Does Yoga Help Children with Attention Problems?
Dr. David Rabiner, Ph.D.
There are a number of reason why there is a pressing need to develop treatments for ADHD in addition to medication and behavior therapy that have strong research support.
Regarding medication, not all children benefit from taking it, some experience intolerable side effects, and many continue to struggle even though medication may be helpful. Behavior therapy can be difficult for parents and/or teachers to consistently implement and does not generally reduce behavior difficulties to normative levels.
Furthermore, even though both treatments can be extremely helpful in managing ADHD symptoms and reducing oppositional behavior, they do not induce lasting changes in the child that persist after treatments is discontinued. Finally, despite numerous studies documenting the short- and intermediate term benefits of these treatments, the impact on children's long-term success remains to be clearly documented.
In addition to these important limitations of what are currently treatments for ADHD with the most extensive research support, prior research has shown that attention difficulties, even when they may not be severe enough to warrant a diagnosis of ADHD, can often have important adverse effects on children's academic performance. For children with more moderate attention difficulties who are not diagnosed with ADHD, medication would generally not be considered an appropriate treatment; however, improving their attention and on-task behavior in the classroom remains important.
Because of these limitations with conventional treatments, there have been numerous efforts to develop alternative and complementary treatments for ADHD that may enhance the benefits offered by medication and behavior therapy. I am well aware that many subscribers to Attention Research Update have a keen interest in research on such interventions, and was thus pleased to find a very interesting study recently on the use of yoga as an intervention for children with attention difficulties (Peck, H., (2005). Yoga as an intervention for children with attention problems. School Psychology Review, 34, 415-424).
As you are probably aware, yoga "...incorporates physical postures, breath control, mental concentration, and deep relaxation..." in an effort to positively affect mental states. Practitioners report that it produces similar effects as relaxation training and tends to "...promote self-control, attention, and concentration." Thus, the purported outcomes of yoga suggest that it could be a helpful intervention for children with attention difficulties, as it "...seems sensible that children's heightened boy awareness, reduced tension, and improved concentration would be conducive to learning.
Participants in this study were 10 1st - 3rd grade children (3 boys and 7 girls) whose teacher had referred them for consultation services at their school because of concerns related to attention difficulties in the classroom. None of the children had been formally diagnosed with ADHD and none were receiving medication for attention difficulties.
The Yoga intervention was delivered using the "Yoga Fitness for Kids" videotape, a commercially available product (See http://www.gaiam.com and search for Yoga for Kids; note that video for older children does not seem to be available.) The videotape required children to follow an adult instructor and 3 children as they engaged in deep breathing, physical postures, and relaxation exercises. The videotapes depicted movement between various physical postures in an age-appropriate and game like manner, and the instructor frequently reminded the children to take slow, deep breaths when engaging in the postures. Each session concluded with guided imagery "...where the children laid on their backs on the floor envisioning peaceful images such as being a seed that sprouted into a beautiful flower."
Students were grouped for the intervention by grade level and the yoga sessions were thus conducted in small groups rather than individually. The sessions were held during the school day for 30 minutes, twice a week, over a period of 3 weeks. All children attended each session and reported that they enjoyed it very much.
There were 3 phases to the study - a baseline phase that lasted at least 3 weeks, the 3-week intervention phases, and then a 3-week follow-up phase. During each week, participants were observed for 2 10-minute sessions each week so that their time on task over the entire study could be determined. Children were engaged in either whole group lessons or individual seatwork, most often in language arts, during the observations.
At the time that each participant was observed, a child of the same gender as the participant was observed to serve as a comparison peer, which a different child serving as the comparison during each 10-second observation interval. A second trained observer independently coded 20% of all observation sessions to determine that the coding system was being used reliably, and the observers agreed about whether the child was on- vs. off-task for over 90% of the joint observations. Thus, there was good evidence that the behavior observations were reliable.
This procedure provided a careful measure of how time on-task during the study for children referred for attention difficulties who had received the intervention compared to their classmates who had neither been referred for attention difficulties nor received the yoga intervention.
If the yoga intervention was helpful, one would expect that participants would have been on-task substantially less often than peers during the baseline phase, but that this difference would diminish or disappear when the intervention began. Ideally, partcipants increase in on-task behavior would persist across the 3-week follow-up period.
As expected, there was a substantial difference in on-task behavior between students with attention difficulties and their classmates during the baseline phase. On average, intervention students were observed to be on-task only about 65% of the time, compared to about 85% of the time for their classmates. This is a substantial difference and one can imagine being on task an average of 20% less often than classmates how over an entire school year could have an important adverse impact on students' acquisition of academic skills as well as their performing up to their ability level.
During the 3-week intervention phase, during which students were observed a total of 6 times, this significant time on-task difference disappeared. In fact, during the intervention, students with attention difficulties were observed to be on-task at virtually the exact same rate as comparison students.
For the 3-week follow-up period, a reduction in on-task behavior for intervention students was observed, as they were once again on-task less often than their classmates. However, despite this decline, they did continue to demonstrate higher rates of on-task behavior than they had during the baseline period. Thus, even though the intervention benefits had diminished, there remained some evidence of continued benefits.
SUMMARY and IMPLICATIONS
Results from this interesting study provide preliminary evidence that yoga may be a helpful intervention for improving time on-task in the classroom for students with attention difficulties. In this report, the beneficial affects associated with yoga practice occurred quickly, showed some evidence of persisting beyond the training itself, and essentially normalized rates of on-task behavior for formally inattentive students during the time that yoga training was occurring.
These are certainly promising results and the authors of this interesting study should be commended for their effort to systematically study the potential benefits of this approach. Despite the promising nature of these findings, which clearly support the need for additional research in this area, it is important to recognize several important study limitations that would need to be addressed before any definitive conclusions about the impact of yoga on attentional difficulties could be addressed.
The most important limitation - in addition to the small sample size - is that the research who conducted the majority of the behavioral observations was the same person who supervised the yoga intervention. This certainly has the potential to have biased the results, although the fact that the researcher adhered strictly to the strictly defined criteria for time on-task and that good reliability with an independent observer was attained, mitigates somewhat against this concern. However, as the researchers themselves note, it would be essential to replicate these results using an observer who is blind to the purpose of the study and to which children had received the intervention.
A second limitation is the absence of a control group. In this study, students essentially served as their own controls by examining their on-task behavior before, during, and after the yoga intervention. However, a stronger design would be one where a larger group of students with attention dfficulties were randomly assigned to receive the yoga intervention or to a control condition in which they also met in small groups with an adult but did not engage in the yoga training.
Documenting that only children who received yoga showed the increase in on-task behavior would enable one to have greater confidence that yoga training itself, and not simply extra time with a supportive adult, is what was responsible for the gains. As noted above, observers in such a study would need to be blind to whether children were in the experimental or control groups.
Finally, given the adverse impact that attention problems have on children's academic achivement and performance, it would also be helpful to incorporate assessments of children's academic performance. Documenting that yoga training enhances day-to-day academic performance in addition to time on-task would be an important addition to the study findings and one that could be used to justify pulling students from the classroom to receive such training.
In addition, because participants in this study were not formally diagnosed with ADHD, it would also be quite important to test whether this intervention can be helpful to students' whose difficulties with attention are likely to be more severe than many of the children who took part in the current investigation.
Until a follow-up study with these factors has been conducted, it is not possible to draw any firm conclusions about the impact of yoga on students with attention difficulties, even though the results reported here appear promising. Hopefully, these promising results will stimulate other researchers to conduct a more extensive and better controlled trial of yoga as an intervention for ADHD, so that more definitive conclusions about the potential benefits of this complementary intervention approach can be made.
This article was originally published in Attention Research Update, an online newsletter written by Dr. David Rabiner of Duke University that helps parents, professionals, and educators keep up with the latest research information on ADHD. Complementary subscriptions are available at www.helpforadd.com.
If you want to keep up with the latest research on ADHD, visit www.helpforadd.com to learn about Attention Research Update, a complementary online newsletter written by Dr. David Rabiner, Associate Research Professor at Duke University. The newsletter summarizes the latest ADHD research findings to help subscribers stay informed about important new developments in the field.
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