Can a Healthy Lifestyle Reduce ADHD Incidence in Children?

Michael Vlessides

April 22, 2020

Children who follow key healthy lifestyle recommendations at age 10 and 11 are much less likely to be diagnosed with attention-deficit/hyperactivity disorder (ADHD) by age 14.

In one of the first investigations of its kind, the study of more than 3000 fifth-grade students in Nova Scotia, Canada, showed that those who met at least seven of nine healthy lifestyle recommendations had a substantially lower incidence of ADHD compared to their counterparts who only met between one and three of the criteria.

"The evidence is there to show that the association between lifestyle and physical health exists. Now it seems that these same recommendations also protect children from developing ADHD. The more factors they comply with, the less likely they are to develop ADHD. To date, no other study has really considered all these lifestyle factors simultaneously," senior investigator Paul Veugelers, PhD, School of Public Health, University of Alberta, Edmonton, Canada, told Medscape Medical News.

The study was published in the April issue of Psychosomatic Medicine.

Lifestyle Link

The incidence of ADHD among North American children and youth remains high, with more than 6 million children in the US diagnosed with the disorder. ADHD affects approximately 1 in 8 boys and 1 in 18 girls. Worldwide, estimates show more than 100 million children and teenagers have an ADHD diagnosis.

What's more, increasing rates of the disorder run parallel to what the investigators describe as deteriorating lifestyle choices. Factors such as poor diet, physical inactivity, poor sleep habits, and sedentary behavior have all been associated with ADHD.

While stimulant medications have proved a useful treatment, the investigators note there has been little research into potential preventive strategies.

To date, said Veugelers, there has been no prospective research examining the independent and combined association between meeting healthy lifestyle recommendations in childhood and incidence of ADHD in adolescence.

"My research interest has always been how the lifestyles of children affect health," said Veugelers. "At first I only considered physical health, but in recent years it's become apparent that lifestyle affects mental health as well.

"So originally I did not intend to look at ADHD," he added. "But because of the associations that kept coming up, I decided this needs further investigation and this study is one of the products of that further investigation."

For the study, investigators analyzed lifestyle survey data from 3436 10- and 11-year-olds who are participants in the Children's Lifestyle and School Performance Study (CLASS).

The children and their parents provided data regarding adherence to nine healthy lifestyle recommendations that included diet, physical activity, sleep and screen time, all of which are supported by evidence demonstrating their beneficial effects on children's health. Parents also provided information on family income, education, and place of residence.

The researchers used Cox proportional hazard and negative binomial regression analyses to determine the association between children's lifestyle and ADHD diagnosis and/or the number of physician visits for ADHD at age 14.

Historically, the prevalence of ADHD has been higher in lower socioeconomic groups so the researchers adjusted for these factors, said Veugelers.

No Surprise?

Investigators found 10.8% of participants had received a diagnosis of ADHD before age 14. They also found that compared with children who met one to three lifestyle recommendations, those who met seven to nine recommendations had a substantially lower incidence of ADHD (hazard ratio, 0.42; 95% CI, 0.28 - 0.61) and fewer ADHD-related physician visits (rate ratio, 0.38; 95% CI, 0.22 - 0.65).

Perhaps not surprisingly, the link between lifestyle and ADHD risk was dose-dependent, so that for each additional recommendation children followed, there was an 18% drop in the likelihood of an ADHD diagnosis.

The study findings came as little surprise to Veugelers, who has long been an advocate of the benefits of a healthy lifestyle.

"Kids who are physically active are generally also the kids who sleep better and who eat healthier, and probably spend less time in front of a screen because they need the time to be physically active," he said.

In an age where ADHD is typically addressed with pharmaceuticals, the study offers parents further impetus to promote healthy lifestyle choices to their children, the investigators note.

"If you ask the average person why they want their children to lead a healthy lifestyle, they'll likely say it's because it's for their physical health. Now we also know that this is going to be beneficial to mental health, and specifically with respect to the prevention of ADHD," Veugelers said.

"Of course, it's not guaranteed since multiple factors contribute to mental health, but this is actually something that parents can work with," said Veugelers.

A Shift in Focus

Commenting on the findings for Medscape Medical News, Julia Rucklidge, PhD, professor of clinical psychology, University of Canterbury, Christchurch, New Zealand, who was not involved in the study, said the results help shift the ADHD dialogue from medications to lifestyle.

"We've been almost exclusively reliant on medications as a way to treat psychiatric problems.... On the other hand, this study is saying that encouraging children to get out and engage in physical activities, and being more careful about the types of foods they eat, are all relevant to their mental health."

The investigators, she said, are focusing attention on the potential impact of environmental factors on ADHD.

"Anything that we can do to reduce the chance of a child being diagnosed with ADHD has got to be a positive thing," she said.

The study was funded by the Canadian Institutes of Health Research and Alberta Innovates. Veugelers and Rucklidge have disclosed no relevant financial relationships.

Psychosom Med. 2020;82:305-15. Abstract

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