The Effect Of Exercise On Core Symptoms And Social Function Of Children With Attention Deficit Hyperactivity Disorder

Purposes:The prevalence of attention deficit hyperactivity disorder(ADHD)is increasing every year,which seriously damages children’s physical health,reduces their quality of life,and causes mental and economic burdens to families and society.Recent studies on exercise interventions to improve ADHD have confirmed the effectiveness of exercise interventions for this population.This study aims to investigate the effect of an exercise intervention on improving core symptoms,social functioning,and behavioral problems in ADHD using a combination of subjective and objective assessment methods and to provide a theoretical and practical basis for an exercise intervention in ADHD.Methods:This study is a randomized controlled trial.From May to August 2021,in cooperation with Shanghai Children’s Medical Center affiliated to Shanghai Jiao Tong University School of Medicine,a total of 82 subjects(72 males and 10 females)were recruited,and finally 40 eligible subjects were screened out.After stratification by medication status,the subjects were randomly assigned to the exercise intervention and waiting-list control groups.The intervention group received 20 sessions of aerobic exercise intervention,90 minutes per session,six times a week.Using the SNAP-IV,the Weiss-P,the PSQ,and IVA-CPT to evaluate the improvement in core symptoms,social functioning and behavior problem of ADHD children before and after the aerobic exercise intervention.Stratified analysis based on medication use was also conducted to explore the effects of an exercise intervention on ADHD improvement under different medication conditions.The data were analyzed using SPSS 26.0,We compared data differences between baseline and post-test within each group using paired samples t-tests,and compared data change values between groups using independent samples t-tests.Results:Within-group comparsions showed that after 20 sessions of aerobic exercise intervention,the intervention group had significantly lower scores on the inattention(t=-5.76,p <0.05,Cohen’s d =-1.36),hyperactivity-impulsivity(t =-3.39,p <0.05,Cohen’s d =-0.80),and oppositional-defiant(t =-3.78,p <0.05,Cohen’s d =-0.89)dimensions of the SNAP-IV scale,the family(t =-2.21,p <0.05,Cohen’s d =-0.52),life skills(t =-2.35,p <0.05,Cohen’s d =-0.56),social activities(t =-2.91,p <0.05,Cohen’s d =-0.69),and adventurous activities(t =-2.98,p <0.05,Cohen’s d =-0.70)four dimensions of the Weiss-P scale,as well as two dimensions of conduct problems(t =-2.18,p <0.05,Cohen’s d =-0.51)and hyperactivity index(t =-2.86,p <0.05,Cohen’s d =-0.67)on the PSQ scale.There are no significant difference in waiting-list group(p>0.05).The between-group analysis revealed that the intervention group had significant lower score change values on the learning and school dimension(t =-2.28,p <0.05,Cohen’s d =-0.75)of the Weiss-P scale,and the hyperactivity-impulsivity(t=-2.18,p <0.05,Cohen’s d =-0.72)and hyperactivity dimensions(t =-2.48,p <0.05,Cohen’s d =-0.82)on the PSQ scale.Further stratified analysis according to whether or not taking medication showed that:(1)among subjects taking medication: intervention group had significant lower scores on the inattention(t =-3.22,p <0.05,Cohen’s d =-1.08)and oppositional defiant(t =-2.80,p <0.05,Cohen’s d =-0.93)two dimensions of the SNAP-IV scale,the learning and school(t =-2.34,p <0.05,Cohen’s d =-0.78),adventure activities(t=-4.83,p <0.05,Cohen’s d =-1.61),and social activities(t =-3.32,p <0.05,Cohen’s d =-1.11)three dimensions of the Weiss-P scale,and the hyperactivity dimension of the PSQ scale(t =-2.48,p <0.05,Cohen’s d =-0.83)compared to the pretest scores.(2)among subjects not taking medicaiton: the intervention group had significant lower scores on inattention(t =-5.10,p <0.05,Cohen’s d =-1.70),hyperactivity-impulsivity(t =-3.01,p <0.05,Cohen’s d =-1.00),and oppositional defiant(t =-2.41,p <0.05,Cohen’s d =-0.81)three dimensions of the SNAP-IV scale,and the life skills dimension of the Weiss-P scale(t =-3.19,p <0.05,Cohen’s d =-1.06)compared to the pretest scores.In addition,intervention group had significantly lower score change values on inattention(t =-4.49,p <0.05,Cohen’s d =-2.12)and oppositional defiant(t =-3.71,p <0.05,Cohen’s d =-1.75)two dimensions of the SNAP-IV scale,the family dimension of the Weiss-P scale(t =-2.41,p <0.05,Cohen’s d =-1.14),and the hyperactivity dimension of the PSQ scale(t =-2.30,p<0.05,Cohen’s d =-1.08)compared to the waiting-list group,the difference was statistically significant.In terms of the neuropsychological test,the stratified analysis according to whether or not taking medication showed that:(1)among subjects taking mediaction:waiting-list group’s score on the Control-Vision dimension of IVA-CPT decreased significantly at post-test compared to pre-test(t =-2.47,p <0.05,Cohen’s d =-0.82).The inter-group comparison showed significant differences in the change values of the Control-Vision(t =-2.74,p <0.05,Cohen’s d =-1.26)and Control-Composite(t =-2.12,p <0.05,Cohen’s d =-0.97)dimensions.(2)among the subjects not taking medication: The intervention group’s scores on IVA-CPT test did not change significantly before and after intervention,and there was no significant difference between the difference before and after intervention and the difference of waiting-list group(p>0.05).Conclusions:The 20-session exercise intervention can effectively improve core symptoms,social function and behavioral problems with ADHD.In addition,the results of subgroup analysis showed that medication may affect the positive effects of exercise on core symptoms and social functioning of children with ADHD to some extent.