The Athletic Advantage

The quest to manage attention-deficit/hyperactivity (ADHD) symptoms is more prominent than ever. According to a national survey of parents using data from 2022, the Centers for Disease Control and Prevention (CDC) estimates that roughly 7 million U.S. children (11.4 percent) have received an ADHD diagnosis. This figure does not account for adults or individuals who don’t have access to care. Presumably, 7 million is a low-ball number. Further, the CDC states that up to 81 percent of parents of these 7 million children have at some point opted for medication management treatment for their child’s ADHD, and up to 62 percent have tried behavioral therapy. Interestingly, most parents also admit that medicating their child is typically not a first-line treatment preference.

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“We’ve tried everything and nothing seems to help, so I guess we need the medication” is a common sentiment among parents of children with ADHD. When working with these parents, I often ask what else has been tried. In addition to the “typical” interventions of behavioral therapy or executive function coaching for skills like time management, task initiation, or inhibitory control, parents also say they’ve tried sports. Extensive research supports the impact of playing sports on the management of ADHD. In fact, one study found that roughly 8 percent of college or elite athletes, including Olympians, have been diagnosed with ADHD. This is roughly double the general population figure of 4.4 percent (Ekman et al., 2021).

Montalva-Valenzuela et al. (2022) demonstrated that just 20 minutes of physical activity, sport, or exercise leads to improvements in executive functions in children and adolescents with ADHD. But are all sports the same? There is growing awareness that certain sports may be more effective at managing ADHD symptoms than others.

For simplicity’s sake, sports can be broken down into either team or individual sports, and open-skill or closed-skill sports. Open-skill sports are typically more fast-paced and can require a large degree of adaptation and variability while playing. Examples include basketball, soccer, or tennis. Closed-skill sports, on the other hand, are sports that require consistent and predictable skill such as swimming, gymnastics, or running.

Wang et al. (2013) demonstrated that open-skill sports can be beneficial for attention problems but also could have implications for increasing inhibitory control. Further, Xie et al. (2021) demonstrated that closed-skill sports can be helpful for hyperactivity and impulsivity. In addition, sports that require being outside, or “green time,” can also be more beneficial than those requiring practice indoors. Typically, sports that may have too much downtime, such as football, baseball, or golf, tend to be less beneficial as can sports with too many rules or play changes, which can become overwhelming. Further, team sports tend to benefit those with attention issues, while individual sports tend to benefit those with hyperactivity or impulsivity.

I once had a 15-year-old boy on my caseload who struggled with ADHD, combined presentation. The parents had tried numerous medications, numerous therapists, and numerous sports. The medications helped but not entirely, and they came with unpleasant side effects. Therapy didn’t seem to help and sports “only seemed to rile him up more.” He was stuck in an unfortunate cycle of needing a medication increase every six months.

After several sessions, his mother disclosed that he had been in football, baseball, hockey, and basketball. She said he did "OK" with basketball but goofed off too much during the other sports, and was even kicked off the football team. She denied that he had tried any individual sports, such as track, tennis, or swimming, and when I initially brought this up to the client, it was met with resistance.

With time, the client finally agreed to try swimming. What happened next was a major surprise to the client, his mother, and me. Not only did the client begin excelling quickly, but other factors also changed. His grades improved, his impulsivity decreased, and he was even able to reduce his medication dosage. He went on to break the school record in the butterfly and even got a scholarship for swimming in college. Although this may be an exceptionally positive outcome, it certainly highlights the importance of using “the right” sport to help manage ADHD symptoms. Swimming allowed this client to focus on himself without getting distracted by sports items like balls/sticks or teammates and provided a healthy release of energy.

It should be noted that ADHD is a complex diagnosis that often requires multiple levels of care. Medication may be a needed subset of treatment for some and should be viewed as a tool in treatment instead of a means to an end. Incorporating other levels of care should include sports, when possible, as well as other lifestyle changes. By choosing the best sport, these individuals may not only improve their athletic ability but also their quality of life. And although we may not all turn into the next Michael Phelps, we can strive to break our own personal records.