title: Longitudinal mapping of cortical thickness and clinical outcome in children and adolescents with attention-deficit/hyperactivity disorder. Measurement of the Effect of Physical Exercise on the Concentration of Individuals with ADHD The Unity and Diversity of Executive Functions and Their Contributions to Complex “Frontal Lobe” Tasks: A Latent Variable Analysis Children With Attention Deficits Concentrate Better After Walk in the Park Physical fitness and shapes of subcortical brain structures in children. Aerobic exercise and attention deficit hyperactivity disorder: brain research. Physical Activity, Affect, and Cognition in Children With Symptoms of ADHD Exercise impact on sustained attention of ADHD children, methylphenidate effects The effects of exercise on children with attention-deficit hyperactivity disorder. A small-scale randomized controlled trial of the revised new forest parenting programme for preschoolers with attention deficit hyperactivity disorder Vitamin‐mineral treatment improves aggression and emotional regulation in children with ADHD: a fully blinded, randomized, placebo‐controlled trial Acute Physical Activity Enhances Executive Functions in Children with ADHD Exercise
abstract: CONTEXT Data from a previous prospect i ve study of lobar volumes in children with attention-deficit/hyperactivity disorder ( ADHD ) are reexamined using a measure of cortical thickness . OBJECTIVE To determine whether regional differences in cortical thickness or cortical changes across time characterize ADHD and predict or reflect its clinical outcome . DESIGN , SETTING , AND PARTICIPANTS Longitudinal study of 163 children with ADHD ( mean age at entry , 8.9 years ) and 166 controls recruited mainly from a local community in Maryl and . Participants were assessed with magnetic resonance imaging . Ninety-seven patients with ADHD ( 60 % ) had 2 or more images and baseline and follow-up clinical evaluations  ( mean follow-up , 5.7 years ) . MAIN OUTCOME MEASURES Cortical thickness across the cerebrum . Patients with ADHD were divided into better and worse outcome groups on the basis of a mean split in scores on the Children 's Global Assessment Scale and persistence/remission of DSM-IV-defined ADHD . RESULTS Children with ADHD had global thinning of the cortex ( mean reduction , -0.09 mm ; P=.02 ) , most prominently in the medial and superior prefrontal and pre central regions . Children with worse clinical outcome had a thinner left medial prefrontal cortex at baseline than the better outcome group ( -0.38 mm ; P=.003 ) and controls ( -0.25 mm ; P=.002 ) . Cortical thickness developmental trajectories did not differ significantly between the ADHD and control groups throughout except in the right parietal cortex , where trajectories converged . This normalization of cortical thickness occurred only in the better outcome group . CONCLUSIONS Children with ADHD show relative cortical thinning in regions important for attentional control . Children with a worse outcome have " fixed " thinning of the left medial prefrontal cortex , which may compromise the anterior attentional network and encumber clinical improvement . Right parietal cortex thickness normalization in patients with a better outcome may represent compensatory cortical change Attention Deficit Hyperactivity Disorder ( ADHD ) mainly affects the academic performance of children and adolescents . In addition to bringing physical and mental health benefits , physical activity has been used to prevent and improve ADHD comorbidities ; however , its effectiveness has not been quantified . In this study , the effect of physical activity on children 's attention was measured using a computer game . Intense physical activity was promoted by a relay race , which requires a 5-min run without a rest interval . The proposed physical stimulus was performed with 28 volunteers : 14 with ADHD ( GE-EF ) and 14 without ADHD symptoms ( GC-EF ) . After 5 min of rest , these volunteers accessed the computer game to accomplish the tasks in the shortest time possible . The computer game was also accessed by another 28 volunteers : 14 with ADHD ( GE ) and 14 without these symptoms ( GC ) . The response time to solve the tasks that require attention was recorded . The results of the four groups were analyzed using D'Agostino statistical tests of normality , Kruskal-Wallis analyses of variance and post-hoc Dunn tests . The groups of volunteers with ADHD who performed exercise ( GE-EF ) showed improved performance for the tasks that require attention with a difference of 30.52 % compared with the volunteers with ADHD who did not perform the exercise ( GE ) . The ( GE-EF ) group showed similar performance ( 2.5 % difference ) with the volunteers in the ( GC ) group who have no ADHD symptoms and did not exercise . This study shows that intense exercise can improve the attention of children with ADHD and may help their school performance This individual differences study examined the separability of three often postulated executive functions-mental set shifting ( " Shifting " ) , information updating and monitoring ( " Updating " ) , and inhibition of prepotent responses ("Inhibition")- and their roles in complex " frontal lobe " or " executive " tasks . One hundred thirty-seven college students performed a set of relatively simple experimental tasks that are considered to predominantly tap each target executive function as well as a set of frequently used executive tasks : the Wisconsin Card Sorting Test ( WCST ) , Tower of Hanoi ( TOH ) , r and om number generation ( RNG ) , operation span , and dual tasking .  Confirmatory factor analysis indicated that the three target executive functions are moderately correlated with one another , but are clearly separable . Moreover , structural equation modeling suggested that the three functions contribute differentially to performance on complex executive tasks . Specifically , WCST performance was related most strongly to Shifting , TOH to Inhibition , RNG to Inhibition and Updating , and operation span to Updating . Dual task performance was not related to any of the three target functions . These results suggest that it is important to recognize both the unity and diversity of executive functions and that latent variable analysis is a useful approach to study ing the organization and roles of executive functions Objective : In the general population , attention is reliably enhanced after exposure to certain physical environments , particularly natural environments . This study examined the impacts of environments on attention in children with ADHD . Method : In this within subjects design , each participant experienced each of three treatments ( environments ) in single blind controlled trials . Seventeen children 7 to12 years old professionally diagnosed with ADHD experienced each of three environments — a city park and two other well-kept urban setting s — via individually guided 20-minute walks . Environments were experienced 1 week apart , with r and omized assignment to treatment order . After each walk , concentration was measured using Digit Span Backwards . Results : Children with ADHD  concentrated better after the walk in the park than after the downtown walk ( p = .0229 ) or the neighborhood walk ( p = .0072 ) . Effect sizes were substantial ( Cohen 's d = .52 and .77 , respectively ) and comparable to those reported for recent formulations of methylpheni date . Conclusion : Twenty minutes in a park setting was sufficient to elevate attention performance relative to the same amount of time in other setting s. These findings indicate that environments can enhance attention not only in the general population but also in ADHD population s. “ Doses of nature ” might serve as a safe , inexpensive , widely accessible new tool in the tool kit for managing ADHD symptoms . ( J. of Att . Dis . 2009 ; 12(5 ) 402 - 409 A few studies have recently reported that higher cardiorespiratory fitness is associated with higher volumes of subcortical brain structures in children . It is , however , unknown how different fitness measures relate to shapes of subcortical brain nuclei . We aim ed to examine the association of the main health-related physical fitness components with shapes of subcortical brain structures in a sample of forty-four Spanish children aged 9·7 ( sd 0·2 ) years from the NUtraceuticals for a HEALthier life project . Cardiorespiratory fitness , muscular strength and speed agility were assessed using valid and reliable tests ( ALPHA-fitness test battery ) . Shape of the subcortical brain structures was assessed by MRI , and its relationship with fitness was examined after controlling for a set of potential confounders using a partial correlation permutation approach . Our results showed that all physical fitness components studied were significantly related to the shapes of subcortical brain nuclei . These associations were both positive and negative , indicating that a higher level of fitness in childhood is related to both expansions and contractions in certain regions of the accumbens , amygdala , cau date , hippocampus , pallidum , putamen and thalamus . Cardiorespiratory fitness was mainly associated with expansions , whereas h and grip was mostly associated with contractions in the structures studied . Future r and omised-controlled trials will confirm or contrast our findings , demonstrating whether changes in fitness modify the shapes of brain structures and the extent to which those changes influence cognitive function PURPOSE As adjuvant therapy for enhancing the effects of stimulants and thereby minimizing medication doses , we hypothesized that aerobic exercise might be an effective adjunctive therapy for enhancing the effects of methylpheni date on the clinical symptoms , cognitive function , and brain activity of adolescents with attention deficit hyperactivity disorder ( ADHD ) . METHODS Thirty-five adolescents with ADHD were r and omly assigned to one of two groups in a 1/1 ratio ; methylpheni date treatment + 6-wk exercise ( sports-ADHD ) or methylpheni date treatment + 6-wk education ( edu-ADHD ) . At baseline and after 6 wk of treatment , symptoms of ADHD , cognitive function , and brain activity were evaluated using the Dupaul attention deficit hyperactivity disorder rating scale -- Korean version ( K-ARS ) , the Wisconsin Card Sorting Test , and 3-T functional magnetic resonance imaging , respectively . RESULTS The K-ARS total score and perseverative errors in the sports-ADHD group decreased compared with those in the edu-ADHD group . After the 6-wk treatment period , the mean β value of the right frontal lobe in the sports-ADHD group increased compared with that in the edu-ADHD group . The mean β value of the right temporal lobe in the sports-ADHD group decreased . However , the mean β value of the right temporal lobe in the edu-ADHD group did not change . The change in activity within the right prefrontal cortex in all adolescents with ADHD was negatively correlated with the change in K-ARS scores and perseverative errors . CONCLUSIONS The current results indicate that aerobic exercise increased the effectiveness of methylpheni date on clinical symptoms , perseverative errors , and brain activity within the right frontal and temporal cortices in response to the Wisconsin card sorting test stimulation Objective : To examine the role of physical activity in determining the affect and executive functioning of children with symptoms of ADHD . Method : In Study 1 , the association between physical activity and affect in the daily lives of children with varying degrees of hyperactivity was examined . In Study 2 , children with ADHD were r and omly assigned a physical activity or a sedentary task before working on a task requiring executive control . Results : Lack of physical activity was shown to relate to depressed affect , more strongly in participants with severe hyperactivity symptoms ( Study 1 ) . The physically active participants showed improved executive functioning after only 5 min of vigorous activity ; the sedentary control participants showed no improvement ( Study 2 ) . Conclusion : These results indicate that interventions to increase the level of physical activity in children with and without ADHD might improve affect and executive functioning Attention deficit hyperactivity disorder ( ADHD ) is related to a deficiency of central catecholamines ( CA ) in cognitive , biochemical , and physical tests , and pharmaceutical intervention may have no effect if it is not accompanied by changes in the environment . The objective of our study was to test the hypothesis that central CA are responsible for the increase in speed reaction seen after physical activity ( PA ) and to measure the impact of high intensity PA on the sustained attention of 25 children diagnosed with ADHD consistent with the Disease Statistical Mental-IV ( DSM-IV ) criteria . It is possible that practicing sports assists in the management of the disorder . The children were divided between users ( US ) and non-users ( NUS ) of methylpheni date ( MTP ) , and the groups were compared to evaluate the effect of the drug on cognition after PA . Post-exercise performance on Conner ’s Continuous Performance Test-II ( CPT ) was not affected by MTP , we observed significant improvements in response time , and we saw normalization in the impulsivity and vigilance measures . These results suggest that the improvements in cognition after physical effort are not CA dependent . Additionally , our results suggest that  children ’s attention deficits can be minimized through PA irrespective of treatment with MTP . Additional studies are necessary to confirm that exercise mitigates the harmful symptoms of ADHD PURPOSE The effects of exercise on children with attention-deficit hyperactivity disorder ( ADHD ) were evaluated by study ing the rate of spontaneous eye blinks , the acoustic startle eye blink response ( ASER ) , and motor impersistence among 8- to 12-yr-old children ( 10 boys and 8 girls ) meeting DSM-III-R criteria for ADHD . METHODS Children ceased methylpheni date medication 24 h before and during each of three daily conditions separated by 24 - 48 h. After a maximal treadmill walking test to determine cardiorespiratory fitness ( VO(2peak ) ) , each child was r and omly assigned to counterbalanced conditions of treadmill walking at an intensity of 65 - 75 % VO(2peak ) or quiet rest . Responses were compared with a group of control participants ( 11 boys and 14 girls ) equated with the ADHD group on several key variables . RESULTS Boys with ADHD had increased spontaneous blink rate , decreased ASER latency , and decreased motor impersistence after maximal exercise . Girls with ADHD had increased ASER amplitude and decreased ASER latency after submaximal exercise . CONCLUSIONS The findings suggest an interaction between sex and exercise intensity that is not explained by physical fitness , activity history , or selected personality attributes . The clinical meaning of the eye blink results is not clear , as improvements in motor impersistence occurred only for boys after maximal exercise . Nonetheless , these preliminary findings are sufficiently positive to encourage additional study to determine whether a session of vigorous exercise has efficacy as a dopaminergic adjuvant in the management of behavioral features of ADHD The revised new forest parenting programme ( NFPP ) is an 8-week psychological intervention design ed to treat ADHD in preschool children by targeting , amongst other things , both underlying impairments in self-regulation and the quality of mother – child interactions . Forty-one children were r and omized to either the revised NFPP or treatment as usual conditions . Outcomes were ADHD and ODD symptoms measured using question naires and direct observation , mothers ’ mental health and the quality of mother – child interactions . Effects of the revised NFPP on ADHD symptoms were large ( effect size > 1 ) and significant and effects persisted for 9 weeks post-intervention . Effects on ODD symptoms were less marked . There were no improvements in maternal mental health or parenting behavior during mother – child interaction although there was a drop in mothers ’ negative and an increase in their positive comments during a 5-min speech sample . The small-scale trial , although limited in power and generalizability , provides support for the efficacy of the revised NFPP . The findings need to be replicated in a larger more diverse sample BACKGROUND Evaluation of broad-spectrum micronutrient ( vitamins and minerals ) treatment for childhood ADHD has been limited to open-label studies that highlight beneficial effects across many aspects of psychological functioning . METHOD This is the first fully blinded r and omized controlled trial of medication-free children ( n = 93 ) with ADHD ( 7 - 12 years ) assigned to either micronutrients ( n = 47 ) or placebo ( n = 46 ) in a 1:1 ratio , for 10 weeks . All children received st and ardized ADHD assessment s. Data were collected from clinicians , parents , participants and teachers across a range of measures assessing ADHD symptoms , general functioning and impairment , mood , aggression and emotional regulation . RESULTS Intent-to-treat analyses showed significant between-group differences favouring micronutrient treatment on the Clinical Global Impression-Improvement ( ES = 0.46 ) , with 47 % of those on micronutrients identified as ' much ' to ' very much ' improved versus 28 % on placebo . No group differences were identified on clinician , parent and teacher ratings of overall ADHD symptoms ( ES ranged 0.03 - 0.17 ) . However , according to clinicians , 32 % of those on micronutrients versus 9 % of those on placebo showed a clinical ly meaningful improvement on inattentive ( OR = 4.9 ; 95 % CI : 1.5 - 16.3 ) , but no group differences on improvement in hyperactive-impulsive symptoms ( OR = 1.0 ; 95 % CI : 0.4 - 2.5 ) . Based on clinician , parent and teacher report , those on micronutrients showed greater improvements in emotional regulation , aggression and general functioning compared to placebo ( ES ranged 0.35 - 0.66 ) . There were two dropouts per group , no group differences in adverse events and no serious adverse events identified . Blinding was successful with guessing no better than chance . CONCLUSIONS Micronutrients  improved overall function , reduced impairment and improved inattention , emotional regulation and aggression , but not hyperactive/impulsive symptoms , in this sample of children with ADHD . Although direct benefit for core ADHD symptoms was modest , with mixed findings across raters , the low rate of adverse effects and the benefits reported across multiple areas of functioning indicate micronutrients may be a favourable option for some children , particularly those with both ADHD and emotional dysregulation . Trial registered with the Australian New Zeal and Clinical Trials Registry ACTRN12613000896774 Acute physical activity of moderate to vigorous intensity has been shown to improve cognitive functions in children . However , the empirical evidence associated with Attention Deficit Hyperactivity Disorder ( ADHD ) in children is still limited , in particular regarding which specific cognitive functions benefit . This study investigated the effects of an acute bout of physical activity on multiple aspects of executive functions ( inhibition , switching , and visual working memory ) in children with ADHD . Forty-six children ( 8–12 years old ; 82.6 % boys ) were r and omly assigned to either 15 minutes of acute exergaming ( physical activity of moderate intensity ) or to a control condition ( sedentary )  . Executive function performance in inhibition , switching and visual working memory were assessed before and after each condition , using a modified version of both the Flanker and the Color Span Backwards Task . The results revealed that participants in the exergaming group performed significantly faster than those in the control group in terms of both inhibition and switching , but there was no significant difference in the accuracy of the two tasks nor in visual working memory performance . These findings suggest that acute physical activity utilizing exergaming has the potential to improve specific aspects of executive functions ( reaction times in inhibition and switching ) in children with ADHD The greater  coronary heart disease morbidity of  sedentary as opposed to physically active workers was demonstrated many years ago by J N Morris and his colleagues in a comparison of London bus drivers and conductors . These two groups of transport workers belonged to the same social class and had similar lifestyles . They differed principally in the amount of physical activity in which they engaged when at work . The drivers were confined to a small enclosed driving compartment which rendered them almost completely immobile , whilst the conductors were continuously active , especially as they constantly had to run up and down the stairs of the doubledecker London buses . During the five-year follow-up the drivers had a CHD incidence almost double that of the conductors . The differences between the two groups became greater as their members grew older ( Table IX.1 ) . ' The finding of this untoward accompaniment of physical inactivity has been confirmed by the results of the Framingham study 2 and a 27 cohort based rigorous meta- analysis reported by Jesse Berlin and Graham Colditz . These authors found a relative risk of death from coronary heart disease of 1.9 ( CL 1.6 - 2.2 ) for sedentary as opposed to high physical activity groups , and the benefits were shown to be greater in the studies that the authors judged to be method ologically stronger.3 Conversely , in the Whitehall study of British civil servants leisure-time physical activity has been found to have cardiovascular health benefits similar to those apparently conferred on the London bus conductors by their workaday exertions . Vigorous weekend exercise apparently protected the middle-aged men from fatal heart attacks and non-fatal first episodes of coronary heart disease.4 It is probable that a r and omized and controlled prospect i ve study of the cardiovascular consequences of prolonged inactivity will never be undertaken . It would be both unethical and impractical to enforce a long-term sedentary lifestyle on a control group . However , the physiological means by which regular exercise has cardioprotective effects are now well defined . Animal studies have shown that the coronary arterial capacity becomes greater relative to the cardiac muscle mass and an increase in coronary artery diameter has been demonstrated angiographically . Capillary growth is induced and increase in coronary blood flow in response to
target: Five minutes of jumping or thirty minutes on a treadmill or static bicycle were enough to produce appreciable improvements in inhibitory control or in cognitive and executive functions .
  Benefits following exercise were also seen in other aspects such as reaction times and preparation for response , motor skills or brain activity .
  CONCLUSION The findings make us optimistic that in the future physical exercise may become an alternative , or at least an effective complement , to the pharmacological treatments currently used for this pathology
background: BACKGROUND There are studies that show preliminary evidence of the benefits of physical exercise for people with Attention Deficit Hyperactivity Disorder ( ADHD ) .
  The objective of the research being reported here was to carry out a systematic review of articles relating to the effects that exercise sessions have on children and adolescents with this pathology .