The effects of physical activity on children diagnosed with attention deficit hyperactivity disorder: a review

Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental psychiatric disorder among children. Despite the noted positive aspects of the disorder, it is often associated with a range of negative outcomes for that are detrimental to children's education and wider well-being. This comprehensive scoping review examined empirical literature from seven academic journal databases and specialist journals, published over 10 years, in relation to the benefits of sport/physical activity upon the effects of ADHD. The databases and time frame were chosen to give the ‘ideal [scenario]?…?that could answer the review question’, within the limitations of journal database access and resource available; searches of grey literature were also conducted. Ten articles were included in the final review. Due to the variation of methodological approach, sample size, and, most importantly, the form of physical activity measured, it is difficult to identify the ‘best’ form of physical activity to mediate symptoms of ADHD. However, it can be plausibly claimed that physical activity interventions may provide an alternative, non-pharmaceutical approach to management of ADHD in children.     

Experimental training of children with attention deficit/hyperactivity disorder

Attention-deficit/hyperactivity disorder （AD/HD） negativelly affects the cognitive and psychomotoric spheres of the pupil＇s social behavior and social adaptation. The review of many studies states that pupils with AD/HD achieve worse learning results because of insufficiently functioning cognitive processess, such as attention, （work） memory, thinking, problem solving, language, small- and large- scale motorics. Behavioral features, exhibited with AD/HD, include low-frustration tolerance, temper problems, persistence, emotional liability, depression, peer rejection, poor self-concept and poor self-esteem. Because of insufficiency of the cognitive processes, the difficulties of social behavior and social adaptation, pupils with AD/HD more often have a dysfunction of pupils＇ role that manifests by learning difficulties and behavior problems. The manifestation of the disorder in the younger school age in the context of children＇s school activities and roles actualizes the exceptional interest of the educational science in the analyzed phenomenon. The search and construction of effective means of socio-educational help for AD/HD primary class pupils should be associated with coordination and adaptation of different effective educational methodologies of different conceptual origin. In order to develop cognitive, psycho-motoric abilities and social behavior of the group of primary class pupils with AD/HD （N=22）, activities of supplementary education were organized after classes （their duration was 6 months）. During the forming experiment, original methodologies were constructed and national and foreign researchers＇ educational methodologies were adapted and tested in new, specific conditions （methods of fairy-tales, correction of cognitive behavior, graphical-logical tasks, games in the sport hall）. Even by relatively rare activities of supplementary education in a homogeneous group of children suffering from AD/HD positive changes of cognitive, psychomotoric sphere, social behavior and social adaptation were achieved.     

Attention deficit disorder: A review of literature

A review of current and available literature tends to suggest that the search for identifying universal and specific features of handicapping conditions continues, as disagreement emerges over the construct of Attention Deficit Disorder. This paper attempts to summarize the debate in professional literature regarding the definitions, implications, diagnosis, and future research of Attention Deficit Disorder with and without hyperactivity.     

Use of digital console game for children with attention deficit hyperactivity disorder

ADHD or ADD （Attention Deficit/Hyperactivity Disorder） is one of the most frequently diagnosed mental and behavioral disorders of children. Children with ADHD are characterized by poor attention and distractibility and/or hyperactive and impulsive behaviors. Although there is no ＂cure＂ for ADHD, there are accepted treatments that specifically target its symptoms. The most common standard treatments include medication, psychological or behavioral modification, and educational approaches. However, more and more parents began to worry about the side effects of medication. For this reason, this study proposed a new treatment by using digital console games to assist children who suffer from ADD to improve their attention condition. With the advantages of gaming apparatus, this study intends to improve the effect of behavioral intervention and cognitive remediation therapy for ADD children.     

A systematic review and synthesis of qualitative research: the influence of school context on symptoms of attention deficit hyperactivity disorder

This systematic review and synthesis of qualitative research explored contextual factors relevant to non-pharmacological interventions for attention deficit hyperactivity disorder (ADHD) in schools. We conducted meta-ethnography to synthesise 34 studies, using theories of stigma to further develop the synthesis. Studies suggested that the classroom context requiring pupils to sit still, be quiet and concentrate could trigger symptoms of ADHD, and that symptoms could then be exacerbated through informal/formal labelling and stigma, damaged self-perceptions and resulting poor relationships with staff and pupils. Influences of the school context on symptoms of ADHD were often invisible to teachers and pupils, with most attributions made to the individual pupil and/or the pupil’s family. We theorise that this ‘invisibility’ is at least partly an artefact of stigma, and that the potential for stigma for ADHD to seem ‘natural and right’ in the context of schools needs to be taken into account when planning any intervention.     

Decreasing attention deficit hyperactivity disorder symptoms utilizing an automated classroom reinforcement device

Psychologists and physicians are frequently approached by parents and, indirectly, by classroom teachers to diagnose and treat Attention Deficit Hyperactivity Disorder. Requests are also frequently made for psychostimulant medication to control ADHD behavioral symptoms. One reason for such requests is that alternative classroom approaches to treating ADHD have focused on positive reinforcement, response cost, and token reinforcement programs, all of which can require extensive teacher involvement. One of the major problems with such behavioral approaches is the fact that teachers have limited time to reinforce positive, attentive behaviors, and/or alternative behaviors to ADHD symptoms. This study examined the efficacy of an automated reinforcement device, the Attention Training System (ATS), in decreasing off-task behavior in an 11-year-old, fifth-grade student who had been diagnosed as being affected with ADHD and had been placed in Special Education Resource Room programming. The Attention Training System provides automated token reinforcement in the form of points on a fixed interval schedule when the youngster is on-task. When distractible, impulsive, or hyperactive behavior occurs, the Attention Training device can be activated by a teacher to provide a response-cost consequence of loss of points. The device in this study was coupled with a token reinforcement program whereby points could be exchanged for selected reinforcers at the end of each day. Results indicated that the ATS plus token reinforcement was successful in reducing off-task behavior across classes of three subject areas: Science, Reading, and Social Studies. Results have implications for psychologists and physicians in their attempts to assist families and schools in their management of youngsters with ADHD.     

Task performance and response to frustration in children with attention deficit hyperactivity disorder

The present study examined performance on an arithmetic task of increasing difficulty and a frustrating puzzle task for children with ADHD and comparison children. Emotional competence also was investigated in the two groups. Sixty‐four children, 21 previously diagnosed with ADHD, participated. Performance on the arithmetic task was measured in terms of completion and accuracy. Children with ADHD had similar rates of accuracy for all levels of difficulty, but completed fewer problems. Performance on the puzzle task was measured both through completion and persistence. Although children with ADHD persisted for a similar amount of time compared to children without ADHD, they were more likely to quit the task before completion. Children with ADHD also were more likely to report that they became frustrated with the task. Furthermore, they tended to report that in general, they become more frustrated than other children. With regard to emotional competence, children with ADHD did not differ from the comparison children on their reported understanding of their own emotions or attention to emotions; however, children with ADHD reported that they engage in less mood repair. © 2006 Wiley Periodicals, Inc. Psychol Schs 43: 377–386, 2006.     

Developing social strategies to overcome peer rejection of children with attention deficit hyperactivity disorder

Abstract

Investigation of 265 children's attitudes towards vignettes of Year 5 peers with Attention Deficit Hyperactivity Disorder (ADHD) revealed strong rejection of Hyperactive and Combined subtypes, relative to Inattentive subtypes and non‐ADHD controls. The social difficulties of children with ADHD may be understood within Barkley's theoretical model of ADHD (Barkley, 1997) that links deficits in response inhibition with four executive neuropsychological functions contributing to social cognition. The theory is also helpful in predicting strategies that may be facilitated by teacher intervention to construct improved social relationships among children with and without ADHD.     

Attention deficit disorder with and without hyperactivity: reaction time and speed of cognitive processing

This study addressed the issue as to whether children reliably diagnosed as attention deficit disordered with hyperactivity (ADD/H) and without hyperactivity (ADD/WO) differed significantly from each other and a clinic control (CC) population on speed and efficiency of cognitive processing. From an outpatient clinic population, 43 ADD/H and 22 ADD/WO children were examined. An analysis of mean reaction time and speeded classification task performance revealed significant group effects on both mean reaction time and on a measure of within-subject variability. ADD/H children performed significantly more slowly and variably than the CC children on several of the speeded classification tasks. However, the ADD/WO group was not distinguished on any measure. Thus, while children may be reliably diagnosed as ADD/H or ADD/WO using behavioral measures, it would appear that they cannot be distinguished on these neurocognitive tasks. Issues related to childhood psychopathology and the neuropsychological basis of ADD/H are discussed.     

Ambivalent attitudes about teaching children with attention deficit/hyperactivity disorder (ADHD)

Drawing on attitude theories from social psychology, we conducted a survey of Australian pre-service (n = 327) and in-service (n = 127) teachers’ attitudes about teaching children with attention-deficit/hyperactivity disorder (ADHD). This paper reports a content analysis of beliefs, affect and behaviours towards teaching children with ADHD and quantitative analyses pertaining to attitudinal ambivalence – that is, where a teacher may simultaneously report negative and positive evaluations of teaching children with ADHD. While on average, overall or global attitudes were mildly positive for both cohorts, considerable ambivalence about teaching children with ADHD was commonly experienced. Participants reported ambivalent beliefs, affect and behaviours, as well as ambivalence between these attitude components. Paradoxically, participants who knew more about ADHD and held stronger positive global attitudes about teaching children with ADHD reported less ambivalent behaviours towards these children, but reported more ambivalent beliefs. The implications for teachers’ professional development and training are discussed.     

The boundaries of attention deficit disorder

This report examines distinctions and interrelationships among attention deficit disorder (ADD) and two closely related conditions: learning disability (LD) and oppositional/conduct (O/C) disorder. To evaluate our hypothesis that some of the difficulty in resolving the relationship between ADD and, particularly, O/C may reflect the consequences of selective referral patterns, we studied groups of children diagnosed as ADD from different referral sources. Results suggest that referral bias does exist and that children referred to mental health settings differ from those referred to pediatricians, child neurologists, or psychologists. Because of the nature of the subjects referred to mental health services, nonrepresentative associations may emerge. Rather than being considered as prototypical of all children with attention disorder, children referred to mental health facilities may represent simply an extreme of the continuum of ADD. Evidence suggests that many children with ADD will be represented by those referred primarily for attentional deficits and learning problems, rather than those with inattention, hyperactivity, or aggression referred for child psychiatric evaluation.     

Emotion,understanding, and social skills among boys at risk of attention deficit hyperactivity disorder

There is growing interest in the role of emotional competence in middle school children's adjustment and functioning, yet many populations remain underresearched. Few studies have explored the emotional competence, especially emotion understanding, of children with, or at risk of, attention deficit hyperactivity disorder (ADHD), and even fewer have examined the role emotion understanding plays in these children's social skills. Our study investigates a profile of the emotion understanding capacities of Israeli boys at risk of ADHD and evaluates its association with their social skills. One hundred and fifty‐two boys (grades 4–6) were each assigned to an at‐risk (n = 66) or comparison (n = 86) group based on their scores on an ADHD symptoms questionnaire (Conners Rating System–Revised). The two groups were matched on age, socioeconomic status and class, and school environment. Group comparisons revealed that relative to their non–at‐risk counterparts, at‐risk boys demonstrated less mature emotion understanding. Finally, our findings indicate that poor emotion understanding plays a more notable role in the social functioning of at‐risk than non–at‐risk children. This study's contribution to the understanding and school treatment of children with ADHD emotional and social competencies is discussed. © 2009 Wiley Periodicals, Inc.     

The diagnosis of attention deficit hyperactivity disorder (ADHD) in community mental health centers: Where and when

The high degree of coexistence of attentional disorders, such as Attention Deficit Hyperactivity Disorder (ADHD), with a number of other disorders continues to pose diagnostic problems and to highlight a continuing need to differentiate better between overlapping diagnoses. The purpose of this study was to assess the extent to which this type of diagnostic confusion continues to exist in referrals for assessment of ADHD to community mental health centers. Using referrals to a specialized ADHD Clinic of our center, 92 children with a previous diagnosis of ADHD were provided comprehensive evaluations, addressing cognitive, intellectual, personality, academic, social, behavioral, developmental, and medical concerns. After comprehensive evaluation and careful review of the results, only 22% of our sample were given a primary diagnosis of ADHD and only 37% a secondary diagnosis of ADHD. Substantial numbers of children were diagnosed instead with primary anxiety and mood disorders. Reasons for this discrepancy are discussed.     

Development and testing of a direct observation code training protocol for elementary aged students with attention deficit/hyperactivity disorder

Observational measures can add objective data to both research and clinical evaluations of children’s behavior in the classroom. However, they pose challenges for training and attaining high levels of interrater reliability between observers. The Behavioral Observation of Students in Schools (BOSS) is a commonly used school-based observation instrument that is well adapted to measure symptoms of attention deficit/hyperactivity disorder (ADHD) in the classroom setting. Reliable use of the BOSS for clinical or research purposes requires training to reach reliable standards (kappa?≥?0.80). The current study conducted training observations in one suburban and one urban elementary school in the Greater Boston area. To enhance interrater reliability and reduce training time, supplemental guidelines, including 30 additional rules to follow, were developed over two consecutive school years. The complete protocol was then used for training in the third school year. To reach sufficient interrater reliability (kappa?≥?0.80) during training, 45 training observations were required in the first year while, in the third year, only 17 observations were required. High interrater reliability was sustained after training across all three school years, accumulating a total of 1,001 post-training observations. It is estimated that clinicians or researchers following this proposed protocol, who are naive to the BOSS, will require approximately 30 training observations to reach proficient reliability. We believe this protocol will make the BOSS more accessible for clinical and research usage, and the procedures used to obtain high interrater reliability using the BOSS are broadly applicable to a variety of observational measures.     

Children with attention-deficit/hyperactivity disorder: A review of the literature on social skills deficits

Social interactions between children with Attention-Deficit/Hyperactivity Disorder (AD/HD) and their teachers, peers, and parents are discussed. The extent to which these interactions may be termed problematic may depend on the social skills deficits displayed by this population. Although the general trend in the liternature has been to examine and describe children with deficient social skills, changing the focus to children with AD/HD who are not experiencing these difficulties may prove beneficial. A review of the previous literature is discussed, as well as suggestions for practice and future research needs.     

Comparison of Quebec and British teachers' beliefs about,training in and experience with attention deficit hyperactivity disorder

Abstract

This study compares belief patterns of teachers from Quebec and Britain about attention deficit hyperactivity disorder (ADHD). It also compares teacher training in ADHD in both countries, as well as their experience with students who have this disorder. The results indicate that: (1) teacher belief patterns about ADHD in Quebec and Britain are different, although teachers from both countries have predominant beliefs about ADHD that are of an allopathic medical nature; (2) British teachers have received less information on ADHD in their initial training than Quebec teachers; and (3) British teachers are contacted more often than Quebec teachers by doctors when they have a youngster using medication to treat ADHD in their classroom. Results are discussed from a sociological and an educational perspective.