Preliminary evidence of improved cognitive performance following vestibular rehabilitation in children with combined ADHD (cADHD) and concurrent vestibular impairment

Published:February 19, 2017DOI:



      Balance function has been reported to be worse in ADHD children than in their normal peers. The present study hypothesized that an improvement in balance could result in better cognitive performance in children with ADHD and concurrent vestibular impairment. This study was designed to evaluate the effects of comprehensive vestibular rehabilitation therapy on the cognitive performance of children with combined ADHD and concurrent vestibular impairment.


      Subject were 54 children with combined ADHD. Those with severe vestibular impairment (n = 33) were randomly assigned to two groups that were matched for age. A rehabilitation program comprising overall balance and gate, postural stability, and eye movement exercises was assigned to the intervention group. Subjects in the control group received no intervention for the same time period. Intervention was administered twice weekly for 12 weeks. Choice reaction time (CRT) and spatial working memory (SWM) subtypes of the Cambridge Neuropsychological Test Automated Battery (CANTAB) were completed pre- and post-intervention to determine the effects of vestibular rehabilitation on the cognitive performance of the subjects with ADHD and concurrent vestibular impairment. ANCOVA was used to compare the test results of the intervention and control group post-test.


      The percentage of correct trial scores for the CRT achieved by the intervention group post-test increased significantly compared to those of the control group (p = 0.029). The CRT mean latency scores were significantly prolonged in the intervention group following intervention (p = 0.007) compared to the control group. No significant change was found in spatial functioning of the subjects with ADHD following 12 weeks of intervention (p > 0.05).


      The study highlights the effect of vestibular rehabilitation on the cognitive performance of children with combined ADHD and concurrent vestibular disorder. The findings indicate that attention can be affected by early vestibular rehabilitation, which is a basic program for improving memory function in such children. Appropriate vestibular rehabilitation programs based on the type of vestibular impairment of children can improve their cognitive ability to some extent in children with ADHD and concurrent vestibular impairment (p > 0.05).


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Auris Nasus Larynx
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hickey G.
        • Fricker P.
        Attention deficit hyperactivity disorder, CNS stimulants and sport.
        Sports Med. 1999; 27: 11-21
        • Parush S.
        • Sohmer H.
        • Steinberg A.
        • Kaitz M.
        Somatosensory function in boys with ADHD and tactile defensiveness.
        Physiol Behav. 2007; 90: 553-558
        • Barkley R.A.
        Attention-deficit hyperactivity disorder: a handbook for diagnosis and treatment.
        4th ed. Guilford Press, New York2014 (pp. 3–51)
        • Mao H.Y.
        • Kuo L.C.
        • Yang A.L.
        • Su C.T.
        Balance in children with attention deficit hyperactivity disorder-combined type.
        Res Dev Disabil. 2014; 35: 1252-1258
        • Niedermeyer E.
        • Naidu S.B.
        Attention-deficit hyperactivity disorder (ADHD) and frontal-motor cortex disconnection.
        Clin Electroencephalogr. 1997; 28: 130-136
        • Mostofsky S.H.
        • Reiss A.L.
        • Lockhart P.
        • Denckla M.B.
        Evaluation of cerebellar size in attention-deficit hyperactivity disorder.
        J Child Neurol. 1998; 13: 434-439
        • Semrud-Clikeman M.
        • Steingard R.J.
        • Filipek P.
        • Biederman J.
        • Bekken K.
        • Renshaw P.F.
        Using MRI to examine brain-behavior relationships in males with attention deficit disorder with hyperactivity.
        J Am Acad Child Adolesc Psychiatry. 2000; 39: 477-484
        • Wang M.C.
        • Liu C.Y.
        • Yu E.C.
        • Wu H.J.
        • Lee G.S.
        Vestibular evoked myogenic potentials in chronic otitis media before and after surgery.
        Acta Otolaryngol. 2009; 129: 1206-1211
        • Smith P.F.
        • Zheng Y.
        • Horii A.
        • Darlington C.L.
        Does vestibular damage cause cognitive dysfunction in humans.
        J Vestib Res. 2005; 15: 1-9
        • Furman J.M.
        • Redfern M.S.
        • Fuhrman S.I.
        • Jennings J.R.
        Visual-vestibular stimulation influences spatial and non-spatial cognitive processing.
        J Vestib Res. 2012; 22: 253-259
        • Hitier M.
        • Besnard S.
        • Smith P.F.
        Vestibular pathways involved in cognition.
        Front Integr Neurosci. 2014; 8: 59
        • Semenov Y.R.
        • Bigelow R.T.
        • Xue Q.L.
        • Lac S.D.
        • Agrawal Y.
        Association between vestibular and cognitive function in U.S. adults: data from the national health and nutrition examination survey.
        J Gerontol A Biol Sci Med Sci. 2015; 71: 243-250
        • Schautzer F.
        • Hamilton D.
        • Kalla R.
        • Strupp M.
        • Brandt T.
        Spatial memory deficits in patients with chronic bilateral vestibular failure.
        Ann N Y Acad Sci. 2003; 1004: 316-324
        • Redfern M.S.
        • Talkowski M.E.
        • Jennings J.R.
        • Furman J.M.
        Cognitive influences in postural control of patients with unilateral vestibular loss.
        Gait Posture. 2004; 19: 105-114
        • Chang Y.-K.
        • Etnier J.L.
        Acute exercise and cognitive function: emerging research issues.
        J Sport Health Sci. 2015; 4: 1-3
        • Chang Y.-K.
        • Liu S.
        • Yu H.-H.
        • Lee Y.-H.
        Effect of acute exercise on executive function in children with attention deficit hyperactivity disorder.
        Arch Clin Neuropsychol. 2012; 27: 225-237
        • Pontifex M.B.
        • Saliba B.J.
        • Raine L.B.
        • Picchietti D.L.
        • Hillman C.H.
        Exercise improves behavioral, neurocognitive, and scholastic performance in children with attention-deficit/hyperactivity disorder.
        J Ped. 2013; 162: 543-551
        • Cushing S.L.
        • Chia R.
        • James A.L.
        • Papsin B.C.
        • Gordon K.A.
        A test of static and dynamic balance function in children with cochlear implants: the vestibular olympics.
        Arch Otolaryngol Head Neck Surg. 2008; 134: 34-38
        • Roque D.T.
        • Teixeira R.A.A.
        • Zachi E.C.
        • Ventura D.F.
        The use of the Cambridge Neuropsychological Test Automated Battery (CANTAB) in neuropsychological assessment: application in Brazilian research with control children and adults with neurological disorders.
        Psychol Neurosci. 2011; 4: 255-265
        • Kim H.S.
        • An Y.M.
        • Kwon J.S.
        • Shin M.-S.
        A preliminary validity study of the cambridge neuropsychological test automated battery for the assessment of executive function in schizophrenia and bipolar disorder.
        Psychiatry Investig. 2014; 11: 394-401
        • Balakrishnan G.
        • Uppinakudru G.
        • Girwar Singh G.
        • Bangera S.
        • Dutt Raghavendra A.
        • Thangavel D.
        A comparative study on visual choice reaction time for different colors in females.
        Neurol Res Int. 2014; 2014: 5
        • Woods D.L.
        • Wyma J.M.
        • Yund E.W.
        • Herron T.J.
        • Reed B.
        Age-related slowing of response selection and production in a visual choice reaction time task.
        Front Hum Neurosci. 2015; 9: 193
        • Levaux M.N.
        • Potvin S.
        • Sepehry A.A.
        • Sablier J.
        • Mendrek A.
        • Stip E.
        Computerized assessment of cognition in schizophrenia: promises and pitfalls of CANTAB.
        Eur Psychiatry. 2007; 22: 104-115
        • Robbins T.W.
        • James M.
        • Owen A.M.
        • Sahakian B.J.
        • Lawrence A.D.
        • McInnes L.
        • et al.
        A study of performance on tests from the CANTAB battery sensitive to frontal lobe dysfunction in a large sample of normal volunteers: implications for theories of executive functioning and cognitive aging. Cambridge Neuropsychological Test Automated Battery.
        J Int Neuropsychol Soc. 1998; 4: 474-490
        • Han B.I.
        • Song H.S.
        • Kim J.S.
        Vestibular rehabilitation therapy: review of indications, mechanisms, and key exercises.
        J Clin Neurol. 2011; 7: 184-196
        • Morozetti P.G.
        • Gananca C.F.
        • Chiari B.M.
        Comparison of different protocols for vestibular rehabilitation in patients with peripheral vestibular disorders.
        J Soc Bras Fonoaudiol. 2011; 23: 44-50
        • Hanes D.A.
        • McCollum G.
        Cognitive-vestibular interactions: a review of patient difficulties and possible mechanisms.
        J Vestib Res. 2006; 16: 75-91
        • Browne R.A.
        • Costa E.C.
        • Sales M.M.
        • Fonteles A.I.
        • Moraes J.F.
        • Barros J.F.
        Acute effect of vigorous aerobic exercise on the inhibitory control in adolescents.
        Rev Paul Pediatr. 2015; 34: 154-161
        • Hogan C.L.
        • Mata J.
        • Carstensen L.L.
        Exercise holds immediate benefits for affect and cognition in younger and older adults.
        Psychol Aging. 2013; 28: 587-594
        • Dauwan M.
        • Begemann M.J.
        • Heringa S.M.
        • Sommer I.E.
        Exercise improves clinical symptoms, quality of life, global functioning, and depression in schizophrenia: a systematic review and meta-analysis.
        Schizophr Bull. 2015; 42: 588-599
        • Kalron A.
        • Zeilig G.
        Efficacy of exercise intervention programs on cognition in people suffering from multiple sclerosis, stroke and Parkinson’s disease: a systematic review and meta-analysis of current evidence.
        NeuroRehabilitation. 2015; 37: 273-289
        • Chang Y.K.
        • Liu S.
        • Yu H.H.
        • Lee Y.H.
        Effect of acute exercise on executive function in children with attention deficit hyperactivity disorder.
        Arch Clin Neuropsychol. 2012; 27: 225-237
        • Pontifex M.B.
        • Saliba B.J.
        • Raine L.B.
        • Picchietti D.L.
        • Hillman C.H.
        Exercise improves behavioral, neurocognitive, and scholastic performance in children with attention-deficit/hyperactivity disorder.
        J Pediatr. 2013; 162: 543-551
        • Mahon A.D.
        • Dean R.S.
        • McIntosh D.E.
        • Marjerrison A.D.
        • Cole A.S.
        • Woodruff M.E.
        • et al.
        Acute exercise effects on measures of attention and impulsivity in children with attention deficit/hyperactivity disorder.
        J Educ Develop Psychol. 2013; 3: 65
        • Edman G.
        • Schalling D.
        • Levander S.E.
        Impulsitivity and speed and errors in a reaction time task: a contribution to the construct validity of the concept of impulsivity.
        J Acta Psychol. 1983; 53: 1-8
        • Prinzmetal W.
        • McCool C.
        • Park S.
        Attention: reaction time and accuracy reveal different mechanisms.
        J Exp Psychol Gen. 2005; 134: 73-92
        • Baunez C.
        • Humby T.
        • Eagle D.M.
        • Ryan L.J.
        • Dunnett S.B.
        • Robbins T.W.
        Effects of STN lesions on simple vs choice reaction time tasks in the rat: preserved motor readiness, but impaired response selection.
        Eur J Neurosci. 2001; 13: 1609-1616
        • Baune B.T.
        • Renger L.
        Pharmacological and non-pharmacological interventions to improve cognitive dysfunction and functional ability in clinical depression — a systematic review.
        Psychiatr Res. 2014; 219: 25-50
        • Plessen K.J.
        • Bansal R.
        • Zhu H.
        • Whiteman R.
        • Amat J.
        • Quackenbush G.A.
        • et al.
        Hippocampus and amygdala morphology in attention-deficit/hyperactivity disorder.
        Arch Gen Psychiatry. 2006; 63: 795-807
        • Smith P.F.
        • Geddes L.H.
        • Baek J.H.
        • Darlington C.L.
        • Zheng Y.
        Modulation of memory by vestibular lesions and galvanic vestibular stimulation.
        Front Neurol. 2010; 1: 141
        • Van Dongen-Boomsma M.
        • Vollebregt M.A.
        • Buitelaar J.K.
        • Slaats-Willemse D.
        Working memory training in young children with ADHD: a randomized placebo-controlled trial.
        J Child Psychol Psychiatry. 2014; 55: 886-896