2006 AD/HD Study
Poster Presentation at American Psychological Association Convention August
2006
RESULTS:
-
72.8% of the 895 participants had symptoms of ADHD (Attention Deficit
Hyperactive Disorder) at the beginning of the study. At the conclusion of the
study this was reduced to 19.1%
-
On average inattention and hyperactivity symptoms were shown to have been
reduced in participants by 60%
-
Further tests showed that improvements were sustained 6-12 months after
completion of the study. This has never been shown before in any study of ADHD
treatment effectiveness
PAPER TITLE: Significant reduction in symptoms of attention-deficit in
learning-disabled children and adults following exercise-based treatment
AUTHORS:
Dr. Roy Rutherford (Dept. of Psychology, University of Sheffield, UK)
Professor Rod Nicolson (Dept. of Psychology, University of Sheffield, UK)
Professor Eugene Arnold (Dept of Psychiatry, Ohio State University,
Columbia, USA)
SUMMARY:
Study of 895 consecutive clients attending the DORE centers in the United
Kingdom
698 participants were under 16 years old
193 participants were over 16 years old
DSM IV Criteria A, B, C and D were used to assess 9 inattention
symptoms and 6 hyperactivity/impulsivity symptoms.
Effect Size: Effect sizes of 0.2, 0.5 and 1.0 are considered
small, medium, and large respectively (Cohen, 1988)
ATTENTION SYMPTOM CHANGES
-
Mean Symptom count of Inattention symptoms of all clients (n=895):
-
6.60 symptoms before to 2.77 after (Effect
size 1.69)
-
72.8% had ADHD positive symptoms to start with reducing to
19.1% at the end. This increased slightly to 21% six
months post-treatment
-
Mean Symptom count of Inattention symptoms of ADHD positive clients (=>6 of
9); (n= 609):
-
8.08 symptoms before to 3.29 after (Effect
size 3.32)
-
577 improved; 29 remained same; 3 regressed
-
ADHD inattentive type = 56.8% at start reducing to 12.00%
at completion of program
-
ADHD combined type= 13.6% at start reducing to 3.2%
at completion
HYPERACTIVITY/IMPULSIVITY CHANGES
-
Mean Symptom count of Hyperactivity/impulsivity symptoms of all clients (n=895)
-
1.74 symptoms before to 1.18 after (Effect
size 0.27)
-
Mean Symptom count of Hyperactivity/impulsivity symptoms of ADHD positive
clients (=> 4 of 6); (n= 130)
-
4.88 symptoms before to 2.04 after (Effect
size 2.6)
-
119 improved; 6 remained same; 5 regressed
CHILDREN VERSUS ADULTS
-
Adults have on average lower number of initial attention symptoms - 5.35
compared to 6.92
in children
-
Adults have no significant difference in initial hyperactivity symptoms - 1.72
compared to 1.75
in children
-
There is no significant difference in the response to treatment between adults
and children when comparing pre and post treatment data
POST-INTERVENTION RETENTION OF IMPROVEMENTS
-
Of 1000 clients assessed in a follow up study of DORE treatment 171
were from the 895 clients included in this study
-
These clients were assessed using the DSM IV ADHD questions between 6 and 12
months after completing DORE treatment
-
Mean symptom count of ADHD inattention symptoms -changed from 2.6
symptoms at the end of the DORE program to 2.73
between 6 and 12 months later. -this change was not significant (ES= -0.05)
suggesting full retention of the improvements in attention symptoms
-
Mean symptom count of ADHD hyperactivity/impulsivity symptoms - changed from
1.09 symptoms at the end of the DORE program to 0.65
between 6 and 12 months later. - this change showed significant further
improvements (ES= 0.4) suggesting further improvements in hyperactivity and
impulsivity symptoms occurred after completion of the DORE program
COMPARISON WITH BALSALL STUDY DATA
The Balsall follow up study (Reynolds D and Nicolson RI 2006 in press) shows
how attention symptoms are retained between 1-2 years after completion of the
DORE intervention.
-
At 1-2 years after completing the intervention 36 subjects with learning
impairments were assessed using DSM IV attention symptom checklists
-
46%
showed significant attention deficits at the beginning of the study
-
8%
showed impairments 1-2 years after completion
-
Average symptom score dropped from 4.67 to 1.93
PLACEBO EFFECT
The question about possible placebo effect being the explanation is a weighty
one because the intensive, costly 13-month-long (on average) treatment
presented maximal opportunities for improvement from expectation, maturation,
and other non-specific effects. This question is best answered by
comparison with another large sample treated in a different manner for about
the same length of time. The National Institute of Mental Health (NIMH)
Multimodal Treatment Study of Children with ADHD (“the MTA”, MTA Cooperative
Group, 1999) randomly assigned 579 children ages 7-9 years to 14 months of
treatment.
Although using differing admission criteria in the MTA study (ADHD combined
types) the length of program was similar to DORE’s thus allowing for intensity
of treatment, maturity and expectation effects.
With regard to the amount of ‘attention’ received the DORE program compares
quite favorably with the MTA combined intervention.
The MTA study combined group received:
-
Medical medication meeting 30 minutes per month
-
35 parent training visits
-
Full time 8 week summer treatment camp
-
10-16 sessions of teacher consultation
-
12 weeks of a half time behaviorally trained paraprofessional aid in class
The DORE program group received:
-
5-10 minute twice daily exercise routine
-
An average of eight 90 minute follow up appointments
The comparison of effect sizes between the MTA combined group and DORE are
as follows:
-
MTA combined group ES pre-post treatment 1.62
-
DORE group ES pre-post treatment 3.23 attention and 2.6
hyperactivity/impulsivity
CONCLUSIONS
We conclude that exercise-based treatment designed to stimulate the cerebellum
seems to be associated with marked and long-lasting improvement in the
attentional and hyperactivity/impulsivity abilities of children and adults with
a range of learning disabilities. These promising preliminary findings have
strong applied and theoretical implications and warrant a controlled trial in
well-diagnosed ADHD of all three types.