Attention-Deficit/Hyperactivity Disorder and Lifestyle-Related Behaviors in Children

Screen time and childhood attention deficit hyperactivity disorder: a meta-analysis

OBJECTIVES

The association between screen time and attention deficit hyperactivity disorder (ADHD) has been controversial. This study sheds light on the contentious correlation between screen time and ADHD.

CONTENT

Until August 2022, electronic searches of the PubMed, Embase, and Web of Science databases were carried out. The combined effect value odds ratios (OR) and 95 % confidence interval (95 % CI) were calculated for the meta-analysis using Stata 12.0. There were 81,234 children in the nine studies that made up this meta-analysis which included 28,997 children with ADHD and 52,237 healthy controls. When compared with the screen time <2  h/d, the OR (95 % CI) value of screen time and ADHD in the screen time ≥2 h/d group was 1.51 (1.20-1.90).

SUMMARY AND OUTLOOK

Based on the current meta-analysis results, our study found a positive correlation between screen time and the risk of ADHD. Excessive screen exposure may significantly contribute to the development of ADHD in children. Therefore, it is necessary to reduce screen time per day in children to prevent the occurrence of ADHD.

Association between free sugars intake and early psychopathological problems

Mental health problems are highly prevalent in childhood and adolescence and may be associated with nutritional intake. It has recently been shown that a high percentage of infants and children consume large amounts of free sugars. In this paper, we analyse the relationship between free sugar consumption at 12 and 30 months and the risk of developing psychological problems at 30 months in a community sample of 86 children evaluated longitudinally. Socio-family and anthropometric data, and the amount of free sugars consumed were collected at both ages. At 30 months, the Child Behavior Checklist 1.5-5 was administered to parents and an interview was conducted to identify psychological disorders in accordance with DC: 0-3's classification. We report a relationship between high free sugar consumption at 30 months and the concurrent presence of sleeping problems, ADHD and anxiety symptoms. However, no significant association was observed between free sugar consumption at 12 months and the subsequent development of psychological problems. Early detection of emotional and behavioural manifestations and high sugar consumption in children may help to prevent the persistence of psychological problems.

Associations of meeting 24-h movement behavior guidelines with cognitive difficulty and social relationships in children and adolescents with attention deficit/hyperactive disorder

BACKGROUND

Evidence-based 24-h movement behavior (24-HMB) guidelines have been developed to integrate recommendations for the time spent on physical activity, sedentary behavior, and sleep. For children and adolescents, these 24-HMB guidelines recommend a maximum of two hours of recreational screen time (as part of sedentary behavior), a minimum of 60 min per day of moderate to vigorous physical activity (MVPA), and an age-appropriate sleep duration (9-11 h for 5 to 13-year-olds; 8-10 h for 14 to 17-year-olds). Although adherence to the guidelines has been associated with positive health outcomes, the effects of adhering to the 24-HMB recommendations have not been fully examined in children and adolescents with attention eficit/hyperactive disorder (ADHD). Therefore, this study examined potential associations between meeting the 24-HMB guidelines and indicators of cognitive and social difficulties in children and adolescents with ADHD.

METHODS

Cross-sectional data on 3470 children and adolescents with ADHD aged between 6 and 17 years was extracted from the National Survey for Children's Health (NSCH 2020). Adherence to 24-HMB guidelines comprised screen time, physical activity, and sleep. ADHD-related outcomes included four indicators; one relating to cognitive difficulties (i.e., serious difficulties in concentrating, remembering, or making decisions) and three indicators of social difficulties (i.e., difficulties in making or keeping friends, bullying others, being bullied). Logistic regression was performed to determine the associations between adherence to 24-HMB guidelines and the cognitive and social outcomes described above, while adjusting for confounders.

RESULTS

In total, 44.8% of participants met at least one movement behavior guideline, while only 5.7% met all three. Adjusted logistic regressions further showed that meeting all three guidelines was associated with lower odds of cognitive difficulties in relation to none of the guidelines, but the strongest model included only screen time and physical activity as predictors (OR = 0.26, 95% CI 0.12-0.53, p < .001). For social relationships, meeting all three guidelines was associated with lower odds of difficulty keeping friends (OR = 0.46, 95% CI 0.21-0.97, p = .04) in relation to none of the guidelines. Meeting the guideline for screen time was associated with lower odds of being bullied (OR = 0.61, 95% CI 0.39-0.97, p = .04) in relation to none of the guidelines. While screen time only, sleep only and the combination of both were associated with lower odds of bullying others, sleep alone was the strongest predictor (OR = 0.44, 95% CI 0.26-0.76, p = .003) in relation to none of the guidelines.

CONCLUSION

Meeting 24-HMB guidelines was associated with reduced likelihood of cognitive and social difficulties in children and adolescents with ADHD. These findings highlight the importance of adhering to healthy lifestyle behaviors as outlined in the 24-HMB recommendations with regard to cognitive and social difficulties in children and adolescents with ADHD. These results need to be confirmed by longitudinal and interventional studies with a large sample size.

Parents' Experiences of Direct and Indirect Implications of Sleep Quality on the Health of Children with ADHD: A Qualitative Study

Sleep problems represent a significant challenge for children with ADHD. However, lack of knowledge about how sleep affects children with ADHD in terms of their health and everyday life prevents the development and implementation of interventions to promote sleep. The aim of this study was to explore parents' experiences of direct and indirect implications of sleep quality on the health of children with ADHD. The study used an abductive qualitative design, with Tengland's two-dimensional theory of health as a deductive analysis framework. Semi-structured interviews were conducted with 21 parents of children aged 6-13 with ADHD and sleep problems. The parents experienced that sleep influenced their children's abilities to control emotional behaviour related to ADHD and to manage everyday life. Sleep also had an impact on the children's well-being, in relation to both vitality and self-esteem. In conclusion, the results show important direct and indirect implications of sleep quality on the health of children with ADHD. This implies a need for greater focus on sleep, to target both abilities and well-being in promoting health among children with ADHD.

ADHD Symptoms and Obesity in Chinese Children and Adolescents: A Longitudinal Study With Abnormal Eating Behaviors as Moderating Factors

BACKGROUND

Emerging studies have explored the possibility of ADHD and associated abnormal eating behaviors as catalysts for obesity in children and adolescents. However, results were largely inconsistent. This study aims to explore the effects of ADHD and abnormal eating behaviors (including eating disorders, emotional eating, and bedtime eating) on obesity, and to assess the moderating role of abnormal eating behaviors between ADHD symptoms and BMI in Chinese children and adolescents.

METHODS

We recruited 546 grade 3 to 11 students and their parents by stratified random sampling from three primary schools and four middle schools in Shanghai, China. This study used parent-reported versions of the ADHD Rating Scale-IV to assess ADHD symptoms, the Eating Attitudes Test and the Children's Eating Attitude Test to assess eating disorder (ED) symptoms, and the Child Eating Behavior Questionnaire to collect information about other abnormal eating behaviors at baseline and at a follow-up survey 1 year later.

RESULTS

Hierarchical linear regression analysis revealed that ED played a moderating role in the relationship between ADHD symptoms and BMI in addition to age (β = .003, p = .008). The simple slope test showed that ADHD symptoms positively correlated with BMI ofs in the older age group with a high level of ED symptoms (β = .16, p < .001). Moreover, the baseline ED symptoms (β = .03, p = .032) and ADHD symptoms (β = .12, p = .015) increased the students' BMI one year later after controlling for confounding factors.

CONCLUSION

Findings of this study suggest that ADHD and ED symptoms raised the students' BMI separately. Moreover, ADHD and ED symptoms raised the students' BMI separately. Moreover, a combined high level of ADHD and ED symptoms is correlated with students' high BMI in the older age group.

Molecular Characterisation of the Mechanism of Action of Stimulant Drugs Lisdexamfetamine and Methylphenidate on ADHD Neurobiology: A Review

Attention-deficit/hyperactivity disorder (ADHD) is a common childhood-onset neurodevelopmental disorder characterised by persistent inattention, hyperactivity and impulsivity. Moreover, ADHD is commonly associated with other comorbid diseases (depression, anxiety, bipolar disorder, etc.). The ADHD symptomatology interferes with subject function and development. The treatment of ADHD requires a multidisciplinary approach based on a combination of non-pharmacological and pharmacological treatments with the aim of ameliorating the symptomatology; among first-line pharmacological treatments are stimulants [such as methylphenidate (MPH) and lisdexamfetamine dimesylate (LDX)]. In this review we explored recent ADHD- and stimulants-related literature, with the aim of compiling available descriptions of molecular pathways altered in ADHD, and molecular mechanisms of current first-line stimulants MPH and LDX. While conducting the narrative review, we applied structured search strategies covering PubMed/MEDLINE database and performed handsearching of reference lists on the results of those searches. The aetiology and pathophysiology of ADHD are incompletely understood; both genetic and environmental factors have been associated with the disorder and its grade of burden, and also the relationship between the molecular mechanisms of pharmacological treatments and their clinical implications. The lack of comprehensive understanding of the underlying molecular pathology makes both the diagnosis and treatment difficult. Few published studies evaluating molecular data on the mechanism of action (MoA) of MPH and LDX on ADHD are available and most of them are based on animal models. Further studies are necessary to improve the knowledge of ADHD pathophysiology and how the MoAs of MPH and LDX differentially modulate ADHD pathophysiology and control ADHD symptomatology.

The relationships between screen time and mental health problems among Chinese adults

BACKGROUND

This study aimed to examine the specific relationships between screen time and various mental health problems among community-dwelling adults in China.

METHODS

Self-reports of weekday and weekend screen time (TV, computer use and cell phone/tablet use), symptoms of PTSD, depression, and ADHD, and psychotic-like experiences (PLEs) were completed by 7121 Chinese adults. Logistic regression was used to examine specific relationships between screen time and mental health problems with demographics, physical activity, drinking, smoking, and sleep duration as covariates.

RESULTS

On weekdays, the participants spending at least 3 h on watching TV, computer use and cell phone/tablet use respectively accounted for 6.8%, 15.9% and 45.9%. On weekends, the proportions were 15.5%, 12.1% and 50.0%. Computer use on weekends was associated with higher risk of PTSD (OR = 1.81); cell phone/tablet use on weekdays and weekends was related to increased depression (OR = 1.38, OR = 1.28, respectively), while only computer use on weekends was related to depression (OR = 1.33); cell phone/tablet use both on weekdays and weekends was also connected to ADHD (OR = 1.56, OR = 1.48, respectively); on weekdays and weekends, more time TV viewing (OR = 1.76-1.79, OR = 1.46-1.71, respectively) and less cell phone/tablet use (OR = 0.66, OR = 0.65, respectively) were associated with higher numbers of PLEs.

CONCLUSIONS

The relationships between different types of screen time and mental health problems are variant. Future longitudinal studies should subdivide screen time on the basis of content and explore the specific causal relationship between screen time and mental health problems.

A Systematic Review of Sleep and Circadian Rhythms in Children with Attention Deficit Hyperactivity Disorder

OBJECTIVE

Children and adults with ADHD often report sleep disturbances that may form part of the etiology and/or symptomatology of ADHD. We review the evidence for sleep changes in children with ADHD.

METHODS

Systematic review with narrative synthesis assessing sleep and circadian function in children aged 5 to 13 years old with a diagnosis of ADHD.

RESULTS

148 studies were included for review, incorporating data from 42,353 children. We found that sleep disturbances in ADHD are common and that they may worsen behavioral outcomes; moreover, sleep interventions may improve ADHD symptoms, and pharmacotherapy for ADHD may impact sleep.

CONCLUSION

Sleep disturbance may represent a clinically important feature of ADHD in children, which might be therapeutically targeted in a useful way. There are a number of important gaps in the literature. We set out a manifesto for future research in the area of sleep, circadian rhythms, and ADHD.

Inattention and hyperactivity symptoms in childhood predict physical activity in adolescence

BACKGROUND

Physical activity has been documented to influence several aspects of physical and mental health. Growing evidence shows that physical activity can improve attention. Less is known about how symptoms of inattention and hyperactivity / impulsivity in childhood are associated with physical activity in adolescence. We aimed to explore this relationship further.

METHODS

We used a cohort of 3949 Swedish children (1884 boys and 2065 girls) with data collected at ages 9 (or 12) and 15. We investigated the influence of symptoms of inattention and hyperactivity / impulsivity in childhood - age 9/12 (inattention and hyperactivity/impulsivity separately) on self-rated physical activity at age 15, using multiple logistic regression models. We considered potential confounders such as sex, parental education level, physical activity in childhood and neurodevelopmental comorbidity. A cluster robust sandwich estimator was applied to adjust the standard errors for the nested twin data when computing the regression models.

RESULTS

Symptoms of inattention in childhood (9/12) predicted less physical activity in adolescence (age 15) (OR = 0.83 CI = 0.78-0.89), whereas the opposite was true for hyperactivity/impulsivity (OR = 1.08 CI = 1.02-1.10). These associations still remained when taking possible confounders into account including neurodevelopmental and neurodevelopmental related comorbidity.

CONCLUSIONS

These findings support the importance of helping children and adolescents with inattention symptoms to engage in physical activity in suitable settings.

Attention Deficit Hyperactivity Disorder (ADHD) among elementary students in rural China: Prevalence, correlates, and consequences

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is a widely recognized mental health problem in developed countries but remains under-investigated in developing settings. This study examines the prevalence, correlates, and consequences of ADHD symptoms among elementary school students in rural China.

METHODS

Cross-sectional data were collected from 6,719 students across 120 rural primary schools in China on ADHD symptoms, demographic characteristics, and academic performance in reading and math. ADHD symptoms were evaluated using the caregiver-reported ADHD Rating Scale-IV.

RESULTS

The prevalence of ADHD symptoms was 7.5% in our sample. Male students, students in lower grade levels, and students with lower cognitive ability showed a significantly higher prevalence of ADHD symptoms (ORs = 2.56, 2.06, and 1.84, respectively; p<0.05). Left-behind children showed a significantly lower prevalence of ADHD symptoms than did children who were living with their parents (OR = 0.74, p < 0.05). Adjusted regressions show that students with ADHD symptoms scored 0.12 standardized deviations lower in reading (p < 0.05) and 0.19 standardized deviations lower in math (p < 0.01).

LIMITATIONS

The ADHD Rating Scale-IV is a screening scale rather than a diagnostic test. Caregiver self-report measures also may underestimate ADHD symptoms for our sample.

CONCLUSIONS

ADHD is a common disorder among rural students in China and appears to be contributing to poor academic outcomes. The higher prevalence of ADHD among students with low cognitive ability also suggests that many rural children in China face multifactorial learning challenges. Taken together, the findings indicate a need for educators and policymakers in rural China to develop programs to reduce risk and support students with ADHD symptoms.

Risk of Colorectal Cancer in Patients With Attention-Deficit Hyperactivity Disorder: A Nationwide, Population-Based Cohort Study

Background: The association between attention-deficit hypersensitivity disorder (ADHD) and the risk of developing colorectal cancer (CRC) is, as yet, to be investigated, and thus, we have conducted this nationwide, cohort study to examine the association in patients from Taiwan. Methods: In this study, 798 individuals with newly diagnosed ADHD and 2,394 (1:3) age-, gender-, and index year- matched controls without ADHD were enrolled, between 2000 and 2013, from the Longitudinal Health Insurance Database, a subset of the National Health Insurance Research Database in Taiwan. The cumulative incidence of CRC was assessed in each cohort by the Kaplan-Meier method. The multivariate Cox proportional hazards model was used to estimate the crude, and the adjusted hazards ratios (HRs) with 95% confidence intervals (CIs), was conducted to estimate the association between ADHD and CRC. Results: The Kaplan-Meier analysis revealed that the cumulative incidence of CRC was significantly higher in patients with ADHD than in those without it (log rank test, p < 0.001). After adjustments for age, gender, comorbidities, and other covariates, the ADHD group was associated with an increased risk of CRC in comparison to the non-ADHD group (adjusted HR = 3.458, 95% CI = 1.640-7.293, p < 0.001). In addition, the usage of methylphenidate was not associated with the risk of developing CRC in patients with ADHD. Conclusion: This retrospective cohort study depicts the evidence that ADHD was associated with the increased risk of CRC. Further studies are needed to confirm the association and the underlying mechanisms.

Child and Parent Physical Activity, Sleep, and Screen Time During COVID-19 and Associations With Mental Health: Implications for Future Psycho-Cardiological Disease?

The COVID-19 pandemic has afforded the opportunity for some to improve lifestyle behaviours, while for others it has presented key challenges. Adverse changes in global lifestyle behaviours, including physical activity, sleep, and screen time can affect proximal mental health and in turn distal cardiovascular outcomes. We investigated differences in physical activity, sleep, and screen time in parents and children during early stages of the COVID-19 pandemic in Australia compared to pre-COVID-19 national data; and estimated associations between these movement behaviours with parent and child mental health. Cross-sectional baseline data from the COVID-19 Pandemic Adjustment Study (CPAS; N = 2,365) were compared to nationally representative pre-pandemic data from the Longitudinal Study of Australian Children (LSAC; N = 9,438). Participants were parents of children aged ≤ 18 years, residing in Australia. Parents provided self-report measures of mental health, physical activity and sleep quality, and reported on child mental health, physical activity and screen time. Children in CPAS had significantly more sleep problems and more weekend screen time. Their parents had significantly poorer sleep quality, despite increased weekly physical activity. Children's sleep problems were significantly associated with increased mental health problems, after accounting for socioeconomic status, physical activity, and screen time. Poorer parent sleep quality and lower levels of physical activity were significantly associated with poorer mental health. Monitoring this cohort over time will be important to examine whether changes in movement behaviour are enduring or naturally improve with the easing of restrictions; and whether these changes have lasting effects on either parent or child mental health, and in turn, future risk for CVD.

Digital screen time and its effect on preschoolers' behavior in China: results from a cross-sectional study

Background

The aims of the study were to determine the effects of electronic exposure on behaviors of preschoolers, which could provide scientific grounds to the control of digital screen time and usage of electronics.

Methods

Children of 3–6 years of age (n = 1897) and their families were included in this study. The daily screen time were recorded for seven days. Children were grouped based on daily screen time of < 60 min or > 60 min. Socio-demographic characteristics of the children were acquired by parental questionnaires. Analyses were made based on the CBCL/1.5–5 results. Chi-square test, t-test and Nonparametric correlation analyses were used to determine the correlation between strength, direction and significance of the relations between the variables. Rates of attention-deficit hyperactivity disorder (ADHD) of children in two groups were compared using χ² test.

Results

Our results indicate that screen time is closely correlated with gender of children, household location, maternal education. We observed that preschoolers with screen time of > 60 min tend to have more behavioral problems than those with screen time of < 60 min (total problem: 35.84 vs. 32.76, p = 0.024; externalizing: 11.54 vs. 9.08, p = 0.016).

Conclusion

Our study suggests that excessive screen time may be a detrimental factor in the development of preschoolers. Caution should be taken in shortening the screen time of preschoolers.

Association Between Psychosocial Problems and Unhealthy Health Behavior Patterns Among Finnish Adolescents

The aim of the study was to investigate how psychosocial problems in childhood and adolescence associate with an unhealthy health behavior pattern among adolescents in Northern Finland. The study population consisted of 4350 participants, drawn from the Northern Finland Birth Cohort 1986 Study. Health behavior patterns were assessed in adolescence and psychosocial problems in childhood and adolescence. Logistic regression analyses were performed to determine the associations. Several psychosocial problems predicted greater likelihood of engaging in unhealthy health behavior pattern. Externalizing problems in childhood predicted greater likelihood of engaging in unhealthy behavior patterns for girls. For both genders, externalizing problems and inattention in adolescence were associated with unhealthy health behavior patterns. Boys and girls with externalizing problems both in childhood and adolescence had an increased risk of unhealthy patterns. Psychosocial problems contribute to unhealthy lifestyles and should therefore be acknowledged when designing and targeting health promotion strategies aimed at adolescents.

Attention Deficit/Hyperactivity, the Metabolic Syndrome, and Type 2 Diabetes

PURPOSE OF REVIEW

To present current data on the coexistence of attention deficit hyperactivity disorder (ADHD) and the metabolic syndrome and type 2 diabetes mellitus in adults and children and to discuss possible mechanisms.

RECENT FINDINGS

Emerging data suggest that risk factors for obesity and insulin resistance such as diabetes during pregnancy and intrauterine growth failure may also have a role in the development of ADHD. Furthermore, ADHD and obesity share lifestyle factors, such as abnormal eating patterns, binge eating, and a sedentary lifestyle. ADHD is a risk factor for components of the metabolic syndrome, particularly obesity and type 2 diabetes mellitus, and also hypertension, both in adults and youth. Associations of ADHD with obesity, diabetes, and hypertension have been ascertained, and various mechanisms have been proposed. Research is needed to decipher the shared genetic, pharmacological, and lifestyle risk factors. Individuals with ADHD should be treated as a high-risk group for cardiometabolic complications.

How early media exposure may affect cognitive function: A review of results from observations in humans and experiments in mice

Attention deficit hyperactivity disorder (ADHD) is now among the most commonly diagnosed chronic psychological dysfunctions of childhood. By varying estimates, it has increased by 30% in the past 20 years. Environmental factors that might explain this increase have been explored. One such factor may be audiovisual media exposure during early childhood. Observational studies in humans have linked exposure to fast-paced television in the first 3 years of life with subsequent attentional deficits in later childhood. Although longitudinal and well controlled, the observational nature of these studies precludes definitive conclusions regarding a causal relationship. As experimental studies in humans are neither ethical nor practical, mouse models of excessive sensory stimulation (ESS) during childhood, akin to the enrichment studies that have previously shown benefits of stimulation in rodents, have been developed. Experimental studies using this model have corroborated that ESS leads to cognitive and behavioral deficits, some of which may be potentially detrimental. Given the ubiquity of media during childhood, these findings in humansand rodents perhaps have important implications for public health.

The moderating roles of bedtime activities and anxiety/depression in the relationship between attention-deficit/hyperactivity disorder symptoms and sleep problems in children

BACKGROUND

Children with attention-deficit/hyperactivity disorder (ADHD) often experience sleep problems, but the comorbidity mechanism has not been sufficiently studied. This study aimed to determine the comorbidity of ADHD symptoms and sleep problems as well as the moderating effects of bedtime activities and depression/anxiety symptoms on the relationship between ADHD symptoms and sleep problems.

METHODS

We recruited 934 primary students from third to fifth grade and their parents by stratified random sampling from three primary schools in Shanghai, China. This study used parent-reported versions of the ADHD Rating Scale-IV, Children's Sleep Habits Questionnaire, and Achenbach Child Behavior Checklist. We used hierarchical linear regression analysis to clarify the moderating effects of bedtime activities and depression/anxiety symptoms.

RESULTS

We found that children with more ADHD symptoms had shorter sleep durations and more sleep problems on weekdays. Screen time before bedtime strengthened the relationship between ADHD symptoms and sleep-disordered breathing. Children with more screen time were more likely to have sleep onset delay, while those with less screen time had more sleep onset problems with increasing ADHD symptoms. The high bedtime eating group experienced more night waking with increasing ADHD symptoms compared with the low bedtime eating group. Anxiety/depression exacerbated total sleep problems and further interacted with ADHD symptoms to predict sleep length and sleep duration problems.

CONCLUSIONS

Bedtime activities and emotional problems had important moderating effects on the relationship between ADHD symptoms and sleep problems. These findings indicate that appropriate bedtime management and emotional management may reduce sleep problems and improve sleep duration for children with ADHD symptoms.