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ADHD SYMPTOM RELIEF

Examine The Effect of Sports Participation on ADHD Symptom Relief for ADHD College
Basketball Players
Noam Weinberger
William Paterson University

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Attention Deficit Hyper Activity Disorder (ADHD) is a chronic and impairing behavioral
disorder that affects behavior, attention and hyperactivity in around 10% of youths (White &
Harris et al, 2013) and tens of millions of Americans (Stabeno, pg. 1). The effects of the disorder
can be far reaching and long term, continuing even into adulthood. The purpose of this study is
to examine the effect of sports participation on ADHD symptom relief for ADHD college
basketball players.
Literature Review:
Many therapies have been suggested and studied in order to treat ADHD, including
medication, behavioral therapies, social interventions, etc. One more natural treatment that has
been studied is the effects of exercise on reducing certain ADHD symptoms. In general, exercise
has been studied to reduce mental and emotional problems and the results have shown significant
benefits and improvements in the conditions under inquiry (Eldar 1992 as referenced in Lufi &
Parish-Plass 2011).
One such study that looked at the effects of exercise on the management of ADHD
symptoms was a pilot physical activity intervention done by Smith & Hoza in 2013. Every day
of 8 weeks during school time, these researchers had the ADHD participants do 26 minutes of
exercise. Teachers were then asked to report on the childrens behavior. The findings were that
as a result of the exercise there were significant changes over time with reduction in certain
hyperactivity\impulsivity symptoms. For example, interrupting and unintentional aggression
showed meaningful improvement, whereas not speaking nicely, intentional aggression and not
following adult directions failed to improve in any significant manner. These improvements also
extended beyond the research period.

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While exercise is a general domain, sports offer a more focused kind of exercise with a
specific purpose of winning as a goal. Sports offer certain challenges for ADHD affected athletes
but also many potential benefits. For example, ADHD Athletes may experience problems with
coordinating their movements or having proper balance which could affect them in specific
sports (White& Harris et al, 2013). In addition, because of the lack of focus, argumentative
attitude, frustration and mood liability, these children have cognitive components as well that
could get in the way of their sportsmanship and team performance. Another factor that must be
noted is the risk of injury. For example, concussions can worsen the symptoms of ADHD and it
may be more difficult to treat ADHD after a concussion (Boschert, 2011). However, the exercise
that is derived by participating in sports may decrease the lack of impulsive behavior and lack of
attention (Halperin & Healy, 2011) and the participation in sports has also been shown to
decrease anxiety and depression. However, it may take participation in numerous sports to see
this decrease (Kiluk & Weden et al, 2008). In a study by Lopez-Williams &Chacko et al (2005)
acceptance of children with ADHD was boosted by sports participation. In other words, the
children that were better athletes were more accepted by their peers, and the children that had
more negative social behaviors were less accepted by their peers.
Michael Stabeno in his book, The ADHD Affected Athlete offers a completely different
take on the matter. He actually suggests that ADHD might be beneficial for athletes in some
ways. He compares this to how people with certain other handicaps or challenges can develop
heightened senses or abilities in response, such as how a blind person develops a heightened
sense of hearing. ADHD athletes can develop a heightened sense of their environment and this
offers them a more adaptive response than regular athletes (Stabeno, pg 57). The author goes on
to say how this can allow these athletes to have a more creative approach to the sport which can

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aid their performance as well. For example, their impulsivity can lead to fearlessness that makes
them more bold and take more risks in the sport. Additionally, their ability to scan their
environment and take note of all stimuli might allow them to notice subtle things going on in the
game that other players might ignore. These small details can be key to the success of the next
move or play depending on the sport.
When taking into account this cost benefit analysis with regards to sports participation of
children with ADHD the following should be noted, despite the barriers noted above: Given the
unpopularity of children with ADHD (Barkley, 1998), the effects of social rejection on the lives
and functioning of ADHD children later (James, Hesselbrock, Myers and Penniman 1979), and
the benefits of sports on social status among children (Chase and drummer 1992), it seems like
sports participation would be a natural choice to help boost the popularity of ADHD children and
mitigate the effects of negative social status as these children grow up. After all, sports
environments are widely recognized as important settings to learn socialization and working with
others, as well as teaching interpersonal skills (Clendenin, Businelle et al, 2005). Exercise can
also be used as a reinforcer for ADHD children (Azrin, Ehle and Beaumont 2006). Because
sports make exercise fun, it seems to be a great way to provide this kind of therapeutic relief for
ADHD children.
In terms of which sports may be the best for these children, studies show that ADHD
children may do better in individual sports than team sports. A study by Johnson and Rosen
(2000) compared participation and outcomes in team sports versus individual sports and found
that, the greater opportunity for contact with opponents, greater potential for negative peer
feedback, and more opportunity for off task behavior found in team sports settings, may lead to a
poorer fit in the team sports environment for ADHD children. The study also found that in

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general even among non ADHD children, team sports led to greater levels of aggression,
emotional reactivity, and disqualification than non-ADHD children. However, Michael Stabeno
suggests in his book noted above that the best sports for ADHD athletes dont depend on the
amount of people playing at a time but instead on the level of chaos in the sport. For example,
Stabeno contends that wrestling is a great sport for ADHD athletes because it has high energy
and excitement as athletes physically try to outmaneuver their opponents, while slower sports
such as golf, swimming, and gymnastics that have stop and go action would be less good for
these athletes because these athletes thrive on what he calls continuous chaos (Stabeno, pg
143)- or in other words excitement.
Sportsmanship and sportsmanlike behavior is one of the other noteworthy challenges in
sports participation for ADHD children, but if mastered, it can also help them get along better
with their peers in and out of the sports arena. One study that sought to teach and improve
sportsmanlike behavior was done by Hupp & Reitman et al (2002). In it, the researchers sought
to improve sportsmanship for the players using a delayed reward system and a token economy
system by comparison. The effects of stimulant medication on decreasing or increasing
sportsmanlike behavior was also studied. The results of the study were that sportsmanlike
behavior was increased in the token system but not in the delayed reward system. However, the
greatest increases in sportsmanlike behavior occurred when both systems were used together.
The medication, however, was not shown to have an effect on sportsmanlike behavior.
Therefore, reward systems with immediate gratification after the sportsmanlike act were seen to
be most successful.
Putting all these things together, some research has focused on integrating sports into
group therapy to try to compound the benefits of various treatments. For example, Lufi and

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Parish-Plass (2011) did a year-long group therapy study (20 weekly sessions) where the children
had several behavioral interventions such as positive reinforcement, prompting, token economy
point system, non- exclusionary time outs, modeling, social skills training, etc. Each session
included 20-30 minutes of an individual sports activity and 40 minutes of team games as well.
The study found that the children reported improvement in anxiety and somatic symptoms, while
the parents indicated improvement in the domains of aggression, anxiety, attention, and social
ability. Reduction in anxiety for these ADHD children was the biggest result. This was all
reported by way of a series of questionnaires (Lufi & Parish-Plass 2011).
Basketball is a good candidate to use as a sports treatment for ADHD because it is one of
the two most universal sports (Sabeno, pg. 155) and so ADHD sufferers can play it around the
world almost anywhere (included an alleyway or park as noted by Sabeno). It must be noted that
in the realm of collegiate sports in particular (which is the population being focused on in this
study), the NCAA requires that special courses of action be taken for players who are taking
stimulant medication to treat their ADHD symptoms. For example, the NCAA requires that the
need for these medications be documented yearly, that the athletes are monitored routinely, and
that the physicians try to prescribe other medications for these athletes and educate them on the
proper use of their medications (White & Harris et al, 2013).
In terms of measuring ADHD symptom relief as a result of sports participation, the
Sports Behavior Checklist (SBC) has emerged as a reliable survey tool. Initially developed in a
study by Johnson and Rosen (2000) noted above, a study by Clendenin & Businelle (2005)
sought to expand its usage to a greater sample size and wider demographic sample. It did so by
examining its psychometric properties by correlating it with the Conners Parent Rating Scales
and the externalizing subscale of the Social Skills Rating System (SSRS) subscales which is was

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developed from. The main result was that the anchor measures of the SBC were found to be in
the proposed direction and magnitude (Clendenin & Businelle 2005) which displayed the
construct validity of this scale. Therefore, the SBC scale was chosen for use in this study as the
main component to base the questionnaire on.
This study has great significance for college-age athletes with ADHD, who are looking
for more natural ways to help alleviate their symptoms so that they can achieve more both
socially and academically in college as they enter into adulthood. This could be helpful for not
only the students, but for parents and teachers as well who are looking to help ADHD sufferers.
From the research already noted above and from my own participation in college basketball
while suffering from ADHD, it seems likely that participation in college basketball will help to
alleviate ADHD symptoms in college basketball players and therefore would be a good
extracurricular activity for these student athletes to choose.
More specifically, the purpose of this study is to show the effect of college basketball
league participation on ADHD symptom relief, as reported on by the coaches of these ADHD
athletes.
Method:
The population being focused on in the current study is college basketball coaches, who were
asked to answer questions about their players symptomology at the beginning of the season and
the end. The specific sample used here was college basketball coaches from Landmark College
in Vermont and Curry College in Massachusetts, two Learning Disability colleges that are
ranked as top schools for children with ADHD. The independent variable was college basketball

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league participation and the dependant variable was coaches perceptions of ADHD symptom
relief.
The questionnaire that was used in this study was modified from the Sports Behavior
Checklist which has been used to assess the quality of involvement of ADHD children in sports
(Johnson and Rosen, 2000). The original scale asks questions about involvement in both team
and individual sports, but because the current inquiry only had to do with team sports, 13
questions that referred to individual sports were removed. The items on the scale assessed the
frequency of aggression, injury, disqualification, emotional reactivity, rule adherence and
sportsman like conduct in children with ADHD. A review of these items revealed that they
reflected characteristics commonly associated with ADHD (Johnson and Rosen, 2000).
Some additional questions were added to assess whether college basketball helped with
other common symptoms and challenges of ADHD children. The goal was to see if these were
alleviated by participating on the basketball teams. These additional items were chosen based on
the studies mentioned in the literature review above. Based on the study by Lopez-Williams &
Chako et al (2005), questions were added about peer acceptance and based on the study by Lofi
& Parish Plass (2011) a question was added about anxiety. Also, based on the result of the Kiluk
& Weden (2008) study that found that more than one sport may be required to see improvement
in symptoms, a question was added about whether the participants were participating in any
other teams during the same season as basketball. Five point Likert Scales were used to assess
each question.
Twenty basketball Coaches from 15 colleges around the United States East Coast were
emailed with an initial inquiry to participate in the study. They were sent a link to a Google form

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where the questionnaire was filled out and the data was collected. Coaches were asked to think
of one student per survey, and to fill out numerous surveys to reflect the different students being
reported on.
One of the problems that the study encountered was getting coaches to fill out the
questionnaires. Some coaches didnt even respond to the initial inquiry and some wouldnt fill
out a survey for more than one player. This caused the sample to be rather small; namely, of all
the coaches that were invited to participate, only 6 questionnaires were filled out. Additionally,
there wasnt a lot of research about ADHD in relation to college basketball, so there was not a lot
of information to build on with the hypotheses for the effect of this particular sport.
Results:
The results came from 6 questionnaires, filled out by coaches from at least two different
colleges. There were numerous significant findings that can be summarized as follows:
50% of the coaches responded that ADHD players overreactions to things that occurred during
play lessened over the course of the season. On a similar note, 67% of coaches reported that
players got less upset over the course of the season, meaning that they were better able to handle
their emotions during play. Additionally, 84% of coaches agreed that their ADHD athletes
improved their ability to focus during both practices and during game play over the course of the
season.
The most significant results were as follows: 100% of coaches agreed that sportsmanship
improved in their ADHD student athletes over the course of the season. Perhaps this could be
related to the method of using a reward system to increase sportsmanlike behavior, which 67% of
coaches reported to have used. Secondly, 100% of coaches agreed that their ADHD players had

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reductions in anxiety over the course of the basketball season. Thirdly, 100% of the coaches
reported that their ADHD players hyperactivity symptoms diminished over the course of the
season. Finally, in terms of looking at the overall picture, every single coach except one (which
in this study amounts to approximately 84%) agreed that basketball helped their ADHD athletes
cope with their symptoms of ADHD over the course of the season.
Conclusions:
The results of this study are consistent with the research reviewed above. Previous
studies have shown that even moderate exercise (such as the 26 minute regiment done in the
2013 Smith & Hoza study) helped ADHD children to deal with their symptoms. Basketball
provides an intense exercise, and the athletes in this study reaped the benefits-displaying a
reduction in anxiety, hyperactivity and lack of focus over the course of the season. These results
are also consistent with the reports of Stabeno (2004) that indicate that high chaos sports are the
best for the ADHD effected athlete to excel in and focus in. Basketball is considered a high
chaos sport, and the results indicated that the athletes both excelled at it and had improved focus
in it.
Another significant result of this study that was consistent with the literature
noted above was the finding in terms of the increase of sportsmanship using a reward system.
The study by Hupp and Reitman (2002) noted above demonstrated that a token economy system
could help improve sportsmanship in children with ADHD, and the reward systems used by the
basketball coaches in the current study also seemed to improve sportsmanship in these ADHD
players with 100% of the coaches reporting an improvement in sportsmanship over the course of
the season.

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Additionally, as indicated in the Lufi & Parish- Plass (2011) study where sports helped to
reduce the ADHD symptom of anxiety, this study also showed that sports (namely basketball)
reduced anxiety in the ADHD athletes.
Taken together, these results show a hopeful future for the use of basketball and
perhaps even sports in general as an alternative therapy or reinforce for other existing therapies
in the treatment of ADHD symptoms for athletes. Since some of the biggest hurdles to ADHD
students success are their lack of focus, hyperactivity and anxiety, the unanimous reports of
improvement in these domains through the use of basketball demonstrates that both exercise and
sports can help ADHD sufferers overcome these barriers in a more natural manner.
Further research should look at a larger sample. Also, the study could be extended to
analyze the effect of participation in other college sports or even non-collegiate level sports on
the treatment of ADHD symptoms. Another avenue would be to look at the effect of individual
sports versus team sports on the effect in ADHD symptom relief for players. Lastly, another
important extension would be to study the players own reflections on their ADHD symptom
improvement instead of just basing the results on the coaches opinions.

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References:
Azrin, N. H. (2006). Physical Exercise As A Reinforcer To Promote Calmness Of An ADHD
Child. Behavior Modification, 30(5), 564-570.
Claude, D., & Firestone, P. (1995). The Development Of ADHD Boys: A 12-year Follow-up..
Canadian Journal of Behavioural Science/Revue canadienne des Sciences du comportement,
27(2), 226-249.
Clendenin, A. A. (2005). Screening ADHD Problems in the Sports Behavior Checklist: Factor
Structure, Convergent and Divergent Validity, and Group Differences. Journal of Attention
Disorders, 8(3), 79-87.
Halperin, J. M., & Healey, D. M. (2011). The Influences Of Environmental Enrichment,
Cognitive Enhancement, And Physical Exercise On Brain Development: Can We Alter The
Developmental Trajectory Of ADHD?. Neuroscience & Biobehavioral Reviews, 35(3), 621-634.
Hupp, S. D., Reitman, D., Northup, J., O'callaghan, P., & Leblanc, M. (2002). The Effects of
Delayed Rewards, Tokens, and Stimulant Medication on Sportsmanlike Behavior with AdhdDiagnosed Children. Behavior Modification, 26(2), 148-162.
Johnson, R. C., & Rosen, L. A. (2000). Sports Behavior Of ADHD Children. Journal of
Attention Disorders, 4(3), 150-160.
Kiluk, B. D., Weden, S., & Culotta, V. P. (2008). Sport Participation And Anxiety In Children
With ADHD. Journal of Attention Disorders, 12(6), 499-506.
Lopez-Williams, A., Pelham, W. E., Burrows-Maclean, L., Chronis, A. M., Gnagy, E. M.,
Seymour, K. E., et al. (2005). Athletic Performance and Social Behavior as Predictors of Peer

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Acceptance in Children Diagnosed With Attention-Deficit/Hyperactivity Disorder. Journal of

Emotional and Behavioral Disorders, 13(3), 173-180.
Mahon, A. D., Stephens, B. R., & Cole, A. S. (2007). Exercise Responses in Boys With
Attention Deficit/Hyperactivity Disorder: Effects of Stimulant Medication. Journal of Attention
Disorders, 12(2), 170-176.
Reitman, D., O'callaghan, P. M., & Mitchell, P. (2005). Parent as Coach: Enhancing Sports
Participation and Social Behavior for ADHD-Diagnosed Children. Child & Family Behavior
Therapy, 27(2), 57-68.
Reitman, D., O'callaghan, P. M., & Mitchell, P. (2005). Parent as Coach: Enhancing Sports
Participation and Social Behavior for ADHD-Diagnosed Children. Child & Family Behavior
Therapy, 27(2), 57-68.
Smith, A. L., Hoza, B., Linnea, K., Mcquade, J. D., Tomb, M., Vaughn, A. J., et al. (2012). Pilot
Physical Activity Intervention Reduces Severity of ADHD Symptoms in Young Children.
Journal of Attention Disorders, 17(1), 70-82.
Stabeno, M. E. (2004). The ADHD affected athlete. Victoria, B.C.: Trafford.

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Appendix A: (Questionnaire)
.

Please think about one individual player per survey. You are encouraged to fill out at

least 5 surveys which represent your reflections on 5 different players.

Please put the initials or first initial of player you are currently responding about:
_________________________________________________________________________
Please list any other sports that you are aware of that this player participated in during the same
season:
______________________________________________________________________________

Please fill one of these out for each individual team member that has ADHD.
Thinking about one individual team player how would you rate them on the following scale 0-5,
Zero being never, one being rarely and 5 being often?:
______________________________________________________________________________
1.

Is this player likely to be injured?

2.

Have the injuries decreased over the length of the season?

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3.

Has this player been involved in verbal arguments during play?

4.

Has the amount of arguments lessened of the course of the season?

5.

Has this athlete been involved in verbal arguments during practice?

6.

Has the amount of arguments lessoned during the course of practices?

7.

Has this player ever seemed unusually agitated related to the team winning or loosing?

8.

Has the player seemed less agitated by this over the course of the season?

9.

Does the player seem to understand the rules of basketball?

10.

Has this player's understanding of the game deepened over the course of the season?

11.

Has the player been involved in a physical altercation during play?

12.

Has this players involvement in physical altercations diminished during the course of the

season?
13.

Has a player been involved in a physical altercation during practice?

14.

Has this players involvement in physical altercations during practices diminished during

the course of the season?

15.

In your opinion does this player over react to things during play?

16.

Has this issue have improvements during the course of the season?

17.

Has this player been disqualified or ejected from a game?

18.

Has this player's disqualification from games diminished?

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19.

Does this player always follow the rules of the game?

20.

Has rule adherence improved during the course of the season?

21.

Does this player easily get upset during play?

22.

Has this player been less upset during games over the course of the season?

23.

Does the player display good sportsmanship?

24.

Has this player shown signs of improvement in good sportsmanship during the course of

the season?
25.

Does this player get easily distracted during games?

26.

Has this player improved his focus during games over the course of the season?

27.

Does this player get easily distracted during practices?

28.

Has this player improved his focus during practices over the course of the season?

29.

Did this player show signs of hyperactivity at the beginning of the season?

30.

Has this player's hyperactivity symptoms diminished over the course of the season?

31.

Do you feel that basketball has helped this child cope with symptoms with ADHD over

the course of the season?

32.

Did you as a coach use a reward system to improve sportsmanship?

33.

If so, did the reward system help improve sportsmanship with this player?

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Other Observations
Pleas rate on a scale from 0-5, 0 being none and 5 being a lot
1.

How much social acceptance did this player appear to have among their peers?

2.

How much did the peer acceptance seem to improve by the end of the season?

3.

How much if any, did the player seem to have a reduction in anxiety over the course of

the season?