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Categories: 2011, June
by Jeffrey M. Halperin, PhD, Carol A. Yoon, and Maria
AS A PARENT OF A CHILD WHO
HAS ADHD, you are probably all too familiar with
the struggle to find the right treatment option for your young one.
Researching all the options available may lead to even more questions
than answers: Which treatment will work for my child? Which will be
ineffective? Which treatments are safe? Which ones involve risk? My
child may be kind of squirmy and inattentive, but does he really need
Parents asking these questions may be relieved to hear that there are
enjoyable activities they can do with their children to help them
develop skills that will lead to better functioning in life.
Causes and common treatment approaches
ADHD is one of the most common childhood neuropsychiatric
disorders, with a prevalence rate assumed to be around four to eight
percent among school-aged children in North America. It typically
emerges during early childhood, and for many, ADHD results in
significant social, academic, and vocational difficulties that persist
well into adulthood. While we do not know the precise cause of ADHD,
which might not be the same for everyone with the disorder, we do know
that both genes and environment play important roles. Recent data
suggest that so-called “gene-by-environment interactions”
result in delayed and/or diminished brain growth, which seems to
underlie the inattentive, impulsive and hyperactive behaviors
characteristic of ADHD.
You probably already know about the medications and psychosocial
interventions available for your child. These interventions decrease the
symptoms of ADHD, improve academic performance, and reduce the frequency
and severity of commonly associated disruptive behaviors such as
oppositionality and aggression. However, they also have several
Medications can have a variety of unwanted side effects and some parents
may feel uncomfortable administering drugs to their children on a daily
basis. Therapeutic interventions such as parent management training and
other behavior management programs are expensive and need to be
maintained continuously and rigorously to be effective. And even when
they are effective, for many children, neither medication nor
psychosocial interventions ever really normalize behavior.
Medications and behavioral interventions are also lacking when
considering long-term outcomes. As soon as children stop these
treatments, their behavior typically reverts back to how it was before
treatment began. Therefore, it’s alarming that the vast majority
of people suffering from ADHD won’t receive treatment for the
disorder for the rest of their lives. The compliance rate for
medications in people who suffer from ADHD is very low: Only about
twenty percent of people continue to take medications a year after they
Playing and exercise can help
New evidence suggests that exercise and play may also be
powerful tools for improving the symptoms of ADHD. Several studies have
provided evidence that enriching children’s environment through
play can serve an important role in cognitive and social skills
development by facilitating neural development.
It has long been known that the environment in which one lives affects
one’s brain development. Recent studies, mostly with animals, have
provided unequivocal evidence that living in more stimulating
environmental conditions not only increases physical brain development,
but also improves learning and behavior. Emerging evidence indicates
that the same applies to humans as well: Cognitive stimulation,
particularly when started at an early age, can facilitate
children’s brain development and in turn have a substantial impact
on learning and behavior. Furthermore, these effects may not be limited
to early childhood. Other studies have shown that cognitive stimulation,
social stimulation, and physical exercise may even delay the onset of
dementia and other neurodegenerative diseases.
Physical exercise has also been found to be effective in stimulating
brain growth in animals and to increase brain activation in children.
This is particularly true for aerobic exercise (high energy activities
that increase breathing and heart rate), as opposed to strength-building
exercise. Investigators have found that children who had better aerobic
fitness had greater volumes in some brain regions and did better on
tasks requiring attention and inhibitory control, as well as some types
of memory. And let’s not forget the many health benefits that go
along with exercise, such as decreased risk of diabetes, cancer,
obesity, and heart disease.
There are many fun exercise options you can choose from, especially
during these warm months. You and your child can go bike riding,
rollerblading, swimming, jogging, play tag, or just dance.
Stuck inside? There are a number of indoor alternatives as well, such as
building your own obstacle course out of hula hoops, pillows, jump
ropes, and other objects around the house. Don’t be afraid to use
your creativity to come up with other fun exercise activities. For the
creatively challenged, try coming up with ideas with your child; it will
be a good collaborative project and there’s a good chance he or
she will have lots of great ideas. These original activities may very
well end up being more fun for your child than the standard ones that he
or she has already learned. Especially for those of you who have a
hyperactive child, exercise is a great activity choice. It is both a
positive outlet for your child’s excess energy and a way to
improve body coordination and control.
Play also has a very important function in facilitating the development
of social skills. Children who engage in socially interactive play
(playing together with others) learn how to read other people’s
intentions, how to take turns, how to regulate their emotions and
behavior, and the give and take nature of healthy relationships.
Children can apply these acquired social skills to their lives in order
to improve their interactions with other people.
Making sense of the science
What these studies tell us is that play and exercise can
be used to stimulate brain growth in areas that are often underdeveloped
in children with ADHD. The idea is similar to weightlifting. When we
consistently use heavier and heavier weights, our muscles grow bigger
and stronger. Our brains respond the same way to cognitive stimulation.
The more they are exercised, the “stronger” they become.
Therefore, it’s likely that the severity of your child’s
disorder can be diminished by encouraging the playing of specific types
of games and exercises which stimulate the growth and development of
specific brain areas.
What kind of games
should I encourage?
Although all games that require your child to think are
valuable tools, most research has focused on the effects of building
working memory (the purposeful remembering and manipulation of new
information) in children with ADHD. Studies have found that training
working memory can be helpful in improving children’s cognitive
functioning and reducing ADHD-related behavioral problems. The idea
again is that the more one practices, the stronger, and more efficient
the working memory “muscle” becomes. You can practice this
type of memory in your children by playing memory games with cards or
pictures (match two from a group of cards or pictures by remembering
their location after they are turned face-down), or “I’m
Going on a Picnic” (take turns adding on to a list of items to
take to a picnic by repeating all of the previously stated items before
adding a new one; to make it more difficult, the order can be
Similarly, evidence suggests that activities targeted towards other
skill areas aside from working memory are also helpful. The Training
Executive, Attention, and Motor Skills (TEAMS) Study is an early
intervention for children with ADHD whose goal is to encourage neural
and cognitive development with games in several different skill areas:
working memory; inhibiting one’s own behavior; visual and spatial
awareness; planning; and body movement, control and coordination.
Many common children’s games involve one or more of these skill
sets. Freeze dance, for example, requires the ability to abruptly stop
one’s own body movement. Building blocks helps children develop
visual-spatial awareness, particularly when they are required to work
out the placement of particular blocks in order to copy a block design
from a picture. Hopscotch requires children to control their body while
jumping, and all sorts of games with balls involve the implementation of
complex motor and coordination skills.
Trying to pick games from various skill sets to play with your child may
be a bit overwhelming, but try not to overthink it. Keep in mind that as
long as your child enjoys playing the games with you, you’re on
the right track. The enjoyment of playing the games will lead to an
increased desire in your child to keep playing them. This is crucial for
continued success. The more your child enjoys these games, the more he
or she will play them with you and others, and the greater the
improvement in skill development will be. In addition, the more
your child plays games, the less television he or she will watch. This
is one big advantage that games and exercise have over other
interventions: They are naturally fun. Instead of having to remind and
encourage your children to take medication daily or go to treatment,
they will be asking you to play brain-building games. Imagine an
intervention for ADHD that is not only painless, but fun!
Once you begin to play these directed games frequently at home, you may
very well find an improvement in the interaction between you and your
child. Quality time between parents and children can be extremely
beneficial in both the short and long term. Your child will value the
positive attention you give him or her, and the shared time can improve
your relationship. Also, unlike current ADHD treatments, in which the
positive effects disappear when the treatment ends, the beneficial
effects of play and exercise are likely to be more long-lasting, for two
reasons. First, if the activities are truly fun, the child will want to
continue with them, hopefully instilling a lifelong desire for
cognitively challenging games (e.g., checkers, chess, many card games,
crossword puzzles) and physical exercise (e.g., running, biking,
hiking). Secondly, if it is true, as evidence suggests, that these
activities enhance brain development, it is reasonable to assume that
the associated behavioral changes will be more enduring and perhaps even
When playing these games with your child, you should regularly take note
of his or her performance and enthusiasm. If you find that your child is
progressing rapidly, soon the game will no longer be challenging. This
doesn’t necessarily mean that you need to abandon it. Instead, try
to come up with creative ways to increase its difficulty. For example,
for the matching game, increase the number of cards over time, or
scatter their placement. You should also frequently praise your child
not only for his or her performance, but also for effort.
Once you incorporate all these techniques into your child’s play
time you might find that his or her behavior improves. Or you might
discover that the two of you have been getting along much better than
usual. Either way, you will quickly discover the important benefits of
this type of engagement with your child. Also keep in mind, depending
upon the needs of your child, this type of intervention does not have to
be instead of other more standard treatments, but can be applied in
addition to them.
Try to block out at least half an hour each day so that
your child can consistently build these brain “muscles.” A
body builder who only lifts weights for a couple of minutes each week
will not see much improvement. He must be consistent in his workout.
Luckily, playing these games will be much more enjoyable than pumping
iron at the gym.
Now you have the necessary tools to build your child’s brain, so
put this magazine down. Take advantage of the warm weather and give it a
try. Go outside. Play a game. Improve your child’s life.
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