Science has finally agreed that the brain is malleable and “plastic.” This means that the brain can, to a surprising extent, reinvent itself with learning, experience, or the right stimulation. This reinvention is called “epigenetic” — the biological process by which life experiences can override, add to, or interact with what genes do, changing how we feel, think, or behave.
Besides nutrition and diet, exercise is particularly relevant to growing the parts of the brain that strengthen self-regulation and executive function, and can help to counteract or improve ADHD. Getting exercise and sleeping well is obviously good for general health, and especially good for children. But for kids with ADHD, exercise and sleep may have specific benefits that will surprise you.
Your Health and Brain
The benefits of exercise and overall fitness are well known for improving general health, mood, and stress management. But what is the benefit for children with ADHD? With the advent of studies that combine exercise and brain imaging, we are learning exactly what exercise can do for brain growth. Recent clinical trials have started to determine to what extent exercise can help children with ADHD.
Particularly interesting is a series of findings showing that, for developing children, aerobic exercise expands the growth of brain connections, the frontal cortex, and the brain chemicals (such as serotonin and dopamine) that support self-regulation and executive functioning. These surprisingly specific findings in typically developing children have led to excitement about the possibility that the right kind of exercise can help ADHD.
Exercise Is Brain-Friendly
Exercise is one of the lifestyle factors with the clearest epigenetic effects. A sustained fitness program, at any age, causes significant epigenetic changes throughout the body (some of which are obvious, like heart and muscle genes), and also in the brain. The epigenetic effects on the brain have been under study for the past several years. While research is ongoing, there is now a sufficiently large literature to be considered definite — and the evidence so far is quite positive. Animal studies suggest that exercise triggers epigenetic changes, such as histone modification and DNA methylation, that specifically alter activity in genes that influence new neuron growth and extend dendritic connections. This means that exercise can exert effects that make the brain grow and become more efficient. Even more encouraging for ADHD treatment is that this seems to happen in the particular brain areas, the hippocampus, basal ganglia, and frontal cortex, that are key to self-regulation and executive functioning.
School, Focus, and Exercise
For kids with ADHD, academic problems are the number one complaint from parents. Fortunately, developmental studies of children and exercise have used academic results as a primary focus. (The caveat is that this literature is still short on high-quality randomized trials that are the acid test of exercise benefits.) However, a major monograph, published in 2014 by the Society for Research in Child Development, concluded that exercise led to improved academic performance in children — more than an equivalent amount of additional class or study time.
Between 2013 and 2016, experts assembled all available studies on exercise’s effect on self-regulation and ADHD to produce several scientific reviews. One, published in the Annual Review of Psychology, concluded that typically developing children show better attention and executive function on the days they exercise.
Such authoritative reviews lead to the following conclusions: Fitness is associated with better working memory, response inhibition, and learning in children. We need more randomized trials, but if we peer into the future, we see that exercise will improve attention and executive functioning in typically developing children, and it directly counteracts ADHD by building self-regulation into the brain.
Current research, while still preliminary, suggests that aerobic exercise can provide noticeable improvements in ADHD symptoms — about half as much improvement as is brought by medication and possibly more than from dietary changes.
Parent-to-Parent: Ideas for Meeting the Exercise Challenge
For many families, daily exercise for children is a challenge, depending on climate, weather, cost, and neighborhood. Here are some solutions that families found:
> Alison went for a long bike ride with her son before school on nice days.
> Alejandro enrolled his daughter in a special martial arts class for children with ADHD.
> Mike installed a punching bag in the basement and taught his teen son how to do workouts with it.
> Jill was able to get her two children outside to jump rope, play hopscotch and tag, and engage in other active play with her neighbor’s kids several times a week, enough to see some change in their mood.
> Tania signed up her daughter for dance lessons, which she enjoyed.
> Bob loved running and got his preteen kids interested in running with him, setting up fun family competitions.
1. Exercise is more important for children with ADHD than it is for other kids.
2. Exercise and fitness have nice side effects of protecting your child from serious health problems (like obesity and diabetes), improving the health of skin, muscle, bone, and improving coordination, while advancing brain growth in systems that support self-regulation and help combat ADHD.
3. The good epigenetic effects may be sustained for years, even after exercising slacks off. We are still learning how many effects are short-term versus long-term.
4. Exercise is a powerful way to create epigenetic change that can overcome negative events that were experienced earlier. Animal studies have reported that exercise can prevent or reverse the effects of stress and trauma in early life.
The Wonders of Sleep
Sleep may be the most important tool nature uses to grow a child’s brain. During sleep the brain makes new connections, stores memories, and repairs cells. One striking scientific finding is called sleep-dependent learning, which means that a person consolidates learning as he sleeps.
You have probably heard someone say that children with ADHD seem to learn something one day but have to learn it again the next day. This is an example of failed memory consolidation. The fact is that children can’t learn things if they don’t sleep. Sleep is also crucial to managing stress and emotions and developing focused attention.
In recent years studies suggest that children and adults learn as much asleep as while awake. Brain-imaging studies, using magnetic resonance imaging to detect patterns of activation, show something remarkable: A particular brain pattern activates when seeing new information while awake. That same pattern is replayed during sleep. Sleep scientists do not see sleep as merely helpful in learning; they see it as necessary. In fact, some recent studies suggest that children who sleep more have higher IQs, as well as better attention and self-control — all relevant for the child who has ADHD.
Sleep, Attention, and Self-Regulation
We don’t need research studies to tell us that we can’t focus or concentrate well without enough sleep. But science adds an important detail. A focus problem can carry over even after sleep is restored. You probably know from experience that you lose self-control after a sleepless night. You can’t cope with stress, handle your emotions, or focus when overtired. In short, if your child isn’t getting enough sleep, her attention and behavior patterns look a lot like ADHD. And what if your child actually has ADHD? Here are the facts about sleep and ADHD to keep in mind:
> Sleep is active, not passive. It’s an essential part of wiring the brain and learning. Kids with ADHD usually have either delays or losses of brain development, as well as problems with learning, so maintaining or restoring a healthy sleep habit is important.
> Lack of sleep can bring symptoms that resemble ADHD, because sleep is necessary to maintain the mental capacity needed for self-regulation. Before we diagnose or treat ADHD, we need to make sure a child is getting adequate sleep.
> Children with ADHD only occasionally have intricate sleep disorders, like obstructive sleep apnea or restless legs syndrome.
> Children with ADHD often have sleep-related behavior problems that interfere with getting good sleep.
How Much Sleep Does My Child Need?
The National Sleep Foundation recommends that infants and toddlers (birth to two years) get more than 12 hours of sleep a day. Many get some of this by napping. Preschoolers (ages three to five) need 10 to 13 hours. School-age children (six to 13) should be getting 10 hours of sleep a night. Teens need only a little less — nine to 10 hours.
If you know your child isn’t getting enough sleep, and is showing the negative effects of under-sleeping, you need to solve the problem. Many kids have negative associations with going to bed or to sleep. So one key concept is to replace those negative associations with positive ones.
Researchers have several basic methods for assessing sleep in children, everything from filling out a questionnaire to using sensors to measure brain waves and breathing. You can pursue one of these with a professional, but if you think your child has a sleep problem, my recommendation is to start simple. Look at bedtime routines and sleep hygiene and try to solve the problem that way.
Parents might also consider sleep training programs in overcoming a sleep/bedtime problem. A randomized controlled clinical trial, in 2014, showed that a formal “sleep training program” — a professionally guided behavior program with a counselor — led to noticeable improvements in mood, emotion, and overall adjustment for children with ADHD. The good news: Improvement occurred after parents received only two sessions of guidance on getting a behavioral sleep program in place.
Action Steps for Good Sleep Hygiene
- No TV in the bedroom.
- Turn off and remove blue light (all screens, including cell phones) for at least an hour before bedtime; no use of cell phones in bed.
- Avoid large meals right before bedtime.
- Keep the bedroom, or at least the bed, only for sleeping.
- No vigorous exercise for at least an hour before bed; keep things calm and low key.
- Set up a going-to-bed routine that takes 30 to 45 minutes.
- Keep your child moving forward during the routine; redirect as necessary.
- Conclude with a ritual enjoyable to the child (a story or a song).
- End the routine with goodnight and the child in bed alone, drowsy but awake (so he doesn’t think he needs you present to fall asleep).
1. If a child calls you back in or leaves his bedroom, minimize engagement and redirect him toward sleep.
2. Maintain consistency, following the same routine and schedule.
3. Keep rewards positive — praise and affection work well.
4. Write out the sleep schedule to help your child follow the steps.
Medication and Sleep Problems
Many parents wonder whether ADHD medication plays a role in their child’s sleep problems. Based on a systematic review of the literature in 2015, it appears that taking stimulants brings a greater chance of: 1) later sleep onset (a child takes longer to fall asleep). Some reviews find that 25 to 50 percent of children with ADHD have a problem with getting to sleep on time. 2) shorter sleep duration; 3) reduced sleep quality (evaluated by studies with electrical sensors).
Certain factors reduced these problems in children who took stimulants. The longer a child was on stimulants, the more her body adjusted, and sleep got closer to normal. Ask your doctor to medicate at different times of day or to skip an evening dose. Alternatively, instead of a long-acting preparation, use a short-acting compound to see if it improves sleep. When stimulants, like Concerta or Adderall, are prescribed, track your child’s sleep. Use a sleep diary or a sleep log for a period of time.
Excerpted from Getting Ahead of ADHD, by JOEL T. NIGG, Ph.D. Copyright © 2017 The Guilford Press. Reprinted with permission of Guilford Press.