Handwriting difficulties are common in children with Attention-Deficit/Hyperactivity Disorder (ADHD), and they have been associated with lower academic achievement and self-esteem. Our aim in this study was to determine if training coordination of the head, eyes, and arm and engaging in the necessary visual concentration associated with table tennis would improve executive functions and school-based handwriting among children with ADHD. We designed a randomized controlled trial to explore the therapeutic efficacy of this table tennis training and recruited 48 children with ADHD that we randomly assigned to one of three equal-sized training groups: (a) actual table tennis, (b) simulated table tennis (exergame), or (c) a control group receiving no additional training. The training intervention lasted 12-weeks in which the two different table tennis trainings (i.e., actual or simulated) were scheduled for three one-hour sessions per week. Outcome measures included a computerized handwriting evaluation, the Stroop test, and the Wisconsin Card Sorting Test (WCST). Participants in each table tennis training group showed significant improvements in handwriting performance, response time, and required time to achieve automation. Both intervention groups also showed significant improvements on the Stroop Color-Word test, but only the actual table tennis training group showed a significant improvement on the WCST. This study provided evidence of at least short-term improvements in executive functions and handwriting problems in children with ADHD through their participation in table tennis motor coordination activities.
AdlerL. A.ShawD. M.KovacsK.AlperinS.SpencerT. (2015). Diagnosing ADHD in children and adults. Attention-deficit hyperactivity disorder in adults and children (pp. 16–23).
AndersonP. J. (2008). Towards a developmental model of executive function. In AndersonV.JacobsR.AndersonP. J. (Eds), Executive functions and the frontal lobes: A lifespan perspective (pp. 3–21). Philadelphia, PA: Taylor & Francis.
4.
AudiffrenM.AndréN. (2019). The exercise–cognition relationship: A virtuous circle. Journal of Sport and Health Science, 8(4), 339–347. doi: 10.1016/j.jshs.2019.03.001. https://doi.org/10.1016/j.jshs.2019.03.001
5.
BarkleyR. A. (2006) Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (p. 3). New York: Guilford press.
6.
BarkleyR. A. (2012). Executive functions: What they are, how they work, and why they evolved. Guilford Press.
7.
BarkleyR. A.MurphyK. R. (2011). The nature of executive function (EF) deficits in daily life activities in adults with ADHD and their relationship to performance on EF tests. Journal of Psychopathology and Behavioral Assessment, 33(2), 137–158. https://doi.org/10.1007/s10862-011-9217-x
8.
BenzingV.SchmidtM. (2018). Exergaming for children and adolescents: strengths, weaknesses, opportunities and threats. Journal of Clinical Medicine, 7(11), 422. https://doi.org/10.3390/jcm7110422
9.
BenzingV.SchmidtM. (2019). The effect of exergaming on executive functions in children with ADHD: A randomized clinical trial. Scandinavian Journal of Medicine & Science inSsports, 29(8), 1243–1253. https://doi.org/10.1111/sms.13446
10.
BiedermanJ.MonuteauxM. C.DoyleA. E.SeidmanL. J.WilensT. E.FerreroF.MorganC. L.FaraoneS. V. (2004). Impact of executive function deficits and attention-deficit/hyperactivity disorder (ADHD) on academic outcomes in children. Journal of Consulting and Clinical Psychology, 72(5), 757–766. https://doi.org/10.1037/0022-006X.72.5.757
11.
Brossard-RacineM.ShevellM.SniderL.BélangerS. A.JulienM.MajnemerA. (2015). Persistent handwriting difficulties in children with ADHD after treatment with stimulant medication. Journal of Attention Disorders, 19(7), 620–629. https://doi.org/10.1177/1087054712461936
12.
BrownT. E. (2009). ADD/ADHD and impaired executive function in clinical practice. Current Attention Disorders Reports, 1(1), 37–41. https://doi.org/10.1007/s12618-009-0006-3
13.
BuftonA.CampbellA.HowieE.StrakerL. (2014). A comparison of the upper limb movement kinematics utilized by children playing virtual and real table tennis. Human Movement Science, 38(2014), 84–93. http://dx.doi.org/10.1016/j.humov.2014.08.004
14.
CapodieciA.LachinaS.CornoldiC. (2018). Handwriting difficulties in children with attention deficit hyperactivity disorder (ADHD). Research in Developmental Disabilities, 74(2018), 41–49. https://doi.org/10.1016/j.ridd.2018.01.003.
15.
CarlsonC. L.LaheyB. B.NeeperR. (1986). Direct assessment of the cognitive correlates of attention deficit disorders with and without hyperactivity. Journal of Psychopathology and Behavioral Assessment, 8(1), 69–86. https://doi.org/10.1007/bf00960874
16.
ChangS. H.YuN. Y. (2005). Evaluation and classification of types of Chinese handwriting deficits in elementary schoolchildren. Perceptual and Motor Skills, 101(2), 631–647. https://doi.org/10.2466/pms.101.2.631-647
17.
ChangS. H.YuN. Y. (2010). Characterization of motor control in handwriting difficulties in children with or without developmental coordination disorder. Developmental Medicine and Child Neurology, 52(3), 244–250. https://doi.org/10.1111/j.1469-8749.2009.03478.x
18.
ChenA.WengX.YuanJ.LeiX.QiuJ.YaoD.LiH. (2008). The temporal features of self-referential processing evoked by Chinese handwriting. Journal of Cognitive Neuroscience, 20(5), 816–827. https://doi.org/10.1162/jocn.2008.20505
19.
CohenJ. (2013). Statistical power analysis for the behavioral sciences. Academic Press.
20.
CoulacoglouC.SaklofskeD. H. (2017). Psychometrics and psychological assessment: Principles and applications. Academic Press.
21.
DoernbergE.HollanderE. (2016). Neurodevelopmental disorders (ASD and ADHD): DSM-5, ICD-10, and ICD-11. CNS Spectrums, 21(4), 295–299. https://doi.org/10.1017/S1092852916000262
22.
EliassonA. C.RösbladB.ForssbergH. (2004). Disturbances in programming goal-directed arm movements in children with ADHD. Developmental Medicine and Child Neurology, 46(1), 19–27. https://doi.org/10.1017/s0012162204000040
23.
ElosúaM. R.Del OlmoS.ContrerasM. J. (2017). Differences in executive functioning in children with attention deficit and hyperactivity disorder (ADHD). Frontiers in Psychology, 8, 976. https://doi.org/10.3389/fpsyg.2017.00976
24.
FaulF.ErdfelderE.LangA. G.BuchnerA. (2007). G* power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191. https://doi.org/10.3758/bf03193146
25.
FringsM.GaertnerK.BuderathP.ChristiansenH.GerwigM.Hein-KroppC.SchochB.HebebrandJ.TimmannD. (2010). Megalographia in children with cerebellar lesions and in children with attention-deficit/hyperactivity disorder. The Cerebellum, 9(3), 429–432. https://doi.org/10.1007/s12311-010-0180-y
GreveK. W.StickleT. R.LoveJ. M.BianchiniK. J.StanfordM. S. (2005). Latent structure of the Wisconsin Card sorting test: A confirmatory factor analytic study. Archives of Clinical Neuropsychology, 20(3), 355–364. https://doi.org/10.1016/j.acn.2004.09.004
28.
HiltonC. L.CumpataK.KlohrC.GaetkeS.ArtnerA.JohnsonH.DobbsS. (2014). Effects of exergaming on executive function and motor skills in children with autism spectrum disorder: A pilot study. American Journal of Occupational Therapy, 68(1), 57–65. https://doi.org/10.5014/ajot.2014.008664
29.
HungL. Y.ChangY. W.ChenS. F.ChenC. S.LeeY. D. (2003). Battery of Chinese basic literacy (BCBL). Psychological Company.
30.
KoppB.LangeF.SteinkeA. (2021). The reliability of the Wisconsin card sorting test in clinical practice. Assessment, 28(1), 248–263. https://doi.org/10.1177/1073191119866257
31.
LangeK. W.TuchaL.WalitzaS.GerlachM.LinderM.TuchaO. (2007). Interaction of attention and graphomotor functions in children with attention deficit hyperactivity disorder. Journal of Neural Transmission, 2007(Suppl 72), 249–259. https://doi.org/10.1007/978-3-211-73574-9_31.
32.
LangmaidR. A.PapadopoulosN.JohnsonB. P.PhillipsJ. G.RinehartN. J. (2014). Handwriting in children with ADHD. Journal of Attention Disorders, 18(6), 504–510. https://doi.org/10.1177/1087054711434154
MerglR.TiggesP.SchröterA.MöllerH. J.HegerlU. (1999). Digitized analysis of handwriting and drawing movements in healthy subjects: methods, results and perspectives. Journal of Neuroscience Methods, 90(2), 157–169. https://doi.org/10.1016/s0165-0270(99)00080-1
35.
MiyakeA.FriedmanN. P.EmersonM. J.WitzkiA. H.HowerterA.WagerT. D. (2000). The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: A latent variable analysis. Cognitive Psychology, 41(1), 49–100. https://doi.org/10.1006/cogp.1999.0734
36.
PanC. Y.TsaiC. L.ChuC. H.SungM. C.HuangC. Y.MaW. Y. (2019). Effects of physical exercise intervention on motor skills and executive functions in children with ADHD: A pilot study. Journal of Attention Disorders, 23(4), 384–397. https://doi.org/10.1177/1087054715569282
37.
RacineM. B.MajnemerA.ShevellM.SniderL. (2008). Handwriting performance in children with attention deficit hyperactivity disorder (ADHD). Journal of Child Neurology, 23(4), 399–406. https://doi.org/10.1177/0883073807309244
38.
RaggiV. L.ChronisA. M. (2006). Interventions to address the academic impairment of children and adolescents with ADHD. Clinical Child and Family Psychology Review, 9(2), 85–111. https://doi.org/10.1007/s10567-006-0006-0
39.
RodriguesS. T.VickersJ. N.WilliamsA. M. (2002). Head, eye and arm coordination in table tennis. Journal of Sports Sciences, 20(3), 187–200. https://doi.org/10.1080/026404102317284754
40.
RosenblumS. (2018). Inter-relationships between objective handwriting features and executive control among children with developmental dysgraphia. Plos One, 13(4), Article e0196098. https://doi.org/10.1371/journal.pone.0196098
41.
SchwartzK.VerhaeghenP. (2008). ADHD and Stroop interference from age 9 to age 41 years: A meta-analysis of developmental effects. Psychological Medicine, 38(11), 1607–1616. https://doi.org/10.1017/S003329170700267X
42.
ShalliceT.MarzocchiG. M.CoserS.Del SavioM.MeuterR. F.RumiatiR. I. (2002). Executive function profile of children with attention deficit hyperactivity disorder. Developmental Neuropsychology, 21(1), 43–71. https://doi.org/10.1207/S15326942DN2101_3
43.
StroopJ. R. (1935). Studies of interference in serial verbal reactions. Journal of Experimental Psychology, 18(6), 643–662. https://doi.org/10.1037/h0054651
44.
SugdenD. (2007). Current approaches to intervention in children with developmental coordination disorder. Developmental Medicine and Child Neurology, 49(6), 467–471. https://doi.org/10.1111/j.1469-8749.2007.00467.x
45.
SwansonJ. M.KraemerH. C.HinshawS. P.ArnoldL. E.ConnersC. K.AbikoffH. B.ClevengerW.DaviesM.ElliottG. R.GreenhillL. L.HechtmanL.HozaB.JensenP. S.MarchJ. S.NewcornJ. H.OwensE. B.PelhamW. E.SchillerE.SevereJ. B.SimpsonS. (2001). Clinical relevance of the primary findings of the MTA: success rates based on severity of ADHD and ODD symptoms at the end of treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 40(2), 168–179. https://doi.org/10.1097/00004583-200102000-00011
46.
TsaiC. L. (2009 Nov-Dec). The effectiveness of exercise intervention on inhibitory control in children with developmental coordination disorder: using a visuospatial attention paradigm as a model. Research in Developmental Disabilities, 30(6), 1268–1280. https://doi.org/10.1016/j.ridd.2009.05.001
47.
TsuchiyaE.OkiJ.YaharaN.FujiedaK. (2005). Computerized version of the Wisconsin card sorting test in children with high-functioning autistic disorder or attention-deficit/hyperactivity disorder. Brain & Development, 27(3), 233–236. https://doi.org/10.1016/j.braindev.2004.06.008
48.
TuchaO.LangeK. W. (2001). Effects of methylphenidate on kinematic aspects of handwriting in hyperactive boys. Journal of Abnormal Child Psychology, 29(4), 351–356. https://doi.org/10.1023/A:1010366014095
49.
TuchaO.PrellS.MecklingerL.Bormann-KischkelC.KübberS.LinderM.WalitzaS.LangeK. W. (2006). Effects of methylphenidate on multiple components of attention in children with attention deficit hyperactivity disorder. Psychopharmacology, 185(3), 315–326. https://doi.org/10.1007/s00213-006-0318-2
50.
VickersJ. N.RodriguesS. T.BrownL. N. (2002). Gaze pursuit and arm control of adolescent males diagnosed with attention deficit hyperactivity disorder (ADHD) and normal controls: evidence of a dissociation in processing visual information of short and long duration. Journal of Sports Sciences, 20(3), 201–216. https://doi.org/10.1080/026404102317284763
51.
WechslerD. (2014). Wechsler intelligence Scale for children (5th edition). Bloomington, MN: PsychCorp.
52.
ZelazoP. D.CarterA.ReznickJ. S.FryeD. (1997). Early development of executive function: A problem-solving framework. Review of General Psychology, 1(2), 198–226. https://doi.org/10.1037/1089-2680.1.2.198
