Hyperactivity in Attention-Deficit/Hyperactivity Disorder (ADHD): Impairing Deficit or Compensatory Behavior?

Abstract

Excess gross motor activity (hyperactivity) is considered a core diagnostic feature of childhood ADHD that impedes learning. This view has been challenged, however, by recent models that conceptualize excess motor activity as a compensatory mechanism that facilitates neurocognitive functioning in children with ADHD. The current study investigated competing model predictions regarding activity level’s relation with working memory (WM) performance and attention in boys aged 8–12 years (M = 9.64, SD = 1.26) with ADHD (n = 29) and typically developing children (TD; n = 23). Children’s phonological WM and attentive behavior were objectively assessed during four counterbalanced WM tasks administered across four separate sessions. These data were then sequenced hierarchically based on behavioral observations of each child’s gross motor activity during each task. Analysis of the relations among intra-individual changes in observed activity level, attention, and performance revealed that higher rates of activity level predicted significantly better, but not normalized WM performance for children with ADHD. Conversely, higher rates of activity level predicted somewhat lower WM performance for TD children. Variations in movement did not predict changes in attention for either group. At the individual level, children with ADHD and TD children were more likely to be classified as reliably Improved and Deteriorated, respectively, when comparing their WM performance at their highest versus lowest observed activity level. These findings appear most consistent with models ascribing a functional role to hyperactivity in ADHD, with implications for selecting behavioral treatment targets to avoid overcorrecting gross motor activity during academic tasks that rely on phonological WM.

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Notes

  1. 1.

    A review of individual children’s records indicated that all children in the ADHD Combined-Type group would meet current DSM-5 diagnostic criteria for ADHD-Combined Presentation.

  2. 2.

    Performance and attention data for a subset of the current sample were used in separate studies to evaluate conceptually unrelated hypotheses (Kofler et al. 2010; Rapport et al. 2008a). We have not previously reported behavioral observations of gross motor activity for any children in the current sample. Additionally, we elected to concentrate on phonological rather than visuospatial working memory given that ADHD-related effect size differences between these two systems are nearly identical (Kasper et al. 2012), and due to previous findings of greater activity level during phonological relative to visuospatial tasks (Rapport et al. 2008a, b).

  3. 3.

    Partial-credit methods count each stimulus on a trial as correct if it is emitted in the correct serial location. It differs from all-or-nothing scoring approaches that count trials correct only if all stimuli in a trial are emitted in the correct sequence. Partial-credit scoring is associated with significantly higher internal consistency and concurrent validity relative to all-or-nothing scoring (Conway et al. 2005).

  4. 4.

    The overall mean duration of out of seat behavior was computed as a validity check to ensure that the out-of-seat code did not misidentify stationary standing behavior (i.e., standing still) as being motorically active. This analysis revealed that out-of-seat behavior was relatively brief for children with ADHD (M = 2.7 to 8.6 s) and TD children (M = 0.1 to 7.4 s), indicating that misidentification was extremely unlikely.

  5. 5.

    The TD Improved subgroup was omitted from these analyses due to insufficient cell size; only two TD children were classified as Improved.

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Acknowledgments

The authors wish to thank Warren May for his statistical consultation. The authors are also grateful for the children and families who participated in the study, and to the undergraduate and graduate members of the UCF Children’s Learning Clinic who contributed to the project.

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Sarver, D.E., Rapport, M.D., Kofler, M.J. et al. Hyperactivity in Attention-Deficit/Hyperactivity Disorder (ADHD): Impairing Deficit or Compensatory Behavior?. J Abnorm Child Psychol 43, 1219–1232 (2015). https://doi.org/10.1007/s10802-015-0011-1

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Keywords

  • Hyperactivity
  • ADHD
  • Working memory
  • Attention
  • Activity level
  • Executive function