A new study shows that children with attention deficit and hyperactivity disorder (ADHD) follow fewer healthy lifestyle behaviours than non-ADHD youth, suggesting that they may benefit from improving lifestyle choices such as increasing water consumption, decreasing screen time and getting at least one hour of physical activity per day.
The disorder is typically managed with prescriptions like Adderall or Ritalin, though many parents are worried about side effects from these medications, and are interested in alternative ways to minimize symptoms in their children. The new study is the first to examine the total number of healthy lifestyle behaviours children with ADHD follow, as compared to typically developing children.
“Many parents of children diagnosed with ADHD do not want their children on medication,” said Dr Kathleen Holton, lead study author and assistant professor in American University’s department of health studies and member of AU’s Centre for Behavioural Neuroscience. “Having their children follow healthy lifestyle behaviours may be an effective intervention either alongside or in the place of traditional ADHD medications.”
Holton and co-author Joel Nigg, of Oregon Health & Science University, looked at whether or not children age 7 to 11 were following key health recommendations for this age range from the American Academy of Paediatrics, the National Sleep Foundation, and the US Department of Agriculture.
Recommendations include getting no more than 1 to 2 hours of total screen time daily; getting at least 1 hour of physical activity daily; limiting consumption of sugar sweetened beverages; getting 9 to 11 hours of sleep per night; and consuming 7 to 10 cups of water daily, depending on age. Holton and Nigg created a lifestyle index to summarise the total number of healthy lifestyle behaviours adhered to by 184 children with ADHD as compared to a control group of 104 non-ADHD youth.
According to the study results, children with ADHD were more likely to consume artificially sweetened juice, less likely to read for more than one hour per day, more likely to have more than two hours of screen time per day, and more likely to engage in fewer hours of physical activity during the week. Parents of children with ADHD were also much more likely to report that their children have difficulty falling asleep, to report concern about their child’s sleep habits, and fear that sleep problems may be leading to behaviour issues. These associations held even in those children not currently taking ADHD medication, which is known to cause sleep disturbance.
“Parents of children with ADHD should talk with their paediatrician about how to improve health behaviours, such as limiting screen time, encouraging physical activity, improving bedtime routines, and drinking water rather than other beverages,” Holton said.
In most ADHD studies, a child’s condition is often assessed only by a single survey question about past diagnoses. Holton and Nigg employed a rigorous study design that involved parental reports, diagnostic interviews, and consensus of two clinical experts to screen for ADHD and additional psychiatric disorders.
The study is limited by the fact that it only looked at children’s behaviours at one time point. However, the results suggest that future clinical trial research is needed to quantify the impact of a combined lifestyle intervention on ADHD symptoms. It is possible that changing multiple lifestyle behaviours at once can lead to other healthy behaviours.
“For example, physical activity increases thirst, making water consumption more attractive. Physical activity can also offset screen time and can improve sleep. Similarly, removal of caffeinated beverages prevents their diuretic effect, helps increase water consumption, and can help prevent sleep disturbance,” Holton said. “As research into health outcomes in children with ADHD continues to provide new insights, focusing on the overall number of healthy lifestyle behaviours may become important.”
Objective: The objective of the study is to examine whether children aged 7 to 11 years with very well-characterized ADHD, recruited from the community, have a similar number of healthy lifestyle behaviors as compared with typically developing children from the same community.
Method: Parents of children with (n= 184) and without (n= 104) ADHD completed a lifestyle questionnaire asking about water intake, sweetened beverage consumption, multivitamin/supplement use, reading, screen time, physical activity, and sleep. A lifestyle index was formed from these seven domains (0-7), and multivariable ordered logistic regression was used to examine the association of ADHD status and total healthy lifestyle behaviors.
Results: Children with ADHD were almost twice as likely to have fewer healthy behaviors, even after adjustment for age, sex, intelligence quotient (IQ), ADHD medication use, household income, and four comorbid psychiatric disorders (odds ratio [OR] [95% confidence interval] = 1.95 [1.16, 3.30], p= .01).
Conclusion: Future research is needed to assess the effects of a combined lifestyle intervention in this group.