A study of the effects of exercise therapy on the comorbidity of attention deficit hyperactivity disorder (ADHD) and developmental co-ordination disorder (DCD).

Abstract

Background: The literature suggests a high prevalence of comorbid ADHD and DCD in South Africa and worldwide. Specific figures of the suspected high prevalence are not available and the link between the two conditions are poorly understood. Medical treatment relies on neurostimulant drugs, which have little or no effect on the motor symptoms and have significant side effects. An intervention that addresses both motor co-ordination and attention/concentration impairments is essential in the overall management of children presenting with these comorbid conditions. This study aimed to document prevalence figures and demographic profile of children aged 8 to 9 years diagnosed with comorbid ADHD and DCD; and to design and develop and test efficacy of an exercise intervention that addresses symptoms of the comorbid conditions. Methodology: The study was located at remedial units within mainstream schools in KwaZulu-Natal, South Africa. Children aged 8 to 9 years diagnosed with ADHD were assessed using the modified Conners’ Teacher Rating Scale and the Copeland’s Symptom Checklist, the Development Co-ordination Disorder Questionnaire (DCDQ) and the Motor Assessment Battery for Children, edition 1 (MABC-1). A three round Delphi technique assisted in the development of an exercise intervention. The efficacy of the exercise intervention was tested via a quasi-experimental study. Children that were assessed were divided into four groups namely: Group (A) that were administered neuropharmacological medication prescribed by a medical practitioner; Group (B) were exposed to the exercise intervention only; Group (C) included children on neuropharmacological medication that were exposed to the exercise intervention and Group (D) served as the control, receiving routine care. All participants were grouped, according to parental preference. Effectiveness of each intervention was assessed using Wilcoxon Signed Ranked Test. Results: 151 children were tested. 74% were diagnosed with comorbid ADHD and DCD. The male to female ratio was 2:1. The combined subtype of ADHD was most commonly diagnosed with comorbidity. Consensus on structure and content in an exercise intervention was achieved in three rounds of the Delphi technique. The programme comprised 12 exercises. ADHD scores were as follows: Group A and B showed significant deterioration in these scores, Group C demonstrated a significant improvement and Group D showed no significant change. Results of motor scores: Group A and D showed a significant deterioration, while Group B and C demonstrated a significant improvement. Conclusions: The combination of medication plus exercises are effective in addressing and improving the symptoms of comorbid ADHD and DCD in children aged 8 to 9 in KZN, SA. Practitioners are cautioned to screen children with ADHD for DCD, following which treatment should be administered to address symptoms of both conditions, hence, providing a more effective and holistic form of management.