Restricted accessResearch articleFirst published online 2023-9
Physical and Extracurricular Activity in Adolescents With and Without ADHD: Examining Group Differences and the Role of Cognitive Disengagement Syndrome Symptoms
This study examined extracurricular and physical activity related to ADHD (diagnosis and symptoms) and cognitive disengagement syndrome (CDS) symptoms.
Methods:
Participants were 302 adolescents (ages 12–14) with and without ADHD and primary caregivers. ADHD diagnosis was determined with parent interview. Questionnaires provided information on parent-reported demographic characteristics, ADHD symptoms, and extracurricular activity involvement; and adolescent-reported ADHD and CDS symptoms and indices of physical activity.
Results:
Although ADHD diagnosis and symptom dimensions were correlated with less extracurricular and physical activity involvement, CDS symptoms were most often independently associated with these outcomes. Females and adolescents from lower income homes also often had less involvement in extracurricular and physical activity.
Conclusions:
Findings point to the need for more research in this area, careful assessment of risk factors (i.e., CDS symptoms, economic burden), and interventions that address inactivity in adolescents with ADHD, including those that address inequity related to income and sex.
AranasK.LeightonJ. P. (2022). Dimensions of physical activity as related to child attention-deficit/hyperactivity disorder symptoms and impairment. Clinical Child Psychology and Psychiatry, 27(4), 953–966. https://doi.org/13591045211058338
2.
BarkleyR. A. (2013). Distinguishing sluggish cognitive tempo from ADHD in children and adolescents: Executive functioning, impairment, and comorbidity. Journal of Clinical Child & Adolescent Psychology, 42(2), 161–173.
3.
BeckerS. P. (2021). Systematic review: Assessment of sluggish cognitive tempo over the past decade. Journal of the American Academy of Child and Adolescent Psychiatry, 60(6), 690–709. https://doi.org/10.1016/j.jaac.2020.10.016
4.
BeckerS. P.BarkleyR. A. (2021). Field of daydreams? Integrating mind wandering in the study of sluggish cognitive tempo and ADHD. JCPP Advances, 1(1), e12002.
5.
BeckerS. P.BurnsG. L.SmithZ. R.LangbergJ. M. (2020). Sluggish cognitive tempo in adolescents with and without ADHD: Differentiation from adolescent-reported ADHD inattention and unique associations with internalizing domains. Journal of Abnormal Child Psychology, 48(3), 391–406. https://doi.org/10.1007/s10802-019-00603-9
6.
BeckerS. P.FredrickJ. W.FosterJ. A.YeamanK. M.EpsteinJ. N.FroehlichT. E.MitchellJ. T. (2022). “My mom calls it Annaland”: A qualitative study of phenomenology, daily life impacts, and treatment considerations of sluggish cognitive tempo. Journal of Attention Disorders, 26(6), 915–931.
7.
BeckerS. P.LangbergJ. M.EadehH. M.IsaacsonP. A.BourchteinE. (2019). Sleep and daytime sleepiness in adolescents with and without ADHD: Differences across ratings, daily diary, and actigraphy. Journal of Child Psychology and Psychiatry, 60(9), 1021–1031.
8.
BeckerS. P.LeopoldD. R.BurnsG. L.JarrettM. A.LangbergJ. M.MarshallS. A.McBurnettK.WaschbuschD. A.WillcuttE. G. (2016). The internal, external, and diagnostic validity of sluggish cognitive tempo: A meta-analysis and critical review. Journal of the American Academy of Child & Adolescent Psychiatry, 55(3), 163–178.
9.
BeckerS. P.WebbK. L.DvorskyM. R. (2021). Initial examination of the bidirectional associations between sluggish cognitive tempo and internalizing symptoms in children. Journal of Clinical Child & Adolescent Psychology, 50(2), 258–266.
10.
BeckerS. P.WillcuttE. G.LeopoldD. R.FredrickJ. W.SmithZ. R.JacobsonL. A.BurnsG. L.MayesS. D.WaschbuschD. A.FroehlichT. E.McBurnettK.ServeraM.BarkleyR. A. (2022). Report of a work group on sluggish cognitive tempo: Key research directions and a consensus change in terminology to cognitive disengagement syndrome. Journal of the American Academy of Child and Adolescent Psychiatry. Advance online publication. https://doi.org/10.1016/j.jaac.2022.07.821
11.
BiddleS. J.AsareM. (2011). Physical activity and mental health in children and adolescents: A review of reviews. British Journal of Sports Medicine, 45(11), 886–895.
12.
BiddleS. J.CiaccioniS.ThomasG.VergeerI. (2019). Physical activity and mental health in children and adolescents: An updated review of reviews and an analysis of causality. Psychology of Sport and Exercise, 42, 146–155.
13.
BonferroniC. (1936). Teoria statistica delle classi e calcolo delle probabilita. Pubblicazioni del R Istituto Superiore di Scienze Economiche e Commericiali di Firenze, 8, 3–62. Italian.
14.
BrenerN. D.KannL.McManusT.KinchenS. A.SundbergE. C.RossJ. G. (2002). Reliability of the 1999 youth risk behavior survey questionnaire. Journal of Adolescent Health, 31(4), 336–342.
15.
BuckleyJ.CohenJ. D.KramerA. F.McAuleyE.MullenS. P. (2014). Cognitive control in the self-regulation of physical activity and sedentary behavior. Frontiers in Human Neuroscience, 8, 747.
16.
ChangY. K.LiuS.YuH. H.LeeY. H. (2012). Effect of acute exercise on executive function in children with attention deficit hyperactivity disorder. Archives of Clinical Neuropsychology, 27(2), 225–237.
17.
Cerrillo-UrbinaA. J.García-HermosoA.Sánchez-LópezM.Pardo-GuijarroM. J.Santos GómezJ. L.Martínez-VizcaínoV. (2015). The effects of physical exercise in children with attention deficit hyperactivity disorder: A systematic review and meta-analysis of randomized control trials. Child: Care, Health and Development, 41(6), 779–788.
18.
CohenP.WestS. G.AikenL. S. (2014). Applied multiple regression/correlation analysis for the behavioral sciences. Psychology Press.
19.
CorneliusC.FedewaA. L.AhnS. (2017). The effect of physical activity on children with ADHD: A quantitative review of the literature. Journal of Applied School Psychology, 33(2), 136–170.
20.
CuijpersP.Van StratenA.WarmerdamL. (2007). Behavioral activation treatments of depression: A meta-analysis. Clinical Psychology Review, 27(3), 318–326.
21.
DimidjianS.BarreraM.Jr.MartellC.MuñozR. F.LewinsohnP. M. (2011). The origins and current status of behavioral activation treatments for depression. Annual Review of Clinical Psychology, 7, 1–38.
22.
DoréI.SylvesterB.SabistonC.SylvestreM.-P.O’LoughlinJ.BrunetJ.BélangerM. (2020). Mechanisms underpinning the association between physical activity and mental health in adolescence: A 6-year study. International Journal of Behavioral Nutrition and Physical Activity, 17(1), 1–9.
23.
FraticelliS.CaratelliG.De BerardisD.DucciG.PettorrusoM.MartinottiG.Di CesareG.Di GiannantonioM. (2022). Gender differences in attention deficit hyperactivity disorder: An update of the current evidence. Rivista di psichiatria, 57(4), 159–164.
24.
FredrickJ. W.BeckerS. P. (2023). Cognitive disengagement syndrome (sluggish cognitive tempo) and social withdrawal: Advancing a conceptual model to guide future research. Journal of Attention Disorders, 27(1):38–45. https://doi.org/10870547221114602.
25.
FredrickJ. W.LangbergJ. M.BeckerS. P. (2022). Longitudinal association of sluggish cognitive tempo with depression in adolescents and the possible role of peer victimization. Research on Child and Adolescent Psychopathology, 50(6), 809–822.
26.
FredrickJ. W.YeamanK. M.YuX.LangbergJ. M.BeckerS. P. (2022). A multi-method examination of sluggish cognitive tempo in relation to adolescent sleep, daytime sleepiness, and circadian preference. Journal of Child Psychology and Psychiatry, 63(12), 1658–1667. https://doi.org/10.1111/jcpp.13568
27.
HeathR. D.AndersonC.TurnerA. C.PayneC. M. (2022). Extracurricular activities and disadvantaged youth: A complicated—but promising—story. Urban Education, 57(8), 1415–1449. https://doi.org/0042085918805797.
28.
HoltonK. F.NiggJ. T. (2020). The association of lifestyle factors and ADHD in children. Journal of Attention Disorders, 24(11), 1511–1520.
29.
KesslerR. C.AdlerL.AmesM.DemlerO.FaraoneS.HiripiE.HowesM. J.JinR.SecnikK.SpencerT. (2005). The World Health Organization adult ADHD self-report scale (ASRS): A short screening scale for use in the general population. Psychological Medicine, 35(2), 245–256. https://doi.org/10.1017/S0033291704002892
30.
KhalifeN.KantomaaM.GloverV.TammelinT.LaitinenJ.EbelingH.HurtigT.JarvelinM.-R.RodriguezA. (2014). Childhood attention-deficit/hyperactivity disorder symptoms are risk factors for obesity and physical inactivity in adolescence. Journal of the American Academy of Child & Adolescent Psychiatry, 53(4), 425–436.
31.
KimJ.MutyalaB.AgiovlasitisS.FernhallB. (2011). Health behaviors and obesity among US children with attention deficit hyperactivity disorder by gender and medication use. Preventive Medicine, 52(3–4), 218–222.
32.
KowalskiK. C.CrockerP. R.KowalskiN. P. (1997). Convergent validity of the physical activity questionnaire for adolescents. Pediatric Exercise Science, 9(4), 342–352.
33.
MercurioL. Y.AmanullahS.GillN.GjelsvikA. (2021). Children with ADHD engage in less physical activity. Journal of Attention Disorders, 25(8), 1187–1195.
34.
MoranM. D. (2003). Arguments for rejecting the sequential Bonferroni in ecological studies. Oikos, 100(2), 403–405.
35.
MutschlerC.NaccaratoE.RouseJ.DaveyC.McShaneK. (2018). Realist-informed review of motivational interviewing for adolescent health behaviors. Systematic Reviews, 7(1), 1–21.
36.
NiggJ. T. (2013). Attention-deficit/hyperactivity disorder and adverse health outcomes. Clinical Psychology Review, 33(2), 215–228.
37.
Rodriguez-AyllonM.Cadenas-SánchezC.Estévez-LópezF.MuñozN. E.Mora-GonzalezJ.MiguelesJ. H.Molina-GarcíaP.HenrikssonH.Mena-MolinaA.Martínez-VizcaínoV. (2019). Role of physical activity and sedentary behavior in the mental health of preschoolers, children and adolescents: A systematic review and meta-analysis. Sports Medicine, 49(9), 1383–1410.
38.
RommelA.-S.LichtensteinP.RydellM.Kuja-HalkolaR.AshersonP.KuntsiJ.LarssonH. (2015). Is physical activity causally associated with symptoms of attention-deficit/hyperactivity disorder?Journal of the American Academy of Child & Adolescent Psychiatry, 54(7), 565–570. https://doi.org/10.1016/j.jaac.2015.04.011
39.
RondonA. T.HiltonD. C.JarrettM. A.OllendickT. H. (2020). Sleep, internalizing problems, and social withdrawal: Unique associations in clinic-referred youth with elevated sluggish cognitive tempo symptoms. Journal of Attention Disorders, 24(4), 524–534. https://doi.org/10.1177/1087054718756197
40.
SáezB.ServeraM.BurnsG. L.BeckerS. P. (2019). Advancing the multi-informant assessment of sluggish cognitive tempo: Child self-report in relation to parent and teacher ratings of SCT and impairment. Journal of Abnormal Child Psychology, 47(1), 35–46. https://doi.org/10.1007/s10802-018-0436-4
41.
SeifferB.HautzingerM.UlrichR.WolfS. (2022). The efficacy of physical activity for children with attention deficit hyperactivity disorder: A meta-analysis of randomized controlled trials. Journal of Attention Disorders, 26(5), 656–673. https://doi.org/10.1177/10870547211017982
42.
SelinusE. N.DurbeejN.ZhanY.LichtensteinP.LundströmS.EkblomM. (2021). Inattention and hyperactivity symptoms in childhood predict physical activity in adolescence. BMC Psychiatry, 21(1), 1–11.
43.
SmithZ. R.EadehH.-M.BreauxR. P.LangbergJ. M. (2019). Sleepy, sluggish, worried, or down? The distinction between self-reported sluggish cognitive tempo, daytime sleepiness, and internalizing symptoms in youth with attention-deficit/hyperactivity disorder. Psychological Assessment, 31(3), 365–375.
44.
SolmonM. A. (2014). Physical education, sports, and gender in schools. Advances in Child Development and Behavior, 47, 117–150.
45.
SonnbyK.SkordasK.OlofsdotterS.VadlinS.NilssonK. W.RamklintM. (2015). Validation of the World Health Organization adult ADHD self-report scale for adolescents. Nordic Journal of Psychiatry, 69(3), 216–223. https://doi.org/10.3109/08039488.2014.968203
46.
Suarez-ManzanoS.Ruiz-ArizaA.De La Torre-CruzM.Martínez-LópezE. J. (2018). Acute and chronic effect of physical activity on cognition and behaviour in young people with ADHD: A systematic review of intervention studies. Research in Developmental Disabilities, 77, 12–23.
47.
SunW.YuM.ZhouX. (2022). Effects of physical exercise on attention deficit and other major symptoms in children with ADHD: A meta-analysis. Psychiatry Research, 311, 114509.
48.
TandonP. S.SasserT.GonzalezE. S.WhitlockK. B.ChristakisD. A.SteinM. A. (2019). Physical activity, screen time, and sleep in children with ADHD. Journal of Physical Activity and Health, 16(6), 416–422.
49.
United States Department of Health and Human Services. (2008). Guidelines for physical activity for Americans. Physical activity guidelines, get active, NHLBI, NIH.
50.
Villalba-HerediaL.RodríguezC.SantanaZ.NuñezJ. C.Méndez-GiménezA. (2022). A cross-sectional study to measure physical activity with accelerometry in ADHD children according to presentations. Children, 10(1), 50.
51.
VellaS. A.CliffD. P.MageeC. A.OkelyA. D. (2014). Sports participation and parent-reported health-related quality of life in children: Longitudinal associations. The Journal of Pediatrics, 164(6), 1469–1474.
52.
WangW.HaegeleJ. A.WuY.LiC. (2022). Meeting the 24-hour movement guidelines and outcomes in adolescents with ADHD: A cross-sectional observational study. International Journal of Environmental Research and Public Health, 19(4), 2132.
53.
WechslerD. (2011). Wechsler abbreviated scale of intelligence - Second Edition (WASI-II). Pearson.
54.
WellerE. B.WellerR.RooneyM. T.FristadM. A. (1999). Children’s interview for psychiatric syndromes (ChIPS). American Psychiatric Association.
55.
WigalS. B.EmmersonN.GehrickeJ. G.GalassettiP. (2013). Exercise: Applications to childhood ADHD. Journal of Attention Disorders, 17(4), 279–290.
56.
WillcuttE. G.NiggJ. T.PenningtonB. F.SolantoM. V.RohdeL. A.TannockR.LooS. K.CarlsonC. L.McBurnettK.LaheyB. B. (2012). Validity of DSM-IV attention deficit/hyperactivity disorder symptom dimensions and subtypes. Journal of Abnormal Psychology, 121(4), 991–1010.
57.
WolraichM. L. (2003). Psychometric properties of the Vanderbilt ADHD diagnostic parent rating scale in a referred population. Journal of Pediatric Psychology, 28(8), 559–568. https://doi.org/10.1093/jpepsy/jsg046
58.
YungT. W.LaiC. Y.ChanJ. Y.NgS. S.ChanC. C. (2020). Neuro-physiological correlates of sluggish cognitive tempo (SCT) symptoms in school-aged children. European Child & Adolescent Psychiatry, 29(3), 315–326.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
