From fidget to focus: Why movement matters for kids with ADHD

It’s no secret that physical activity can make a big difference for kids with ADHD. The hard part is figuring out how to give kids the time and space to move when they need to.

In this episode of In It, hosts Gretchen Vierstra and Rachel Bozek welcome Dr. Andy Kahn. Andy is a licensed psychologist and the associate director of behavior change and expertise here at Understood.org. He’s also the host of the podcast Parenting Behavior with Dr. Andy Kahn. 

He helps us take a good look at movement and why it makes such a difference for kids with ADHD. Tune in for easy tips to get more activity into your child’s daily routine.

We love hearing from our listeners. Email us at init@understood.org.

• Teaching tip: My “go to” teaching technique for overstimulated kids 

• What can I do if my child’s teacher takes recess away?

• How to get your child involved in sports

• 7 tips for improving your relationship with your child’s teacher

• Listen: How to get your child to try new things

(1:15) Exercise vs. physical activity

(3:53) “Spending” energy to regulate

(9:42) Ideas that encourage movement

(10:20) How much time is the right amount of time

(13:04) Afterschool sports and activities

(16:29) The importance of recess

(21:52) 504 plans, IEPs, and movement

(22:18) Getting creative

Gretchen: Hello and welcome to "In It," a podcast for families with kids who learn and think differently.

Rachel: Here you'll find advice, camaraderie, stories of successes, and yes, sometimes failures from experts and from parents and caregivers like you.

Gretchen: I'm Gretchen Vierstra, a former classroom teacher and an editor here at Understood.org. And I'm Rachel Bozek, a writer, editor, and mom who has definitely been in it. Today, we've got questions about how exercise might benefit kids with ADHD.

Gretchen: And lucky for us! Andy Kahn has answers.

Rachel: If you're a regular listener here, you know Andy's our go-to guy for all things ADHD.

Gretchen: He's a licensed psychologist and the associate director of behavior change and expertise here at Understood. He's also the host of the podcast, "Parenting Behavior with Dr. Andy Kahn." Andy, welcome back to "In It."

Andy: Hey, thanks so much for having me again.

Gretchen: All right, let's get into this. Let's start with the very basics. We've heard that exercise can be beneficial for kids with ADHD. Why is that? What do we know about exercise and the ADHD brain?

Andy: All right. So, let's play a little fun game with the words here for a second. I think one of the things that first happens here is when we use the word exercise, it becomes quite a bit of a buzzword. I really prefer to talk about physical activity because if you think about childhood, OK, think about your own childhood, did you exercise as a child? No, you played and you played games and sports and did whatever it was. And many times, particularly for people of a certain age, those activities were active and physical.

So, today, as adults, we would say, "Oh, I'm going to get some exercise today, because for some reason we stopped playing. But for kids, we're talking mostly about physical activity. I think in the research, they use the word exercise, which sort of hamstrings us a little bit. So, back to the key point. ADHD folks, particularly like myself, really do thrive when we get enough physical activity and physical activity is associated with things like regulating your emotions, navigating energy levels, and also being able to regulate and navigate some of our thinking processes.

The things that allow us to do things like learn in school, listen to our parents, pay attention to the things going on around us. So, there's always been a lot of conversation around how physical activity and exercise can affect the ADHD brain. And there's been a lot of talk about it. The question of the research may be a little more vague, but that's sort of where this is all coming from.

Gretchen: Got it. And I love, I love what you said, physical activity, which for many kids when they're younger is playing.

Andy: Yeah. Exactly. Exactly, and I think that so much of this comes from the idea that parents, teachers, all of us are trying to help our kids just sort of function as best they can and regulate. And sometimes it comes from a parent perspective of, "My kid's driving me a bit crazy. They're bouncing off the walls this morning. I can't get them out the door to go to school," or "I can't get them to sit still in class."

So, I think adults have spent all this time looking for the magic answers. So, they think, "Well, these kids are too active. What do we do about this?" You know, so I think that's a lot of where this comes from. I spent many years in classrooms, watching kids do go noodle or some other activity to get them out of your seat and let's get your bodies going. And I think, that sometimes, you know, I think all the right intentions are there, sometimes we need to combine the science and some of the rationale with just good common sense approaches to help us navigate what our kids need.

Rachel: Yeah, and I feel like you're moving in the direction of this question right now is that, you know, we can sort of intuitively understand why exercise would be beneficial for kids whose ADHD is of the hyperactive variety. You know, we imagine, like you said, it's about getting all that excess energy out, that kind of like bubbling over. Is that actually how it works? Like, can you tell us a little more about where it sounded like you were kind of going there?

Andy: Yeah, I think that's the surface perception is that if kids have too much fuel in the tank and too much energy, that we need to spend some of that. And in some cases, maybe there's some truth to that. I think more often than not, this is about regulating energy levels. Because if you think about it, spending energy can help people be more settled, but it isn't always about having excess energy, that is. It's about having the inability to regulate and manage what is this maelstrom of energy, emotionality, and inability to sort of focus that can drive kids looking like they're all over the place.

So, you know, it's not always like a pressure valve that, "Oh, we just have to hit the button and let a little bit of that energy out. Now you're gonna function typically again." I view it more like there is a set point for how the human body regulates itself. So, think about for yourselves, are you at your best right now? Gretchen, we were talking about, oh, you haven't had your coffee yet, right?

Gretchen: I have not.

Andy: What is it...What do you need to do to regulate yourself to be ready to work as an adult? Well, asking that same question for our kids is super high value. For some kids, it's moving your body in order to get yourself going, to energize, and also then to be able to settle your body to focus. So, everybody has a slightly different need. But yes, I think that the truth here is that we're really looking at regulating the body more so than just hitting a pressure valve. That's been my experience as a general rule.

Rachel: Do you feel like that varies, like the need for that or the amount of need for that, between the ADHD for the hyperactive kid versus the inattentive?

Andy: So, you know, a lot of us view ADHD from sort of the iceberg model, which is if you think about ADHD as a sum total difference, as I often do, hyperactivity as we see it manifest in the kids who have the combined or hyperactive type of ADHD, you see their bodies on the move, you see the energy, you feel the vibration that comes off those bodies.

The thing that we take for granted, and this has affected a lot of our women and girls, is that you can also have cognitive hyperactivity; you can't stop your brain. All these thoughts can't sort and organize what's going on inside your head. And it may not be reflected in the, in the physical body that you see while looking at someone.

So, I don't necessarily make the assumption that it really has to do with being physically hyperactive as much as the body and mind of people with ADHD are often not regulated and are not at an adequate set point. Meaning that that point that they need in order to be really focused and engaged. So, I don't really differentiate that. And when we talk a little bit later about research, we're even going to go a little further from just ADHD as a rule because, preview, maybe this is good for all bodies.

Rachel: Yeah, I just thought of this as you were saying that the idea of like, "I need to go for a run to clear my head." It's like, "I need to go for a run" has nothing to do with me feeling physically antsy, right? It's like I'm feeling mentally antsy.

Andy: You know, I think it depends. So, yeah, I think that's true. So, I'll give you an example. For myself, one of the things that'll show in my behavior as someone with ADHD is irritability. I may have a good night's sleep, and I can be grumpy in the morning. So, my first thing that I do for myself is I get up and I do something sort of active to start my day before I even interact with other humans. I'll go and I'll hop on a bike or I'll take a really short brisk walk in my neighborhood.

So, yeah, I mean… I think there is something to be said for clearing my head by way of just sort of resetting the machine, right? Hit that control, alt, delete on the machine. And however each person needs to do that will help them be regulated and be more ready.

Gretchen: So, if we want to help our kids and teach them that some kind of physical activity might help them regulate themselves, what do we suggest to them? Like you said, it could be just play, right? It could be running around. Does it have to be cardio? Does your heart rate have to be elevated for this to work? What are your thoughts on this?

Andy: This is a little bit tough because obviously, like when we do psychological research, I said, that's the generic we, I'm not part of that we. When people do psychological research, the thing that they tend to do is they create very concretized methods that they evaluate. And the methods that I've seen in the research have used moderate or strong physical activity as the standard that they measure when they look at, does this help?

So, in the grand scheme of things. We do want to get the heart pumping. We do wanna get some significant movement going. Not all kids are going to do this. So, you may have to do take your kid as far as they can go in that direction to get him physically active. This is a great thing to start in the summer, where our kids may be home and we're trying to regulate their activities outside of the regular school schedule.

Our morning routine is we're going to go out and we'll gonna play in the yard, or go to the park with our or we're going to go do something where you embed physical activity, you know, not all kids are athletes, not all kids or interested in sport and they don't all seek those activities, but you know tags a pretty universal game and you're running and you're breathing. Doing little time scavenger hunts where you lay things out around the house. These are all ways to sort of get the body to move and to let you not think about the fact that maybe it's that form of activity that we might call exercise.

Gretchen: Awesome. And so, if a parent wants to start with this with their kids, is 10 minutes enough, or does it need to be longer than that?

Andy: Ultimately, it's whatever your kid tolerates. You know, the research right now talks about doing these 20 to 30 minute blocks of time. But again, within the research, a few of the studies that I've seen have done things like they introduce the activity for two or three minutes, then they do some short bursts of activity, then they reteach a structured skill in real life, we're not doing what they do in the research. We may not have 30 minutes of time, so if you've got a good 10, 15 minutes, try it out.

It's, we think about physical activity, food, and even in the case of people who take medication, OK, we're all about finding that right dose of that activity, the med, the food for you and your child. So, 10 minutes might be perfect, but keep track. So, this way you can know over time, are you seeing that, "Hey, when we do 20 minutes, things are much smoother in the morning than if we only do 10 minutes." So, again, give yourself some grace as a parent to figure this out, for have it not go terribly well, and then to revisit and try it again.

Rachel: That makes a lot of sense. So, are we saying that morning is best or how important is time of day?

Andy: You know, I'm a huge proponent of trying to start the day with good rituals. So, while I think the research has shown, and a lot of the research is looking at kids pre-school, not preschool as in below the age five, but before the start of the school day, because ultimately what we want, what educators want to do is, "Hey, can we unlock our kids potential by doing something early that makes the day better?" And there's a reasonable benefit in saying, "Love to start today with some good, modeled physical activity and regulating activity."

In reality, if you have a kid who's really struggling to regulate their body, this might be something, if you have the time you do in the morning, you do in the middle of the day, and you do at the end of the day. Because don't forget, dysregulated kids struggle with sleep, and a kid who can't regulate at bedtime is going to make the next morning really challenging.

So, thinking about the trajectory of your child's energy and self-regulation throughout the day can be really helpful. We don't all have that kind of time, OK? So, I'm giving you the ideal circumstance. If you've got 10 minutes in the morning, that's excellent. And I would highly recommend it. If you also have the ability to do relaxing, isometric, you know, hand-on-hand pressure, deep body pressure, things that release energy before bedtime, that also can be really great to help your child get the rest they need.

Rachel: That all makes sense about morning and kind of getting your day going. What about afterschool sports? Is that something that you see as beneficial for some kids with ADHD?

Andy: I find that afterschool sports or even afterschool activities of any kind, can be super helpful for kids. Again, you know, not all kids are going to be sporty kids, but there's a lot of different varieties, particularly as kids get older. One of the great sort of sport activities that I found that was most sort of inclusive for kids with differences were cross country and track. These activities, and, you know, I'm saying as I pat myself, I was, you know, I ran cross country and track in high school and played other sports, but that was my most diverse group of kids because here's the thing.

You don't have to be the fastest. There are a lot of different events. There's throwing, there's hopping, there's all kinds of cool stuff. And in terms of inclusive activities, I just love those kinds of sports because, technically speaking, kids are looking to get their personal best. And they don't always have to compete against, "Oh, I finished sixth or eighth. Did I hit a PR, my personal record?" You know, and those are the kind of things that are easy to coach that are really inclusive, and I love afterschool activities for kids.

If your kid wants to be active and is willing, I love it for them. And it can be great in terms of regulating before doing schoolwork and homework. My favorite afterschool sports are ones that build in a study rubric for kids, too. Some sports will say, "Hey, we're going to do 20 minutes. Is your homework done? Do you have what you need?" Cause the other, the flip side of this, and you got to be mindful, is that sometimes kids empty the tank. They come home, and then they have, they have work to do. And some kids who may not have the energy and wherewithal to still get the work done.

So, if they love what they're doing for sport, it really is important then to figure out how to accommodate that. It also for high-schoolers is a big question. How do you navigate this for your high-schoolers if they've got a travel game and they're getting home at nine o'clock at night on a school night? You know, that's something that we wouldn't do to our kids intentionally, but in the name of sport and team, we have to figure out, OK, if those things are happening, are there down-regulating activities to do with your child?

Because I don't know about you guys if you've played sports, but when you do something exciting and you've got bedtime within a couple of hours, really hard to come back down from that.

Rachel: Yeah.

Gretchen: So hard.

I love those activities for kids, particularly kids who struggle to regulate themselves. But again, as you take on that activity, you have to have a plan for, it's almost like returning them to orbit after going to space. They need a few orbital turns around the earth before they're gonna be able to settle down and be able to rest or do homework or any other things. So, really important to think about that. And for some kids who really are struggling academically, we need to figure out, are there ways to accommodate that schedule-wise?

Gretchen: Yeah.

Andy: And there often are. Very few of our kids are becoming professionals, even though we'd love it. So, we need to think about balancing life and self-care and self-regulation. And they have jobs. They're students. They are peers and have social things to fit into. So, yeah, I love the sports for kids after school if they're doing them. We just have to be mindful of that's a high-dose activity. Can they come down from it and still do other things?

Gretchen: Yeah.

Rachel: Yeah. And another kind of activity that's often in the middle of the school day is recess.

Andy: Yes.

Rachel: And something I wanted to ask you about is the idea of, and this has come about here and there over the "In It" years, but the idea of when recess is taken away as a consequence for behavior — transgressions, for lack of a better word — and I mean, I feel like recess shouldn't be taken away from any kid, but especially for kids with ADHD, what that can do on so many levels. But just from a physical activity standpoint, can you talk a little bit about what, if any, are the ramifications of that, and what schools need to maybe think about there? Because whenever I hear about that, I just like, it's very upsetting.

Andy: Right. For sure. I spent 20 years in schools, and this is a complicated issue. Let me give you the simple truth first, OK? You would never take away a child's meal time because they misbehaved in class, because you would think that their nutrition is a necessary physical thing that they need, and it would be cruel and unusual to take that away.

Rachel: Right

Andy: For kids who need, neurologically, to move and expend energy in order to regulate, there are many cases to be made that taking away recess is similar to taking away food for some of these kids. They need it to regulate. They need to be ready to do the next activity. That being said, I can understand where teachers would be stressed. If a child is misbehaving and is making an example to the kids in the classroom, that's something that is going on that is either inappropriate or outside of the expectations, then they get to go out and do something fun.

It's hard to share that message with the other kids who are like, "I spent a lot of energy behaving here. Why are they out here playing with me?" Right? So, for some kids who were really struggling to navigate and manage their behavior, there may be alternative ways to give them physical activity that may not be with a larger group. Give them the chance to move and exercise. Oh, I used the E word. Give give them a chance to get out there and move their bodies without maybe having to have the same full social access, which is give them, like giving them the food, but not giving them the opportunity to have full access to the other things.

So, I have to, you have to respect that there's concern for discipline and modeling that happens in a group environment like a school. But no, I'm not a fan of taking away recess, particularly for kids who are neurodivergent. The other thing that I will state, and I alluded to it earlier, but somehow we've skated around this, physical activity for neurological regulation isn't just an ADHD thing. It's a human thing.

Andy: Human beings will improve in many ways if they have that activity level. And that was one of the findings in some of the recent studies that if we think about, and we've probably dropped this in prior episodes, universal design for learning, OK. This is a concept that we provide all kinds of different ways of allowing humans to get access to information, to express what they know, to be evaluated for what they now, and by providing some really specific tools like access to all kinds of little accommodations to all people, then it improves everyone's functioning and learning.

This is very similar to what we see with activity and physical activity. It is a universal that human beings benefit from physical movement. It improves their ability to navigate emotion and function. So this isn't just an ADHD thing. This is a kid human species thing. So keep that in mind in terms of if you're trying to integrate this into your kid's life. And you have more than one kid.

Get them all involved, get your spouse or partner, get your aunt or uncle or grandparents involved. This is a human activity, and it's necessary. And we've become so sedentary as a species that for me, it was never an issue. I, as a kid, would drag my friends out into a field with a bucket of balls and say, "Throw these and I'm going to chase them down and catch them." And I didn't realize, and I wasn't exercising, I didn't realize I was behaving like a golden retriever; it was just out fetching for an hour, but that regulated me.

It didn't, I wasn't identified as having ADHD as a kid, primarily because it wasn't hyperactive, but also I did activity like that all the time. Every day before school, we played pickup football. Every day at lunch, we've played pickup sports. Every day after school, we played sports or played on our teams. So, the fact that I wasn't dysregulated more extremely was coincidental to my interests and access.

So, for parents who have sedentary kids and lives, this is going to take some intentional effort to make this happen, and it's worthwhile. We know this helps humans. So, it is not enough for those of you who have kids who don't have ADHD. Oh, this helps. I tell you, it will help.

Gretchen: I noticed it for me and my kids, like we all sleep better. We're just not as cranky. Yeah.

Andy: Oh yeah.

Gretchen: So, if this is good for all kids, but especially for kids with ADHD, is physical activity something that can be an accommodation put in an IEP or a 504 plan?

Andy: Oh yeah, we very commonly see these in plans in my schools, trying to give kids access to movement opportunities, and giving them a chance to even just move their bodies within the actual lesson time.

This is something that I do. I have a standing desk, for example, and I always tell people when I'm meeting new people, "Just so you're aware, I'm neurodivergent. I may stand and sit, I may be up and down. I may go off camera, so to speak, if I'm on a remote meeting."

This is something that can very easily be built into plans. The thing that teachers and parents need to think about is that, obviously, movement can disrupt other people's experience. So, being strategic and intentional. If you have a child who has a movement accommodation, they may need to sit on the periphery of the classroom where they can step to the back of the space or step to the side of the room. The goal of these accommodations for movement or managing your body in a place like a classroom should always include what can you do in your seat that allows you to manage your body.

Things like practicing pressing your feet to the floor. I'm getting up and doing a wall push-up adjacent to the room, in the room you're in. Because the historic way of doing this is, I'm gonna let you walk to the office or go to the water fountain. Every time we remove a child from the learning social opportunities of their day, we're taking away chances for success. So, integrating this takes a little bit of creativity and a lot of bit of patience.

For some teachers, again, going back to universal design, if you've got three kids out of 30 who have a movement need, why not build in movement breaks for all kids? And then we don't stigmatize those children. And remember, movement helps all humans. So in that situation, a teacher concerned with, I don't think I can let that one child get up and move because it's gonna disrupt, then move all your kids. And it may turn out to be a lot more efficient, and guess what? The teachers, the adults, we need it too.

Gretchen: Yeah!

Andy: We're on our butts too much.

Gretchen: Totally.

Andy: You know, so yes, the long answer to that is yes. It can absolutely be part of a plan when they give you the yes bowl, "Yes, but I don't know how this can fit." This is where we can talk about getting creative and understanding teaching and parenting are two of the hardest things that are being done and being empathic and mindful of what teachers have to do while being creative and saying, "We have to be a little uncomfortable at times to accommodate and to navigate what all of our kids need."

Gretchen: Yeah.

Andy: But it's shocking how many things that we would do for just one or two kids could help all kids.

Rachel: On that note, is recess a reasonable request to say in an IEP or a 504 that the child can't lose recess?

Andy: I think that I would be mindful of that and how that is phrased.

Rachel: Yeah.

Andy: Because we don't want to take away the concept of how we apply discipline when things are unexpected and perhaps even unsafe. So, what I would say, I would make that more like "The child will not lose access to opportunities to move and engage in physical activity as a consequence for behavior." How you provide that opportunity is something we can shape.

If you have a child who maybe is in their process of learning how to self-regulate, who's having more behavioral concerns, we need to be mindful of how to create a program for them that will give them that opportunity while still not taking away that sanity from the classroom and the teacher so that all can learn and that child can have the best opportunities. It's a delicate balance, but that would be, again, I would shape that as opposed to saying something quite so universal.

Rachel: Right. That language, I think, is so helpful. I wish I had had it a few years ago.

Andy: I've been in a lot of those meetings, Rachel, and it's, you know, it's nuanced and difficult. But remember, assuming positive intent from parents and educators that we all want our kids to be successful. But when we try to do it, sometimes our lives are hard and our situations are challenging and to accept the fact that it isn't easy for that teacher, it isn't easy for you as a parent in how we develop our plans and programs can create a collaboration that is so much healthier than what we often see when we feel we have reason to feel entitled that our kids should get what they need, but the how is where we can collaborate and without having to make it a conflict.

Rachel: Right.

Gretchen: Love that.

Gretchen: So, from what you can tell, are schools getting smarter about all of this? Are you hearing about programs where all kids are moving around first thing in the morning or throughout the day, or, you know, in any of the ways that that we've been talking about?

Andy: I've seen a lot of schools make efforts towards these kind of strategies. What I, I don't see it universally, and I don't see it, it may vary from classroom to classroom, from school to school, within the same districts. The challenge sometimes is that schools can buy programs and get involved in initiatives, and those initiatives, when they're brought down in some universal way, don't always have the success they hope for.

Rachel: Right.

Andy: I think that, you know, doing things like what we're doing today and having these conversations. The most important thing we need to do is affect the culture of how a classroom exists and how schools approach kids in their physical and emotional needs. And if social emotional learning like self-regulation is the priority it deserves to be, then we're gonna see more and more schools consistently integrate these kinds of approaches. We're not there yet. I would say that more schools than not are struggling with this. And right now it's just, we're not there yet.

Gretchen: Yeah. And I just want to, this is related to this, this made me think too, like, yeah, I think a thing that schools are struggling with is instructional time. Like we've got to fit in all this instructional time, we've gotta meet all these standards versus break time. And I've seen my own kids, their schools, like the recesses get shorter, the breaks get shorter. How can you get to class A to B? You have no time to even like take a little break. So, I feel like we need to remind folks, like it's not just about instructional time.

Andy: Right. And I think that the rationale here that is often missed is that are we creating adequate readiness to learn? Readiness to learn may require self-regulating activity in advance of delivering lessons and education. And if we view that as an essential pre-component or even a, even a self-corrective component, you know, as someone who's taught when you're teaching and it's not landing and you're flailing because you're trying desperately to deliver a point. And you can see that the kids aren't ready and aren't absorbing.

There is a lot of value in just saying, "We're going to stop. We're going do something to reset ourselves because I can waste an hour trying to drive home two points because I've never addressed readiness." You know, go out and try to plant some flowers or vegetables in a yard without prepping the soil, without creating the environment that allows it to be successful. Cultivating learning and kids is very much the same idea. This doesn't derail learning or take away time. This supports it and magnifies what good teachers do well.

Gretchen: Thank you so much, Andy. This has, as always, been a great conversation.

Rachel: Thank you.

Andy: Thanks, guys. I really appreciate being here.

Rachel: Thanks so much for listening today. If you have any thoughts about the episode, we'd love to hear from you. You can email us at init@understood.org.

Gretchen: And check out the show notes for this episode, where we have more resources and links to anything we mentioned.

Rachel: This show is brought to you by Understood.org. Understood is a nonprofit organization dedicated to empowering people with learning and thinking differences like ADHD and dyslexia. If you'd like to help us continue this work, donate at Understood.org/give.

Gretchen: "In It" is produced and edited by Julie Subrin, with additional production support from Cody Nelson and Samiah Adams. Justin D. Wright mixes the show, and Mike Ericco wrote our theme music. Briana Berry is our production director. Neil Drumming is our editorial director.

Rachel: From Understood.org, our executive directors are Laura Key, Scott Cocchiere, and Seth Melnick. Thanks for listening.

Gretchen: And thanks for always being in it with us.