A new study published in the Journal of Attention Disorders reveals that youngsters with Attention Deficit Hyperactivity Disorder follow fewer healthy lifestyle behaviors as compared to youth groups that do not have ADHD, suggesting that they may benefit from improving those lifestyle choices. This could include increasing water consumption and ensuring at least one hour of daily physical activity. This new study holds the accolade of being the first to examine the total number of lifestyle behaviors children with ADHD adhere to, as compared to “typically developing” kids.
The lead author of the study and Assistant Professor in American University’s Department of Health Studies, Kathleen Holton, said, “Many parents of children diagnosed with Attention Deficit Hyperactivity Disorder do not wish for their kids to take medication; an effective intervention may indeed be to demand their children follow healthy lifestyle behaviors either alongside or in place of traditional ADHD medications.” Holton is also a member of American University’s Center for Behavioral Neuroscience, adding another notch of credibility to her statements.
Following Key Healthy Lifestyle Recommendations
Along with co-author Joel Nigg of Oregon Health & Science University, Holton’s basis of the study revolved around analyzing children aged seven to 11 and whether they were following “key health recommendations” for this age range, or not, as put forth by the American Academy of Pediatrics, the National Sleep Foundation and the U.S. Department of Agriculture. Their recommendations included getting no more than one to two hours of total “screen time” (electronic device use) daily, getting at least one hour of daily physical activity, cutting down on sugary beverages, indulging in 9 to 11 hours of sleep per night and drinking seven to 10 cups of water daily, all dependent on age. Further, Holton and Nigg created a “Lifestyle Index” to summarize the total number of healthy lifestyle behaviors adhered to by 184 children with ADHD, as compared to a non-ADHD youth control group.
The results of the study were quite interesting – children with ADHD tended to drink artificially-sweetened juice, were less likely to read for more than one hour daily, were more prone to indulge in more than two hours of non-therapeutic screen time per day, and more likely to engage in fewer hours of physical activity during the week. Included as factors were parents of children with ADHD, with the study discovering that they were much more likely to report that their children have a hard time falling asleep, report concern regarding their sleep habits and express concern that sleep problems may be leading to behavior issues. Most fascinating was that these associations were confirmed even in those children who were not medicated for ADHD at the time – which is known to contribute to sleep disturbance.
In the context of these findings and with regard to them, Holton was quoted as saying, “Parents of children diagnosed with ADHD should ideally sit down with their pediatrician and have a discussion about ways to improve health behaviors, such as non-therapeutic screen time limitations, physical activity encouragement, bedtime routine improvement and water-drinking encouragement in place of consuming other sweet beverages.” Further, Holton believes that in most ADHD studies, a child’s condition is often assessed solely by a single survey question regarding past diagnoses, thus leading to her and Nigg employing a rigorous study design that encompassed diagnostic interviews, parental reports and consensus of two clinical experts in order to test for ADHD and additional psychiatric disorders.
The study was limited, however, by the fact that it only took into consideration and looked at children’s behavior at one point in time – still, both Holton and Nigg agree that the results suggest that future clinical trial research is required to quantify the impact a combined lifestyle intervention may have on ADHD symptoms. As she herself explains it, “It is possible that altering more than one lifestyle behavior at once can yield other healthy behaviors – as an example: Physical activity has, of course, been confirmed to increase thirst, making drinking water more of a reality. What’s more, non-therapeutic screen time can offset physical activity and improve sleep, while the removal of caffeinated beverages can prevent their diuretic effect, help increase water intake and help prevent sleep disturbance. As research into health outcomes in children with ADHD continues to shed new light and provide new insights, focusing on the overall number of lifestyle behaviors should indeed become important.”
Some of the Core Elements of the Journal of Attention Disorders Study
In order to be eligible for the ADHD group, children had to meet Diagnostic and Statistical Manual of Mental Disorders or DSM-5 criteria for ADHD by consensus of the two clinical experts; be free of confounding medical or neurological conditions; be free of lifetime or current bipolar disorder or psychosis, current substance use disorder and current major depressive episode and, finally, could not be taking long-acting psychoactive medications such as anti-depressants. Comparison subjects, typically developing, went through the same evaluation and diagnostic procedure and had the same exclusions – save for the fact that they also had to exhibit no prior diagnosis of ADHD or conduct disorder.
Also pertinent to this study was a cross-sectional 35-item Lifestyle Questionnaire completed by one parent about the child in order to measure lifestyle choices – lifestyle choices known to affect health, as reflected in behaviors over the past month. The questionnaire included queries on the aforementioned elements like water consumption (intake), sweetened beverage consumption (intake), supplement usage, reading, screen time, physical activity and sleep, and was used to form the aforementioned Lifestyle Index constructed to represent current health behavior recommendations.
Experts like Holton and Nigg concluded that at the end of the day, children with ADHD are less likely to engage in healthy lifestyle habits and behaviors than youth groups not suffering with Attention Deficit Hyperactivity Disorder, and though causal effects have not been fully realized, children with ADHD may indeed benefit from improved lifestyle choices. Furthermore, concluded test representatives, an important target of conversation between clinicians and parents during appointments could be healthy behavior change, and future research is warranted to examine the effects of a combined lifestyle intervention on children with ADHD, using accurate and detailed assessments of each lifestyle behavior.