a maladaptive direction, sug-
gesting that physical activity is unlikely to be harmful when
employed as a management strategy for ADHD. In light of
the overall pattern of findings, we believe that investing in
controlled, larger-scale examinations of physical activity
effects on the management of ADHD are warranted.
The assessment of overall motor proficiency (i.e., BOT-
2; Bruininks & Bruininks, 2005) showed a large change
from pre- to postprogram. This suggests that the physical
activity intervention was designed in a way that afforded
development of fitness parameters and motor control. The
emphasis on sustained MVPA within a framework of games
and activities that employ a variety of movement skills
would be expected to yield such an outcome, and is recom-
mended for future work with young children. Designing
the intervention in this way offers the stimulus necessary to
promote fitness and motor skill development while offer-
ing the variety and challenge necessary to sustain partici-
pant interest. Also, because ADHD is a disorder
appearing to involve a variety of brain regions (see Nigg,
2006), such a dynamic physical activity intervention seems
appropriate.
Of note is the absence of intervention effect on the con-
tinuation timing task. Because this task is simplified and
highly timing dependent, it is strongly linked to cerebellar
function (Ivry, Keele, & Diener, 1988). The findings sug-
gest that if any benefits of a physical activity intervention to
motor timing and cerebellar function exist, they would be
less marked than those for broader motor functioning and/
or would require an extended intervention time frame to
detect. Pursuit of long-term intervention investigations will
offer opportunity to understand this finding better. In light
of the imprecise etiology of ADHD, it is reasonable to
expect that physical activity benefits on particular symp-
toms or brain systems would be neither uniform nor accrued
at equal rates.
A broad range of tasks were employed to measure cogni-
tive function of study participants, with measures assessing
response inhibition, set shifting, planning, and working
memory. Such executive functions were selected for exami-
nation because deficits in these functions represent core
impairments associated with ADHD (Barkley, 1997) and
emerging work indicates that fitness levels and physical
activity may be linked to their preservation and enhance-
ment (Etnier & Chang, 2009; Hillman, Buck, Themanson,
Pontifex, & Castelli, 2009). The strength of findings was
mixed across tasks. For example, working memory tasks
did not show meaningful effect size values (i.e., |0.20|)
except when involving additional cognitive load as in the
Numbers Reversed task (effect size = 0.43). The latter task
involves planning, which in children has been shown to
benefit from exercise training (Davis et al., 2007). However,
the Mazes task, which purportedly measures planning,
yielded a small effect size in our study. The more consistent
effects were found for the tasks requiring response inhibi-
tion. The effect size values for these tasks ranged from 0.35
to 0.60, with the exception of the Simon Says task. Though
we were able to reliably measure behavioral responses on
this particular task, children could correct themselves before
their behaviors were coded as inhibition failures. That is,
children could return to their previous body position before
fully adopting the body position to inhibit. Many children
appeared to use the feedback available from viewing coact-
ing peers, which essentially served as a second piece of
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78 Journal of Attention Disorders 17(1)
information (beyond the leader’s instruction) about the cor-
rect response. The children did not have sufficient time to
make such corrections in the Red Light/Green Light task,
which was fast paced and had maximally concise com-
mands. Accordingly, we believe the latter task was a par-
ticularly sensitive ecological assessment of response
inhibition. The overall findings lead us to conclude that
physical activity may offer cognitive benefits to young chil-
dren with ADHD symptoms, particularly with regard to
executive tasks requiring inhibitory control.
Social and behavioral functioning was assessed by
weekly teacher ratings and daily observations of social
behaviors. The weekly teacher ratings showed meaningful
effect size values (0.40 to 0.70), suggesting improved
school-day social and behavioral functioning across the
time frame of the before-school physical activity program.
This finding is notable, suggesting that possible physical
activity effects on social and behavioral symptoms can
extend beyond the physical activity period and context.
Such carryover is essential if physical activity is to be a
viable option for ADHD intervention. Within the program
setting itself, the observed behaviors of interrupting (effect
size = 0.78) and unintentional aggression (effect size = 0.40)
showed meaningful improvement, whereas the behaviors
of not speaking nicely, intentional aggression, and not
following adult directions failed to meaningfully change.
Interrupting and unintentional aggressive acts are under-
pinned by impulsiveness, and therefore these behavioral
findings align closely with the response inhibition findings.
This noted, the reader is reminded that the reliability of our
behavioral coding system is uncertain and therefore the daily
behavior findings must be cautiously interpreted.
In line with the behavioral observations, fewer children
were rated by adult informants as showing some degree of
improvement over the program in name calling/teasing/
aggression and following rules than in some other areas,
although it is important to remember that only those children
who had problems in these areas could be rated as improved.
A comparable outcome was observed for responsibility.
More encouraging findings were obtained for adult ratings
of child self-esteem, social skills, and overall functioning.
Defiance/noncompliance improvement rating values were
between the values for these sets. Overall, we interpret the
ratings to offer some support for the validity of our behav-
ioral observation system and to suggest a generalized poten-
tial benefit of the before-school program to our participants.
The finding for overall functioning is comparable with
improvement percentages for children upon initial stimulant
use (Spencer et al., 1996), suggesting that physical activity
may hold promise as an intervention strategy for ADHD.
This work is clearly preliminary and must be considered in
light of its limitations, including lack of a control condition,
lack of a comparison group of typically developing peers, a
relatively small sample, and the administration of weekly tasks
(i.e., Simon Says, Red Light/Green Light) that in themselves
could improve inhibitory control independent of the physical
activity intervention. Important delimitations include the
exclusive enrollment of young children and those exhibiting
hyperactivity/impulsivity in the study. The present work can-
not speak of possible physical activity benefits to older chil-
dren or those with the inattentive-only form of ADHD.
However, we believe the results stemming from this pilot
before-school physical activity program are noteworthy
because (a) all meaningful changes were in adaptive direc-
tions, (b) the lack of meaningful maladaptive outcomes sug-
gests such an intervention program has low probability of
doing harm to participants, (c) observable changes were
detected despite a small sample size, and (d) none of the med-
ication naïve participants initiated medication use over the
span of the program, though families were free to pursue this
option. Moreover, these encouraging program outcomes are
observed within an intervention context yielding high partici-
pant adherence. Program attendance was strong, suggesting
that reasonable adherence to a physical activity intervention
protocol can be expected in a before-school setting over
about a 2-month time frame. Future work to assess adherence
rates over longer time spans is warranted, as chronic physical
activity participation will be necessary to manage persistent
ADHD symptoms.
Beyond an extended and controlled field investigation of
physical activity intervention effects on ADHD symptoms
that addresses the limitations noted above, future work
would be strengthened by adopting a translational approach
where basic research on mechanisms of ADHD and physical
activity effects on behavior, as well as brain function and
development, informs clinical research. Recent animal work
by Hopkins, Sharma, Evans, and Bucci (2009), for example,
showed exercise to yield adaptive effects on attention and
social behavior in female mice possessing behavioral and
neurobiological characteristics of ADHD compared with
controls. The effects were not observed in male counter-
parts, suggesting that sex may be an important moderator of
physical activity effects on ADHD. This finding should be
carefully explored within human intervention trials. If physi-
cal activity is established as an effective intervention for
ADHD, it will also be important to address possible comple-
mentary effects of physical activity and existing treatment
strategies, dose–response relationships, costs of physical
activity intervention, long-term adherence challenges, and
developmental implications of early physical activity inter-
vention among other issues. We believe that the present pilot
findings justify the expenditure of time, effort, and resources
necessary to pursue these interesting and clinically valuable
research avenues.
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Smith et al. 79
Acknowledgments
The authors thank David Bucci and John Green for thoughtful
feedback on an earlier draft of the manuscript, J. D. DeF reese for assis-
tance with assessment scoring, and Howard Zelaznik for guidance
on the motor timing methods and analysis. Finally, the authors
thank the participating children, parents, teachers, and school
administrators that contributed to the success of this project.
Authors’ Notes
Aaron J. Vaughn is now with the Division of Behavioral Medicine,
Cincinnati Children’s Hospital, OH. Meghan Tomb is now with
Columbia University Medical Center/New York Presbyterian
Hospital. She completed her PhD and is now a post doc there.
Hoza and Smith are equal contributors to this research.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support
for the research, authorship, and/or publication of this article: The
authors thank the McNeil Prevention and Community Psychology
Fund at the University of Vermont for supporting this research.
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Bios
Alan L. Smith, PhD, is a professor of health and kinesiology at Purdue
University. His research addresses social and motivational aspects
of children’s sport involvement and physical activity behavior.
Betsy Hoza, PhD, is a professor of psychology at the University
of Vermont. Her research addresses mechanisms of ADHD, as
well as treatment outcomes, from a developmental psychopathol-
ogy perspective.
Kate Linnea, BA, is a doctoral student in clinical psychology at the
University of Vermont. Her research examines peer relationships in
children with ADHD and the role of sport involvement and skill.
Julia D. McQuade, BA, is a doctoral student in clinical psychol-
ogy at the University of Vermont. Her research addresses cogni-
tive risk and protective factors of emotional and social adjustment
for children with ADHD from a developmental psychopathology
perspective.
Meghan Tomb, PhD, is a postdoctoral fellow at Columbia
University Medical Center/New York Presbyterian Hospital. Her
research interests include social and cognitive processes of chil-
dren with ADHD and related disorders.
Aaron J. Vaughn, PhD, is an assistant professor at Cincinnati
Children’s Hospital Medical Center. His research pertains to
assessment and treatment of ADHD.
Erin K. Shoulberg, MA, is a doctoral student in developmental
psychology at the University of Vermont. Her research examines
how children’s and adolescents’ relationships influence their
social and academic functioning.
Holly Hook, MS, is a physical education and health teacher in
Indiana.
at MICHIGAN STATE UNIV LIBRARIES on December 11, 2012jad.sagepub.comDownloaded from
... Questo può essere particolarmente efficace per i bambini che mostrano una forte inclinazione verso questo stile di apprendimento, consentendo loro di massimizzare il loro potenziale educativo utilizzando le loro abilità fisiche e cinestetiche. Nello scenario delle teorizzazioni sul valore inclusivo dell'educazione motoria emerge sempre con maggiore forza che essa rappresenta il traguardo di una didattica efficace, frutto di un'azione condivisa (Booth, 2011), volta a valorizzare tutte le differenze soggettive e ad affermare l'equità dei diritti, sia ad un livello istituzionale macro che ad un livello micro, implicando l'agire professionale finalizzato a realizzare il successo formativo di tutti e ciascuno (Sibilio e Aiello, 2015). La logica dell'inclusione, infatti, pone l'accento sull'esigenza di rispondere ai differenti bisogni manifestati dagli studenti durante il percorso scolastico, con l'obiettivo di rimuovere le barriere che ostacolano l'apprendimento e favorire, in tal modo, la partecipazione di tutti gli alunni alla vita scolastica indipendentemente da eventuali situazioni di disabilità, da diversità linguistico-culturali o da svantaggio economico-sociale al fine di prevenire fenomeni di marginalizzazione e discriminazione (UNESCO, 1994;2000). ...
... L'integrazione dell'educazione motoria e della Body Percussion nei programmi educativi per bambini con ADHD rappresenta un approccio promettente che allinea le pratiche pedagogiche con i principi dell'embodied cognition. In questo contesto si inserisce una metodologia di educazione al movimento innovativa, Sincrony, che attraverso l'uso consapevole del corpo e un approccio integrativo tra motorio e cognitivo aiuta a sostenere l'apprendimento nelle fasi crescita (De Bernardi, 2008;Barakat et al., 2023;Kanellos et al., 2018;Vazou & Mavilidi, 2021;Ekins et al., 2021;Lelong et al., 2021;Smith et al., 2013). Nello specifico, il metodo, tra i vari strumenti di lavoro evidenzia l'importanza della centratura, capacità di focalizzare l'attenzione e le pressioni nell'area addominale in funzione (Fogliata et al., 2022). ...
... Ulteriori studi clinici potrebbero approfondire la comprensione di come questa pratica possa influenzare specificamente i bambini con ADHD, ma le basi scientifiche suggeriscono che la Body Percussion può essere un'aggiunta benefica all'arsenale degli interventi educativi. Al docente è demandato il compito di partire dal corpo e dalle sue potenzialità di azione nella ristrutturazione della progettazione educativa e di acquisire consapevolezza dei significati che il discente veicola attraverso forme di comunicazione analogiche che si traducono in comportamenti non sempre manifesti (Sibilio e Aiello, 2015). Ciò vuol dire che il docente attraverso la Body Percussion può met-tere in atto in modo pratico e tangibile le potenzialità della corporeità e del movimento nell'ambito dei contesti educativi nel rispetto della diversità e dell'altro. ...
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This work explores the hypothesis of a connection between Artificial Intelligence AI), Embodied Cognition and Body Percussion. The fundamental premise is that traditional machine learning methods in AI differ greatly from the ways humans learn. Embodied Cog�nition emphasizes the essential role of the physical body and its interactions with the envi�ronment in the learning process. This revolutionary perspective contradicts traditional cogni�tive theories that isolate the mind as an information processor far from the body. In this context, the hypothesis is considered that intelligent agents, including virtual robots, should learn in a similar way to humans, actively interacting with the environment and their body. Body Percussion, a musical-motor activity that involves the human body in the creation of rhythms and sounds, emerges as a bridge between Embodied Cognition and AI. This work suggests that the practice of Body Percussion can be an innovative method to develop cog�nitive and motor skills and promote inclusion in education. It also stresses the importance of considering the body and the environment as key components in designing more advanced AI systems. This study provides food for thought for further research and practical applica�tions in education and robotics. Keywords: Artificial Intelligence; Embodied Cognition; Body Percussion
... Studies have indicated an inverse association between increased PA and attention problems and academic performance [16], as well improved cognitive and behavioural outcomes in children with attention deficit hyperactivity disorder (ADHD) [2,17,18]. Imprudent DH, such as high sugar and saturated fat intake, has been linked to an increased risk of ADHD, while, for example high fruit and vegetable consumption, may reduce the risk of such issues [19,20]. Although ADHD is a medical diagnosis and is diagnosed by complex questionaries and interviews by clinicians, attention problems are considered as one of the ADHD symptoms [21]. ...
... To determine (BMI, kg/m 2 ) data on weight and height were collected and percentile was calculated according to World Health Organization (WHO) growth reference data for [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] year-old children [23]. ...
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... [31]assigned 18 children with ADHD (11-16 years old) and healthy children to either an experimental group (EG) or a control group (CG) and showed a general benefit in executive function after 10-15 minutes of moderate aerobic exercise and similar benefits in cognitive flexibility in children with ADHD and healthy controls, due in part to parasympathetic inhibition-induced arousal enhancement. [32] conducted an 8-week preschool physical activity program with 17 third grade children at risk for ADHD, in which participants completed 24 minutes of moderate-to high-intensity physical activity per day. That study found that 17 participants showed significant increases in motor proficiency, including gross and fine motor tasks. ...
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Attention deficit/hyperactivity disorder (ADHD) affects the physical and mental health in children and adolescents. Evidence suggests that participation in exercise may benefit children and adolescents with ADHD and enhance current and future physical and mental health. This systematic review and meta-analysis investigated the effects of exercise interventions on the physical and mental health of children and adolescents with ADHD, based on the International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY) framework. This review systematically searched for studies published up to August 1, 2023, through PubMed, Web of Science, PsycINFO, and Scopus. A meta-analysis was performed on studies that reported physical and mental health outcomes more than 10 times. A semiquantitative analysis was performed on studies that reported those indicators less than 10 times. In addition, all physical and mental health outcome indicators were linked to ICF-CY codes. A total of 43 studies were included in the systematic review, 13 of which were eligible for meta-analysis. Our meta-analysis results showed that levels of anxiety and depression significantly decreased after exercise intervention, with medium (Hedges’g = − 0.63, 95% CI [1.17, − 0.09], P < 0.05) and large effect sizes (Hedges’g = − 1.03, 95% CI [− 1.94, − 0.12], P < 0.05), respectively. The level of attention problem significantly decreased after exercise intervention, with a large effect size (Hedges’g = − 1.28, 95% CI [− 2.59, 0.04], P = 0.06), but no statistical difference was observed. The level of motor skills significantly improved after exercise intervention with a large effect size (Hedges’g = 0.97, 95% CI [0.42, 1.51], P < 0.01). The level of muscle strength significantly improved after exercise intervention, with a small effect size (Hedges’g = 0.37, 95% CI [0.05, 0.68], P < 0.05). The included studies covered a total of 31 outcome indicators, which could be divided into 4 one-level classifications and 27 two-level classifications according to the ICF-CY framework. Among the outcome indicators, 21 (67.74%) were related to “physical functions”, 9 (29.03%) were related to “activities and participation”, and 1 (3.23%) was related to “body structures”. This study confirmed that exercise could improve the physical and mental health in children and adolescents with ADHD. Regarding exercise intervention to improve the health of children and adolescents with ADHD, existing research has focused on verifying the immediate effect of intervention from the perspective of “physical functions”. However, there is a lack of in-depth exploration into changes in the dimensions of “body structures” and “activities and participation”, as well as the long-term intervention effects. Future studies should focus more on a holistic view of health that considers “body structures and functions” and “activities and participation”, which could ultimately favor comprehensive and long-term improvements in the health status of children and adolescents with ADHD.
Article
Background Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder characterized by diverse clinical manifestations including inattention, hyperactivity and impulsivity. Objective The present study aims to investigate the effects of neurocognitive training (NT), a personalized and specialized exercise programme on symptoms, attention and dynamic balance in treatment‐naïve children diagnosed with ADHD. Methods Fourteen treatment‐naïve children aged 7–12 years diagnosed with ADHD were enrolled in the intervention group. The NT intervention was administered weekly for 10 consecutive weeks, supplemented by a structured home exercise programme for 6 days a week over the same 10‐week period. ADHD‐related symptoms, attention and dynamic balance were assessed in pre‐treatment, post‐treatment, 6 months, and 12 months. Fifteen typically developing (TD) children, matched for age, underwent evaluation only once to establish baseline normative values. Results Following the NT (post‐treatment), significant improvements were observed in hyperactivity‐impulsivity scores, oppositional‐defiant behaviours and dynamic balance when compared to the TD children ( p < 0.05). In the ADHD group, a significant difference was found in the long term (12‐month follow‐up) in hyperactivity–impulsivity, oppositional‐defiant behaviours and dynamic balance ( p < 0.05). Conclusion The findings suggest that the NT yields favourable effects on hyperactivity–impulsivity, oppositional defiant behaviours and dynamic balance in children diagnosed with ADHD, with these improvements appearing to be sustained over the long term. Clinical trial registration number : NCT04707040.
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Objectives To describe the daily Physical Activity (PA) patterns of adolescents with Attention-deficit/hyperactivity disorder (ADHD), to analyze the differences in terms of PA patterns between adolescents with ADHD and those without ADHD, and to study the factors associated with achieving the daily PA recommendations. Methods The sample was composed of 778 adolescents who provided complete information on their PA patterns through the Physical Activity Questionnaire for Adolescents (PAQ-A). Of these, 97 had ADHD according to DSM-5 criteria. Results The results show that being a girl or being of foreign origin and having ADHD have an impact on the achievement of the recommended amount of daily PA. Conclusions When promoting PA in adolescents with ADHD within the school environment, it is necessary to consider different domains and specific contexts of a school day, paying special attention to girls and adolescents with ADHD of immigrant origin.
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This study examined whether the links between children’s ADHD symptom severity and academic and social functioning varied based on their aerobic fitness levels. Hierarchical regression models were used to examine the main and interactive effects of inattentive and hyperactive/impulsive (HI) symptom severity and aerobic fitness levels on academic and social functioning in 198 children (Mage = 6.83; 53% male; 68% White, 14% Mixed Race, 8% Black or African American; 2% Asian; 8% selected the “Other” category when reporting racial identity; across race categories, 15% identified as Hispanic or Latino ethnicity). Children’s aerobic fitness levels were assessed using a multistage fitness test. Parents rated children’s ADHD symptoms, and teachers rated academic and social functioning. Results highlighted negative associations between ADHD symptom severity and adaptive academic and social functioning. Aerobic fitness was positively linked with academic performance. Aerobic fitness moderated the associations between HI symptom severity and academic outcomes, highlighting that aerobic fitness may be protective against academic impairments for children with elevated HI symptoms.
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The symbiotic relationship between sports practice and psychological well-being has, in recent times, surged to the forefront of academic and public attention. The aim of this narrative review is to comprehensively explore the intricate pathways linking physical engagement in sports to its subsequent impacts on mental health and synthesize the multifarious effects of sports on psychological health, offering insights for integrating physical and psychological strategies to enhance well-being. From neurobiological underpinnings to therapeutic applications, this comprehensive manuscript provides an in-depth dive into the multifaceted world of sports and psychology. Highlighting evidence-based interventions, this review aspires to offer actionable insights for practitioners , athletes, and individuals alike, advocating for a holistic approach to mental well-being. This manuscript highlights the profound impact of sports on mental health, emphasizing its role in emotional regulation, resilience, cognitive function, and treating psychological conditions. It details how sports induce neurochemical changes, enhance brain functions like memory and learning, and aid against cognitive decline. This review also notes the benefits of regular exercise in mood improvement , stress management, and social skill enhancement, particularly when combined with mind-fulness practices. It underscores the importance of considering cultural and gender perspectives in sports psychology, advocating for an integrated physical-psychological approach to promote overall well-being.
Book
Development is a lifelong process. It begins with conception and ends with death. Developmental psychology reflects this idea by examining the changes in mind and behavior over the lifespan. Development is also the result of an interaction of various processes on the biological, cognitive, and socioemotional level. Lifespan psychological development is, therefore, complex, and this course book seeks to help you examine it more closely. The course book Developmental Psychology will present you with an overview of the field, the methods of research used in this field, and the key debates that govern it. You will then progress through the lifespan by examining core psychological components. These domains include physical and motoric development, perceptual development, cognitive development, language development, emotional development, and social and moral development. In each case, you will encounter the relevant developmental progressions from the prenatal period into childhood, including atypical developmental pathways. Because developmental changes are more dominant in early stages of the lifespan, warranting a separate examination of each domain, later stages are more compact. In the subsequent units, you will, therefore, engage with specific life stages. You will learn about the significant changes in adolescence, particularly on the brain and social identity levels. From here, you will engage with the psychosocial challenges of early and middle adulthood. Finally, the course book will end with the final stage of life. Here, you will come across key issues in late adulthood, including the closure of the lifespan.
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As interest in the public health challenge of youth inactivity increases, the ambitious Youth Physical Activity and Sedentary Behavior sets a standard for addressing a problem with worldwide implications. Drawing on the contributions of a diverse group of international experts, this reference challenges professionals, researchers, and students to implement new solutions and further their research and work. No other text addresses the causes, contributing factors, and fundamental issues in dealing with youth physical activity with such depth or comprehensive coverage. Using a multidisciplinary approach, Youth Physical Activity and Sedentary Behavior breaks away from traditional thinking that places activity and sedentary behavior on a single continuum, which may limit progress in addressing youth inactivity. By looking at a variety of psychosocial and epidemiological factors, the authors set the stage for a critical analysis of beliefs and views at a time when many assumptions are taken for granted. This book is organized in three parts that build on one another to deepen readers' understanding of this complex problem. Each chapter presents the latest theory and research, real-world approaches to implementation, and background information to encourage discussion and future directions in national policy making. Youth Physical Activity and Sedentary Behavior: Challenges and Solutions considers current research about Youth Physical Activity and Sedentary Behavior across a range of personal factors as well as cultural and social influences. The text communicates the knowledge base on developmental, economic, psychological, and social factors related to Youth Physical Activity and Sedentary Behavior and provides an overview of youth-specific approaches to addressing the problem of inactivity among youth.
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To identify the most consistent relationships among psychological variables and physical activity in youth (ages 11-21 years), 20 articles on depression, anxiety, stress, self-esteem, self-concept, hostility, anger, intellectual functioning, and psychiatric disorders were reviewed. Physical activity was consistently related to improvements in self-esteem, self-concept, depressive symptoms, and anxiety/stress. The effect sizes were +.12, -.15, and -.38 for self-esteem/self-concept, stress/anxiety, and depression, respectively. The evidence for hostility/anger and academic achievement was inconclusive. No negative effects of physical activity were reported. The literature suggests that physical activity in youth is psychologically beneficial. More research is needed to confirm previous findings. Adolescents should engage in moderate or vigorous aerobic activity approximately three times per week for a total of at least 60 minutes per week.
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This article reviews controlled, prospective follow-up studies of children with attention-deficit disorder (ADHD) into young adulthood and adulthood. In their late teens, those with ADHD as children, compared with non-ADHD comparisions, show relative deficits in academic and social. functioning. In addition, about two-fifths of these children continue to experience ADHD symptoms, and a significant minority demonstrate pervasive antisocial behaviors, including drug abuse. Many of these same difficulties persist into adulthood. Compared with the comparisons, former ADHD probands complete less formal schooling, hold lower ranking occupational positions, and continue to exhibit poor social skills, antisocial personality, and symptoms of the childhood syndrome. On the other hand, as adults, nearly all former cases are gainfully employed, some in higher level positions, and a full two-thirds show no evidence of any mental disorder. Although relative deficits are seen in early to middle adolescence, young adulthood, and adulthood, childhood ADHD does not preclude achieving one's educational and vocational goals, and the majority of these children do not experience emotional or behavioral problems by their mid-twenties.
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This study presents the results of a diachronic literature review of publications about approaches to ADHD treatment, in order to determine the number and efficacy of treatment approaches during the last 25 years. Results derived from this literature review of three temporal periods (1986-1992; 1994-2000; 2001-2011), show that studies were mainly focused on pharmacological treatment. Possible explanations of this trend are argued, emphasising the need to promote multimodal and contextual interventions.
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This clinical practice guideline provides recommendations for the assessment and diagnosis of school-aged children with attention-deficit/hyperactivity disorder (ADHD). This guideline, the first of 2 sets of guidelines to provide recommendations on this condition, is intended for use by primary care clinicians working in primary care settings. The second set of guidelines will address the issue of treatment of children with ADHD. The Committee on Quality Improvement of the American Academy of Pediatrics selected a committee composed of pediatricians and other experts in the fields of neurology, psychology, child psychiatry, development, and education, as well as experts from epidemiology and pediatric practice. In addition, this panel consists of experts in education and family practice. The panel worked with Technical Resources International, Washington, DC, under the auspices of the Agency for Healthcare Research and Quality, to develop the evidence base of literature on this topic. The resulting evidence report was used to formulate recommendations for evaluation of the child with ADHD. Major issues contained within the guideline address child and family assessment; school assessment, including the use of various rating scales; and conditions seen frequently among children with ADHD. Information is also included on the use of current diagnostic coding strategies. The deliberations of the committee were informed by a systematic review of evidence about prevalence, coexisting conditions, and diagnostic tests. Committee decisions were made by consensus where definitive evidence was not available. The committee report underwent review by sections of the American Academy of Pediatrics and external organizations before approval by the Board of Directors. The guideline contains the following recommendations for diagnosis of ADHD: 1) in a child 6 to 12 years old who presents with inattention, hyperactivity, impulsivity, academic underachievement, or behavior problems, primary care clinicians should initiate an evaluation for ADHD; 2) the diagnosis of ADHD requires that a child meet Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria; 3) the assessment of ADHD requires evidence directly obtained from parents or caregivers regarding the core symptoms of ADHD in various settings, the age of onset, duration of symptoms, and degree of functional impairment; 4) the assessment of ADHD requires evidence directly obtained from the classroom teacher (or other school professional) regarding the core symptoms of ADHD, duration of symptoms, degree of functional impairment, and associated conditions; 5) evaluation of the child with ADHD should include assessment for associated (coexisting) conditions; and 6) other diagnostic tests are not routinely indicated to establish the diagnosis of ADHD but may be used for the assessment of other coexisting conditions (eg, learning disabilities and mental retardation). This clinical practice guideline is not intended as a sole source of guidance in the evaluation of children with ADHD. Rather, it is designed to assist primary care clinicians by providing a framework for diagnostic decisionmaking. It is not intended to replace clinical judgment or to establish a protocol for all children with this condition and may not provide the only appropriate approach to this problem.
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Attention-deficit/hyperactivity disorder (ADHD) is a commonly diagnosed behavioral disorder of childhood that represents a costly major public health problem. Despite progress, ADHD and its treatment have remained controversial, especially the use of psychostimulants for both short- and long-term treatment. Although an independent diagnostic test for ADHD does not exist, there is evidence supporting the validity of the disorder. Studies (primarily short-term, approximately 3 months), including randomized clinical trials, have established the efficacy of stimulants and psychosocial treatments for alleviating the symptoms of ADHD and associated aggressiveness and have indicated that stimulants are more effective than psychosocial therapies in treating these symptoms. Because of the lack of consistent improvement beyond the core symptoms and the paucity of long-term studies (beyond 14 months), there is a need for longer-term studies with drugs and behavioral modalities and their combination. Although trials are under way, conclusive recommendations concerning treatment for the long term cannot be made at present. There are wide variations in the use of psychostimulants across communities and physicians, suggesting no consensus regarding which ADHD patients should be treated with psychostimulants, and thus the need for improved assessment, treatment, and follow-up. Furthermore, the lack of insurance coverage, preventing the appropriate diagnosis and treatment of ADHD, and the lack of integration with educational services are substantial barriers and represent considerable long-term costs for society. Finally, after years of clinical research and experience with ADHD, knowledge about the cause or causes of ADHD remain largely speculative. Consequently, there are no documented strategies for the prevention of ADHD.