Comparative effectiveness of 12-week open- and closed-skill exercises on executive function in children with ADHD and...

Children with attention deficit/hyperactivity disorder and comorbid developmental dyslexia (ADHD + DD) demonstrate both core symptoms of ADHD and pronounced reading difficulties, which further compromise executive function (EF). This study compared the effects of open-versus closed-skill exercises (OSE vs. CSE) on EF in children with ADHD + DD.

Thirty children (6.9-8.5 years) with ADHD + DD were randomly assigned to OSE (n = 15) or CSE (n = 15) training, with 15 typically developing (TD) children receiving CSE. All completed 12-week, thrice-weekly, moderate-to-high intensity (> 60% VO₂ max) sessions. OSE performed table tennis; CSE did track-and-field. EF was assessed with SCWT, CFT, and TMT; visual perception used DTVP-3. Data were analyzed by two-way repeated-measures ANOVA, with ANCOVA used to adjust baseline differences.

Compared with TD peers, ADHD + DD children exhibited impairments in inhibitory control (including Stroop A/B/C/D RT, Stroop B/D error count, and word interference time), all working memory indices, cognitive flexibility (digit-alphabet linking time), and all visual perception measures (all p < 0.05). After intervention the outcomes revealed significant Group × Time differences in EF, including inhibitory control (Stroop B/D RT, word interference time), working memory (delayed detail and structural memory), and cognitive flexibility (digit-alphabet linking time) (p < 0.05). Post-hoc tests confirmed that OSE yielded significantly greater improvements than CSE. For secondary visual perception outcomes, all measures showed significant Group × Time interactions (all p < 0.05). Further adjusted analyses demonstrated that OSE outperformed CSE significantly in visual-motor integration (VMI), copying ability, motor-reduced visual perception (MRP), form consistency, and general visual perception (GVP) (all p < 0.05).

OSE (table tennis training) has superior efficacy in improving EF and visual perception in children with ADHD + DD compared with CSE (track-and-field training), providing preliminary empirical evidence for a feasible non-pharmacological intervention strategy for this population.