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9 Oct 2021

Chen K, Phipps S. Soc Sci Med 2021; 284: 114232

There is limited knowledge on accessible non-pharmacological options to reduce inattentive/hyperactive (I/H) behaviours. Another current topic of interest is whether girls’ academic achievement has surpassed boys’. In Canada in 2020, more women than men aged 25–34 have a bachelor’s degree (Statistics Canada, 2021). This study subsequently aimed to evaluate the effect of daily physical activity on I/H behaviours among young children, using evidence from a quasi-experiment in Canada, which implemented province-wide programmes to encourage physical activity in elementary school children. An additional aim of the study was to determine whether observed increases in I/H behaviours, particularly for young boys, may contribute to the gender gap in educational attainment.

The data used in this study, which were obtained from the Statistics Canada National Longitudinal Survey of Children and Youth (NLSCY) and the Public Use Microdata File of the Canadian Community Health Survey (CCHS), were the results from a quasi-experiment in which programmes were introduced in three Canadian provinces between 2000 and 2008, requiring all elementary school students to participate in 20–30 minutes of additional daily physical activity (DPA) at school. In order to control for I/H behaviour prior to school entry, the study selected children in Grades 1 through 6 over the period 1994-2009 whose behaviours were observed in an earlier cycle at ages 3 to 4.

The measure of inattention/hyperactivity was based on parent reports. Responses to the survey were scored and summed to construct a scale ranging in value from 0 to 14, with a high score indicating the highest level of I/H behaviour. A difference-in-differences (DD) model was utilised to compare changes in I/H symptoms in participants compared with non-participants in other provinces. The DPA coefficient (γ) represents an estimate of the impact of DPA on I/H behaviours. To investigate the educational gender gap, brother-sister families aged between 6 and 11 years were selected. The child’s attitude towards school, as well as parental reports of the child’s overall success at school, were assessed through survey questions. Differences between brothers’ and sisters’ age-, grade- and month-standardised math test scores were also studied.

The mean age of participants was 103 months for both boys and girls, with a mean I/H score of 4.512 and 3.363 (p<0.01), respectively. Very few differences were observed in characteristics between child gender. The inclusion of pre-school I/H score had little impact on the estimated DPA coefficients. Controlling for pre-existing conditions prior to school entry, an extra 20–30 minutes of exercise every day at school significantly reduced I/H scores by 6.9% (p<0.05) of a standard deviation (SD) for all children in grades 1 through 6, although the effect was only statistically significant in boys (8.9%; p<0.05). Conditional on participation, an additional 10 minutes of daily exercise reduced I/H further by 0.3% of a SD for boys.

Growing up in a lone-parent household was associated with a 14% and 17% of a SD higher I/H score for all children and boys, respectively. Boys had a significantly higher level of I/H than girls by 26% of a SD, and children with the highest I/H scores as pre-schoolers were also likely to have the highest I/H scores in class (by 14% of a SD). Children with potential ADHD diagnoses or those with the most severe behavioural issues at age 3 or 4 benefited most from the programme with a reduction of I/H behaviour by 8–16% of a SD; this was particularly marked for boys (17–33% of a SD). Although the results from the full girls’ sample suggested no impact of DPA, this was not the case for girls in the pre-school I/H cohort. Comparing responses to the survey of individual sibling pairs, 15.4% of brothers liked school less than their sisters, and 6.6% of sisters liked school better than their brothers. Parents reported that 55.8% of sisters were doing “very well” compared with 41.5% of brothers. It was also found that I/H behaviour adversely affected child math performance; however, there was a smaller difference between brothers and sisters in standardised math scores than for the other non-cognitive outcomes. Furthermore, math score was the only outcome where brothers were less likely to perform worse than their sisters (24.6% of brothers had a lower math score than their sister; 27% of sisters had a lower math score than their brother). Negative consequences of I/H behaviour for math scores were greater for boys than girls.

It was noted that the findings of this study must be interpreted in the context of some limitations. Firstly, programme compliance was inferred through data from the CCHS on a group of older children; therefore, the estimated treatment effect of DPA in this study is only accurate to the extent that the programme-induced physical activities for young adolescents are comparable with those for elementary school-aged children. Secondly, because the NLSCY was discontinued after 2009, we have limited post-treatment data to evaluate the longer-term effect of DPA on I/H behaviour. Finally, further explorations are needed to gain a better understanding of why girls are less affected by the DPA programmes.

The authors concluded that mandating 20–30 minutes of exercise every day at school lowers I/H scores among elementary school-aged children, by 6.9% of a SD. They also noted that the effects of the DPA mandates are driven by boys, particularly boys with higher pre-school I/H scores. It was suggested that interventions such as the mandate of DPA for young children at school may contribute to improving boys’ relative motivation and performance, and 20–30 minutes of exercise per day may potentially reduce gender gaps in attitude toward school, overall success at school and parental educational hopes.

Read more about the effect of daily physical activity on childhood I/H here

Disclaimer: The views expressed here are the views of the author(s) and not those of Takeda.

Chen K, Phipps S. “Why can’t you sit still?” The effect of daily physical activity on childhood inattention/hyperactivity and the educational gender gap. Soc Sci Med 2021; 284: 114232.

Statistics Canada, 2021. Educational attainment of the population aged 25 to 64, by age group and sex [Table 37-10-0130-01]. Available at: Accessed October 2021.

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