Children, Exercise, and ADHD.

A recent New York Times article on ADHD unleashed a predictable flurry of responses. Some comments lauded the author for his skepticism concerning the medications; others called him ignorant, biased, and even “evil.” The level of vitriol and passion is understandable: in a society that’s inundated with a barrage of emails, texts, and TikTok videos, everyone is impacted. Children, with their still developing brains, are particularly vulnerable. And, having been diagnosed with ADHD myself, the article really struck a nerve. 

Three of the main contentions of the article were that ADHD was situational rather than perpetual - meaning the condition is heavily influenced by environmental factors — that ADHD medications didn't improve academic performance, and that they entail a host of serious side effects including growth impediment and moodiness. (1)

 The response to the NYT article from one of the preeminent ADHD medical advocacy publications (whose members were quoted in the article) was quick and unequivocal. It called the article "misrepresentative, biased, and dangerous." (2) 

The rebuttal claimed that the author of the NYT article cited scientists in the ADHD group out of context, without the benefit of an actual interview. It also accused the NYT author of ignoring a plethora of studies that showed ADHD meds mitigate a host of symptoms including impulse control, self-harm, drug use, and reckless behavior. Shockingly, the rebuttal did not cite studies refuting the NYT article's contention that medications don’t directly improve academic performance.

Most people’s experiences with ADHD falls somewhere in the middle of the polarizing extremes. ADHD meds can help some of the people some of the time. 

As a wayward college student, Ritalin enabled me to finally finish a journalism assignment that changed the trajectory of my life.* Conversely, when I tried to use Ritalin to avoid collapsing in a drool infused slumber in geometry class, I failed miserably. There’s simply no pharmaceutical solution to my inherent disinterest in geometry. Or chemistry, for that matter.

But nuance isn’t sexy. And both the NYT article and the rebuttal ignore an antidote that is widely available, inexpensive, and doesn’t require a prescription. It’s called exercise. 

The inspiration for the book "Spark," by Harvard professor John Ratey, which explores the connection between exercise and mental health, was the school system in Naperville, Illinois.

Two decades ago, the school system underwent a dramatic change in the way physical education was taught and experienced. Gone were the traditional benchmarks for fitness: sit-ups, push-ups, pull-ups, running laps. Gone, too, was the drudgery and dread that accompanied those exercises.

In its place was ... square dancing. Or rock climbing. Or volleyball. Students had a full menu of options, and they were no longer graded on skill but effort. Additionally, Naperville Central High freshman volunteers from a program called "Zero Hour" worked out a higher intensity than the rest of their classmates — they stayed between 80 and 90 percent of their maximum hear rates. The results, as detailed in "Spark" were profound: students who were a part of the "Zero Hour" program showed a 17 percent improvement in reading and comprehension compared with a 10.7 percent improvement among the students who had opted for the standard physical education classes. (Which was still an improvement over previous test scores.)

Other test scores underscored the exercise/brain connection more dramatically. In 1999, Naperville's eighth grade students participated in the TIMSS test (Trends in International Mathematics and Science Study) which evaluates math and science skills. 230,000 students from around the world participated. Naperville's eight graders finished sixth in math and first in science.

The correlation between physical activity and brain function — specifically pertaining to ADHD — has been borne out by other studies as well.

A recent PubMed study that analyzed over a decade of research produced some definitive results. The study found that children with higher physical activity levels have better executive function performance in working memory, inhibitory control, and information-processing speed. Additionally, the study showed that a single shorter bout of intense activity resulted in inhibition control for children with ADHD symptoms for an hour after completion of the exercise. (3)

Particularly of interest was the data using four different methods to mitigate ADHD symptoms: (1) exercise (2) meditation (3) vitamin and mineral supplements and (4) cognitive behavioral therapy. The study found that exercise was the most effective form of intervention, followed by meditation and behavioral therapy.

As with must studies, the language was dry and technical. Perhaps the one exception was when the authors dispensed with the scientific jargon and urged people to heed its findings. "Systemic and systematic and planned moderate-high exercise courses should be administered as soon as possible."

Perhaps part of the urgency can be attributed to two distinct underlying factors — COVID has severely impacted academic performance and kids are spending a record amount of time on screens.

According to the National Center for Education Statistics, average scores for age 9 students in 2022 declined 5 points in reading and 7 points in mathematics compared to 2020. Those numbers constituted the largest average score decline in reading since 1990, and the first ever score decline in mathematics.

Screen time for children is at unfathomable numbers. According to the American Academy of Child and Adolescent Psychiatry, children between the ages of 8-12 spend 4-6 hours per day watching or using screens, and teens spend up to nine hours a day.

Are the lagging scores and inability to focus the outlier or the new norm? The ubiquity of the circumstances might help explain why the U.S. Centers for Disease Control and Prevention have reported that an estimated 7 million children (11.4 percent of the population) between the ages of 3-17 have received an ADHD diagnosis, which is a record high. The CDC also claimed that about six in ten children had moderate or severe ADHD.

For Bay Area parent Sam, negotiating screen time is one of the biggest hurdles in parenting a child with ADHD. Sam's kid, who is excelling academically, has severe impulse control issues, and has been on ADHD medications since the third grade.

"You can almost see the damage happen minute by minute with screen time," said Sam. "It's horrible. With every minute of screen time, communication with my son becomes more difficult and fraught.

"But what are the options? Unless you're living on a farm or a kibbutz, you can't give kids zero screen time. Depriving them of digital access means cutting them off from friendships. That's not how modern society works."

Sam saw marked improvement in his son's behavior when his kid attended a summer camp in the Sierras. Ironically, that summer was the only time his kid had gone unmedicated for any stretch of time.

While offering a disclaimer that there was no actual "science" behind his opinions, Sam said that there was one clear hallmark of success — he and his partner didn't receive any phone calls of his son acting out.

"It may have happened," Sam said with a laugh. "But we don't know because we didn't receive any phone calls about his behavior," Sam said, adding that when his son attends school locally, he's constantly being disciplined about destructive and impulsive behavior.

"Going on bike rides, playing team sports, or being in nature yield very positive improvements in our son's ability to control himself," Sam said. "I don't know how the science works, but it allows him an opportunity to interact with people in a much healthier way."

Sam's experiences resonated with Iowa resident Jason, who has seen the benefits of ADHD medication with his daughter, and how outdoor activities mitigate ADHD symptoms.

Jason's daughter, now 18, was diagnosed with ADHD when she was seven. The decision to put her on ADHD was a painstaking, and, in Jason's words, "required a lot of long dog walks with my wife."

"You know, it's difficult to parse the data," Jason said. "What are the chemical compositions of the medications we're giving her? Are we just giving our daughter speed?"

Ultimately, Jason and his wife opted to give their daughter ADHD medication, and she thrived academically ("twentieth in her senior class out of 580 students," Jason said, proudly) and was able to control her propensity towards being "hyper verbal."

"Ultimately, the medication is a tool to help navigate social situations in a more traditionally accepted way," Jason said.

As a former volunteer with a well-known nonprofit cycling mentorship program in the state, Jason also saw first-hand how exercise and being outdoors can produce profound results on kids diagnosed with ADHD.

The kids in the program came from a variety of socio-economic backgrounds (Jason eschews the term "at-risk") but a majority of them were dealing with impulsive behavior or academic issues that are prevalent in kids with ADHD.

"I don't use this term lightly, but cycling is 'magical'" said Jason. "When you get kids who have never really been on a bike out on a long ride, the difference it makes is just amazing to behold.

"You have to be focused to cycle up big hills," he continued. "And then you have the all the creeks, the fields, and the rivers and the woods. When you cycle next to them, you can hear their voices full of wonder about everything they're seeing and experiencing.

"And the end of a fifty or sixty mile ride, their cups are so full," Jason said. "They have all the stimuli they need to be relaxed, calmer, and more focused."

I think the New York Times article was very well-researched and thought provoking. It jibed with a lot of my experiences on ADHD medication. Did it ignore evidence that ADHD medications can help with some symptoms — specifically impulse control? Quite possibly. That might've complicated the narrative. As alluded to above, nuance just isn't as sexy as definitive statements.

Based on my own experience, and in talking with many parents I know, ADHD medication can have a positive effect for many kids (and for adults as well). But I think the author's main concern is entirely valid: in a society less and less able to pay attention (and academically regressed due to COVID), I think many, many kids are at risk of being misdiagnosed.

One of the best solutions is also the simplest: go outside and play.

Sources and acknowledgements:

* This article is dedicated to my college professor Erna Smith, with deep gratitude and appreciation.

(1) Paul Tough (04/13/2025) "Have We Been Thinking About A.D.H.D. All Wrong? The New York Times

(2) Anni Layne Rodgers (04/16/2025) "Setting the Record Straight About ADHD and Its Treatments." ADDitude

(3) Yuan-Shuo Chan et al. (11/29/2021) "Effects of physical exercise on children with attention deficit hyperactivity disorder." PubMed

Joshua Brandt is an Oakland based personal trainer. He can be reached at joshua@joshuabrandtpt.com or (415) 412-7339. 

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