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Dynamic balance in children with attention-deficit hyperactivity disorder and its relationship with cognitive
Michal Goetz1, Jaroslava Paulasova Schwabova2, Zdenek Hlavka3
1Department of Child Psychiatry, Second Faculty of Medicine, Motol University Hospital.
Insights
Children with attention-deficit hyperactivity disorder (ADHD) exhibit poorer dynamic balance control, which correlates with reaction time consistency and cerebellar symptoms. These findings suggest a potential link between cerebellar dysfunction, balance deficits, and cognitive impairments in ADHD.
Area of Science:
- Neuroscience
- Developmental Psychology
- Pediatrics
Background:
- Attention-deficit hyperactivity disorder (ADHD) is frequently associated with motor deficits, notably impaired balance.
- The cerebellum plays a crucial role in both balance control and cognitive functions, including timing and anticipatory regulation.
- Cerebellar development may be delayed in ADHD, potentially contributing to observed deficits.
Purpose of the Study:
- To investigate dynamic balance deficits in children with ADHD.
- To examine the correlation between balance deficits, attention, and cerebellar functions in ADHD.
- To explore the potential link between cerebellar dysfunction and ADHD-related impairments.
Main Methods:
- Sixty-two children with ADHD and 62 typically developing (TD) children were assessed using the Phyaction Balance Board.
- Balance performance was evaluated across five trials.
- Cerebellar symptoms were assessed using an international ataxia rating scale, and reaction time patterns were measured with Conners' Continuous Performance Test.
Main Results:
- Children with ADHD demonstrated significantly poorer dynamic balance performance compared to TD children (P<0.001).
- Greater sway amplitudes were observed in ADHD participants across all five balance trials, with increasing effect sizes.
- Balance performance correlated with reaction time variability (r=0.25-0.41) and cerebellar symptom severity (r=0.49-0.50) in both groups.
Conclusions:
- ADHD is associated with impaired dynamic balance control.
- Maintaining balance in ADHD is linked to the consistency of reaction time and cerebellar function.
- Balance deficits and cognitive impairments in ADHD may stem from common cerebellar dysfunction.
Background:
Attention-deficit hyperactivity disorder (ADHD) is linked to the presence of motor deficiencies, including balance deficits. The cerebellum serves as an integrative structure for balance control and is also involved in cognition, including timing and anticipatory regulation. Cerebellar development may be delayed in children and adolescents with ADHD, and inconsistent reaction time is commonly seen in ADHD. We hypothesized that dynamic balance deficits would be present in children with ADHD and they would correlate with attention and cerebellar functions.
Methods:
Sixty-two children with ADHD and no other neurological conditions and 62 typically developing (TD) children were examined with five trials of the Phyaction Balance Board, an electronic balancing platform. Cerebellar clinical symptoms were evaluated using an international ataxia rating scale. Conners' Continuous Performance Test was used to evaluate patterns of reaction.
Results:
Children with ADHD had poorer performance on balancing tasks, compared to TD children (P<0.001). They exhibited significantly greater sway amplitudes than TD children (P<0.001) in all of the five balancing trials. The effect size of the difference between the groups increased continuously from the first to the last trial. Balance score in both groups was related to the variation in the reaction time, including reaction time standard error (r =0.25; P=0.0409, respectively, r =0.31; P=0.0131) and Variability of Standard Error (r =0.28; P=0.0252, respectively, r =0.41; P<0.001). The burden of cerebellar symptoms was strongly related to balance performance in both groups (r =0.50, P<0.001; r =0.49, P=0.001).
Conclusion:
This study showed that ADHD may be associated with poor dynamic balance control. Furthermore, we showed that maintaining balance correlates with neuropsychological measures of consistency of reaction time. Balance deficits and impaired cognitive functioning could reflect a common cerebellar dysfunction in ADHD children.
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Diagnostic Criteria and Symptoms
To diagnose ADHD, symptoms must manifest before age 12 and be evident across multiple settings.