When someone presents for evaluation and treatment of ADHD, what does your treatment plan look like? Sure medications are often considered, and hopefully also some parent behavioral coaching too. Anything else? A new meta-analysis, recently published in the Journal of the American Academy of Child and Adolescent Psychiatry, provides some strong evidence about the the cognitive benefits associated with physical activity.
The meta-analysis examined 36 studies, mostly randomized-controlled trials. Over 5,000 children were in the interventions in total and children (taken from the general population and not specifically targeting those with ADHD) ranged in age from 4 to 14. Most of the physical activity programs occurred at school. With a few exceptions, these program increased physical activity from 15 to 120 minutes per day for 4 to 54 weeks.
Overall, 29 of the 36 studies showed gains related to the physical activity intervention and core executive functioning. Significant effects were also found for working memory, selective attention, cognitive flexibility, and metacognition (more global measures of cognitive ability).
The authors concluded that physical activity programs can be effective for promoting many cognitive domains in youth, and they note that this increasing evidence comes at the same time that many physical education programs at school are being cut back.
While the benefits of exercise certainly appear to be present for children in general, primary care physicians would do well to keep these kinds of studies in mind when working with children who meet criteria for ADHD.
The hope is that the Assessment/Plan section of your progress note might change from something like this……
A: ADHD P: methylphenidate
To something like this…..
A: ADHD P: methylphenidate, parent behavioral therapy, daily physical activity, reduction in screen time, nutritional counseling, reading outside of school, mindfulness training, sleep hygiene counseling
Easier said than done of course, but these important and evidence-based elements will never get addressed if they don’t even get into the treatment plan.
Reference
Alvarez-Bueno C, et al. The Effect of Physical Activity Interventions on Children’s Cognition and Metacognition: A Systematic Review and Meta-Analysis. JAACAP 2017:56(9):729-738.