Een niet-medicamenteuze behandeling voor ADHD en waarom het werkt?september 9, 2019
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According to the National Health Interview Survey, the prevalence of ADHD in children 4-17 years of age was 10.2% in 2015-2016 (1). ADHD is a neurological condition that affects brain functions important for school and work success. The condition most noticeably impacts a group of cognitive functions, known collectively as executive control. These include inhibition, working memory and cognitive flexibility. Inhibition is the ability to resist distraction and maintain focus. Working memory is the ability to hold and manipulate information in use. Cognitive flexibility is the opposite of rigidness. According to the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), there are three types of ADHD: Hyperactive-Impulsive, Inattentive (previously ADD) or combined.
Children with the hyperactive type act as if they are driven by a motor and have poor impulse control. They tend to find it challenging to sit still in a traditional classroom. Children with inattentive ADHD (formally known as ADD) are frequently overlooked because they can sit still. But, as school work becomes more demanding, their ADHD symptoms become obvious. They are easily distracted, forgetful and day dream. The combined type is a combination of the hyperactive and inattentive.
ADHD symptoms negatively impact executive functioning, leading to weak impulse control, poor decision making, difficulty shifting from one task to another. In turn the child becomes frustrated and this manifests as behavior problems and emotion dysregulation. Treatment is essential in reducing the child’s frustration and increasing their daily functioning. It is likely that a combination of treatments for ADHD would be most effective. Many studies have pointed to a protective solution, exercise.
In one study, researchers randomly assigned 8-9 year olds to a 9 months after-school fitness program (FITKids) or to a wait-list control group (2). All participants performed cognitive tasks that assessed attentional inhibition and cognitive flexibility while measuring brain electrical activity before the intervention (fitness program/wait list) and after. Researchers focused on a brainwave signature for attention, working memory and cognitive processing speed (P3).
The fitness group improved more than the wait-list group on accuracy and speed on the executive control tasks. Notably, the brainwave signature for focus/attention was more intense in the fitness group than the control group. This brain component was significantly greater in magnitude and arrived faster for the fitness group.
There are many studies vouching for the “exercise prescription” for ADHD. Another study published in the Journal of Attention Disorders, showed that moderate to vigorous exercise for 45 minutes, three times a week improved cognitive functions and behavior in children with ADHD (3). They were faster and demonstrated more efficient information processing.
One study showed similar results but added an important consideration: sex. Any parent/doctor/teacher will tell you that boys and girls wear their ADHD symptoms differently. According to this study, boys require more vigorous exercise than girls to collect the benefits of exercise on attention (3).
In sum, these results indicate that exercise increases focus and accelerates cognitive processing in children with ADHD.
Why would exercise improve ADHD symptoms?
- Exercise is an excellent outlet for stress, which exacerbates symptoms
- Exercise absorbs the useless anxious energy and alleviates anxiety. And of course, anxiety disturbs attentional processes and other cognitive abilities.
- Exercise increases chemicals called brain-derived neurotrophic factors. These neurotransmitters are crucially involved in learning and memory. Some studies have suggested that people with ADHD have a shortage of these nurturing chemicals.
- Exercise targets many of the same neurotransmitters involved in ADHD and medicinal treatments.
- For the hyperactive type, exercise can be a useful way to release excessive energy “fidgetiness”.
- In general, higher level of fitness leads to a healthier brain and body. Indeed, a diseased mind or/and body can severely interrupt cognitive faculties such as attention.
But what kind of exercise?
Many children who suffer from ADHD have low self-esteem and confidence. I would advise parents to stay away from highly competitive sports that require challenging schedules and a very fast pace- unless the child is naturally talented, for example s/he is 6 feet tall and wants to play basketball. Sports such as cross-country might be best for children/teens with ADHD. Most importantly is to find something your child enjoys and encourage and support them to routinely engage in it.
Treatment decisions can be difficult given the side effects of medications and cost and time commitment of behavioral therapy. But regardless of the chosen treatment, exercise can be an excellent therapeutic adjunct for treatment.
(1) Xu, Guifeng et al. (2018). Twenty-Year Trends in Diagnosed Attention-Deficit/Hyperactivity Disorder Among US Children and Adolescents, 1997-2016. JAMA Network Open, 1(4):e181471.
(2) Hillman, C. H. et al. (2014). Effects of the FITKids Randomized Controlled Trial on Executive Control and Brain Function. Pediatrics, 134(4), e1063-1071.
(3) Ratey J. J. Spark: The Revolutionary New Science of Exercise and the Brain. New York, NY: Little, Brown and Company, 2008.