Research Article: Increased Anterior Pelvic Angle Characterizes the Gait of Children with Attention Deficit/Hyperactivity Disorder (ADHD)

Date Published: January 18, 2017

Publisher: Public Library of Science

Author(s): Hiroaki Naruse, Takashi X. Fujisawa, Chiho Yatsuga, Masafumi Kubota, Hideaki Matsuo, Shinichiro Takiguchi, Seiichiro Shimada, Yuto Imai, Michio Hiratani, Hirotaka Kosaka, Akemi Tomoda, Kenji Hashimoto.


Children with attention deficit/hyperactivity disorder (ADHD) frequently have motor problems. Previous studies have reported that the characteristic gait in children with ADHD is immature and that subjects demonstrate higher levels of variability in gait characteristics for the lower extremities than healthy controls. However, little is known about body movement during gait in children with ADHD. The purpose of this study was to identify the characteristic body movements associated with ADHD symptoms in children with ADHD.

Using a three-dimensional motion analysis system, we compared gait variables in boys with ADHD (n = 19; mean age, 9.58 years) and boys with typical development (TD) (n = 21; mean age, 10.71 years) to determine the specific gait characteristics related to ADHD symptoms. We assessed spatiotemporal gait variables (i.e. speed, stride length, and cadence), and kinematic gait variables (i.e. angle of pelvis, hip, knee, and ankle) to measure body movement when walking at a self-selected pace.

In comparison with the TD group, the ADHD group demonstrated significantly higher values in cadence (t = 3.33, p = 0.002) and anterior pelvic angle (t = 3.08, p = 0.004). In multiple regression analysis, anterior pelvic angle was associated with the ADHD rating scale hyperactive/impulsive scores (β = 0.62, t = 2.58, p = 0.025), but not other psychiatric symptoms in the ADHD group.

Our results suggest that anterior pelvic angle represents a specific gait variable related to ADHD symptoms. Our kinematic findings could have potential implications for evaluating the body movement in boys with ADHD.

Partial Text

Attention deficit hyperactivity disorder (ADHD) is the most prevalent childhood onset neurodevelopmental disorder, affecting 7.2% of school-age children [1]. ADHD is characterized by age-inappropriate level of inattention, hyperactivity, and impulsivity that are present prior to age 12 years of age [2]. Additionally, up to 50% of children with ADHD demonstrate a subnormal level of motor performance in their age group [3–6]. Previous studies have reported that poor coordination and impairments in fine and gross motor function are caused by difficulty in directing attention and by display of impulsive behavior [7, 8]. To date, motor function, including gait function, has been clinically assessed as a neurological soft sign in children with ADHD [9]. Gait function is one of the fundamental motor skills requiring both attention and executive function [7, 10]. From MRI studies, children with ADHD have a reduction in volume of the cerebellum [11] and dysfunction of the circuits involving basal ganglia [12]. These brain regions have a role in regulating the balance during gait [13, 14] and gait abnormalities have been reported in this population. However, there are few reports based on objective measurements using instrumented gait analysis techniques.

Demographic and clinical characteristics for the study participants are listed in Table 1. In comparison with the TD group, the ADHD group scored significantly lower on the FSIQ (t = 2.70, p = 0.011). Significant differences were found in the measures of severity of ADHD symptoms (ADHD-RS total score, F [1, 36] = 101.18, p < 0.001; Inattentive score, F [1, 36] = 79.92, p < 0.001; Hyperactive/Impulsive score, F [1, 36] = 42.08, p < 0.001), ASD traits (AQ total; F [1, 36] = 18.95, p < 0.001), and DCD traits (M-ABC2 total; F [1, 36] = 3.76, p = 0.060) between the two groups. The purpose of the present study was to determine whether spatiotemporal and kinematic gait variables differ between controls and children with ADHD by using a 3D motion analysis system. Our results demonstrated that children with ADHD exhibit higher values for cadence and anterior pelvic angle compared to healthy controls, and that pelvic angle had a significant positive correlation with the severity of ADHD symptoms. These results suggest that children with ADHD have the characteristics of a high frequency gait cycle and an increased anterior pelvic angle. Furthermore, in multiple regression analysis, anterior pelvic angle was associated with the severity of ADHD symptoms, whereas there was no association with ASD or DCD symptoms in children with ADHD. Additionally, the variable of cadence showed no association with any psychiatric traits. These findings suggest that increased anterior pelvic angle during gait is a specific variable of ADHD symptoms.   Source:


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