Medication vs. Movement in ADHD: Interaction Between Medication and Physical Activity on Neurocognitive Functioning

<b>Background/Objectives</b>: Movement during attention-demanding tasks may help compensate for cortical under-arousal in pediatric ADHD patients. However, the influence of medication during movement is unknown. This study assessed the impact of concurrent movement during executive functioning tasks on dorsolateral prefrontal cortex (DLPFC) activation and inhibitory control, with a particular focus on the influence of medication status. <b>Methods</b>: Twenty-six children with ADHD (15 medicated; 11 unmedicated) and 24 children without ADHD performed a Stroop task under two conditions: while remaining seated (Stationary condition) and while pedalling on a desk cycle (Movement condition). Functional near-infrared spectroscopy (fNIRS) was used to measure changes in oxygenated and deoxygenated hemoglobin levels in the left DLPFC. <b>Results</b>: Sixty-four percent of unmedicated children with ADHD showed greater left DLPFC activity while desk-cycling compared to remaining stationary. Only 37% of medicated children with ADHD showed the same pattern, with 63% showing greater left DLPFC activation when remaining stationary during executive functioning. Children without ADHD had similar DLPFC patterns as unmedicated ADHD children, with 65% showing increased activation during movement. Unmedicated ADHD children who were able to desk-cycle during the Stroop task had higher overall and incongruent accuracy scores; no Stroop differences were found between conditions for children with ADHD who were medicated or for controls. <b>Conclusions</b>: Medicated ADHD children did not benefit from physical activity during tasks requiring executive control, yet unmedicated ADHD children showed significantly greater DLPFC activation and inhibitory control when engaging in movement. If medication is not suitable for children with ADHD due to adverse side effects, movement during executive functioning may help mimic the benefit of medications and similarly support attention.