Effects of Exercise and Sport on Impulse Control in Children with ADHD

Abstract

People often cannot control doing something they are aware of and ADHD children are especially susceptible to being unable to control their impulses. The researcher for this study suggests that exercise and sports could improve impulse control in children from the ages of five to twelve that have been diagnosed with ADHD. The researcher hypothesizes that participants with ADHD will show significant improvement on an impulsivity task after engaging in mediated physical activity, compared to results from the same task without exercise. A control group without ADHD will also attempt the impulse control task, which is “The Quiet Game” before engaging in physical activity and after, too. The researcher expects the results to likely show the performance of ADHD children improved after physical activity was completed. If the researcher could affirm that impulse control in ADHD will improve beyond the participants that do not have ADHD after engaging in sports activity, that would be ideal but there probably will not be a difference that significant in the statistics. In the future, the researcher should examine the relationship between ADHD and impulse control further with new tasks, as well as different age groups.

Keywords: ADHD, impulse control, physical activity, sports

Can Sports Affect Impulse Control in Children with ADHD?

People are easily distracted by new things in their environment, especially when something is unfamiliar to them. In fact, it is often a challenge to ignore the immense desire to resist that stimuli in their surroundings, which is related to impulse control with stimuli people are already familiar with and enjoy. People with attention deficit hyperactivity disorder, or ADHD, struggle to pay attention or control themselves from doing something at that exact time interval. This lack of control regarding attention does not get better and in fact, folks often have to do everything in their power just to maintain it. The researcher of this proposed study attempts to remedy a lack of control over one’s impulses through physical exercise.

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Behavior in a sports setting is important to consider for the current study. Research conducted by Rosen and Johnson in 2000 compiled and analyzed sport behavior of male children with ADHD and male children without ADHD (Rosen, et al., 2000). Their study is a basis for investigating differences between ADHD and non-ADHD children. A total of 75 male children were recruited, 34 had been diagnosed with ADHD and 41 were not.  Parents of participating children completed a questionnaire packet regarding their child’s behavior in team and individual sports. The Sports Behavior Checklist was used to discuss which sports the children partook in, as well as for how long they stayed in the sport. Plus, the parents recorded how their aggression and other emotions were throughout, as well as rate of disqualification. In summation, the results showed two strong associations. One was that there was an association between having ADHD and sport behavior across individual and team sports settings. The second association was there was a relationship between sport setting and sport behavior in spite of having ADHD. It was revealed that children with ADHD show higher levels of aggression than non-ADHD peers. Also, ADHD children were more likely to get disqualified in the middle of the sports activities. However, both ADHD and non-ADHD children showed that aggression and disqualification were more frequent in a team sports setting, significantly. Research in aggression of ADHD children and non-ADHD children could relate to impulse control, which would explain why non-ADHD children might express their hasty tendencies in athletic settings and those with ADHD would do better in individual sports.

A group of researchers in another study investigated the impact of a summer treatment program, or STP, on children with ADHD. The goal was to compare whether or not kids with ADHD could be encouraged to partake in sports and see if teambuilding skills and knowledge of sports cold contribute to improved motor efficiency (Connor et al., 2014). Participants in this intensive behavioral treatment program study included 98 children who were diagnosed with ADHD. These children were part of another study that examined how behavior therapy and stimulant drug medication could influence their initiation rates of playing on team sports. The children were split into groups with a ratio of one counselor to every three children. The treatment group showed significantly greater improvements on measures of game knowledge and in-game performance tasks for soccer and tee-ball, motor proficiency, appropriately trapping a soccer ball, reducing the number of handball penalties while dribbling a soccer ball, and catching a baseball. The past study’s results show that children who attended the STP had significantly greater improvements on functional measures of sports outcomes such as tee ball performance or catching a handball. Children whom did not attend the STP did not show significantly great improvement in their strategizing in sports and children with ADHD did better after the STP with the intervention given by the STP. Training the children in a sports setting significantly improved sport functions, especially committing fewer errors in ADHD children, which suggests that sports functioning in children could improve.

The goal of a previous study conducted by Kiluk and Weden in 2009 was to see if there were psychological benefits, particularly with improving mood and reducing anxiety in children with ADHD (Kiluk, et al., 2009). The study wanted to see if there was a relationship between physical activity participation and better emotional regulation. The researchers collected scores from the parents’ own reports of measures of behavior and of their children. Those were then compared with a group of 65 other ADHD children, based on sports participation, ranging from ages 6 to 14. The ADHD group of children with 32 children that had learning disorder were compared. The researchers found that children with ADHD who participated in three or more sports presented less anxiety or depression symptoms compared to children with ADHD that participated in less than three sports. As for a significant difference in terms of improved mood or less anxiety-related symptoms between the two groups, there was not one. The study advises that sport participation could be associated with less anxious and depressive symptoms in children with ADHD. There needs to be an objective measure of physical activity in the future. Parents had reported their kids with low-mood symptoms, which may not be as objective to the study since children have their own standards of feeling anxious and depressed compared to what their parents might notice. Children with ADHD would be at greater risk for not performing well while experiencing anxiety or depression, which would make staying on task more difficult. Physical activity may serve as a remedy but it should be combined with traditional medicine used to curb ADHD tendencies. Despite this study being slightly dissimilar to the intended study, exercise had an impact on mood in children with ADHD. Thus, ADHD children can most likely be impacted by exercise in other aspects like impulse control.

The study by Böhm, et al. in 2004 investigated the impact of emotions on behavior and those aspects can potentially be at risk for ADHD, if also born preterm. The authors sought to propose a theory in which emotions were suggested to be causes of behavior, indirectly. This group wanted to convey that emotions drive behaviors by saying that it works as a feedback system that reacts to behavior instead, without sorting emotions into different categories. The researchers collected data from cohorts of infants that were born between 1988 and 1993 and were comprehensively studied with the Nepsy neuropsychological Swedish battery test with 19/46 subtests, when they reached age 4-7. Impulse control was one of the main categories tested. The children had to follow the examiner’s instructions to point when hearing “ceiling and floor” but not “window”. Also, children were tested to see if they could do the opposite of what the researcher demonstrated. Next, they were tested to see if they could hold their arm at a bent position, while scored every 10 seconds. Last, children were asked to sit and close their eyes while being provoked into opening their eyes and were scored every ten seconds of succession. The controversy of emotions relating to self-defeat or reckless behavior towards the self was unpacked. Emotions can affect cognitive processes, which can get lapses in judgement to appear frequently just because of a need to satisfy internal gratification quicker. In conclusion, the researchers found association with gender and brain chemistry that can lead to children developing ADHD in time, if born prenatal, and are more likely to be impulsive but found no significant data to support distractibility between groups of children with attention disorders and children without those and other dysfunctions. This study did not directly address exercise and its role in regulating impulses, but gives insight as to what other tests could be conducted to measure impulsivity for the future study.

Another study on emotion and its effect on decision making was completed and related to how children can learn regulation strategies from sports participation. The researchers of this study focused on whether or not operational sports organizations can help with improving emotional intelligence abilities, as well as ways to regulate emotions (Wagstaff, et al., 2012). Researchers interviewed 21 participants from different places in the sports industry, ranging from “athletes, coaches, administrators, national performance directors, to chief executive officers.” Core criteria for inquiry in this study involved identifying, processing, and managing emotions by using techniques such as “forward-tracking, back-tracking, reappraisal, suppression, and impulse control”. Participants in the interview were asked to discuss their daily routines and emotions that accompanied them from within the sports organizations they were a part of. Later, participants were asked about challenges that hampered or promoted their ability to adapt new circumstances. Then, the interviewer asked about strategies used by the participants in order to promote continuous interactions with fellow teammates. Finally, the participants told the interviewers their own potential suggestions for emotional regulation that could help others. The study felt that it had accomplished its goal of finding how members of various stages in the community were able to regulate their emotions while in their sports organizations. The results showed identifying, understanding and executing emotions depended on context, which would vary in different contexts. Emotions could be influenced by social norms, meaning that the study did not indicate the development of emotion abilities. Emotions seem to not be related with the future study but by studying them, the potential they have of influencing in-the-moment decisions is mentioned by the researcher as a key point. Emotions determine how an individual might act; if the individual has pessimistic emotions in their mind, their actions are likely to be impulsive and not thought out thoroughly. Not only can emotion be directly linked to how controlled one’s impulses may be but it also serves to be a baseline for how exercise can mediate brash decision making.

Recently, researchers conducted a meta-analysis on experiments on 579 individuals from ages 3-25 years old that had ADHD, as well as individuals with autism-spectrum disorder, or ASD, ranging from toddlerhood to young adulthood (Tan et al., 2016). The researchers’ objective over their half year of reviewing past research from 22 studies, was to determine whether or not physical activity affected cognition in these individuals. 16 experiments focused on children with ADHD while 6 focused on children with ASD. Participants were assigned on-task duration and simple learning tasks. The results yielded that there was an effect of exercise on cognition. The overall mean effect size taken from each of the 22 studies indicated that there was similar to the overall effect size of children without learning disabilities. Exercise had an effect pertaining to on-task assignments than simple-learning tasks, such as the number of correct answers regarding to coin values. Aerobic exercise only had an effect on certain aspects such as limiting inhibition in ADHD individuals but no other realms of cognition were noticeably different. Exercise, overall, helped ASD individuals with cognition more than it did ADHD individuals. ADHD individuals would benefit from exercise, but the future study hopes to conclude that there is a correlation between exercise in ADHD children and extra effort to regulate impulses from exercise with specific measures and tasks that are not as vague as the procedures given by the past study with rough effect size limitations or tasks not fully explained.

In another experiment, researchers conducted a study of participants from late childhood to early adolescence regarding aerobic exercise and its potential effect on inhibiting impulses (Ludyga et al., 2017). Also, the researchers hoped to understand where attention goes in controlling impulses before acting upon them. Eighteen children had ADHD, 7 females and 11 males, and the other eighteen, 8 females and 10 males, did not. Research was conducted in a lab and the children had to complete Flanker tasks, which ask the participants hit two keys on the keyboard that correspond with the central letter in a string of letters that changes but those keys represent other letters like C and X. The participants were asked to do so before and after 20 minutes of aerobic exercise. Reaction time decreased after exercise, compared to being measured before exercising. The researchers also had a control group of children watch a video on exercise behavior, in place of the actual exercise. Afterwards, an echocardiogram was used to measure children’s heart rates and the results found that the single instance of physical exercise impacted the participants’ attention and behavior. More specifically, aerobic exercise had more of slowing down of impulses effect than coordinative exercise in ADHD children. On the other hand, there were no significant differences to be found in children without ADHD that did aerobic and coordinative exercise. As for functions that were not related to inhibition, the researchers were unable to find exercise helped with greater cognitive developments in both groups of participants, which suggests cognition and inhibition do not necessarily function in tandem.

Other countries have researched effects of physical exercise effects on ADHD impulsivity, too. In China, researchers studied the effect of aerobic respiration for half an hour on forty ADHD children between the ages of eight and fifteen (Chang et al., 2012). The control group of children watched a video on exercise during that time the experimental group exercised. The participants’ executive functions were recorded before and after each condition with the Stroop test and the Wisconsin Card Sorting Task (WCST).  The Stroop test asked participants to identify the color of ink verbally in as little time as possible and involved the Stroop Word, Stroop Color, and Stroop Color-Word subtests with 50 trials each. The Wisconsin Card Sorting Task tested executive functioning by asking participants to look at four stimulus cards and 128 response cards, in which they had to sort response cards based on categories listed on the stimulus cards. The results found that the exercise did have an effect on both the Stroop test and the WCST. Particularly, exercise had the greatest influence on the Stroop Color-Word condition and the Non-Preservative Errors and Categories Completed parts of the WCST. However, the past study aims to overcome the challenge the Stroop Test poses towards measuring inhibition since it was said does not need suppression of impulses among multiple stimuli or processes, which would make it difficult to use all trials of the Stroop Test for the intended study, in the future.

The researcher hypothesizes that there will be a correlation between exercise and impulse control in children with ADHD. Children between the ages of five to twelve will engage in physical activity, including one group of children that have been diagnosed with ADHD and are non-ADHD children.  Children with ADHD are expected to employ greater control over their impulses of completing the task assigned to them by researchers after physical activity. Also, the researcher hopes that there will be a significant difference between children with ADHD after physical exercise compared to children without ADHD after exercise. It would be pivotal that the researcher finds that the ADHD group of children demonstrates an enhanced control over the ability to carefully consider their options before making a decision impulsively on the task after participating in the physical activity.

Method

Participants

This study hopes to have a total of 40 participants (N = 40). The participants will be between the ages of five to twelve years old. Children under the age of five and individuals over the age of twelve will not be studied. A total of 20 children who have been diagnosed with ADHD before the study with impulsive behavior will be asked to partake.  The possibility of random selection will not be available. Parents will be given questionnaires to disclose their children as having ADHD or not in order to facilitate the screening process. Every child must also volunteer on their own and with their guardians’ permission, with the ability to secede at any point they wish. It is expected that more males than females with ADHD will be included in the study. The subjects will be joined by 20 other male and female children without ADHD, as a control.

Materials

Two forms will be created and used throughout the experiment: a recruitment form and a questionnaire. The recruitment form allows the researcher to select participants diagnosed with ADHD and have been known to display impulsive behavior. The questionnaire will be used to for data collection regarding the diagnosis of the child. Plus, it will ask parents how involved their children are in sports or any physical activities and the control group of participants will be selected, based on them not being diagnosed with ADHD.

Procedure

First, the researcher will have to recruit enough children to participate in their experiment. A survey regarding the behavior of their child will be completed by parents and guardians. They must indicate whether or not their child is already involved in sports or physical activities in their daily routine. After recruiting the participants, the researcher would not disclose which group each child is in and engage them in playing “The Quiet Game”, with the goal of seeing who could remain silent for the longest period of time. The researcher will be measuring impulsivity in two measures, including how long in minutes and seconds an individual can endure being silent, as well as how often constant fidgeting occurs. The researcher will then compare how well the children with ADHD performed, with the children without that diagnosis. Afterwards, the participants will then be asked to engage in a game of soccer together, divided by a team of ADHD children and non-ADHD children, unbeknownst to them. Proceeding that, the participants will be asked to engage in another round of “The Quiet Game”. Subsequently, the data will be collected again regarding the stamina the children have to uphold silence. Finally, the researcher will associate the results from before the soccer game to the results after the soccer game and come up with a relationship between exercise and impulse control.

Results

A two sample t test would be used. The purpose is to establish if impulsivity levels and behavior in children diagnosed with ADHD can be regulated with participation in physical activity. At the beginning a baseline between sport participants and non-sport participants’ impulsive movements will be established. Generated results likely should show that children already in sports would have statistically significant low levels of impulse control compared to those that were not. The researcher also predicts that there will be a statistically significant decrease in impulsivity levels in children with ADHD after playing in the soccer game. With these intended results, then the researcher could make the conclusions that affirm their hypotheses. These findings may also not occur. In such scenarios, the results would not be enough substantiation to conclude that sports and physical activity have an effect on impulse control, especially in children with ADHD.

Discussion

The study will not be without its limitations, despite the researcher’s best efforts to attend to them all. For example, one stipulation of the intended study is that researchers would not be able to use random selection to recruit participants. Normally, that is the most efficient way to prevent in group biases from occurring but this is necessary because there would not be enough children with ADHD. To avoid that and trying to satisfy the quota of N = 40, the researcher will ask parents if their child has been diagnosed with ADHD, which would jeopardize the results of the study due to the relatively small sample size. The chances of researchers finding willing participants will be unlikely because a social stigma related to mental health exists, especially towards ADHD. Many parents do not want this circumstance to affect how their child is treated by anyone else in the community. The connotations affiliated with being ill, especially mentally, enables others to impinge their lives due to a lack of understanding or empathizing. Many people are reluctant to treat children with ADHD as normal children, if they knew their peers had it and the parents of the other children would likely advise their own kids not to interact with ADHD children. The complexities that occur in the minds of those with ADHD are not attempted to be understood and unforeseen tensions may arise that result in participants seceding from the study mid-way, although that is not sure to happen but a possibility, albeit, it could happen, nonetheless.

Additionally, the researcher should also expect to have a disproportionate number of male participants to female participants. It is more common for males to be diagnosed with ADHD. The researcher will likely find it difficult to find ten ADHD females to satisfy the sample size intended, which might potentially create a gender bias that skews in favor of or not in favor of proving their hypothesis correct. Many female children might have to be screened for ADHD in advance, to keep the timespan of the experiment as intended. However, if the screening process does not work, the researcher may have to select a smaller, equal number of males and females in their study in order to compare gender differences in the results.

The intended study focuses on impulse control in children with ADHD. The participants may be as young as five years old, and they may have more difficulty controlling impulses, regardless of having ADHD or not. Younger children in the data could distort the results that shows impulse control cannot be furthered by exercise or physical activity. An oppositional effect could also happen. Older children are able to control their impulses better because of prior experiences, which could then negatively affect the results, as well. Concluding whether physical activity aids in controlling impulses for children or if it was based on learning based on peer feedback is not accurate. Furthermore, the age range of the participants may affect the results. Some children will be more reserved and control their impulses, as aforementioned, or one person not controlling their impulses could lead to other children copying the same thing.

The task that will measure impulsivity is “The Quiet Game.” This activity is unpredictable, even though it has most likely been experienced by many of the participants but is not always the easiest to continue. Some of the kids will get restless, regardless of having ADHD or not. Some kids might distract the other participants by fidgeting and making faces. Other participants might break out in laughter and cause a chain reaction to ripple through all of the participants. Simultaneously, children can be unpredictable how long they choose before conceding in “The Quiet Game” plays a role, too. In the future, it may be helpful to introduce a time limit, to prevent the restlessness to get the better of too many too fast, as well as preventing those with immense endurance to not stick it out for hours on end, thus disabling the impulse task from being allowed to take place.

The study intends to determine if a relation between physical activity and impulse control in ADHD children from the ages of five to twelve exists. ADHD children are thought to perform significantly better in “The Quiet Game” after physical activity than without being physically active. Between the children with ADHD and those without ADHD, there is expected to be a significant different, too. The study is not, however, expecting to find significance between the impulse control of children without ADHD and ADHD children after exercising. There will be a statistically significant difference between males and females with ADHD, if an equal number of male and female participants can be satisfied. More data could be collected about differences between males and females with ADHD. The researcher may also choose to study how different physical activities help with impulse control, such as how soccer and yoga would have an effect on ADHD and non-ADHD children’s impulses. The study be improved further by encompassing diverse types of impulse control tests that include but are not limited to, decision making and endurance. Comprehension of impulse control in not only neuro-typical people, but especially those who have ADHD will be greatly advanced.

References

• Böhm, B., Smedler, A-C., & Forssberg, H. (2004). Impulse control, working memory and other executive functions in preterm children when starting school. Acta Paediatrica, 93, 1363-1371.
• Chang, Y., Liu, S., Yu, H., Lee, Y. (2012). Effect of acute exercise on executive function in children with attention deficit hyperactivity disorder. Archives of Clinical Neuropsychology, 27(2), 225-237.
• Johnson R. C. & Rosen L. A. (2000). Sports behavior of ADHD children. Journal of Attention Disorders, 4(3), 150-160.
• Kiluk, B. D., & Weden, S. (2009, May). Sport Participation and Anxiety in Children with                 ADHD. Journal of Attention Disorders, 12(6), 499-506.       
• Ludyga, S., Brand, S., Gerber, M., Weber, P., Brotzmann, M., Habibifar, F., Puhse, U. (2017). An event-related potential investigation of the acute effects of aerobic and coordinative exercise on inhibitory control in children with ADHD.  Journal of Developmental Cognitive Science, 28, 21-28.
• O’Connor, B.C., Fabiano, G.A., Waschbusch, D.A. et al. Effects of a Summer Treatment Program on Functional Sports Outcomes in Young Children with ADHD. Journal of Abnormal Child Psychology (2014) 42: 1005.
• Tan, B.W.Z., Pooley, J.A., Speelman, C.P. J. (2016). A Meta-Analytic Review of the Efficacy of Physical Exercise Interventions on Cognition in Individuals with Autism Spectrum Disorder and ADHD. Journal of Autism Developmental Disorders, 46(9): 3126-3143.
• Wagstaff, C. R. D., Fletcher, D., & Hanton, S. (2012). Exploring emotion abilities and regulation strategies in sport organizations. Sport, Exercise, and Performance Psychology, 1(4), 268-282.