Healthc Inform Res.  2011 Mar;17(1):29-37. 10.4258/hir.2011.17.1.29.

High-Resolution Actigraphic Analysis of ADHD: A Wide Range of Movement Variability Observation in Three School Courses - A Pilot Study

• Kam HJ
• Lee K
• Cho SM
• Shin YM
• Park RW

• KMID: 2166593
• DOI: http://doi.org/10.4258/hir.2011.17.1.29

Abstract

OBJECTIVES
This study was conducted to determine whether or not newly proposed high-resolution activity features could provide a superior analytic foundation compared to those commonly used to assess transitions in children's activities, under circumstances in which the types of courses attended exert different situational effects on activity levels.
METHODS
From 153 children at a local elementary school, 10 subjects with attention deficit hyperactivity disorder (ADHD) and 7 controls were recruited. Their activity data was collected using an actigraph while they attended school. Ratios of partitioned activity ranges (0.5-2.8 G) during the entire activity were extracted during three classes: art, mathematics, and native language (Korean). Extracted activity features for each participant were compared between the two groups of children (ADHD and control) using graphs and statistical analysis.
RESULTS
Activity distributions between ADHD and control groups for each class showed statistically significant differences spread through the entire range in art class compared to native language and mathematics classes. The ADHD group, but not the control group, experienced many significantly different intervals (> 50%) having low to very high activity acceleration regions during the art and languages courses.
CONCLUSIONS
Class content appears to influence the activity patterns of ADHD children. Monitoring the actual magnitude and activity counts in a wide range of subjects could facilitate the examination of distributions or patterns of activities. Objective activity measurements made with an actigraph may be useful for monitoring changes in activities in children with ADHD in a timely manner.

Keyword

Actigraphy; Attention Deficit Disorder with Hyperactivity; Motor Activity; Schools; Activities of Daily Living

MeSH Terms

Acceleration
Actigraphy
Activities of Daily Living
Attention Deficit Disorder with Hyperactivity
Child
Humans
Mathematics
Motor Activity
Pilot Projects

Figure

• 

  Figure 1 Actigraphs that were used for the activity data acquisition. To evaluate the activities of children, an actigraph (LIG Nex1 Co., Ltd., Yongin, Korea) was placed on each child's non-dominant wrist from the beginning to the end of the final lesson. The actigraphs were managed by four assistant researchers who had been trained in the distribution and management of actigraphs, and were described to participating children as 'watches to measure activities.' The actigraphs were unwrapped after the last lesson via the same procedure. 3-axial acceleration data from each actigraph was collected for a whole 3 hours at school and recorded in a built-in memory chip at a frequency of 32 Hz.

• 

  Figure 2 Distribution of activity features for attention defi cit hyperactivity disorder (ADHD) and non-ADHD groups according to each course. The x-axis is the degree of activity acceleration (in a gravity unit; G) and the y-axis is the mean (or variance) percentage (%) of activity acceleration of corresponding group members (on a log scale). Each line-pair represents the activity distributions of ADHD and non-ADHD groups at each course such as art (ADHD = 8 and non-ADHD = 4), language (ADHD = 9 and non-ADHD = 5) and math (ADHD = 6 and non-ADHD = 5), respectively. The triangle (and corresponding square) marks on the lines indicate significantly different intervals between the two groups (p < 0.05 using an independent t-test or a Mann-Whitney U-test). Here, 'Difference' means the fraction of intervals with a significant difference between the two groups and 'Overlap' means the percentage of the overlap area between the two distributions.

• 

  Figure 3 Activity distribution graphs of attention defi cit hyperactivity disorder (ADHD) and non-ADHD groups between courses: mean (upper-right) or variance (lower-left) of activity acceleration. In each sub-graph, the activity distributions between two courses were drawn for ADHD (solid lines) and non-ADHD (dotted lines): art vs. language (ADHD = 8 and non-ADHD = 4), art vs. math (ADHD = 6 and non-ADHD = 4) and language vs. math (ADHD = 6 and non-ADHD = 5). Again, the triangle (and corresponding square) marks on the lines indicate significantly different intervals between the corresponding two courses (p < 0.05 using a paired t-test or a Wilcoxon matched-pairs signed rank U-test). Each inset bar chart shows the fractions of intervals with significant differences between the two courses in the ADHD and non-ADHD groups (light gray bars) and the percentages of the areas of overlap between the two distributions (dark gray bars).

Reference

1. Teicher MH, Ito Y, Glod CA, Barber NI. Objective measurement of hyperactivity and attentional problems in ADHD. J Am Acad Child Adolesc Psychiatry. 1996. 35:334–342.

2. Kofler MJ, Rapport MD, Alderson RM. Quantifying ADHD classroom inattentiveness, its moderators, and variability: a meta-analytic review. J Child Psychol Psychiatry. 2008. 49:59–69.

3. Goodyear P, Hynd GW. Attention-deficit disorder with (ADD/H) and without (ADD/WO) hyperactivity: behavioral and neuropsychological differentiation. J Clin Child Psychol. 1992. 21:273–305.

4. Morein-Zamir S, Hommersen P, Johnston C, Kingstone A. Novel measures of response performance and inhibition in children with ADHD. J Abnorm Child Psychol. 2008. 36:1199–1210.

5. Teicher MH. Actigraphy and motion analysis: new tools for psychiatry. Harv Rev Psychiatry. 1995. 3:18–35.

6. Lauth GW, Heubeck BG, Mackowiak K. Observation of children with attention-deficit hyperactivity (ADHD) problems in three natural classroom contexts. Br J Educ Psychol. 2006. 76(Pt 2):385–404.

7. Tsujii N, Okada A, Kaku R, Kuriki N, Hanada K, Matsuo J, Kusube T, Hitomi K. Association between activity level and situational factors in children with attention deficit/hyperactivity disorder in elementary school. Psychiatry Clin Neurosci. 2007. 61:181–185.

8. Tsujii N, Okada A, Kaku R, Kuriki N, Hanada K, Shirakawa O. Differentiation between attention-deficit/hyperactivity disorder and pervasive developmental disorders with hyperactivity on objective activity levels using actigraphs. Psychiatry Clin Neurosci. 2009. 63:336–343.

9. Rapport MD, Bolden J, Kofler MJ, Sarver DE, Raiker JS, Alderson RM. Hyperactivity in boys with attention-deficit/ hyperactivity disorder (ADHD): a ubiquitous core symptom or manifestation of working memory deficits? J Abnorm Child Psychol. 2009. 37:521–534.

10. Antrop I, Roeyers H, De Baecke L. Effects of time of day on classroom behavior in children with ADHD. Sch Psychol Int. 2005. 26:29–43.

11. Tuisku K, Lauerma H, Holi M, Markkula J, Rimon R. Measuring neuroleptic-induced akathisia by three-channel actometry. Schizophr Res. 1999. 40:105–110.

12. Tuisku K, Virkkunen M, Holi M, Lauerma H, Naukkarinen H, Rimon R, Wahlbeck K. Antisocial violent offenders with attention deficit hyperactivity disorder demonstrate akathisia-like hyperactivity in three-channel actometry. J Neuropsychiatry Clin Neurosci. 2003. 15:194–199.

13. Gruber R, Grizenko N, Schwartz G, Ben Amor L, Gauthier J, de Guzman R, Joober R. Sleep and COMT polymorphism in ADHD children: preliminary actigraphic data. J Am Acad Child Adolesc Psychiatry. 2006. 45:982–989.

14. Halperin JM, Matier K, Bedi G, Sharma V, Newcorn JH. Specificity of inattention, impulsivity, and hyperactivity to the diagnosis of attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 1992. 31:190–196.

15. Halperin JM, Newcorn JH, Matier K, Sharma V, McKay KE, Schwartz S. Discriminant validity of attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 1993. 32:1038–1043.

16. Porrino LJ, Rapoport JL, Behar D, Sceery W, Ismond DR, Bunney WE Jr. A naturalistic assessment of the motor activity of hyperactive boys. I. Comparison with normal controls. Arch Gen Psychiatry. 1983. 40:681–687.

17. Wood AC, Asherson P, Rijsdijk F, Kuntsi J. Is overactivity a core feature in ADHD? Familial and receiver operating characteristic curve analysis of mechanically assessed activity level. J Am Acad Child Adolesc Psychiatry. 2009. 48:1023–1030.

18. Oh K, Lee H, Hong K, Ha E. K-CBCL child and adolescent behavior checklist manual. 1997. Seoul: Chung Ang Aptitude Pressing.

19. Achenbach TM. Manual for the child behavior checklist/4-18 and 1991 profile. 1991. Burlington: Department of Psychiatry, University of Vermont.

20. DuPaul George J.. ADHD rating scale-IV: checklists, norms, and clinical interpretation. 1998. New York: Guilford Press.

21. So YK, Noh JS, Kim YS, Ko SG, Koh YJ. The reliability and validity of Korean parent and teacher ADHD rating scale. J Korean Neuropsychiatr Assoc. 2002. 41:283–289.

22. Kim YS, Cheon KA, Kim BN, Chang SA, Yoo HJ, Kim JW, Cho SC, Seo DH, Bae MO, So YK, Noh JS, Koh YJ, McBurnett K, Leventhal B. The reliability and validity of kiddie-schedule for affective disorders and schizophrenia-present and lifetime version: Korean version (K-SADS-PL-K). Yonsei Med J. 2004. 45:81–89.

23. Kwak GJ, Park HY, Kim CT. Korean-Wechsler intelligence scale for children. 2001. 3rd ed. Seoul: Special Education Publishing Co..

24. Purper-Ouakil D, Wohl M, Michel G, Mouren MC, Gorwood P. Symptom variations in ADHD: importance of context, development and comorbidity. Encephale. 2004. 30:533–539.

25. Van Someren EJ, Pticek MD, Speelman JD, Schuurman PR, Esselink R, Swaab DF. New actigraph for long-term tremor recording. Mov Disord. 2006. 21:1136–1143.

26. Dane AV, Schachar RJ, Tannock R. Does actigraphy differentiate ADHD subtypes in a clinical research setting? J Am Acad Child Adolesc Psychiatry. 2000. 39:752–760.