Skip to main content

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

Notes

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

References

  • Abikoff, H., & Gittelman, R. (1984). Does behavior therapy normalize the classroom behavior of hyperactive children? Archives of General Psychiatry, 41, 449–454.

    Article  PubMed  Google Scholar 

  • Abikoff, H. B., Jensen, P. S., Arnold, L. L. E., Hoza, B., Hechtman, L., Pollack, S., & Wigal, T. (2002). Observed classroom behavior of children with ADHD: relationship to gender and comorbidity. Journal of Abnormal Child Psychology, 30, 349–359.

    Article  PubMed  Google Scholar 

  • Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA school-age forms & profiles. Burlington: University of Vermont.

    Google Scholar 

  • Alderson, R. M., Rapport, M. D., Kasper, L. J., Sarver, D. E., & Kofler, M. J. (2012). Hyperactivity in boys with ADHD: the association between deficient behavioral inhibition, attentional processes, and objectively measured activity. Child Neuropsychology, 18, 487–505.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, (DSM-5®). Author.

  • Andrade, J. (2010). What does doodling do? Applied Cognitive Psychology, 24, 100–106.

    Article  Google Scholar 

  • Awh, E., & Jonides, J. (2001). Overlapping mechanisms of attention and spatial working memory. Trends in Cognitive Sciences, 5, 119–126.

  • Baddeley, A. (2007). Working memory, thought, and action. Oxford: Oxford University Press.

    Book  Google Scholar 

  • Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychological Bulletin, 121, 65–94.

    Article  PubMed  Google Scholar 

  • Barkley, R. A. (2002). Psychosocial treatments for attention-deficit/hyperactivity disorder in children. Journal of Clinical Psychiatry, 63, 36–43.

    PubMed  Google Scholar 

  • Biederman, J., Mick, E., & Faraone, S. V. (2000). Age-dependent decline of symptoms of ADHD: impact of remission definition and symptom type. American Journal of Psychiatry, 157, 816–818.

    Article  PubMed  Google Scholar 

  • Bolden, J., Rapport, M. D., Raiker, J. S., Sarver, D. E., & Kofler, M. J. (2012). Understanding phonological memory deficits in boys with attention-deficit/hyperactivity disorder (ADHD): dissociation of shortterm storage and articulatory rehearsal processes. Journal of Abnormal Child Psychology, 40, 999–1011.

  • Brocki, K. C., Tillman, C. M., & Bohlin, G. (2010). CPT performance, motor activity, and continuous relations to ADHD symptom domains: a developmental study. The European Journal of Developmental Psychology, 7, 178–197.

    Article  Google Scholar 

  • Brooks, L. R. (1968). Spatial and verbal components of the act of recall. Canadian Journal of Psychology, 22, 349–368.

  • Campbell, S., & Ewing, L. (1990). Follow-up of hard-to-manage preschoolers: adjustment at age 9 and predictors of continuing symptoms. Journal of Child Psychology & Psychiatry, 31, 871–889.

    Article  Google Scholar 

  • Campbell, D. W., Eaton, W. O., & McKeen, N. A. (2002). Motor activity level and behavioural control in young children. International Journal of Behavioral Development, 26, 289–296.

    Article  Google Scholar 

  • Chafee, M. V., & Goldman-Rakic, P. S. (2000). Inactivation of parietal and prefrontal cortex reveals interdependence of neural activity during memory-guided saccades. Journal of Neurophysiology, 83, 1550–1566.

    PubMed  Google Scholar 

  • Conners, C. K., & Kronsberg, S. (1985). Measuring activity level in children. Psychopharmacology Bulletin, 21, 893–897.

    PubMed  Google Scholar 

  • Conway, A. R., Kane, M. J., Bunting, M. F., & Engle, R. W. (2005). Working memory span tasks: a methodological review and user’s guide. Psychonomic Bulletin & Review, 12, 769–786.

    Article  Google Scholar 

  • Cortese, S., Faraone, S. V., Konofal, E., & Lecendreux, M. (2009). Sleep in children with attention-deficit/hyperactivity disorder: meta-analysis of subjective and objective studies. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 894–908.

    PubMed  Google Scholar 

  • Dane, A. V., Schachar, R. J., & Tannock, R. (2000). Does actigraphy differentiate ADHD subtypes in a clinical research setting? Journal of the American Academy of Child and Adolescent Psychiatry, 39, 752–760.

    Article  PubMed  Google Scholar 

  • Della Sala, S., Gray, C., Baddeley, A., Allamano, N., & Wilson, L. (1999). Pattern span: a tool for unwelding visuo–spatial memory. Neuropsychologia, 37, 1189–1199.

  • Diamantopoulou, S., Rydell, A., Thorell, L. B., & Bohlin, G. (2007). Impact of executive functioning and symptoms of attention deficit hyperactivity disorder on children’s peer relations and school performance. Developmental Neuropsychology, 32, 521–542.

    Article  PubMed  Google Scholar 

  • Dickstein, S. G., Bannon, K., Castellanos, F. X., & Milham, M. P. (2006). The neural correlates of ADHD: an ALE meta-analysis. Journal of Child Psychology and Psychiatry, 47, 1051–1062.

    Article  PubMed  Google Scholar 

  • DuPaul, G. J. (1991). Parent and teacher ratings of ADHD symptoms: psychometric properties in a community-based sample. Journal of Clinical Child and Adolescent Psychology, 20, 245–253.

    Article  Google Scholar 

  • Eaton, W. O., McKeen, N. A., & Saudino, K. J. (1996). Measuring human individual differences in general motor activity with actometers. In K. P. Ossenkopp, M. Kavaliers, & P. R. Sanberg (Eds.), Measuring movement and locomotion: From invertebrates in humans (pp. 79–92). Austin: R. G. Landes Co.

  • Eaton, W. O., McKeen, N. A., & Campbell, D. W. (2001). The waxing and waning of movement: implications for psychological development. Developmental Review, 21, 205–223.

    Article  Google Scholar 

  • Ebenegger, V., Marques-Vidal, P. M., Munsch, S., Quartier, V., Nydegger, A., Barral, J., et al. (2012). Relationship of hyperactivity/inattention with adiposity and lifestyle characteristics in preschool children. Journal of Child Neurology, 27, 852–858.

  • El-Sayed, E., Larsson, J. O., Persson, H. E., & Rydelius, P. A. (2002). Altered cortical activity in children with attention-deficit/hyperactivity disorder during attentional load task. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 811–819.

    Article  PubMed  Google Scholar 

  • Fair, D. A., Bathula, D., Nikolas, M. A., & Nigg, J. T. (2012). Distinct neuropsychological subgroups in typically developing youth inform heterogeneity in children with ADHD. Proceedings of the National Academy of Sciences, 109, 6769–6774.

    Article  Google Scholar 

  • Gadow, K., Sprafkin, J., Salisbury, H., Schneider, J., & Loney, J. (2004). Further validity evidence for the teacher version of the Child Symptom Inventory-4. School Psychology Quarterly, 19, 50–71.

    Article  Google Scholar 

  • Gomez, R., & Sanson, A. V. (1994). Effects of experimenter and mother presence on the attentional performance and activity of hyperactive boys. Journal of Abnormal Child Psychology, 22, 517–529.

  • Halperin, J. M., & Schulz, K. P. (2006). Revisiting the role of the prefrontal cortex in the patho-physiology of attention-deficit/hyperactivity disorder. Psychological Bulletin, 132, 560–581.

    Article  PubMed  Google Scholar 

  • Halperin, J. M., Matier, K., Bedi, G., Sharma, V., & Newcorn, J. H. (1992). Specificity of inattention, impulsivity, and hyperactivity to the diagnosis of attention-deficit hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 190–196.

    Article  PubMed  Google Scholar 

  • Halperin, J. M., Trampush, J. W., Miller, C. J., Marks, D. J., & Newcorn, J. H. (2008). Neuropsychological outcome in adolescents/young adults with childhood ADHD: profiles of persisters, remitters and controls. Journal of Child Psychology and Psychiatry, 49, 958–966.

    PubMed Central  Article  PubMed  Google Scholar 

  • Harris, F. C., & Lahey, B. B. (1982). Subject reactivity in direct observational assessment: A review and critical analysis. Clinical Psychology Review, 2, 523–538.

  • Hollingshead, A. (1975). Four factor index of social status. New Haven: Yale University, Department of Sociology.

    Google Scholar 

  • Imeraj, L., Antrop, I., Roeyers, H., Deschepper, E., Bal, S., & Deboutte, D. (2011). Diurnal variations in arousal: a naturalistic heart rate study in children with ADHD. European Child & Adolescent Psychiatry, 20, 381–392.

    Article  Google Scholar 

  • Jacobson, N. S., & Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12.

  • Kasper, L. J., Alderson, R. M., & Hudec, K. L. (2012). Moderators of working memory deficits in children with ADHD: a meta-analytic review. Clinical Psychology Review, 32, 605–617.

    Article  PubMed  Google Scholar 

  • Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., & Ryan, N. (1997). Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 980–988.

    Article  PubMed  Google Scholar 

  • Kofler, M. J., Rapport, M. D., & Alderson, R. M. (2008). Quantifying ADHD classroom inattentiveness, its moderators, and variability: a meta-analytic review. Journal of Child Psychology and Psychiatry, 49, 59–69.

    Article  PubMed  Google Scholar 

  • Kofler, M. J., Rapport, M. D., Bolden, J., Sarver, D. E., & Raiker, J. S. (2010). ADHD and working memory: the impact of central executive deficits and exceeding storage/rehearsal capacity on observed inattentive behavior. Journal of Abnormal Child Psychology, 38, 149–161.

    Article  PubMed  Google Scholar 

  • Lawrence, B. M., Myerson, J., Oonk, H. M., & Abrams, R. A. (2001). The effects of eye and limb movements on working memory. Memory, 9, 433–444.

    Article  Google Scholar 

  • Mann, C., Lubar, J., Zimmerman, A., Miller, C., & Muenchen, R. (1992). Quantitative analysis of EEG in boys with attention deficit hyperactivity disorder: controlled study with clinical implications. Pediatric Neurology, 8, 30–36.

    Article  PubMed  Google Scholar 

  • Milich, R., Loney, J., & Landau, S. (1982). Independent dimensions of hyperactivity and aggression: a validation with playroom observation data. Journal of Abnormal Psychology, 91, 183–198.

    Article  PubMed  Google Scholar 

  • Nigg, J. T. (1999). The ADHD response-inhibition deficit as measured by the stop task: replication with DSM–IV combined type, extension, and qualification. Journal of Abnormal Child Psychology, 27, 393–402.

    Article  PubMed  Google Scholar 

  • Noldus Information Technology. (2011). The observer XT reference manual version 10.5. Wageningen: Author.

    Google Scholar 

  • Onyper, S. V., Carr, T. L., Farrar, J. S., & Floyd, B. R. (2011). Cognitive advantages of chewing gum. Now you see them, now you don’t. Appetite, 57, 321–328.

    Article  PubMed  Google Scholar 

  • Pelham, W. E., Jr., Waschbusch, D. A., Hoza, B., Gnagy, E. M., & Carter, R. L. (2011). Music and video as distractors for boys with ADHD in the classroom: comparison with controls, individual differences, and medication effects. Journal of Abnormal Child Psychology, 39, 1085–1098.

    Article  PubMed  Google Scholar 

  • Plomin, R., & Foch, T. T. (1981). Hyperactivity and pediatrician diagnosis, parent ratings, specific cognitive abilities, and laboratory measures. Journal of Abnormal Child Psychology, 9, 55–64.

    Article  PubMed  Google Scholar 

  • Porrino, L. J., Rapoport, J. L., Behar, D., Sceery, W., Ismond, D. R., & Bunney, W. E., Jr. (1983). A naturalistic assessment of the motor activity of hyperactive boys. I. Comparison with normal controls. Archives of General Psychiatry, 40, 681–687.

    Article  PubMed  Google Scholar 

  • Rajendran, K., Trampush, J. W., Rindskopf, D., Marks, D. J., O’Neill, S., & Halperin, J. M. (2013). Association between variation in neuropsychological development and trajectory of ADHD severity in early childhood. American Journal of Psychiatry, 170, 1205–1211.

    Article  PubMed  Google Scholar 

  • Rapport, M. D., Kofler, M. J., & Himmerich, C. (2006). Assessing activity level in children. In M. Hersen (Ed.), Clinician’s handbook of child behavioral assessment. San Diego: Elsevier.

    Google Scholar 

  • Rapport, M. D., Alderson, R. M., Kofler, M. J., Sarver, D. E., Bolden, J., & Sims, V. (2008a). Working memory deficits in boys with ADHD: the contribution of central executive and subsystem processes. Journal of Abnormal Child Psychology, 36, 825–837.

    Article  PubMed  Google Scholar 

  • Rapport, M. D., Kofler, M. J., Alderson, R. M., & Raiker, J. S. (2008b). Attention-deficit/hyperactivity disorder. In M. Hersen, D. Reitman, M. Hersen, & D. Reitman (Eds.), Handbook of psychological assessment, case conceptualization, and treatment (Children and adolescents, Vol. 2, pp. 349–404). Hoboken, NJ US: Wiley.

    Google Scholar 

  • Rapport, M. D., Bolden, J., Kofler, M. J., Sarver, D. E., Raiker, J. S., & Alderson, R. M. (2009). Hyperactivity in boys with ADHD: a ubiquitous core symptom or manifestation of working memory deficits? Journal of Abnormal Child Psychology, 37, 521–534.

    Article  PubMed  Google Scholar 

  • Reichenbach, L. C., Halperin, J. M., Sharma, V., & Newcorn, J. H. (1992). Children’s motor activity: reliability and relationship to attention and behavior. Developmental Neuropsychology, 8, 87–97.

  • Sarver, D. E., Rapport, M. D., Kofler, M. J., Scanlan, S. W., Raiker, J. S., Altro, T. A., & Bolden, J. (2012). Attention problems, phonological short-term memory, and visuospatial short-term memory: differential effects on near-and long-term scholastic achievement. Learning and Individual Differences, 22, 8–19.

    Article  Google Scholar 

  • SuperLab Pro (Version 2) [Computer software]. San Pedro, CA: Cedrus Corporation.

  • Swanson, L., & Kim, K. (2007). Working memory, short-term memory, and naming speed as predictors of children’s mathematical performance. Intelligence, 35, 151–168.

    Article  Google Scholar 

  • Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics (5th ed.). Boston: Allyn & Bacon/Pearson Education.

    Google Scholar 

  • Teicher, M. H., Ito, Y., Glod, C. A., & Barber, N. I. (1996). Objective measurement of hyperactivity and attentional problems in ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 334–342.

    Article  PubMed  Google Scholar 

  • Tryon, W., Tryon, G., Kazlausky, T., Gruen, W., & Swanson, J. (2006). Reducing hyper-activity with a feedback actigraph: initial findings. Clinical Child Psychology and Psychiatry, 11, 607–617.

    Article  PubMed  Google Scholar 

  • van der Oord, S., Prins, P. J. M., Oosterlaan, J., & Emmelkamp, P. M. G. (2008). Efficacy of methylphenidate, psychosocial treatments and their combination in school-aged children with ADHD: a meta-analysis. Clinical Psychology Review, 28, 783–800.

    Article  PubMed  Google Scholar 

  • Walters, E. C. (1965). Prediction of postnatal development from fetal activity. Child Development, 36, 801–808.

    Article  Google Scholar 

  • Waschbusch, D. A. (2002). A meta-analytic examination of comorbid hyperactive-impulsive-attention problems and conduct problems. Psychological Bulletin, 128, 118–150.

    Article  PubMed  Google Scholar 

  • Wechsler, D. (1991). WISC-3: Wechsler intelligence scale for children: manual. San Antonio, TX: Psychological Corporation.

  • Wechsler, D. (2003). Wechsler intelligence scale for children (4th ed.). San Antonio: Psychological Corporation.

    Google Scholar 

  • Wells, K. C., Pelham, W. E., Jr., Kotkin, R. A., Hoza, B., Abikoff, H. B., Abramowitz, A., & Schiller, E. (2000). Psychosocial treatment strategies in the MTA study: rationale, methods, and critical issues in design and implementation. Journal of Abnormal Child Psychology, 28, 483–505.

    Article  PubMed  Google Scholar 

  • Werry, J. S. (1968). Developmental hyperactivity. Pediatric Clinics of North America, 15, 581–599.

    PubMed  Google Scholar 

  • Whalen, C. K., Collins, B. E., Henker, B., Alkus, S. R., Adams, D., & Stapp, J. (1978). Behavior observations of hyperactive children and methylphenidate (Ritalin) effects in systematically structured classroom environments: now you see them, now you don’t. Journal of Pediatric Psychology, 3, 177–187.

  • Willcutt, E. G., Nigg, J. T., Pennington, B. F., Carlson, C. L., McBurnett, K., Rohde, L. A., & Lahey, B. B. (2012). Validity of DSM-IV attention-deficit/hyperactivity disorder symptom dimensions and subtypes. Journal of Abnormal Psychology, 121, 991–1010.

    PubMed Central  Article  PubMed  Google Scholar 

  • Wymbs, B. T., Pelham, W., Jr., Molina, S., & Gnagy, E. (2008). Rate and predictors of divorce among parents of youths with ADHD. Journal of Consulting and Clinical Psychology, 76, 735–744.

    PubMed Central  Article  PubMed  Google Scholar 

  • Yerkes, R. M., & Dodson, J. D. (1908). The relation of strength of stimulus to rapidity of habit‐formation. Journal of Comparative Neurology and Psychology, 18, 459–482.

    Article  Google Scholar 

  • Zentall, S. S., & Zentall, T. R. (1983). Optimal stimulation: a model of disordered activity and performance in normal and deviant children. Psychological Bulletin, 94, 446–471.

    Article  PubMed  Google Scholar 

Download references

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.

Conflict of Interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Dustin E. Sarver.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10802-015-0011-1

Keywords

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