Journal of Novel Physiotherapies
Open Access

Attention Deficit Hyperactivity Disorder (ADHD) stands as one of the most prevalent neurodevelopmental disorders affecting individuals across the lifespan. Its hallmark features of inattention, hyperactivity, and impulsivity have traditionally been linked to cognitive and behavioral domains. However, a growing body of research has unveiled a broader scope of challenges associated with ADHD, extending into motor function and neurological regulation.

Motor control, the ability to initiate, coordinate, and execute movements, constitutes a vital aspect of human functioning, contributing substantially to daily activities and overall quality of life. In the context of ADHD, disruptions in motor function have garnered attention as potential indicators of underlying neurological dysregulation. Individuals with ADHD frequently exhibit motor impairments, such as difficulties with fine and gross motor coordination, postural stability, and motor planning [1]. These motor deficits not only contribute to academic and social struggles but also impact self-esteem and psychosocial well-being.

The intricate link between ADHD and motor function prompts inquiries into the neurological underpinnings of these challenges. Neuromuscular coordination, encompassing the complex interplay between the central nervous system and the muscular system, plays a pivotal role in executing precise and controlled movements. While the precise mechanisms linking ADHD and neuromuscular difficulties are not fully elucidated, emerging research suggests potential contributions of altered neurotransmitter pathways, cerebellar dysfunction, and executive control deficits.

This paper seeks to explore the existing literature that underscores the connections between ADHD, motor function, and neurological regulation, specifically focusing on the intricate nature of neuromuscular challenges. By synthesizing current findings, this study aims to deepen our understanding of how ADHD influences motor control and to shed light on the underlying neurobiological mechanisms [2]. Recognizing and addressing motor-related deficits in individuals with ADHD could lead to more comprehensive assessment strategies and targeted interventions that address the multidimensional nature of this disorder.

However, with repeated performance of the same subtest movements over time, individuals with ADHD often exhibited a progression towards increased restriction, peculiarity, and abruptness in their movements. This contrasted starkly with children without ADHD, who rarely displayed such issues. The motor deficiencies identified encompassed problems with muscular inhibition— the ability to release the activated agonist while using the antagonist muscles—alongside heightened muscle tone and limited movement within the back muscles. Many of the affected children presented with a noticeably "stiff " body and gait, noticeably running out of breath during physically demanding activities like jumping or running. Engaging in physically demanding play resulted in a walking and running style characterized by heaviness, pronounced impact, and exuberance. In classroom settings, children often leaned over their desks, incessantly shifting positions or seeking postures that required minimal effort. A common observation by physiotherapists was the presence of heightened muscle tone in muscles such as the M. Longissimus, M. Latissimus dorsi, and M. Iliopsoas, leading to restricted movement in the thorax, shoulders, and hips, ultimately impinging on breathing capacity. Palpation frequently revealed the M. Longissimus to have a sensation akin to bone. Similar increases in muscle tone and restricted movement were detected in the calf and foot muscles. This exaggerated muscle tone appeared to compensate for difficulties in maintaining an upright trunk posture. Unlike typically stabilizing the trunk's proximal muscles, children with ADHD seemed to lack this inherent stability, leading to heightened tone—a phenomenon scarcely observed in non- ADHD children, mirroring issues with muscular inhibition. These motor-related patterns persisted into adulthood, with adults displaying ADHD often expressing feelings of physical discomfort and fatigue [3].

Reliability

In a study involving 25 boys with ADHD and 27 controls without the disorder, the internal consistency of the entire set of subtests was assessed using Cronbach's alpha. The utilization of a total sum score (TS) for each individual subtest was meaningful due to the high Alpha value, and no indications of multidimensionality within the subtests were identified. Rater agreement among physiotherapists trained in MFNU usage demonstrated high or very high levels in a separate study. Another study involving nine physiotherapists with limited MFNU experience individually scored video-recorded sessions of children, both with and without ADHD, on the 17 subtests of MFNU. This yielded an Intraclass Connection (ICC) of .99 for the MFNU Complete Score (TS), indicating a strong level of agreement. The conclusion drawn was that, given standardized administration and scoring, the MFNU stands as a highly reliable tool for consistently assessing the targeted construct. Impact of Methylphenidate on Motor Function in ADHD: The third study aimed to establish a link between MFNU scores and the response to Methylphenidate (MPH) treatment concerning core ADHD symptoms. The hypothesis posited that positive MPH responders would exhibit higher MFNU scores in relation to more severe problems compared to non-responders [4]. Examination of MFNU profiles from 73 medication-responsive children and adolescents with ADHD revealed no effect on the diagnosis itself. Subsequently, the impact of MPH on primary ADHD symptoms—impulsivity, inattention, and hyperactivity—was evaluated. The participants were retrospectively divided into medication responders (MR-group) and non-medication responders (NMR-group), and their respective MFNU scores were compared. No significant age or gender differences were observed between the two groups. As hypothesized, the high responders to Methylphenidate demonstrated significantly elevated MFNU problem scores compared to low responders.

Motor Control and Pain in Adults with ADHD: In a controlled study, the objective was to determine whether motor functional issues observed in children and adolescents with ADHD extended into adulthood, and if high MFNU problem scores correlated with reported physical pain—a common experience among ADHD patients of various age groups. The study encompassed 25 Methylphenidate-responsive adults diagnosed with ADHD (age range: 20 to 51 years) and a control group of 23 individuals (age range: 24 to 64 years) without ADHD. As anticipated, the ADHD group exhibited significantly more motor problems than the control group on muscle tone subtests. Although fewer issues were found in specific subtests such as "Synkinesis," "Walking," and "Dynamic balance, 2 legs," the ADHD group still displayed notable impairments [5-9]. The ADHD group also reported more severe and widespread pain compared to the control group, with a substantial majority of ADHD participants indicating the experience of widespread pain. In contrast, the control group reported minimal pain occurrences.

Conclusion

Even though many children with ADHD have DCD issues, our experience indicates that the typical motor difficulties that children with ADHD experience in day-to-day activities are distinct from standardized motor skills and dyscoordination impairments. Our study on the effects of MPH on MFNU performance supports the possibility of a functional connection between the behavioral symptoms of ADHD and muscular regulation issues measured by the MFNU. It is supported by the significant improvements in core ADHD behavior and MFNU-score, as well as the subsequent reversal of symptoms when the medication is metabolized, that muscular inhibition issues and elevated muscular tone are integral features of ADHD itself and have little connection to motor skills issues.

In the realm of Attention Deficit Hyperactivity Disorder (ADHD), this exploration into the realm of neurological regulation and its interconnectedness with neuromuscular challenges has illuminated a multidimensional facet of the disorder. Beyond its widely recognized cognitive and behavioral aspects, ADHD exerts a discernible influence on motor function and neurological coordination. The findings synthesized in this investigation shed light on the intricate web of interactions between ADHD and the intricate orchestration of neuromuscular control.

The motor-related manifestations observed in individuals with ADHD, marked by increased muscular tone, restricted movements, and challenges in motor inhibition, highlight the intimate relationship between the central nervous system and muscular coordination. The propensity for these motor difficulties to persist from childhood into adulthood underscores the significance of these challenges across the lifespan. Notably, the correlation between heightened motor problems and positive responses to Methylphenidate treatment provides valuable insights for therapeutic interventions, potentially offering a new lens through which to tailor treatment strategies for better outcomes.

Furthermore, this examination underscores the potential impact of these neuromuscular challenges on the overall well-being of individuals with ADHD. The experiences of physical pain and fatigue reported by both children and adults with ADHD accentuate the far-reaching consequences of disrupted neurological regulation, extending beyond the realms of motor control to encompass psychosocial dimensions.

By acknowledging and comprehending the intricate connection between ADHD and neuromuscular challenges, a more comprehensive understanding of the disorder emerges. This knowledge has the potential to inform more holistic assessment approaches, enabling tailored interventions that address the diverse facets of ADHD's impact on an individual's life. As research in this field advances, it is crucial to recognize the nuanced nature of neurological regulation and its role in the broader ADHD landscape, paving the way for more effective, multidimensional care strategies that improve the quality of life for individuals affected by this complex disorder.

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