The diagnosis of attention-deficit hyperactivity disorder (ADHD) has become so common that between two and 10 percent of school-aged children have been labeled as having ADHD, with boys three times more likely than girls to develop and be diagnosed with the disorder (Barkley, 1998). Due to the prevalence of children with ADHD or ADHD-like symptoms, it is important for park and recreation practitioners to have a basic understanding of the diagnosis, symptoms and treatment of ADHD, as well as the impact that recreation and sport can have on the lives of these children.
This understanding is important because children with ADHD may initially feel resistant about participating if they have had difficulty with previous peer interactions, may quit due to perceptions of inadequacy or present behavioral challenges for the staff.
Diagnosis and Symptoms
According to the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV-TR), ADHD is characterized by three main symptoms. The first symptom is inattention that sometimes manifests as the individual having difficulty sustaining attention, does not seem to listen to spoken instruction, has trouble following through with instructions, and frequently misplacing things (American Psychiatric Association [APA], 1994).
The second main symptom of ADHD is hyperactivity. Hyperactivity can be described as fidgeting, excessive talking, inability to remain seated or still when this is expected, or is commonly described as "on the go" (APA). The final symptom is impulsivity. The best way to describe impulsivity is a tendency to blurt out responses quickly, inability to wait for their turn, or frequently interrupts/intrudes.
A child with ADHD will most likely have all three of these symptoms to some extent, but each child will differ in the degree to which each symptom presents itself (APA).
Children with ADHD are often rejected by their peers and have fewer friends than other children their age who do not have ADHD (Bagwell, Brooke, Pelham, & Hoza, 2001). Contrary to popular belief that children outgrow ADHD, it may persist into adulthood, and is associated with an increase in peer problems (Bagwell et al).
Bagwell and colleagues investigated self-reported peer acceptance, parent-reported peer rejection, and close friendships in 211 adolescents (111 of which had childhood ADHD). Results showed that adolescents who had childhood ADHD (regardless of whether or not their symptoms still persist) were more rejected by their peers as teenagers. Also, behaviors associated with ADHD may make children more likely to form friendships with deviant peers that may in turn reinforce negative behaviors (Bagwell et al).
More specific to the sport setting, Harvey and Reid (1997) observed that children with ADHD had lower performance in gross motor skills and physical fitness when compared to the normative data. The researchers concluded that the results they saw were probably caused by lack of sustained effort leading to lower training levels, lower self-esteem and lower participation. This cascade is of great concern since physical activity participation is important in regards to health status in children presently and for their future as adults (Harvey & Reid, 1997).
Because ADHD can affect so many aspects of a child's life, it is important to somehow gain control over these behaviors. Several treatment options have been developed, but the most emphasized is pharmacological treatment, that uses central nervous system (CNS) stimulants, specifically methylphenidate (commonly referred to as Ritalin) (Wade, 1976). CNS stimulants help to control and improve impairments associated with ADHD such as motor coordination, sequencing, anticipation and planning (Hickey & Fricker, 1999).
Several studies have looked at the use of CNS stimulants and their relationship to sport performance. …