Exercise has positive effects on children with ADHD

Ramesh- this is Journal Club

Engaging in moderately intense aerobic exercise for just 20 minutes leads to improved neurocognitive function and inhibitory control in children with attention-deficit/hyperactivity disorder (ADHD), a recent study shows. For this trial, investigators recruited 20 children aged 8 to 10 years who had diagnosed or suspected ADHD and no comorbid conditions. Participants completed brief intelligence tests and were evaluated for disruptive behaviors and other measures of ADHD.

After baseline testing, all participants, including healthy matched controls, visited a laboratory on 2 separate days and spent 20 minutes either sitting and reading or working out on a treadmill. They were then assessed for the inhibitory aspects of cognitive control with a screen-based task. At the same time, investigators performed neuroelectric assessments of brain responses to this task and conducted assessments of reading comprehension, spelling, and arithmetic.

Children in both the ADHD group and the control group performed better on tests of reading comprehension and arithmetic after exercising than after sitting or reading, although children with ADHD performed less well than those in the control group on the cognitive control task. Both groups also exhibited greater response accuracy and stimulus-related processing. In addition, after the single 20-minute session of exercise, children with ADHD also showed selective enhancements in regulatory processes, compared with their performance after sitting (Pontifex MB, et al. J Pediatr. 2013;162[3]:543-551).

Commentary

I am reminded of an experienced teacher who regularly sent a fidgety second grader on an errand to deliver a note to the gym teacher. The note requested that the gym teacher allow the courier to run 5 laps around the gym while waiting for the gym teacher to send a fictional response. The improved performance after exercise in both children with ADHD and controls offers another argument for retaining active recess and physical education classes in elementary school curricula.

Less exposure to screen violence improves preschoolers’ behavior

Substituting educational programming for aggression-filled TV and video viewing can significantly enhance the overall social and emotional competence of preschool-aged children, a group of Seattle investigators has shown.

In a trial involving more than 500 3- to 5- year-old children recruited from area pediatric practices, investigators provided the treatment group with a “media diet” that focused on the content of what the preschoolers watched, not how much time they spent in front of a screen (daily average of 74 minutes). Case managers made an initial home visit to discuss the child’s current media use, provide intervention handouts, and help the parents set goals, emphasizing replacing exposure to violent television with educational/prosocial programming.

The initial visit was followed by monthly newsletters and phone calls, as well as program guides tailored to participating families’ television service. The control group received a nutrition intervention with analogous monthly newsletters promoting healthy food choices and monthly check-in calls.

Although time spent exposed to media violence was the same for the intervention and control groups at baseline, at 6 months the intervention group had significantly less exposure both in terms of minutes per day (22.4 vs 29.7 minutes) and as a proportion of total daily screen time (22.9% vs 30%).

Using the Social Competence and Behavior Evaluation parent version scale (the higher the score, the better), investigators compared the intervention and control groups at 6 months, finding that the intervention group had a 2.11-point better score than the control group. Compared with the control group, the intervention group also showed less externalizing (angry, aggressive, oppositional) behavior and more social competence. The intervention also had a positive effect on internalizing (anxious, depressive, withdrawn) behavior, although that difference was not statistically significant. Boys from low-income families seemed to benefit the most from the intervention (Christakis DA, et al. Pediatrics. 2013;131[3]:431-438).

Commentary

The authors suggest that rather than fighting a losing battle trying to get parents to limit screen time, perhaps we should change tactics by helping parents to choose wisely from the dozens of viewing options available all day and night. But first we’ll need to see more evidence that this approach has a positive impact-not only on childhood behaviors but on language development; time spent in unstructured, outdoor play; and obesity. I don’t think I am ready to throw in the towel just yet.

Is early otitis media associated with IBD?

An analysis of 2 decades of data from a Canadian population-based database indicates that the answer to this question is “yes.” The large sample size-2,671 children-included 294 with an inflammatory bowel disease (IBD) diagnosis, made at a mean age of 13.1 years. At 1 year of age, 50% of children later found to have IBD had at least 1 diagnosis of otitis media, compared with 48% of controls. By age 2, 72% of children with IBD and 68% of controls had an otitis media diagnosis, with the percentages rising to 89% and 82%, respectively, by age 5.

Investigators determined that the relationship between otitis and IBD was significant whether the type of IBD was ulcerative colitis (UC) or Crohn disease (CD), although the association was stronger for UC. Whereas having a diagnosis of otitis media by age 1 year was associated with a more than 2-fold greater likelihood of being diagnosed with CD, it was 3-fold greater for developing UC. When both types of IBD were considered, those with an otitis media diagnosis by age 1 year were 2.8-fold more likely to develop IBD than children who never received an otitis media diagnosis. The odds were similar at 5 years of age (Shaw SY, et al. J Pediatr. 2013;162[3]:510-514).

Commentary

Is the diagnosis of otitis media simply a proxy for exposure to antibiotics in these children? The authors think so. In 1 of 4 hypotheses to explain the increased odds of IBD in this population, the authors suggest that antibiotics alter intestinal microflora with long-lasting effects on gut homeostasis and later risk of IBD. This theory serves as a reminder that whatever we do to treat our patients today has the potential for both intended and unintended consequences, sometimes years later.

Also of Note

Recruiting young women for HIV screening via a social network is an effective strategy. Investigators enlisted more than 150 young women, primarily black and Hispanic/Latina, to recruit members of female friendship networks to undergo HIV screening. The 150 enlisters recruited a total of 381 network members, 90% of whom agreed to be screened for HIV (Boyer CB, et al. JAMA Pediatr. 2013;167[3]:289-296).