Running Head: EXERCISE AND ADHD

EDPS 654 Research Paper: The Effects of Exercise on Children with Attention Deficit Disorder
Christina Majcher
University of Calgary
15 November 2012

Exercise and ADHD

In my career as a special education teacher, the neurodevelopmental condition that seems

to cause the most frustration to classroom teachers is attention deficit hyperactivity disorder
(ADHD). Every staff room has stories of teachers whose otherwise calm demeanors have been
challenged by students diagnosed with ADHD. Often first identified in elementary school- aged
children, ADHD persists into adolescence and early adulthood (Barkley, 2003). Identified by the
core symptoms of inattention, impulsivity and hyperactivity, children diagnosed with ADHD also
present with many neurocognitive deficits (Barkley, 2003). When a child with these challenges
is asked about their favorite parts of school, they are often quick to reply with recess, lunch and
gym class. Often misinterpreted in the past as a behaviour disorder, Dr. Rosemary Tannock
(2007) notes that ADHD is associated with structural and functional differences in the brain,
specifically those regions that support critical psychological processes (para. 4). How does
ADHD affect a childs ability to mange in a classroom? Do the neurodevelopmental learning
deficits associated with ADHD impact a childs school performance? Are there strategies and
interventions available other than pharmaceuticals to help both the physiological needs and
neurodevelopmental basis of this disorder? This paper will review current literature on ADHD,
the impacts of this disorder on learning and the efficacy of exercise as an intervention. In
addition, it will look at a case study of a child with a diagnosis of attention deficit hyperactivity
disorder to identify if exercise may help improve his abilities within the classroom.
Before examining the effects of exercise, this paper will examine research regarding the
challenges often associated with ADHD, particularly the relationship with memory and attention.
Memory and attention are cornerstones to a childs success at school. A critical component of
the elementary school curriculum is the students ability to attend to the teacher, retain
instructions or directions and then follow through to complete the task. The importance of

Exercise and ADHD

attention and memory are particularly evident in the elementary school grades when children are
still acquiring these vital processes of intellectual functioning. Many peer-reviewed articles have
examined the role of attention and memory challenges in learning.
Memory affects learning. McCloughlin and Lewis (2008) state, memory is the ability to
recall previously learned material(p. 245). Children can have varying abilities and performance
with all aspects of memory, affecting various areas of their school curriculum. Memory is
necessary for all aspects of our lives and everything we do, from perceiving the world,
synthesizing and analyzing information to applying knowledge to new situations (Weiss, 2000).
Attention is also highly interconnected with learning. McCloughlin and Lewis (1992)
described attention as the process whereby an individuals awareness is directed towards some
stimulus or set of stimuli (p. 245). In the classroom, attention abilities are evident by a students
ability to focus on one thing while ignoring distracting elements of the environment around
them. Memory and learning are so interconnected that they are inseparable (Klingberg, 2008;
Weiss, 2000). Chun and Turke-Brown (2007) pose, one of the most important problems for
21st century neuroscience is to understand how attention regulates the processes that stabilize
experiential memories (p. 177). Understandably, learning can be very difficult for children who
experience deficits with memory and attention.
Children diagnosed with attention deficit hyperactivity disorder often experience a great
deal of challenge with these important cognitive functions. Research over the past several
decades has shown that ADHD is associated with subtle but significant structural and functional
differences in the brain, particularly areas that support the critical psychological processes of
executive functioning, memory, learning and speed of processing (Tannock, 2007). These
significant deficits in memory and attention seriously impact a childs success in the classroom.

Exercise and ADHD

When a child has difficulties planning, updating working memory, shifting attention from one
mental task to another while inhibiting impulsive behaviour, they are likely to find school very
challenging (Tomparoski, Davis, Miller & Naglieri, 2008). Why do children with ADHD have
such a hard time with these skills?
Our neurogenetic understanding of ADHD has significantly increased over the past
decade along with the field of neuropsychology (Barkley, 2003). We now know that this
disorder is associated with neurochemical abnormalities, with strong evidence suggesting
interactions in the dopaminergic and noradrenergic systems, particularly a lack of dopamine or
norepinephrine (Barkley, 2003). Studies have demonstrated deficits in the prefrontal cortex
region, decreased blood flow to the prefrontal cortex region as well as pathways that connect this
region to the limbic system (Barkley, 2003). One widely accepted hypothesis shown to play a
role in the pathophysiology of ADHD has been dysregulated dopamine (Wigal, Emmerson,
Gehricke & Gallasetti, 2012). Wigal and her colleagues (2012) note that the prefrontal cortex
and dopaminergic systems interact as a regulated network that is associated with cognitive and
behavioural control (p. 1).
Several studies have shown that dopamine levels increase in the prefrontal cortex when
performing tasks requiring working memory (Wigal et al., 2012). When dopamine receptors are
obstructed in the prefrontal cortex, there are working memory deficits (Wigal et al., 2012). This
has led researchers to hypothesize that a dysregulation in dopamine levels of the prefrontal
cortex is associated with some of the cognitive impairments associated with ADHD, particularly
attentional impairments (Wigal et al., 2012). In addition, researchers have been examining the
effects of norepinephrine to assist with attention regulation, working memory and behavioural
inhibition (Wigal et al., 2012). As noted by Wigal and her colleagues (2012), low concentrations

Exercise and ADHD

of norepinephrine in the prefrontal cortex have also been associated with impairments in working
memory and executive functioning. Many stimulant medications have been created to help
improve the functioning of critical brain systems thereby increasing daily success for children
and adults suffering with the effects of attention deficit hyperactivity disorder.
When parents meet with pediatricians and psychiatrists to discuss interventions to help
improve these cognitive functions, they are often faced with the difficult decision of
pharmacotherapy. Studies indicate that 85% of children diagnosed with ADHD are prescribed
stimulant medication (Lenz, 2012; Wigal et al., 2012). This common method of treatment is
used to regulate dopamine and norepinephrine levels in the brain (Lenz, 2012). Although
treatment rates with stimulant drugs have proven effective to manage ADHD symptoms, many
parents are uncomfortable with the prospect of their child taking these controversial medications
(Pontifex, Saliba, Raine, Picchietti & Hillman, 2012; Tantillo, Kesick, Hynd & Dishman, 2002;
Wigal et al., 2012). Concerns are often associated with adverse side effects, high costs and
incomplete response to the medications (Pontifex et al., 2012; Tantillo et al., 2002). Parents are
often keen to try alternative approaches such as naturapath medicine or adapting their childs
nutrition. This has led many people in the field of ADHD research to consider the need for
developing more natural interventions to be used as an alternative or in tandem with
pharmacotherapy (Berwid & Halperin, 2012; Tantillo et al., 2002; Wigal et al., 2012).
One healthy intervention for children that has become an area of great interest is exercise.
The strong belief that physical activity can be linked to intellectual functioning dates back to
ancient Greek times (Tomparowski et al., 2008; Wigal et al., 2012). Numerous studies on the
benefits of exercise and proper nutrition are shared with the public daily through news articles
and social media sites. Why exercise? A great deal of research exploring the effects of exercise

Exercise and ADHD

on mental health was conducted during the health and wellness movement of the eighties
(Hillman, Erickson & Kramer, 2008; Tomparowski et al., 2008). Numerous studies have shown
that the onset of exercise immediately results in increased dopamine and norepinephrine to
regulate the prefrontal cortex, basal ganglia and amygdala responsible for memory processing
and emotional reactions (Lenz, 2012). Exercise has also shown to have a positive effect on the
thinking and movement centre of the brain (Lenz, 2012). Therefore, it would be logical to
assume that there would be a positive effect on individuals with ADHD. However, the majority
of the studies conducted in the past several decades have examined the results of exercise in
relation to adults and animals (Hillman, Erickson & Kramer, 2008; Tomparowski et al., 2008).
This has limited the overall understanding of the effects of exercise on children diagnosed with
ADHD. However, there have been some thought provoking studies conducted in the past 10
years, with several published within the last year.
Researchers have been exploring the significant implications of exercise on children
diagnosed with ADHD. Although the exact neuroatonomical structures and neurophysiological
systems affecting ADHD are still not completely understood, as previously stated, a great deal of
research indicates that brain dopaminergic systems may have a role, linked to the caudate
nucleus of the striatum (Tantillo et al., 2002). Other studies have also shown that exercise
stimulates adrenoneurogenic mediators (Wigal et al., 2012). Furthermore, the physiological
effects of aerobic activity target the same catecholaminergic systems that stimulant medications
for ADHD attempt to influence (Tomparowski et al., 2012).
One ground-breaking study examined the role of exercise and dopamine in children with
ADHD. This experimental study examining the effects of acute exercise on dopamine responses
was conducted in 2002 by Mary Tantillo and her colleagues (Tantillo et al., 2002). Over the

Exercise and ADHD

years, several studies have used spontaneous eye blinks as a noninvasive measure of dopamine
levels in the caudate nucleus (Tantillo et al., 2002). This study used this same method. Eighteen
children diagnosed with ADHD and twenty-five children without ADHD participated in
treadmill bouts of exercise (Tantillo et al., 2002). Specifically, Tantillo and her colleagues (2002)
were interested in exploring whether or not acute exercise would increase spontaneous eye
blinks, increase startle blink response and decrease motor impersistence. The findings of this
study indicated boys with ADHD had increased spontaneous blink rate, decreased spontaneous
blinks and decreased motor impersistence following maximal exercise (Tantillo et al., 2002).
Girls with ADHD were found to have increased spontaneous eye blinks after submaximal
exercise (Tantillo et al., 2002). This initial study did indicate the potential benefits of exercise to
aid in the treatment of ADHD and led other researchers to further study the benefits of physical
exercise to complement current treatment options for ADHD.
A recent study was conducted to determine the effect of a single bout of moderateintensity aerobic exercise on the behavioural, neurocognitive, and scholastic performance in
forty children, twenty diagnosed with ADHD (Pontifex et al., 2012). The participants in the
study were asked to perform an attentional-control task after either a 20-minute bout of exercise
or seated reading (Pontifex et al., 2012). The results of the study indicated greater response
accuracy and stimulus-related processing with both the control group as well as the children with
ADHD (Pontifex et al., 2012). Furthermore, the children with ADHD also demonstrated
enhancements in regulatory processes and both groups showed greater performance in reading
and arithmetic following exercise (Pontifex et al., 2012). The findings of this study indicated
that exercise had positive implications on aspects of neurocognitive functioning in children with
ADHD (Pontifex et al., 2012).

Exercise and ADHD

A similar study was conducted to determine the effect of acute aerobic exercise on the
executive function in children with ADHD (Chang, Liu, Yu & Lee, 2012). Participants in this
study were randomly assigned to either a moderate intensity aerobic exercise group for thirty
minutes or a control group to watch a running/exercise related video (Chang, Liu, Yu & Lee,
2012). Participants were assessed before and after treatment using the Stroop Test and
Wisconsin Card Sorting Test (Chang, Liu, Yu & Lee, 2012). As indicated by Chang et al. (2012),
the results of the study showed positive links between exercise, executive function and ADHD.
Overall, children in the exercise group demonstrated improvement between testing conducted
before and after treatment, whereas the control group demonstrated no influence (Chang et al.,
2012). It was postulated that the exercise helped improve the allocation of attention resources,
influencing the prefrontal cortex and was linked with exercise induced dopamine release
(Change et al., 2012).
Further exploration on the effects of a moderate to high intensity physical activity
program on the cognitive functions of children with ADHD was conducted by Verret, Guay,
Berthiume, Gardiner and Beliveau (2012). Twenty-one participants were assigned to either a 10week training program or to the control group (Verret et al., 2012). As with previous studies,
participants were assessed before and after treatment (Verret et al., 2012). The results of this
study indicated that physical activity improved the behaviour and cognitive function in children
with ADHD (Verret et al., 2012). However, Verret et al. (2012) did note that their study had
methodological issues and that the results of the study should be considered exploratory.
Although research is beginning to indicate the positive results of exercise, medical
interventions continue to be the most common method of intervention. A comparison between
these two interventions helps identify the need for further research. A very recent article written

Exercise and ADHD

by Thomas Lenz (2012), explored a pharmacological/physiological comparison between ADHD

medications and exercise. In particular, it compared the pharmacological and pathophysiological
similarities between medication and exercise with regard to ADHD (Lenz, 2012). Results
indicated that both of these methods are effective in treating symptoms of ADHD, with distinct
differences in terms of side effects (Lenz, 2012). The primary difference noted between the two
forms of treatment is that medications have a direct effect on the symptoms of ADHD, whereas
exercise has physical, mental and emotional benefits that far outweigh the effects of medication
(Lenz, 2012).
As indicated by all of the reviewed studies, there is clearly a great deal of research to be
done on the effects of exercise on the symptoms of ADHD. As a special education teacher often
supporting children with ADHD and their families, this information can have a significant impact
on interventions and strategies to support a child. The majority of parents are not interested in
medical intervention and yet many children continue to struggle with several aspects of
schooling without pharmacotherapy.
To help apply theory to practice, this paper will use a case study of a 10-year-old boy.
The child has experienced a great deal of challenge throughout his past five school years. He has
been described as always on the go, impulsive, working below his cognitive potential and
inattentive. In addition, over the years his teachers have all stated that he is unable to sit in his
seat, he is always wandering around the room and that he frequently interrupts the teacher. Most
importantly, he is seriously affecting the learning of his classmates. The school met with the
family and made a recommendation for an assessment with a psychologist. The boy was
assessed and received a diagnosis of ADHD. A recommendation was made to consult with a
doctor in regards to medical intervention. There were also many other recommendations such

Exercise and ADHD

10

classroom adaptations and learning assistance. The school and psychologist both indicated that
his learning needs and behaviour associated with his diagnosis of ADHD were seriously
impacting his success at school and encouraged the parents to follow through with the
recommendations listed. The parents were not supportive of medical intervention. Although the
school is currently trying their best to manage the childs symptoms of ADHD, there has been
limited affect with the non-medical interventions attempted thus far. In particular, the school is
finding that the boy continues to struggle with many aspects of attention and memory, resulting
in increased frustration. As a result of this paper, the school decided to implement a running
program as an intervention to help determine the effects of exercise to help improve attention and
memory in class. A baseline was collected and the child was then taken outside every day to run
for 4 minutes, once between the start of the day and recess and once between recess and lunch.
His classroom teacher and educational assistant were then asked to complete a weekly
observations page to help compare the effects of the intervention on his abilities in the
classroom. The results of this trial are currently inconclusive due to the short amount of time of
the intervention. It is the hope that over time, this will be an appropriate intervention to help
modify this childs environment, thereby improving his success in the classroom.
Although more studies are required to determine the effects of exercise on children with
ADHD, the current research does indicate positive correlations and a need for further
exploration. There are many benefits to exercise. In this current age when obesity rates and the
prevalence of ADHD are concerning to educators, a vigorous physical education program could
be useful to many students. In particular, it would be interesting to examine the results of
exercise on brain systems. Perhaps changes in the amount of time a child spends outside and the
decrease in physical activities at schools could also be examined. There is currently a great deal

Exercise and ADHD

11

of research in British Columbia exploring the effects of self-regulation and the importance of
regular exercise breaks. Several schools are adopting this practice with positive results. Perhaps
this will be the mode that will bring exercise into the classroom, benefitting children with and
without ADHD.

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Exercise and ADHD

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