Yoga Therapy for Children with ADHD

 Yoga Therapy for Children with ADHD

Scientific Articles Synopsis

1. Meditation therapies for attention-deficit/hyperactivity disorder (ADHD)- Randomized controlled trials of Four studies, including 83 participants that investigated the efficacy of meditation therapy in children or adults diagnosed with ADHD. Two studies used mantra meditation while the other two used yoga compared with drugs, relaxation training, non-specific exercises and standard treatment control. Attention-deficit/hyperactivity disorder (ADHD) is one of the most common developmental disorders experienced in childhood, has early onset and is characterized by a combination of overactive, poorly modulated behavior with marked inattention. In the long term it can impair academic performance, vocational success and social-emotional development. Meditation is increasingly used for psychological conditions and could be used as a tool for attentional training in the ADHD population. Conclusion, As a result of the limited number of included studies, the small sample sizes and the high risk of bias, results are inconclusive and more studies are needed. 

2. Interventions Based on Mind–Body Therapies for the Improvement of Attention-Deficit/Hyperactivity Disorder Symptoms in Youth- A Systematic Review- Barranco-Ruiz Study 2019 in Spain was a Systematic review of 388 children ages 5-18 years old with a clinical diagnosis of ADHD in the Americas, Europe, Asia and Australia. The studies ranged from 8-20 weeks with at least one session per week. The studies included MBT-based interventions such as, yoga, meditation, mindfulness, relaxation, or zen therapies or programs. ADHD symptoms, such as inattention, hyperactivity, or impulsivity, and related skills, which are attenuated with ADHD diagnostics (e.g., accuracy rate, reaction time, etc.). Secondary outcomes, such as anxiety, shyness, social problems, perfectionism, and impulsivity, planning, inhibition, and self-reported emotion dysregulation, and depressive symptoms were also significantly improved after MBT interventions. Eleven out of the twelve studies suggested a positive result between MBT and the symptoms of ADHD. Conclusions: MBTs, such as yoga or mindfulness, could be positive strategies to mitigate ADHD symptoms in children and adolescents. 

3. The Differential Impact of Acute Exercise and Mindfulness Meditation on Executive Functioning and Psycho-Emotional Well-Being in Children and Youth With ADHD- In the Bigelow Study done in 2021 in Canada, sixteen children ages 10-14 years old were studied. This study concluded that one meditation session improved executive functions. Participants completed three interventions: 10 min of exercise, 10 min of mindfulness meditation, and 10 min of reading (control). Before and after each intervention, executive functioning (inhibitory control, working memory, task-switching) and psycho-emotional well-being (mood, self-efficacy) were assessed. Mindfulness meditation increased performance on all executive functioning tasks whereas the other interventions did not . Exercise enhanced positive mood and self-efficacy whereas the other interventions did not. Testing included; The General Self-Efficacy scale to assess participants' self-efficacy at the beginning and end of the protocol on each day of testing, The Child Physical Activity Questionnaire/PAQ-C was used to assess children's general physical activity levels during a regular week, Mood was assessed using Williamson Adapted Version of the Profile of Mood States on a 5-item scale, The Trail Making Task (TMT) was used to assess task-switching, The Leiter-3 Reverse Memory Subscale was used to assess working memory, The Stroop Task was used to assess inhibitory control in children with ADHD, heart rate and rates of perceived exertion were used as well.  This work provides preliminary evidence for how acute exercise and mindfulness meditation can support differential aspects of executive and psycho-emotional functioning among children and youth with ADHD. Meditation influenced inhibitory control positively. Active exercise increases the mood and overall well-being of children. 

4. The Effects of Yoga on Attention, Impulsivity and Hyperactivity in Preschool Age Children with ADHD Symptoms- The Cohen Study done in the USA in 2018 involved twenty-three children ages 3-5 years old. This study evaluated the effects of yoga in preschoolers on parent and teacher rated attention/challenging behaviors; tests used were; attentional control (KiTAP); and heart rate variability (HRV). Group one (yoga first) showed improvement in inattention. This was a randomized waitlist-controlled trial that tested a 6-week yoga intervention in preschoolers with ≥ 4 ADHD symptoms on the ADHD Rating Scale-IV Preschool Version. Group 1 practiced yoga first; Group 2 practiced yoga second. Data was collected at four time points: baseline, T1 (6 wk), T2 (12 wk), follow-up (3 mo after T2). After T1 (six weeks), group one reacted faster on the KiTAP go/no-go task. The distractibility task had fewer omission mistakes but more commission mistakes than the control group. None of the groups showed a difference in HRV.  Yoga was associated with modest improvements on an objective measure of attention (KiTAP) and selective improvements on parent ratings. Yoga may be a promising treatment for ADHD symptoms in preschoolers.

5. Application of Mindfulness-Oriented Meditation: A Preliminary Study in Children with ADHD- In the Santonastaso 2020 clinical trial study done in Italy twenty-five children ages 7-11 years old participated in the MOM (Mindfulness-oriented meditation is a self-regulatory training used for attentional and behavioral problems) 3 times per week for 8 weeks. The program showed improving ADHD symptoms in participants compared to the control group. Neuropsychological and academic measures and behavioral, emotional, and mindfulness ratings were collected before and after the two programs. On average, MOM training had positive effects on neuropsychological measures, as evidenced by a significant mean improvement in all outcome measures after training. Positive effects on ADHD symptoms were found only in the MOM group. Testing was done with the combination of objective neuropsychological measures with parent and self-report questionnaires. Results find that MOM training promotes changes in neuropsychological measures and in certain behavioral symptoms, suggesting it as a promising tool for ameliorating cognitive and clinical manifestations of ADHD.

6. An Evaluation of Yoga and Meditation to Improve Attention, Hyperactivity, and Stress in High-School Students- The Saxena Clinical Trial Study done in the USA in 2020 studied one hundred and seventy-four children ages 14-15 from Texas. The Yoga Group participated in 25-min Hatha yoga classes twice weekly over 12 weeks. After 12 weeks of either being in the yoga group or the control group, the self-questionnaire of the children showed improvement regarding inattention and hyperactivity in the yoga group. Neither group showed changes in stress levels. These findings suggest that Hatha yoga may improve attention and hyperactivity in high school students.

7. A randomized controlled trial (MindChamp) of a mindfulness-based intervention for children with ADHD and their parents- The Siebelink Qualitative Study out of the Netherlands from 2021 examines sixty-nine families with children ages 9-16 years old for eight weeks in ninety minute sessions with a follow up after the eight weeks. Family mindfulness‐based intervention (MBI) for child attention‐deficit/hyperactivity disorder (ADHD) targets child self‐control, parenting and parental mental health. Follow up interviews after the study show that after participating for eight weeks in a group based training called “My Mind” indicated positive effects of the symptoms of ADHD. ADHD symptoms significantly reduced post‐treatment according to parent (Conners’ and SWAN) and teacher ratings (BRIEF) per protocol. Testing was measured by the 75‐item Behaviour Rating Inventory of Executive Function (BRIEF) by parents, children and teachers. Family MBI (Mindfulness Based Interventions) did not outperform CAU (Care as usual) only in reducing child self‐control deficits on a group level but more children reliably improved. Effects on parents were larger and more durable. When CAU for ADHD is insufficient, family MBI could be a valuable addition. The analysis revealed that children in the MBI group showed better self‐control at post‐treatment than those in the CAU group. Family MBI may complement current treatment for families with a child with ADHD in terms of long‐term improvement of parental psychological symptoms, self‐compassion and mindful parenting.

8. A meta-analytic investigation of the impact of mindfulness-based interventions on ADHD symptoms- The Xue study for 2019 out of China is a meta-analysis of not just children but also adults with ADHD. There were six hundred eighty-two participants (210 children ages 5-8 years old) and 472 adults ages 18-65 years old. Results showed that MBI (Mindfulness Based Intervention) training positively affects ADHD symptoms, such as impulsive behavior, attention span, and hyperactivity. The present meta-analysis suggested that MBIs had large effects in reducing ADHD core symptoms in comparison with the control group. When all studies were included, the primary results showed a large effect size for ADHD core symptoms, suggesting that MBIs could significantly reduce ADHD core symptoms.

Reference List

1. Krisanaprakornkit T, Ngamjarus C, Witoonchart C, Piyavhatkul N. Meditation therapies for attention-deficit/hyperactivity disorder (ADHD). Cochrane Database Syst Rev. 2010 Jun 16;2010(6):CD006507. doi: 10.1002/14651858.CD006507.pub2. PMID: 20556767; PMCID: PMC6823216.

2. Barranco-Ruiz Y, Etxabe BE, Ramírez-Vélez R, Villa-González E. Interventions Based on Mind-Body Therapies for the Improvement of Attention-Deficit/Hyperactivity Disorder Symptoms in Youth: A Systematic Review. Medicina (Kaunas). 2019 Jun 30;55(7):325. doi: 10.3390/medicina55070325. PMID: 31262094; PMCID: PMC6680862.

3. Bigelow H, Gottlieb MD, Ogrodnik M, Graham JD, Fenesi B. The Differential Impact of Acute Exercise and Mindfulness Meditation on Executive Functioning and Psycho-Emotional Well-Being in Children and Youth With ADHD. Front Psychol. 2021 Jun 14;12:660845. doi: 10.3389/fpsyg.2021.660845. PMID: 34194365; PMCID: PMC8236645.

4. Cohen SCL, Harvey DJ, Shields RH, Shields GS, Rashedi RN, Tancredi DJ, Angkustsiri K, Hansen RL, Schweitzer JB. Effects of Yoga on Attention, Impulsivity, and Hyperactivity in Preschool-Aged Children with Attention-Deficit Hyperactivity Disorder Symptoms. J Dev Behav Pediatr. 2018 Apr;39(3):200-209. doi: 10.1097/DBP.0000000000000552. PMID: 29538185; PMCID: PMC5871620.

5. Santonastaso O, Zaccari V, Crescentini C, Fabbro F, Capurso V, Vicari S, Menghini D. Clinical Application of Mindfulness-Oriented Meditation: A Preliminary Study in Children with ADHD. Int J Environ Res Public Health. 2020 Sep 22;17(18):6916. doi: 10.3390/ijerph17186916. PMID: 32971803; PMCID: PMC7557753.

6. Saxena K, Verrico CD, Saxena J, Kurian S, Alexander S, Kahlon RS, Arvind RP, Goldberg A, DeVito N, Baig M, Grieb A, Bakhshaie J, Simonetti A, Storch EA, Williams L, Gillan L. An Evaluation of Yoga and Meditation to Improve Attention, Hyperactivity, and Stress in High-School Students. J Altern Complement Med. 2020 Aug;26(8):701-707. doi: 10.1089/acm.2020.0126. Epub 2020 Jun 17. PMID: 32551827.

7. Siebelink NM, Bögels SM, Speckens AEM, Dammers JT, Wolfers T, Buitelaar JK, Greven CU. A randomized controlled trial (MindChamp) of a mindfulness-based intervention for children with ADHD and their parents. J Child Psychol Psychiatry. 2022 Feb;63(2):165-177. doi: 10.1111/jcpp.13430. Epub 2021 May 24. PMID: 34030214; PMCID: PMC9292876.

8. Xue J, Zhang Y, Huang Y. A meta-analytic investigation of the impact of mindfulness-based interventions on ADHD symptoms. Medicine (Baltimore). 2019 Jun;98(23):e15957. doi: 10.1097/MD.0000000000015957. PMID: 31169722; PMCID: PMC6571280.

Synopsis- Although two of the studies (study #1 and #7) showed inconclusive or insignificant results, the other five studies showed that mindfulness based Interventions had a positive impact on children diagnosed with ADHD. The studies did not combine yoga, meditation and mantra, except for study #2 which did use all of these methods but not on every group. Study #8 was done with adults as well as children. More research may be done to combine the yoga therapies and see what a combination of yoga therapies as well as teacher and parent support will do for a child with ADHD. 

Summary- The studies that were done on children to measure the effects of yoga therapies on children diagnosed with ADHD suggested that yoga therapies might promote changes in neuropsychological measures and help mitigate some of the negative behavioral symptoms of ADHD (studies #2-6, 8).  Secondary outcomes, such as anxiety, shyness, social problems, perfectionism, and impulsivity, planning, inhibition, and self-reported emotion dysregulation, and depressive symptoms were also significantly improved after  interventions. This suggests that yoga therapies such as yoga asanas, breathwork, mantra and meditation all might be useful tools along with other therapies to improve cognitive skills as well as managing the manifestations of ADHD. Since drug therapy has ​limitations, such as adverse effects, a high dropout rate, and many patients showing partial or even no responses to the treatment, Yoga Therapies should be seriously considered as a natural alternative to managing ADHD with no adverse side effects.