Effects of physical activity and fitness on cognitive function, self-control, and resilience in young people with attention deficit hyperactivity disorder

This thesis is presented as a collection of four studies that examine the effects of physical activity on cognitive function, self-control, and resilience in young people with attention deficit/hyperactivity disorder (ADHD). Previous literature has highlighted beneficial effects of physical activity for cognition, self-control, and resilience in neurotypical young people. However, there is limited evidence regarding these effects in young people with ADHD; despite young people with ADHD typically displaying poorer cognition, self-control, and resilience than their neurotypical counterparts. Furthermore, acute physical activity interventions in young people with ADHD have predominantly only considered individual sports such as running or cycling, both of which are not commonly undertaken in this population and age-group. Furthermore, limited research has examined the effects of physical activity and physical fitness on self-control and resilience in this population; two psychological constructs key to young people’s development. Furthermore, no research to date has investigated the qualitative preferences and perceptions of physical activity in young people with ADHD, their parents, and their teachers to gain a deeper insight into what a potential successful physical activity intervention might look like in this population. The current thesis aims to address these limitations and extend the literature base. Study one was a meta-analysis of studies that have examined the acute effects of physical activity on cognitive function in young people with ADHD, considering key variables such as the duration and modality of physical activity, and study design. The meta-analysis highlighted that physical activity appears to have acute beneficial effects on cognition in young people with ADHD. Specifically, the study found a small overall benefit of acute physical activity on cognitive function in children and adolescents with ADHD (Standardised Mean Difference [SMD] = 0.18), with domain-specific benefits on cognitive flexibility (SMD = 0.21), attention (SMD = 0.20) and inhibitory control (SMD = 0.18); whilst no effect was observed for memory (SMD = 0.02). Furthermore, the optimal intervention duration was between 11-20 min (SMD = 0.23 vs. 0-10 min; SMD = 0.11, >20 min; SMD = 0.13) and modality-wise; running (SMD = 0.21) or ‘other’ types of physical activity (trampolining, exergaming and coordinative tasks; SMD = 0.39) were shown to improve cognitive function in this population, whilst cycling had no effect (SMD = 0.06). Study two examined the associations between psychological constructs important in the development of young people with ADHD (cognitive function, trait self-control, and trait resilience) and cardiorespiratory fitness and physical activity. The study identified positive associations between cardiorespiratory fitness and enhanced performance on tests of inhibitory control (r = -0.348; p = 0.01) and attention (simple Stroop IES r = -0.386; p = 0.004 and congruent Flanker task IES r = - 0.302; p = 0.026). There was also a tendency for a positive association between cardiorespiratory fitness and trait resilience (r = 0.253; p = 0.065). Furthermore, moderate-to-vigorous physical activity was positively associated with higher trait self-control (r = 0.370; p = 0.021). Thus, overall, study two demonstrates positive associations between physical activity/physical fitness and the important psychological constructs of cognitive function, self-control, and resilience in young people with ADHD. These findings then guided the third study that aimed to identify the perceptions of physical activity to inform future physical activity intervention design from the perspective of young people with ADHD, their parents, and their teachers. The study found four common themes across the three key stakeholders which were; the need for reduced stopping and starting in interventions, ensuring activities are short, quick-paced and dynamic with clear instruction, reduced exposure to sensory situations that could lead to emotional dysregulation, and rethinking behaviour management and discipline methods in order to maintain enthusiasm and engagement without punishing young people for being unable to manage their ADHD symptoms (typically involving movement). Thus, concluding that a games-based physical activity was a potential modality of physical activity that met the criteria identified within the study findings. Utilising these findings, study four examined the acute effects of a games-based physical activity session (30 min basketball-based activities) on cognitive function, state self-control, and state resilience in young people with ADHD. It was found that the 30-min basketball intervention did not acutely affect cognitive function performance (p = 0.109-0.971), self-control (p = 0.232) or resilience (p = 0.495) in young people with ADHD, compared to a resting control condition. Therefore, suggesting that an acute games-based physical activity intervention does not improve cognitive function, state self-control and state resilience in young people with ADHD. Overall, the findings of this thesis demonstrate the importance of physical activity (and physical fitness) for young people with ADHD. Specifically, positive effects of physical activity on cognitive performance were demonstrated acutely via a meta-analysis in Chapter IV, and chronically in Chapter V; whilst the games-based intervention in Chapter VII did not show positive effects of physical activity acutely to enhance cognitive function. Similarly, Chapter V demonstrated a positive association between physical activity and trait self-control, though the games-based intervention in Chapter VII did not influence state self-control in an acute setting. Finally, whilst there was a tendency for a positive association between physical fitness and trait resilience in Chapter V, the acute games-based intervention in Chapter VII did not affect state resilience. This thesis also assessed qualitative perceptions of physical activity interventions in young people with ADHD and other key stakeholders in Chapter VI, which was used to inform the games-based physical activity intervention in Chapter VII. Thus, whilst the intervention in Chapter VII did not acutely influence cognition, self-control or resilience in young people with ADHD, it is possible this was due to the limited ‘dose’ (i.e., a single session). Given that the intervention was developed with ecological validity in mind, future work should perhaps focus on the longer-term effects of such an intervention in this population.

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