Sports Participation, Anxiety and ADHD

Dr. David Rabiner, Ph.D.

Extensive research has demonstrated that exercise has benefits that extend beyond physical health to mental health. Thus, several reviews have concluded that physical activity improves mood and reduces symptoms of depression while other research has suggested that exercise may be comparable to antidepressant medication in the treatment of depression. Although the bulk of this research has been conducted with adults, there is also evidence suggesting participation in sports and exercise may have benefits for emotional functioning in children, including reduced negative affect, increased self-esteem, and elevated feelings of well-being.

Because anxiety and depressed mood tends to be higher in children with ADHD compared to peers, it would be interesting to study whether exercise and sports participation might help address these symptoms, particularly since these symptoms are not those typically targeted by ADHD treatments. One possible physiological basis for anticipating such benefits is that physical activity influences the activity in several neurotransmitter systems, i.e., dopaminerginc, noradrenergic, and serotonegic systems, and research has suggested that children with ADHD have some dysfunction in dopaminergic activity.

The current study [Kiluk, Weden, & Culotta (2009). Sports participation and anxiety in children with ADHD. Journal of Attention Disorders, 12, pp. 499-506.] provides an initial exploration of whether sports participation may help manage anxiety symptoms in children with ADHD. Participants were 65 6 to 14-year old children diagnosed with pure ADHD, i.e., no other diagnosed conditions, and 32 similarly aged children diagnosed with a learning disability (LD). Each group contained a good representation of females (38% in the ADHD group and 50% in the LD group.

As part of each child's evaluation, parents completed the Child Behavior Checklist, a standardized behavior rating scale that inquires about participation in sports and about symptoms of anxiety/depression. The authors simply examined whether symptoms of anxiety/depression were lower among children with ADHD and children with LD groups based on how many sports they had participated in during the prior year. (Although it would have been interesting to examine the association between sports participation and core ADHD symptoms, this was not possible because all children in the ADHD group met criteria for an ADHD diagnosis, and there was thus limited variability in core symptoms.)

- Results -

For both boys and girls in the ADHD group, there was a significant and moderately strong negative correlation between the number of sports they participated in and parent ratings of anxious/depressed symptoms, -.531 for boys and -.492 for girls. This means that children with greater sports involvement displayed fewer anxious/depressed symptoms according to parents. For children in the LD group, no such association was found.

The authors also divided children into high vs. low sports participation groups, i.e., 2 or fewer sports vs. 3 or more sports, and compared the average scores on the Anxious/Depressed scale for these groups. For children with ADHD, boys and girls in the high sports group had significantly lower anxious/depressed scores than children in the low participation group. The magnitude of this affect would be considered large as the groups differed by more than a full standard deviation. Furthermore, this difference remained significant even when controlling for parents' ratings of children's social functioning and more general functioning at school. Once again, no such differences were found among children with a learning disability.

- Summary and Implications -

Results from this study provide preliminary evidence that sports participation may have unique benefits for children with ADHD in terms of reducing anxious/depressed symptoms that frequently accompany the condition. Based on the data collected here, these benefits appear to be equivalent for males and females. Thus, physical activity and sports participation may serve as an important complement to traditional ADHD treatments that don't typically directly target symptoms of emotional distress.

It is noteworthy that sports participation was only associated with reduced anxious/depressed symptoms in children with ADHD and not children with LD. The authors suggest that physical activity may be particularly helpful in reducing anxious/depressed symptoms in children with ADHD "...because of the dysfunction in the neurotransmission associated with this disorder." This is an interesting hypothesis, but it is important to recognize that it is highly speculative. The fact that benefits remained even after controlling for social and school functioning suggests that sports participation may have benefits above and beyond the socialization opportunities that are provided.

While this is an intriguing study that yielded encouraging initial findings, it should be clear that this is truly an exploratory investigation and the authors recognize several important limitations that prevent firm conclusions from being drawn. These include the absence of any direct measure of children's physical activity, using a purely correlational design rather than examining how sports participation influence anxious/depressed symptoms over time, and the inability to control for differences in family circumstances between high and low sports participation groups that may have contributed to the findings. The authors are appropriately cautious in emphasizing these limitations and correctly note that additional research in this area is required.

Despite these important limitations, this study opens a potentially significant new avenue for addressing some of the emotional difficulties that accompany ADHD for many children. In addition, sports participation is unlikely to have adverse consequences so this would appear to be a relatively 'low risk' approach that may be associated with meaningful benefits. One hopes that additional studies examining whether and how physical activity and participating in sports benefits children with ADHD will be forthcoming.

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This article was originally published in Attention Research Update, an online newsletter written by Dr. David Rabiner of Duke University that helps parents, professionals, and educators keep up with the latest research information on ADHD. Complementary subscriptions are available at www.helpforadd.com.

If you want to keep up with the latest research on ADHD, visit www.helpforadd.com to learn about Attention Research Update, a complementary online newsletter written by Dr. David Rabiner, Associate Research Professor at Duke University. The newsletter summarizes the latest ADHD research findings to help subscribers stay informed about important new developments in the field.

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