The Effect of Sustained Attention Tasks on Gait Pattern Variations in Children with Attention Deficit-Hyperactivity Disorder: A Clinical Trial Study

Document Type : Original Articles


1 PhD Candidate in Motor Development, Department of Motor Behavior, School of Physical Education and Sport Sciences, Kharazmi University, Tehran, Iran

2 Professor, Department of Motor Behavior, School of Physical Education and Sport Sciences, Kharazmi University, Tehran, Iran

3 Assistant Professor, Department of Motor Behavior, School of Physical Education and Sport Sciences, Kharazmi University, Tehran, Iran

4 Professor, Department of Behavioral and Cognitive Sciences in Sports, School of Sports and Health Sciences, Shahid Beheshti University, Tehran, Iran



Introduction: The current gait profile of children with attention deficit-hyperactivity disorder (ADHD) is incomplete and mainly based on a short-time walking without the involvement of different senses. The aim of this study was to investigate the dual-task gait of ADHD and typically-developed (TD) children while receiving sustained visual-vestibular stimulus.
Materials and Methods: 21 children with ADHD and 12 TD children (7-10 years) participated in the study. Participants walked on the treadmill in three self-selected speeds three-minute trials in single-task (without visual instructions) and dual-task (simultaneously following visual-vestibular saccade and smooth pursuit stimuli) conditions. Stride length, global angle of the dominant leg, step width, and the variability of these parameters were assessed using a factor analysis of variance at significant level of α = 0.05.
Results: The effect of group-stimulus interaction on stride length was not significant (P = 0.860), but its variability was significant [less variability for typical children compared to children with ADHD (P = 0.001)]. The interactive effects on the global angle were significant (P = 0.001), but its variability was not significant (P = 0.720). In without instruction and in smooth pursuit conditions, significant ankle rotation was observed in children with ADHD (P = 0.001) compared to that of typical children. Step width (P = 0.001) and its variability (P = 0.003) were significantly affected and typical children had wider walking with less variability than the other groups (P = 0.001).
Conclusion: Different visual-vestibular instructions can affect the gait of the children with ADHD in various ways. These results can be considered as a basis for the integration of dualistic and synergy models and guidance for educators of children with ADHD.


Main Subjects

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th Arlington, VA: American Psychiatric Association; 2013
  2. Ren Y, Yu L, Yang L, Cheng J, Feng L, Wang Y. Postural control and sensory information integration abilities of boys with two subtypes of attention deficit hyperactivity disorder: A case-control study. Chin Med J (Engl) 2014; 127(24): 4197-203.
  3. Kim SM, Hyun GJ, Jung TW, Son YD, Cho IH, Kee BS, et al. Balance deficit and brain connectivity in children with attention-deficit/hyperactivity disorder. Psychiatry Investig 2017; 14(4): 452-7.
  4. Patankar VC, Sangle JP, Shah HR, Dave M, Kamath RM. Neurological soft signs in children with attention deficit hyperactivity disorder. Indian J Psychiatry 2012; 54(2): 159-65.
  5. Simmons RW, Taggart TC, Thomas JD, Mattson SN, Riley EP. Gait control in children with attention-deficit/hyperactivity disorder. Hum Mov Sci 2020; 70: 102584.
  6. Kim J, Mutyala B, Agiovlasitis S, Fernhall B. Health behaviors and obesity among US children with attention deficit hyperactivity disorder by gender and medication use. Prev Med 2011; 52(3-4): 218-22.
  7. Barkley RA. ADHD and injuries: Accidental and self-inflicted. The ADHD Report 2014; 22(2): 1-8.
  8. Wang J, Wang Y, Ren Y. A case-control study on balance function of attention deficit hyperactivity disorder (ADHD) children. Beijing Da Xue Xue Bao Yi Xue Ban 2003; 35(3): 280-3. [In Chinese].
  9. Buderath P, Gartner K, Frings M, Christiansen H, Schoch B, Konczak J, et al. Postural and gait performance in children with attention deficit/hyperactivity disorder. Gait Posture 2009; 29(2): 249-54.
  10. Soto I, V, Moreno VB, Losada Del PR, Rodrigo MM, Martinez GM, Cutillas RR, et al. Do children with attention deficit and hyperactivity disorder (ADHD) have a diferent gait pattern? Relationship between idiopathic toe-walking and ADHD. An Pediatr (Engl Ed) 2018; 88(4): 191-5. [In Spanish].
  11. Manicolo O, Grob A, Hagmann-von AP. Gait in children with attention-deficit hyperactivity disorder in a dual-task paradigm. Front Psychol 2017; 8: 34.
  12. Manicolo O, Grob A, Lemola S, Hagmann-von AP. Age-related decline of gait variability in children with attention-deficit/hyperactivity disorder: Support for the maturational delay hypothesis in gait. Gait Posture 2016; 44: 245-9.
  13. Mohring W, Klupp S, Grob A. Effects of dual tasking and methylphenidate on gait in children with attention deficit hyperactivity disorder. Hum Mov Sci 2018; 62: 48-57.
  14. Naruse H, Fujisawa TX, Yatsuga C, Kubota M, Matsuo H, Takiguchi S, et al. Increased anterior pelvic angle characterizes the gait of children with Attention Deficit/Hyperactivity Disorder (ADHD). PLoS One 2017; 12(1): e0170096.
  15. Papadopoulos N, McGinley JL, Bradshaw JL, Rinehart NJ. An investigation of gait in children with Attention Deficit Hyperactivity Disorder: A case controlled study. Psychiatry Res 2014; 218(3): 319-23.
  16. Leitner Y, Barak R, Giladi N, Peretz C, Eshel R, Gruendlinger L, et al. Gait in attention deficit hyperactivity disorder: Effects of methylphenidate and dual tasking. J Neurol 2007; 254(10): 1330-8.
  17. Bustos L, Schneider A, Wright A. Gait and attention deficit/hyperactivity disorder: A review. Extremitas Journal of Lower Limb Medicine 2019; 6: 10-3.
  18. Inoue A, Iwasaki S, Ushio M, Chihara Y, Fujimoto C, Egami N, et al. Effect of vestibular dysfunction on the development of gross motor function in children with profound hearing loss. Audiol Neurootol 2013; 18(3): 143-51.
  19. Bucci MP, Gouleme N, Dehouck D, Stordeur C, Acquaviva E, Septier M, et al. Interactions between eye movements and posture in children with neurodevelopmental disorders. Int J Dev Neurosci 2018; 71: 61-7.
  20. Bucci MP, Seassau M, Larger S, Bui-Quoc E, Gerard CL. Effect of visual attention on postural control in children with attention-deficit/hyperactivity disorder. Res Dev Disabil 2014; 35(6): 1292-300.
  21. Woollacott M, Shumway-Cook A. Attention and the control of posture and gait: A review of an emerging area of research. Gait Posture 2002; 16(1): 1-14.
  22. Plummer P, Eskes G, Wallace S, Giuffrida C, Fraas M, Campbell G, et al. Cognitive-motor interference during functional mobility after stroke: state of the science and implications for future research. Arch Phys Med Rehabil 2013; 94(12): 2565-74.
  23. Al-Yahya E, Dawes H, Smith L, Dennis A, Howells K, Cockburn J. Cognitive motor interference while walking: A systematic review and meta-analysis. Neurosci Biobehav Rev 2011; 35(3): 715-28.
  24. Gillberg C. Deficits in attention, motor control, and perception: A brief review. Arch Dis Child 2003; 88(10): 904-10.
  25. Caldani S, Razuk M, Septier M, Barela JA, Delorme R, Acquaviva E, et al. The effect of dual task on attentional performance in children with ADHD. Front Integr Neurosci 2018; 12: 67.
  26. Huxhold O, Li SC, Schmiedek F, Lindenberger U. Dual-tasking postural control: aging and the effects of cognitive demand in conjunction with focus of attention. Brain Res Bull 2006; 69(3): 294-305.
  27. Bonnet CT, Baudry S. Active vision task and postural control in healthy, young adults: Synergy and probably not duality. Gait Posture 2016; 48: 57-63.
  28. Bonnet CT, Baudry S. A functional synergistic model to explain postural control during precise visual tasks. Gait Posture 2016; 50: 120-5.
  29. Mitra S, Fraizer EV. Effects of explicit sway-minimization on postural--suprapostural dual-task performance. Hum Mov Sci 2004; 23(1): 1-20.
  30. Thier P, Ilg UJ. The neural basis of smooth-pursuit eye movements. Curr Opin Neurobiol 2005; 15(6): 645-52.
  31. Srulijes K, Mack DJ, Klenk J, Schwickert L, Ihlen EA, Schwenk M, et al. Association between vestibulo-ocular reflex suppression, balance, gait, and fall risk in ageing and neurodegenerative disease: Protocol of a one-year prospective follow-up study. BMC Neurol 2015; 15: 192.
  32. Lotfi Y, Rezazadeh N, Moossavi A, Haghgoo HA, Rostami R, Bakhshi E, et al. Rotational and collic vestibular-evoked myogenic potential testing in normal developing children and children with combined attention deficit/hyperactivity disorder. Ear Hear 2017; 38(6): e352-e358.
  33. Isaac V, Olmedo D, Aboitiz F, Delano PH. Altered cervical vestibular-evoked myogenic potential in children with attention deficit and hyperactivity disorder. Front Neurol 2017; 8: 90.
  34. Grigorian A, Nahmias J, Dolich M, Barrios C, Schubl SD, Sheehan B, et al. Increased risk of head injury in pediatric patients with attention deficit hyperactivity disorder. J Child Adolesc Psychiatr Nurs 2019; 32(4): 171-6.
  35. Li KZH, Krampe RT, Bondar A. An ecological approach to studying aging and dual-task performance. In: Engle RW, Sedek G, von Hecker U, McIntosh DN, editors. Cognitive limitations in aging and psychopathology. New York, NY: Cambridge University Press; 2005. p. 190-218.
  36. Schaefer S. The ecological approach to cognitive-motor dual-tasking: Findings on the effects of expertise and age. Front Psychol 2014; 5: 1167.
  37. Rao AK, Louis ED. Timing control of gait: A study of essential tremor patients vs. age-matched controls. Cerebellum Ataxias 2016; 3: 5.
  38. Burhan AM, Subramanian P, Pallaveshi L, Barnes B, Montero-Odasso M. Modulation of the Left Prefrontal Cortex with High Frequency Repetitive Transcranial Magnetic Stimulation Facilitates Gait in Multiple Sclerosis. Case Rep Neurol Med 2015; 2015: 251829.
  39. Annweiler C, Beauchet O, Bartha R, Wells JL, Borrie MJ, Hachinski V, et al. Motor cortex and gait in mild cognitive impairment: A magnetic resonance spectroscopy and volumetric imaging study. Brain 2013; 136(Pt 3): 859-71.
  40. Biotteau M, Chaix Y, Blais M, Tallet J, Peran P, Albaret JM. Neural signature of DCD: A critical review of MRI neuroimaging studies. Front Neurol 2016; 7: 227.
  41. Sharifi V, Assadi SM, Mohammadi MR, Amini H, Kaviani H, Semnani Y, et al. A Persian translation of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition: Psychometric properties. Compr Psychiatry 2009; 50(1): 86-91.
  42. DSM-IV sourcebook, Vol. 3. Arlington, VA: American Psychiatric Publishing, Inc.; 1997.
  43. Chen CL, Tang YW, Zhou YF, Chen YX. Development of audio and visual attention assessment system in combination with brain wave instrument: Apply to children with Attention Deficit Hyperactivity Disorder. Singapore: Springer Singapore; 2018. p. 153-61.
  44. Rahmani Kolangarani N, Sayah Siyari N. Comparison of integrated indexes of visual-auditory performance in students with hyperactivity, attention deficit and attention deficit-hyperactivity disorder. Thoughts and Behavior in Clinical Psychology 2018; 13(49): 67-77. [In Persian].
  45. Conners CK, Sitarenios G, Parker JD, Epstein JN. The revised Conners' Parent Rating Scale (CPRS-R): Factor structure, reliability, and criterion validity. J Abnorm Child Psychol 1998; 26(4): 257-68.
  46. Shahaeian A, Shahim S, Bashash L, Yousefi F. Standardization, factor analysis and reliability of the Conners' Parent Rating Scales for 6 To 11 years old children in Shiraz. Journal of Educational Psychology Studies 2007; 3(3): 97-120. [In Persian].
  47. Akbaripour R, Daneshfar A, Shojaei M. Reliability of the Movement Assessment Battery for Children-Second Edition (MABC-2) in children aged 7-10 years in Tehran. Scientific Rehabilitation Medicine 2019; 7(4): 91-6. [In Persian].
  48. Brown T, Lalor A. The Movement Assessment Battery for Children--Second Edition (MABC-2): a review and critique. Phys Occup Ther Pediatr 2009; 29(1): 86-103.
  49. Plug-In Gait Reference Guide [Online]. [cited 2021]; Available from: URL:
  50. Bucci MP, Ajrezo L, Wiener-Vacher S. Oculomotor tasks affect differently postural control in healthy children. Int J Dev Neurosci 2015; 46: 1-6.
  51. Karimi MT, Nadi A. A review on kinetic parameters in scoliotic patients. J Res Rehabil Sci 2013; 8(8): 1363-70. [In Persian].
  52. Cohen J. Statistical power analysis for the behavioral sciences. 2nd Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.
  53. Beauchet O, Dubost V, Aminian K, Gonthier R, Kressig RW. Dual-task-related gait changes in the elderly: does the type of cognitive task matter? J Mot Behav 2005; 37(4): 259-64.
  54. Shorer Z, Becker B, Jacobi-Polishook T, Oddsson L, Melzer I. Postural control among children with and without attention deficit hyperactivity disorder in single and dual conditions. Eur J Pediatr 2012; 171(7): 1087-94.
  55. Abbasi A, Yazdanbakhsh F, Tazji MK, Aghaie AP, Svoboda Z, Nazarpour K, et al. A comparison of coordination and its variability in lower extremity segments during treadmill and overground running at different speeds. Gait Posture 2020; 79: 139-44.
Volume 18, Issue 1
Pages 1-11
  • Receive Date: 21 July 2022
  • Revise Date: 16 August 2022
  • Accept Date: 15 August 2022
  • First Publish Date: 15 August 2022