Following evidence-based 24-hour movement behavior guidelines was associated with decreased risk for cognitive and social difficulties among children and adolescents with attention-deficit/hyperactivity disorder (ADHD), according to the results of a study published in Child and Adolescent Psychiatry and Mental Health.

The guidelines recommend that children should engage in 2 hours or less of noneducational screen time, a minimum of 60 minutes of moderate to vigorous physical activity (MVPA), and age-appropriate sleep durations every day.

For this cross-sectional study, data were sourced from the 2020 National Survey for Children’s Health (NSCH) survey collected in the United States between 2020 and 2021. A total of 42,777 primary caregivers of a child aged 6 to 17 years provided demographic information and medical data; the caregivers also reported on adherence to the guidelines. Among the subset of children with ADHD (n=3470), the relationships between meeting daily movement behavior guidelines and cognitive and social difficulties were assessed.

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The mean age of study participants was 11.97 (SD, 3.48) years, 69.55% were boys, 69.18% were White, 14.95% were overweight, 14.52% had severe ADHD, and 26.27% had never received medication treatment for ADHD.

A quarter of the study population (27.56%) reported no adherence to the guidelines, 26.87% adhered to the sleep recommendation, 10.87% adhered to the screen time recommendation, 4.93% adhered to the MVPA recommendation, 5.68% adhered to all recommendations, and the rest adhered to a combination of 2 of the 3 recommendations.

Caregivers reported that 55.57% of children had serious difficulty concentrating, remembering, or making decisions; 17.49% had a lot of difficulty and 36.54% had a little difficulty making or keeping friends; 3.17% bullied others almost every day, 2.73% bullied others 1 or 2 times per week, 5.16% bullied others 1 or 2 times per month, and 19.73% bullied others 1 or 2 times in the past year; and 6.93% were bullied by others almost every day, 7.40% were bullied 1 or 2 times per week, 11.15% were bullied 1 or 2 times per month, and 33.67% were bullied 1 or 2 times in the past year.

Children who followed all 3 recommendations were less likely to have difficulty concentrating, remembering, or making decisions (odds ratio [OR], 0.43; 95% CI, 0.24-0.78; P =.01) and making or keeping friends (OR, 0.46; 95% CI, 0.21-0.97; P =.04).

Meeting some of the recommendations was also associated with beneficial outcomes, in which the risk for cognitive difficulties was lower for children who met the screen time and physical activity recommendations (OR, 0.26; P <.001); risk for bullying others was lower for those who achieved the screen time only (OR, 0.44; P =.003), screen time and sleep (OR, 0.60; P =.02), and sleep only (OR, 0.65; P =.03) recommendations; and risk for being bullied was decreased for those who met the screen time recommendations (OR, 0.61; P =.04).

However, children who met physical activity recommendations only were at increased risk for being bullied by others (OR, 2.47; P =.03).

The major limitation of this study was the reliance on caregiver reporting.

The study authors concluded, “[M]eeting all three 24-HMB guidelines was associated with reduced odds of the occurrence of 1 or more negative outcomes for cognitive and social difficulties.”


Taylor A, Kong C, Zhang Z, et al. Associations of meeting 24‑h movement behavior guidelines with cognitive difficulty and social relationships in children and adolescents with attention deficit/hyperactive disorder. Child Adolesc Psychiatry Ment Health. 2023;17(1):42. doi:10.1186/s13034-023-00588-w

This article originally appeared on Psychiatry Advisor