The balance ability in children with attention deficit hyperactivity disorder-combined type (ADHD-C) has not been fully examined, particularly dynamic sitting balance. Moreover, the findings of some published studies are contradictory. We examined the static and dynamic sitting balance ability in 20 children with ADHD-C (mean age: 9 years 3 months; 18 boys, 2 girls) and 20 age-, sex-, height-, weight-, and IQ-matched healthy and typically developing controls (mean age: 9 years 2 months; 18 boys, 2 girls). The balance subtests of the Movement Assessment Battery for Children (MABC) and the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) were used to compare the two groups, and a mechanical horseback riding test was recorded using a motion-capture system. Compared with the controls, children with ADHD-C had less-consistent patterns of movement, more deviation of movement area, and less-effective balance strategies during mechanical horseback riding. In addition, their performance on the balance subtests of the MABC and BOTMP were not as well as those of the controls. Our findings suggest that balance ability skill levels in children with ADHD-C were generally not as high as those of the controls in various aspects, including static and dynamic balance.
Attention deficit hyperactivity disorder (ADHD) is one of the most common disorders in school-age children; the worldwide-pooled prevalence is 5.29% (Polanczyk, de Lima, Horta, Biederman, & Rohde, 2007). Some researchers have paid attention to the balance ability in children with ADHD (Piek et al., 1999, Raberger and Wimmer, 2003, Schlee et al., 2012 and Tseng et al., 2004). Adequate balance ability is important for many daily activities (Larkin & Hoare, 1992). Insufficient balance ability negatively affects not only children's motor performance but also the psychosocial aspect of their life (Shum and Pang, 2009 and Simeonsson et al., 2003). Some studies (Piek et al., 1999, Shum and Pang, 2009 and Tseng et al., 2004) on children with ADHD-combined type (ADHD-C) report that their balance is significantly less proficient than that of matched controls without ADHD, but this finding was not consistent with other reports (Pitcher, Piek, & Hay, 2003).
1.1. ADHD and balance ability
Piek et al. (1999) used the Movement Assessment Battery for Children (MABC) to assess motor performance in 16 children with ADHD-predominantly inattentive type (ADHD-PI), 16 children with ADHD-C, and a group of 16 age- and verbal-IQ-matched children without ADHD (controls). Their results showed that children with ADHD-PI “had significantly poorer fine motor skills… [and that those] with ADHD-C had significantly greater difficulty with gross motor skill” than did the controls. Consistently, Tseng et al. (2004) found that children with ADHD-C demonstrated poorer balance as measured by the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP). However, in another MABC-based study on balance in 104 boys with ADHD and 39 controls without (Pitcher et al., 2003), they found no significant differences in the static and dynamic balance subtest results. Thus, the question of balance ability in children with ADHD-C is still open.
1.2. ADHD and dynamic balance ability
Although the MABC and BOTMP balance subtests can tell us something about balance performance, they are less informative about dynamic balance performance and balance strategies (Hatzitaki, Zisi, Kollias, & Kioumourtzoglou, 2002). In daily life, dynamic balance ability is required for many tasks (Shumway-Cook & Woollacott, 2007). Because few studies have investigated dynamic balance in children with ADHD, we used a (dynamic) mechanical horse and a motion analysis system in our study.
1.3. Purposes of this study
The aim of our study was to examine the static and dynamic balance ability of children with ADHD-C. To our knowledge, this was the first study measuring dynamic balance ability in children with ADHD by using the objective motion analysis and mechanic horse. We hypothesized that children with ADHD-C would have static and dynamic balance performance levels that differed significantly from those of children without ADHD.
This was the first study to show that children with ADHD-C have impaired dynamic balance during mechanical horseback riding. Specifically, they had less-consistent patterns of movement and a more extended area for trial-and-error in their attempt to maintain dynamic balance. In addition, children with ADHD did not score as well as children without ADHD on the MABC and BOTMP balance subtests.
