Associations of meeting 24-h movement behavior guidelines with cognitive difficulty and social relationships in children and adolescents with attention deficit/hyperactive disorder

Abstract

Background Evidence-based 24-h movement behavior (24-HMB) guidelines have been developed to integrate recommendations for the time spent on physical activity, sedentary behavior, and sleep. For children and adolescents, these 24-HMB guidelines recommend a maximum of two hours of recreational screen time (as part of sedentary behavior), a minimum of 60 min per day of moderate to vigorous physical activity (MVPA), and an age-appropriate sleep duration (9–11 h for 5 to 13-year-olds; 8–10 h for 14 to 17-year-olds). Although adherence to the guidelines has been associated with positive health outcomes, the effects of adhering to the 24-HMB recommendations have not been fully examined in children and adolescents with attention eficit/hyperactive disorder (ADHD). Therefore, this study examined potential associations between meeting the 24-HMB guidelines and indicators of cognitive and social difficulties in children and adolescents with ADHD. Methods Cross-sectional data on 3470 children and adolescents with ADHD aged between 6 and 17 years was extracted from the National Survey for Children’s Health (NSCH 2020). Adherence to 24-HMB guidelines comprised screen time, physical activity, and sleep. ADHD-related outcomes included four indicators; one relating to cognitive difficulties (i.e., serious difficulties in concentrating, remembering, or making decisions) and three indicators of social difficulties (i.e., difficulties in making or keeping friends, bullying others, being bullied). Logistic regression was performed to determine the associations between adherence to 24-HMB guidelines and the cognitive and social outcomes described above, while adjusting for confounders. Results In total, 44.8% of participants met at least one movement behavior guideline, while only 5.7% met all three. Adjusted logistic regressions further showed that meeting all three guidelines was associated with lower odds of cognitive difficulties in relation to none of the guidelines, but the strongest model included only screen time and physical activity as predictors (OR = 0.26, 95% CI 0.12–0.53, p < .001). For social relationships, meeting all three guidelines was associated with lower odds of difficulty keeping friends (OR = 0.46, 95% CI 0.21–0.97, p = .04) in relation to none of the guidelines. Meeting the guideline for screen time was associated with lower odds of being bullied (OR = 0.61, 95% CI 0.39–0.97, p = .04) in relation to none of the guidelines. While screen time only, sleep only and the combination of both were associated with lower odds of bullying others, sleep alone was the strongest predictor (OR = 0.44, 95% CI 0.26–0.76, p = .003) in relation to none of the guidelines. Conclusion Meeting 24-HMB guidelines was associated with reduced likelihood of cognitive and social difficulties in children and adolescents with ADHD. These findings highlight the importance of adhering to healthy lifestyle behaviors as outlined in the 24-HMB recommendations with regard to cognitive and social difficulties in children and adolescents with ADHD. These results need to be confirmed by longitudinal and interventional studies with a large sample size.

Associations of 24-hour movement behaviors with externalizing and internalizing problems among children and adolescents prescribed with eyeglasses/contact lenses

“…The results of this study indicated that meeting at least two components of 24-HMB guidelines was beneficially linked to arguments, defiant behaviors, care difficulty, and/or difficulties in making friends within the framework of externalizing behaviors. Such findings are supported by previous studies on healthy and clinical participants (e.g., visual impairment, autism spectrum disorder, and attention deficit hyperactivity disorder) across various age groups (e.g., preschooler and youth) ( Carson et al., 2019 ; Hou et al., 2023 ; Kong et al., 2023 ; Sampasa-Kanyinga et al., 2021 ; Taylor et al., 2023 ). For instance, a youth study indicated that meeting at least 2 guidelines showed stronger and more beneficial association with externalizing behaviors than meeting one or none guideline ( Sampasa-Kanyinga et al., 2021 ).…”

“…Participants who met all three 24-HMB guidelines were coded as 1, whereas those who did not met the 24-HMB guidelines were coded as 0. Such coding procedures were used in previous studies ( Hou et al., 2023 ; Kong et al., 2023 ; Taylor et al., 2023 ; Zhao et al., 2023 ). Both categorical (PA, ST, SL, PA+ST, PA+SL, ST+SL, PA+ST+SL) and continuous (e.g., 0–3) number of 24-HMB guidelines were used in this study.…”

MVPA and Motor Proficiency between Children with ADHD and Typical Development: Associations with Sleep Quality

“…Our study found that, compared with children with TD, children with ADHD engaged less time in MVPA daily (101.00 min·d −1 vs 84.19 min·d −1 ) and had a lower proportion to meet the MVPA guidelines (93% vs 78%). It was noted that previous findings on accelerometer-measured MVPA and subjective reports on 60 min of MVPA guideline attainment on children with ADHD are mixed (38.47, 51.75, and 27.57 min·d −1 ) (10,19,31,32), and MVPA disparities in children with ADHD warrant further investigation. Moreover, the 2020 WHO Guidelines on Physical Activity and Sedentary Behaviours recommended that children and adolescents with living disabilities engage in at least 60 min of MVPA daily, including children with ADHD (33).…”

“…The multitude of biopsychosocial risk factors that caused sleep problems in children with ADHD has been proposed, including biological (e.g., sleep–wake cycle and circadian rhythm), psychological (e.g., co-occurring mental health problems), and contextual factors (e.g., PA levels) (11). One recent cross-sectional study in 3470 children with ADHD using the National Survey for Children’s Health (NSCH 2020) reported that only 4.9% of participants met 60 min of MVPA guidelines and that 26.9% of participants had sufficient sleep (19). Although the emerging associations between higher daytime MVPA and minor sleep latency (20), short sleep duration and severe ADHD symptoms (21), and lower motor proficiency and severer sleep problems (11) in children with ADHD have been reported, little research has examined the relationships among MVPA, motor proficiency, and sleep quality in children with ADHD.…”

Evaluation of a pilot physical activity intervention for children with ADHD symptoms and reading difficulties

“…Furthermore, the prevalence of obesity is very high (Faraone et al, 2021), with some studies reporting an increased prevalence of 40% compared to children without ADHD (Cortese et al, 2016). There is therefore a need to support increases in MVPA for children with ADHD (Taylor et al, 2023).…”