Cited by 237Attention Deficit Hyperactivity DisorderDevelopmental and Educational NeuropsychologyAutism Spectrum Disorder Research

The DOI matches its Crossref record; 262 of the 262 references it cites were found in a registry or an index; none of the 181 sources its claims cite is checked for support yet.

The influences of environmental enrichment, cognitive enhancement, and physical exercise on brain development: Can we alter the developmental trajectory of ADHD?

Open access
Halperin, Jeffrey M., Healey, Dione M.·2011·Neuroscience & Biobehavioral Reviews

Abstract

Attention-deficit/Hyperactivity Disorder (ADHD) is characterized by a pervasive pattern of developmentally inappropriate inattentive, impulsive and hyperactive behaviors that typically begin during the preschool years and often persist into adulthood. The most effective and widely used treatments for ADHD are medication and behavior modification. These empirically-supported interventions are generally successful in reducing ADHD symptoms, but treatment effects are rarely maintained beyond the active intervention. Because ADHD is now generally thought of as a chronic disorder that is often present well into adolescence and early adulthood, the need for continued treatment throughout the lifetime is both costly and problematic for a number of logistical reasons. Therefore, it would be highly beneficial if treatments would have lasting effects that remain after the intervention is terminated. This review examines the burgeoning literature on the underlying neural determinants of ADHD along research demonstrating powerful influences of environmental factors on brain development and functioning. Based upon these largely distinct scientific literatures, we propose an approach that employs directed play and physical exercise to promote brain growth which, in turn, could lead to the development of potentially more enduring treatments for the disorder.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review argues that medication and behavioral treatments for ADHD reduce symptoms but rarely produce lasting gains, and it proposes that environmental enrichment, cognitive challenge, and physical exercise—especially through directed play—may promote brain development and compensatory neural growth. The authors frame this as a conceptual approach that could potentially alter the developmental trajectory of ADHD rather than cure its core pathology.

Key findings

  • Stimulant medication and behavioral interventions are well-supported and improve ADHD symptoms and functioning, but benefits generally do not persist after active treatment. The review cites that 32–64% of children continued to show clinically significant ADHD despite intensive medication and behavioral treatment, and that more than half of children prescribed stimulants stop within a school year, with most adhering for fewer than two months and fewer than 10% continuing long-term medication.
  • Neuroimaging and neuropsychological evidence indicates ADHD involves differences across frontostriatal circuits and many other cortical/subcortical regions, including cerebellum and corpus callosum. One cited longitudinal line reports cortical maturation delays of 2–3 years depending on region, and a meta-analysis of 83 studies (N = 6,703) found executive-function effect sizes generally in the .46–.69 range, though such weaknesses were described as neither necessary nor sufficient to explain all ADHD.
  • The authors highlight a developmental compensation hypothesis: primary subcortical deficits may remain relatively static, while later prefrontal/executive development could reduce symptom severity. Consistent findings include links between cortical development trajectories and outcome, and the DRD4 7-repeat allele being associated with normalized cortical thinning, better outcome, higher IQ, and better global functioning.
  • Animal and limited human literature suggests environmental enrichment and exercise increase neurogenesis, dendritic branching, synaptic density, neurotrophins such as BDNF, long-term potentiation, and memory performance. In children with ADHD, only two exercise studies are cited, and neither assessed clinical response or brain changes; cognitive training studies improve working memory, attention, and some behavior, but are narrow, computer-based, and sometimes poorly retained (e.g., 18/27 completed one working-memory trial).

Methods

  • Narrative review synthesizing separate literatures on evidence-based ADHD treatments, neural substrates of ADHD, neurodevelopment, environmental enrichment, physical exercise, and cognitive training.
  • No new empirical data are collected; the paper draws on animal studies, human neuroimaging, neuropsychological meta-analyses, clinical trials, and developmental genetics.
  • The authors propose a conceptual intervention model using directed play and physical exercise, delivered in family, school, or group settings, to promote broad neural and cognitive growth.

Limitations

  • The paper states that human evidence for environmental enrichment is limited, child research is sparse, and only two exercise studies in ADHD exist, neither of which examined clinical response or brain-related changes. It also notes that data on play as a therapeutic approach are sparse and that many questions remain about clinical utility.
  • The authors acknowledge that short-term effects of the proposed play/exercise approach are unlikely to match medication effect sizes, that extended follow-up would be needed, and that they do not claim it targets the core neural pathology of ADHD.
  • Evident from the text: as a review, it offers no direct test of the proposed intervention; the approach is speculative, compliance and generalizability are uncertain, and ADHD heterogeneity may limit interventions focused on single cognitive domains.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.neubiorev.2010.07.006

Cites

262 of 262 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 181 cited sources checked · 0 supported · 0 flagged

Show all 76 claims

  • It may state two separate claims as one. 43
  • Probably not a substantial claim. 32
69 of 69
  • The paper relies on this without support.

    Continued treatment for ADHD throughout the lifetime is costly and problematic for logistical reasons.

    “The need for continued treatment throughout the lifetime is both costly and problematic for a number of logistical reasons.”
  • The paper relies on this without support.

    Findings from animal research on environmental enrichment and neurodevelopmental processes generalize to humans with ADHD.

    “a distinct scientific literature, largely consisting of research with animals, indicates that an array of neurodevelopmental processes facilitate efficient neurotransmission and are highly responsive to environmental influences.”
  • The paper relies on this without support.

    Findings from animal models of neurodevelopment and neurodevelopmental disorders generalize to humans, particularly children with ADHD.

    “Thus, literature in children is sparse, but the extensive body of animal research suggests that environmental enrichment and early brain rehabilitation could play a key role in the treatment, and possibly even the amelioration, of ADHD symptomatology through improving the core neural deficits associated with the disorder.”
  • The paper relies on this without support.

    Early childhood is the period of greatest neural plasticity.

    “Although early childhood is the period of greatest neural plasticity, and the most prominent cell proliferation in response to exercise has been shown to occur at younger ages in rats (Kim et al., 2004), far less research has been conducted with children.”
  • The paper relies on this without support.

    Children with ADHD are highly responsive to continuously rewarding contingencies.

    “who are known to be highly responsive to continuously rewarding contingencies; yet highly resistant to more effortful and less rewarding (i.e., less fun) tasks.”
  • The paper relies on this without support.

    Children with ADHD are highly resistant to effortful and less rewarding tasks.

    “who are known to be highly responsive to continuously rewarding contingencies; yet highly resistant to more effortful and less rewarding (i.e., less fun) tasks.”
  • The paper relies on this without support.

    ADHD is associated with diffuse neurocognitive deficits.

    “targeting the diffuse neurocognitive deficits that have been associated with ADHD.”
  • The paper relies on this without support.

    ADHD is caused by a core neural pathology.

    “the core neural pathology that causes ADHD.”
  • The paper relies on this without support.

    Play is intrinsically rewarding or fun.

    “the intrinsic rewarding qualities of play (i.e., it’s fun)”
  • The paper relies on this without support.

    Common children's games engage specific neurocognitive functions such as inhibitory control, working memory, and motor control.

    “For example, the game “S]imon-says” involves inhibitory control, “my grandmother went to the market” involves working memory, and “hopscotch” involves physical exercise and requires motor control.”
10 of 10

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  • A mouse study is described as a rat study

    Minor

    The text attributes the cited dentate-gyrus finding to experiments in rats, but its reference identifies the subjects as adult mice.

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Citations

Cites

Items 201–262 of 262

Flagged first, then by citations

Research works printed but not linked: 5

  1. Chronis, 2001, Comprehensive, sustained behavioral and pharmacological treatment for attention-deficit/hyperactivity disorder: a case study, Behav. Therapy, 8, 346
  2. Hebb, D.O., 1949. The Organization of Behavior: A Neuropsychological Theory. Wiley, New York, p. 335.
  3. Rapport, 1996, Methylphenidate and attentional training. Comparative effects on behavior and neurocognitive performance in twin girls with attention-deficit/hyperactivity disorder, Behav. Modif., 20, 428, 10.1177/01454455960204004 · DOI
  4. Ravaglia, 2008, Physical activity and dementia risk in the elderly: findings from a prospective Italian study, Neurology, 70, 1786, 10.1212/01.wnl.0000296276.50595.86 · DOI
  5. Weiss, 2006, Effectiveness outcomes in attention-deficit/hyperactivity disorder, J. Clin. Psychiatry, 67, 38

Cited by

Sorted by citations

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Metadata

Authors
Halperin, J. M., & Healey, D. M.
Affiliations
  • Queens College, CUNY (US)
  • University of Otago (NZ)
Corresponding author
Halperin, Jeffrey M.
Venue
Neuroscience & Biobehavioral Reviews
Publisher
Elsevier BV
Published
2011-01
Volume
35
Issue
3
Pages
621-634
ISSN
0149-7634 (ISSN-L)
OpenAlex
W1989027174
Cited by
237
References
262
Citations by year
2026: 11 · 2025: 13 · 2024: 8 · 2023: 9 · 2022: 9 · 2021: 17 · 2020: 12 · 2019: 17 · 2018: 14 · 2017: 12 · 2016: 17 · 2015: 18 · 2014: 27 · 2013: 16 · 2012: 23
FWCI
2.32
Type
journal article
Language
en
Open access
Locations
  • Neuroscience & Biobehavioral Reviews (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (R21MH085898, R01 MH068286)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
Keywords
attention deficit hyperactivity disorder, environmental enrichment, cognitive enhancement, physical activity, brain development, developmental trajectories
MeSH terms
Attention Deficit Disorder with Hyperactivity, Brain, Environment, Humans, Exercise, Nootropic Agents

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