A Randomized Trial of a Swimming-Based Alternative Treatment for Children with Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is considered a highly prevalent neurodevelopmental childhood disorder extending from ages 1–2 to 12–13, associated with impairment across multiple domains, including social, emotional, and cognitive functioning. Little is known about alternative treatments for this disorder. Interest has grown in physical activity as a potential intervention for rehabilitating children with ADHD. This study aimed to investigate the impact of adapted swimming activity on cognitive functions, academic performance, and related behavior of Tunisian children with ADHD. The study was conducted on school children aged 9 to 12 years (n = 40, 5 female and 35 male) diagnosed with ADHD. They were randomly assigned to an experimental group (exercise intervention) or the control group. The Hayling test was used to assess cognitive performance, the Children Behavior Check List (CBCL) was used to assess ADHD-related behavior, and the change in reading and numeracy proficiency was assessed pre- and post-intervention. After 12 weeks of the intervention, the results revealed that there were significant improvements in behavior (p < 0.001), inhibition process (p < 0.001), and academic performance (p < 0.001) in the experimental group compared with the control group. These findings suggest that adapted swimming activity may have positive implications for cognitive function, behavior, and academic performance. This research may provide preliminary support for alternative therapeutic interventions that could be used by practitioners. Moreover, the results support active practice of recreational physical activities as a strategy to support children in overcoming ADHD deficiencies.

[1]  R. Ramírez-Campillo,et al.  Advancing Sports Science and Physical Education Research Through a Shared Understanding of the Term Motor Performance Skills: A Scoping Review with Content Analysis , 2022, International Journal of Kinesiology and Sports Science.

[2]  Ricardo Ferraz,et al.  Pedagogical Concerns in Sports and Physical Education for Child Growth and Health Promotion , 2022, International journal of environmental research and public health.

[3]  Wenxin Sun,et al.  Effects of physical exercise on attention deficit and other major symptoms in children with ADHD: A meta-analysis , 2022, Psychiatry Research.

[4]  D. Marinho,et al.  School-based swimming lessons enhance specific skills and motor coordination in children: the comparison between two interventions , 2022 .

[5]  A. Dana,et al.  The Effect of Water Treadmill Exercise on Children with Attention Deficit Hyperactivity Disorder , 2021 .

[6]  N. Aldunate,et al.  Arousal and Executive Alterations in Attention Deficit Hyperactivity Disorder (ADHD) , 2020, Frontiers in Psychology.

[7]  V. Nejati Cognitive rehabilitation in children with attention deficit- hyperactivity disorder: Transferability to untrained cognitive domains and behavior. , 2020, Asian journal of psychiatry.

[8]  Ricardo Aurino Pinho,et al.  Swimming training improves mental health parameters, cognition and motor coordination in children with Attention Deficit Hyperactivity Disorder , 2019, International journal of environmental health research.

[9]  Y. Zang Impact of physical exercise on children with attention deficit hyperactivity disorders , 2019, Medicine.

[10]  B. Olstad,et al.  Maximal Heart Rate for Swimmers , 2019, Sports.

[11]  A. Bouden,et al.  Rehabilitation of ADHD children by sport intervention: a Tunisian experience. , 2019, La Tunisie medicale.

[12]  A. M. Costa,et al.  Competência Aquática: um valor acrescentado à Educação Básica , 2019 .

[13]  Langendorfer,et al.  Self-agency and Swimming: Letting Babies Be Your Teachers , 2019, International Journal of Aquatic Research and Education.

[14]  B. Pillay,et al.  Fine motor deficits and attention deficit hyperactivity disorder in primary school children , 2019, The South African journal of psychiatry : SAJP : the journal of the Society of Psychiatrists of South Africa.

[15]  E. Z. Golumbic,et al.  Non-pharmacological interventions for cognitive difficulties in ADHD: A systematic review and meta-analysis. , 2020, Journal of psychiatric research.

[16]  R. Pope,et al.  Relationships between Motor Proficiency and Academic Performance in Mathematics and Reading in School-Aged Children and Adolescents: A Systematic Review , 2018, International journal of environmental research and public health.

[17]  P. Świtaj,et al.  Peer Rejection and Perceived Quality of Relations With Schoolmates Among Children With ADHD , 2018, Journal of attention disorders.

[18]  H. Koenig,et al.  Prevalence of attention deficit hyperactivity disorder and comorbid psychiatric and behavioral problems among primary school students in western Saudi Arabia , 2018, Saudi medical journal.

[19]  A. Vlad,et al.  Can a Person with Attention Deficit Hyperactivity Disorder be an Athlete? , 2017 .

[20]  D. Le Gall,et al.  Development of executive functioning in school-age Tunisian children , 2016, Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence.

[21]  Chia-Liang Tsai,et al.  A racket-sport intervention improves behavioral and cognitive performance in children with attention-deficit/hyperactivity disorder. , 2016, Research in developmental disabilities.

[22]  Teresa K. Dail,et al.  Swimming and Children with Attention-Deficit Hyperactive Disorder: A Winning Combination , 2016 .

[23]  A. Nada,et al.  Impact of functional constipation on psychosocial functioning and quality of life of children: A cross sectional study , 2016 .

[24]  Clayton E. Keller,et al.  A Psychometric Analysis of the Child Behavior Checklist for Elementary School Children in Qatar , 2016 .

[25]  Chris Visscher,et al.  The relationship between motor skills and cognitive skills in 4-16 year old typically developing children: A systematic review. , 2015, Journal of science and medicine in sport.

[26]  B. Hatfield,et al.  Effects of an aquatic exercise program on inhibitory control in children with ADHD: a preliminary study. , 2014, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[27]  Martin H. Teicher,et al.  ADHD in girls and boys – gender differences in co-existing symptoms and executive function measures , 2013, BMC Psychiatry.

[28]  S. Gau,et al.  Executive function as a mediator in the link between attention-deficit/hyperactivity disorder and social problems. , 2013, Journal of child psychology and psychiatry, and allied disciplines.

[29]  Chung-Ju Huang,et al.  Motor ability and inhibitory processes in children with ADHD: a neuroelectric study. , 2013, Journal of sport & exercise psychology.

[30]  Adalberto Veronese da Costa,et al.  Validation of an equation for estimating maximal oxygen consumption of nonexpert adult swimmers , 2013, Open access journal of sports medicine.

[31]  B. Hoza,et al.  Pilot Physical Activity Intervention Reduces Severity of ADHD Symptoms in Young Children , 2013, Journal of attention disorders.

[32]  L. Thorell,et al.  Disorganized Attachment and Inhibitory Capacity: Predicting Externalizing Problem Behaviors , 2012, Journal of abnormal child psychology.

[33]  Reinout W. Wiers,et al.  Can Motivation Normalize Working Memory and Task Persistence in Children with Attention-Deficit/Hyperactivity Disorder? The Effects of Money and Computer-Gaming , 2011, Journal of Abnormal Child Psychology.

[34]  R. Meulenbroek,et al.  Effects of physical exercise on Autism Spectrum Disorders: A meta-analysis , 2012 .

[35]  Abdurrahman Aktop,et al.  Physical Education Teacher's Views of Effective Teaching Methods in Physical Education , 2012 .

[36]  Y. Nevo,et al.  Early developmental cues for diagnosis of attention deficit/hyperactivity disorder in young children. , 2011, Developmental disabilities research reviews.

[37]  D. Bucci,et al.  Effects of physical exercise on ADHD-like behavior in male and female adolescent spontaneously hypertensive rats. , 2011, Developmental psychobiology.

[38]  Michael W. Metzler,et al.  Instructional Models for Physical Education , 2011 .

[39]  P. Gardiner,et al.  Fitness level and gross motor performance of children with attention-deficit hyperactivity disorder. , 2010, Adapted physical activity quarterly : APAQ.

[40]  C. Clément Hypothèses et modèles théoriques du TDA/H : vers une approche holistique du trouble , 2010 .

[41]  C. Ferguson An effect size primer: A guide for clinicians and researchers. , 2009 .

[42]  M. Audiffren,et al.  Exercise and Cognitive Function , 2009, Journal of clinical medicine.

[43]  John R. Williams The Declaration of Helsinki and public health. , 2008, Bulletin of the World Health Organization.

[44]  Jack A. Naglieri,et al.  Exercise and Children’s Intelligence, Cognition, and Academic Achievement , 2008, Educational psychology review.

[45]  Charles H Hillman,et al.  The relation of aerobic fitness to stroop task performance in preadolescent children. , 2008, Medicine and science in sports and exercise.

[46]  R. Chan,et al.  Time perception deficit in children with ADHD , 2007, Brain Research.

[47]  Arthur F. Kramer,et al.  Capitalizing on cortical plasticity: influence of physical activity on cognition and brain function , 2007, Trends in Cognitive Sciences.

[48]  B. Horta,et al.  The worldwide prevalence of ADHD: a systematic review and metaregression analysis. , 2007, The American journal of psychiatry.

[49]  V. Eapen,et al.  Psychometric Properties of the Child Behavior Checklist/2-3 in an Arab Population , 2007, Psychological reports.

[50]  A. Arnsten,et al.  Fundamentals of attention-deficit/hyperactivity disorder: circuits and pathways. , 2006, The Journal of clinical psychiatry.

[51]  Marty G. Woldorff,et al.  Abnormal Brain Activity Related to Performance Monitoring and Error Detection in Children with ADHD , 2005, Cortex.

[52]  L. White,et al.  Exercise and cognitive function , 2005, The Lancet Neurology.

[53]  Betsy Jane Becker,et al.  Physical activity and psychological well-being in advanced age: a meta-analysis of intervention studies. , 2005, Psychology and aging.

[54]  N. Makris,et al.  Structural Brain Imaging of Attention-Deficit/Hyperactivity Disorder , 2005, Biological Psychiatry.

[55]  V. Russell,et al.  A dynamic developmental theory of attention-deficit/hyperactivity disorder (ADHD) predominantly hyperactive/impulsive and combined subtypes. , 2005, The Behavioral and brain sciences.

[56]  S. Hogg-Johnson,et al.  A meta-analysis of working memory impairments in children with attention-deficit/hyperactivity disorder. , 2005, Journal of the American Academy of Child and Adolescent Psychiatry.

[57]  Leigh M. Smith,et al.  The relationship between motor coordination, executive functioning and attention in school aged children. , 2004, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[58]  E. Rolls The functions of the orbitofrontal cortex , 1999, Brain and Cognition.

[59]  Charles H Hillman,et al.  Acute cardiovascular exercise and executive control function. , 2003, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[60]  T. Sagvolden,et al.  Attention-deficit/hyperactivity disorder (ADHD) behaviour explained by dysfunctioning reinforcement and extinction processes , 2002, Behavioural Brain Research.

[61]  Christina M. Kesick,et al.  The effects of exercise on children with attention-deficit hyperactivity disorder. , 2002, Medicine and science in sports and exercise.

[62]  Tim Shallice,et al.  Fractionation of the supervisory system. , 2002 .

[63]  J. Guevara,et al.  Evidence based management of attention deficit hyperactivity disorder , 2001, BMJ : British Medical Journal.

[64]  Terence Dwyer,et al.  Relation of Academic Performance to Physical Activity and Fitness in Children , 2001 .

[65]  T. Achenbach,et al.  The Child Behavior Checklist and Related Forms for Assessing Behavioral/Emotional Problems and Competencies , 2000, Pediatrics In Review.

[66]  J. Meere,et al.  Information Processing and Energetic Factors in Attention-Deficit/Hyperactivity Disorder , 1999 .

[67]  Herbert C. Quay,et al.  Handbook of disruptive behavior disorders , 1999 .

[68]  Tim Shallice,et al.  The Hayling and Brixton Tests , 1997 .

[69]  R. Barkley Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. , 1997, Psychological bulletin.

[70]  J M Swanson,et al.  A divided attention analysis of the effects of methylphenidate on the arithmetic performance of children with attention-deficit hyperactivity disorder. , 1991, Journal of child psychology and psychiatry, and allied disciplines.

[71]  W. F. Caul,et al.  Attention deficit disorder with hyperactivity: a specific hypothesis of reward dysfunction. , 1987, Journal of the American Academy of Child and Adolescent Psychiatry.