Behandelings effekte van motoriese en neuroterugvoergebasseerde terapie op motoriese– en aandagtekorthiperaktiwiteit (ADHD)–status van 6– tot 8–jarige kinders
Several motor problems in ADHD learners are reported, including problems with balance, fine muscle control (Szatmari & Taylor; 1984; Havey & Reid, 2003) and motor planning (Piek et al., 1999; Pless & Corisson, 2000). It seems that overlapping conditions such as DAMP (which is a combination of ADHD and Developmental Coordination Disorder (DCD)) display greater connections with motor problems, than when a child displays only ADHD symptoms (Gillberg, 2003; Gibbs et al., 2007). There is also continuing controversy in the research literature as to whether ADHD is in fact remediable and what the most appropriate methods in this regard would be. Behavioural therapy at school and various forms of psychotherapy are reported to be the most popular forms of interventions complementary to medication. It also appears that motor exercise can stimulate the brain in various ways, resulting in improvement in learning and attention (Summerford, 2005). Motor therapy appears to be important, since many ADHD learners display motor difficulties. Motor control problems of learners with ADHD are also neglected during research. The objectives of this study were firstly to determine the nature and extent of coordination related neuro-motor and visual-motor integration deficits of an availability sample of six- to eight-year-old (N=95) learners diagnosed with ADHD in Brakpan, South Africa. A further objective was to determine whether treatment methods, including neuro-motor therapy, pharmacological agents and neuro biofeedback can indeed address neuro-motor problems and ADHD symptoms successfully. A further objective was to determine which of the various treatment programs, including neuro-motor therapy, pharmacological agents and brain conditioning intervention, will be the most effective for the treatment of six- to eight-year-old ADHD learners. The "Disruptive Behaviour Scale" checklist for ADHD (Bester, 2006) was used to identify learners with ADHD. The "Movement Assessment Battery for Learners 2" (MABC), and the “Quick Neurological Screening Test II" (QNST-II) were used to determine the learners’ motor skills, as well as neuro-motor progress. The "Beery Developmental Test of Visual-Motor Integration" (VMI-IV) was used to examine the learners' visual-motor integration (VMI), visual perception (VP) and motor coordination (MC). "Statistica for Windows 2012" was used for the analysis of the results. One-way Analysis of Variance, independent t-testing and co-variance analysis were used respectively to analyze data related to the abovementioned objectives. A p-value less than or equal to 0.05 was accepted as statistically significant, and effect sizes were calculated to determine the practical significance of the results (d≤0.8). The results of the study showed that the neuro-motor status of the selected six- to eight-year-old ADHD learners (N=95) that had been identified, using the Bester questionnaire, and analyzed by means of the MABC, QNST and VMI, was affected negatively by the condition. Fine motor and hand control skills of learners with ADHD were indeed found to be significantly weaker compared to learners without ADHD, and the fine motor skills of learners with DAMP showed impairment to a greater degree. Neurological and visual-motor integration do not appear to differ between learners with and without ADHD symptoms, although trends of weaker values and significant differences were found in the palm shape recognition, arm-leg extension (muscle tone) subscale and the stimulation of hand and cheek subscale in the ADHD and DAMP groups. For objective 2, the learners were divided into two groups (an ADHD intervention group (n=10) that was subjected to an neuro-motor intervention program of nine weeks, 37 minutes per session, twice a week, and compared to a non-control group consisting of non-ADHD learners (n=18)). When the pre-test differences between the groups are taken into account, it indicated that the ADHD group performed weaker than the control group in the QNST and MABC total, MABC percentile, ball skills and palm shape recognition subtest values, before starting the intervention, but that during the after-test no more differences were observed between the groups. This suggests that the intervention group showed improvement and that their average values draw closer to those of the control group, confirming that the intervention did exert an influence on the deficits that these ADHD learners experienced. The neuro-motor dysfunction of the group of learners with ADHD did not show a significant improvement, although non- significant trends of improvement that occurred in all variables may indeed be attributed to the effect of the intervention. A reduction in the ADHD symptoms and improved visual-motor integration in learners with ADHD were observed, suggesting that the severity of the symptoms of ADHD displayed by this group before the start of the intervention was significantly reduced. For objective 3, the learners (n=95) were divided into five groups (Sharper Brain group (n=25); neuro-motor intervention group (n=21); medication group (n=17); a group with no symptoms of ADHD (n=18), and an ADHD control group (n=14)). The Sharper Brain group showed practical significant lower values than the ADHD control group and the medication group in most of the MABC variables, from which can be deduced that neuro-biofeedback therapy will not improve motor problems. The results obtained in the visual-motor integration subtest showed that the neuro-motor intervention group performed significantly better than the ADHD control group, although the groups did not differ significantly. ADHD symptoms decreased significantly in all groups, most of all in the Sharper Brain group, from which can be deduced that the intervention has possibilities to improve focus and attention. A trend also occurred (p>0.05) that the neuro-motor intervention contributed more to improving visual-motor integration than the other intervention groups, while the medication intervention meaningfully addressed visual perception skills. However, from the results could not be determined whether one group performed better than another group, as no significant differences occurred consistently between groups. The neuro-biofeedback therapy, medication and neuro-motor intervention each had a achieved a unique improvement, and it is recommended that a combination of the various intervention methods should be used in the treatment of ADHD. In summary, the conclusion can be drawn that ADHD learners experience problems with skills related to attention, visual-motor integration and fine motor skills to a greater extent than non-ADHD learners, and that learners diagnosed with DAMP display more serious problems in this regard. The results showed that the various interventions have various treatment effects, but did not have a significant effect on the motor status of the ADHD learners. The conclusion may be drawn that there is no one single method of treatment for learners with ADHD symptoms, but that a combination of treatment methods should rather be implemented. From the study it is clear that ADHD does indeed affect learners negatively, but also that the exposure to focused intervention programs has a positive effect on their neuro-motor skills and ADHD symptoms.
- Health Sciences