|Use sports in
treating hyperactive children
Jeffery L. Alexander,
Most of us can remember having been the 'goat' in a childhood ball
game because a grounder scooted between our legs or we struck out
in a crucial situation. For hyperactive children, early experiences
in organized sports all too often follow just such a script. As
a result, these children quickly learn to dislike sports and games.
This is unfortunate,
because sports and recreation can and should be one of the cornerstones
of treatment for children with attention deficit hyperactive disorder.
I can't cite a stack of articles to back this assertion, because
the role of sports and recreation in hyperactive children's lives
has received little formal study. But my experience has convinced
me that helping a child to succeed in sports and recreation programs
can make an important contribution to therapy. Carefully chosen
activities, perhaps combined with the use of appropriate medicattions,
can help enhance the chid's confidence, self-esteem, fitness, and
Attention deficit disorder, with or without hyperactivity, is the
most common reason for referral of children to child guidance clinics
and specialists in child behavior and developmental medicine. The
precise incidence of this disorder is not clear, but most experts
agree that between 2% and 5% of children have it. Many children,
particularly girls, who have attention deficit disorder without
hyperactivity are diagnosed late or incorrectly. (Though the two
are not precisely the same, in this article I use the terms "attention
deficit disorder" and "hyperactivity" interchangeably
For most children,
the core symptoms of attention deficit hyperactivity disorder are
hyperactivity, short attention span, distractibility, and impulsiveness.
Most parents are aware of these problem behaviors by toddlerhood
or preschool, but they often become more apparent, and sometimes
are greatly exaggerated, once the child enters school. Teachers
complain that these children don't listen, disturd other children,
can't concentrate, can't sit still, and have a short attention span.
As the years
go by, the problems mount. The disorder sabatoges academic performance;
grades substantially understate the child's potential in most cases.
In addition, the impulsive behavior ruins relationships with other
young people and adults. If left untreated, the child may exhibit
chronic school underacheivement, behavioral problems, cinduct disorders,
and, not infrequently, depression and/or anxiety.
Most experts now agree that the most efective treatment for hyperactivity
is medication, such as methylphenidate (Ritalin), dextroamphetamine
sulfate (Dexedrine), pemoline (Cylert), or one of several antidepressant
medications. These medications may produce nuisance side effects
and sometimes more serious problems, but the great benefits they
provide may be worth the risks. Obviously the question of benefits
and risks is difficult.
can also be helpful for a child with attention deficit disorder
especially in teaching parents which behavior are attributable to
the disorder and which are not. The thrust is to help the family
structure the child's activities,learn to identify the child's special
skills or gifts, and provide consequences for inappropriate behavior.
Much is made
of educational treatment. In fact, the American Academy of Pediatrics
Committee on Children with Disabilities has stated that behavioral
and educational treatment should be tried before medication. However,
only one state and Washington, DC, provide for academic and behavioral
assistance for hyperactive children. Although some teachers are
very good with these children, many teachers have little training
in dealing with them. Too often, children are incorrectly labeled
as emotionally and behaviorally disturbed and are unnecessarily
transferred to special settings.
(PE) offers an opportunity for therapy, but it is seldom exploited
properly. Hyperactive children typically have a rough time inPE
because of their poor listening skills, distractibility , and impulsiveness.
PE teachers should receive in-service training in the proper management
of these children, as should playground montors and school bus drivers.
For the present,
however, most pediatricians cannot count on successful educational
modificaations and must rely on family therapy and medication. Sports
participation can serve as an important adjuct to these modalities.
To integrate recreation and sports into treatment, the activities
must be planned thoughtfully. Parents are familiar with "individual
education plans," based on careful consideration about which
sports or recreation programs are suitable.
interviews with children and parents, a pediatrician usually can
help the family select activities most likely to bring success.
Find out why certain athletic and recreational activities have failed
in the past. How does the child spend free time? What activity does
the child usually do when asked what he or she would like to do?
What assets do the parents see in the child in the way of eye-hand
coordination, running skills, speed, endurance, and strength? How
mature is the child physically and emotionally? If the pediatrician
knows about local opportunities for sports and recreation, he or
she can greatly assist the parents in choosing an activity or activities.
For children with motor coordination problems or other special problems,
the pediatrician might want to consult an adaptive PE instructor
for advice about the best activity.
It is important
for parents to talk to the coach ofr recreation leader about their
child's skills and problems before a program begins. Parents worry
that this will create a negative attitude in the coach or teacher.
On hte contrary, most coaches want and need to know about potential
problems in advance. If not made aware of the problem, the coach
probably will interpret some of the child's behaviors as deliberate
and possibly directed at the coach, which will leave a particularly
The best sports
From 15 years of using recreation and sports in the treatment of
hyperactive children, it is my impression that certain activities
are much better than others. Baseball, for a negative example, can
be a nightmare for these children because of its slow pace and the
need for well-developed motor skills and hand-eye cioordination
skills. But other activities help children learn to enjoy athletics
and, in fact, often awaken in them a passion for sports. The sports
that seem to work best are discussed below and age guidelines for
participation are listed in table 1.
Soccer is one
of the most attractive sports for young children with attention
deficit disorder. Currently it is the second largest sport for children
in the United States, quite remarkable for a country without a soccer
tradition. For young hyperactive children it is often ideal because
it entails ample participation for all, lots of running, and kicking
a relatively large ball. Position playis not terribly important
at younger age levels, and the natural impulsiveness of hyperactive
children does not interfere with their performance. And since most
coaches of youngsters inthis sport are parents who don't particularly
know the nuances of soccer, they usually allow the children to go
out and have a good time.
Soccer is a
good building block for other sports because it enhances speed,
endurance, and leg strength, and is very safe. Also, the hyperactive
child doesn't look that much different from other kids on the field.
Most communities have summer and fall soccer programs, and warmer
climates provide for soccer year-round. Older children may find
soccer enjoyable if they are coachable, ie, if they listen well,
follow instructions, and learn to play positions.
kwon do and karate are, in my experience, the most enjoyable sports
for hyperactive children after soccer. Parents often do a double
take when these sports are mentioned, fearing that a martial art
will lead to serious social problems for their children because
of their impulsiveness and aggressiveness. But to me, tae kwon do
and karate are two of the most therapeutic programs for children
with this syndrome, and children can start as early as 6 or 7 years
sports are beneficial because they involove structure, rules, rituals,
a stop-and-think attitude, and absolute obedience. No techniques
are taught until the children have learned to stop, listen, and
think. Classe usually are small. The techniques are monitored carefully,
emphasizing over and over that these are sports and arenot to be
used for any aggressive play. Students who disobey the rules usually
are expelled from the class.
is well suited to children with attention deficit disorder. Swimming
tends to be a fairly explosive activity in which impulsiveness may
be an advantage. In general, swimming is highly recommended for
children with motor coordination problems.
for hyperactive children also have been quite successful, In wrestling
the coach usuallu teaches the athlete one-on-one, which enhances
listening and works better than group teaching. As in swimming and
soccer, endurance and stamina are improved, as is strength of all
in which hyperactive children have been particularly succesful are
diving, weight lifting, track and field, gymnastics, and, in some
cases, tennis and golf. Tennis and golf, however, are difficult
to learn and often end in frustration, which may bring out more
of the attention deficit symptoms. Weight lifting is a fairly explosive
sport which doesn't require sustained concentration, but it should
be done under the guidance of a coach and should be reserved for
children who are physically mature enough to avoid injury.
The role of
Often one of the most successful ways to enhance sports participation
is to use methylphenidate or other medications. Hyperactive kids
battle withthe same problems on the athletic field as theydo in
the classroom. Methylphenidate and other medications are used primarily
to improve the efficiency of learning by increasing atention span
and decreasing hyperactive behavior, distractibility, andimpulsiveness.
Medication won't make children smarter, but they may very well study
more effectively. There is also evidence that methylphenidate and
other stimulant medications improve social skills.
If one of the
purposes of medication is to increase attention and thereby improve
academic achievement, it also makes sense to consider the benefits
of medication to improve athletic and other recreatonal skills.
The reason for using medications in these children, after all, is
to help them succeed in general-not just in sports or academics.
But when their confidence and self-esteem are improved by helping
them perform better in sports, other benefits may multiply. Many
physicians now recommend that medication doses be adjusted so they
will be effective during athletic practices and events. The fact
is that medication makes many children more coachable.
one boy was asked what sport he was playing. "Hockey,"
he replied. "What position do you play?" "E.O.B."
"What's E.O.B.?" "End of the bench," answered
the boy. His father then said, "What makes this particularly
sad is that I'm the coach, but no one wants to play on his line.
He skates well, handles tha puck well, and shoots very well. The
problem is that he doesn't listen to his coach or teammates, he's
possessive of the puck and rarely passes, and has no concept of
This boy was
taking 10mg of methylphenidate in the morning and at noon. He was
then instructed to take another 10mg of methylphenidate later in
the afternoon, about 30 minutes before hockey practices and games.
At a follow-up visit 2 months later, the father said the boy had
improved so much in team play that he was selected fo the all-star
team at the end of the season. This suggests that many children
have all ingredients for success, but they are sabotaged by the
attention deficit symptoms.
This is not
to say that medication should be given solely for the sake of sports
performance. If an afternoon dose of medication is really needed
for a sports event, it should be given regularly at that time to
help the youngster cope with other afternoon and evening situations
that otherwise would cause frustration.
studying hyperactive children in group settings have often reported
beneficial effects of medications. One recent study looked at the
effects of methylphenidate on baseball performance by boys with
this disorder. DOses of 0.3 and 0.6 mg/kgof body weight were used
in the double-blind placebo-controlled study, which involved 17
boys aged 7.8 to 9.9 years. Measures of attention improved dramatically,
though there was no significant difference between the two doses.
The players were more often able to tell the score and the number
of outs, they were in a ready position more often when out on the
field, and they were less likely to swin impulsively at balls well
out of the strike zone. The researchers said the actual athletic
skills of the children did not improve; what improved was their
ability to stay focused on the game, and this enhanced their performance.
are banned in Olympic and NCAA competition. That may not be a problem
for atheletes with attention deficit, because by the end of high
school most children have compensated for most of their symptoms,
and if they are candidates for high-level competition, they have
probably learned to concentrate and are coachable. On the other
hand, there is really no evidence that the medications used to treat
attention deficit disorder in and of themselves enhance strength
, speed, or stamina. Of course, the ban exists because these medications
are controlled substances and can be easily abused. But no one in
good conscience could recommend that an athlete discontinue the
phenobarbitol he or she takes for epilepsy, even though it is also
a narcotic. Similarly, athletes with exercise-induced asthma commonly
use albuterol inhalers, which allows them to breathe normally so
they can compete to the best of their ability. Likewise, when wisely
used, medications for hyperactivity can allow young athletes to
do their best.
One final note:
A bonus of athletis activity is that, if parents participate with
their child, barriers are let down and more meaningful communication
can occur. For example, although atempts at dinner conversation
may be futile, dialog may flow freely if parent and child go outside
to shoot baskets together.
Many hyperactive children have been turned off to sports because
of poor early experiences in organized sports and PE classes. The
negative attitudes engendered early must be turned around because
of the benefits of fitness and the enjoyment that comes from participating
in sports and recreation. Carefully chosen activities can be therapeutic
as wellas enjoyable. The judicious use of medication before these
activities can enhance successful participation, particularly by
improving coachability and team play.