Transcript The Effects of Yoga on the Attention and Behaviour of Boys with

Yoga for Young People with ADHD
and other Challenging Behaviours
REVIEW OF TWO STUDIES :
PAULINE JENSEN AND A/PROF. DIANNA KENNY
SCHOOL OF BEHAVIOURAL AND COMMUNITY HEALTH SCIENCES
FACULTY
OF HEALTH
SCIENCE
Dr Pauline
Jensen
1-3 October 2016
[email protected]
THE UNIVERSITY OF SYDNEY
1
AIM OF THE FIRST STUDY
• To evaluate yogic practices as an adjuvant
treatment to pharmacological and behavioural
management in reducing the primary and
secondary symptoms of Attention Deficit
Hyperactivity Disorder in boys aged 8-12 years.
1-3 October 2016
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Behaviours:
Inattention/Hyperactivity/Impulsivity/Disorganisation/
Risk Taking-Sexual, Physical, Criminal, Drugs/Stealing /
Fighting/Arson/Lying.
Disorders:
Attention Deficit Hyperactivity Disorder (ADHD), Oppositional
Defiant Disorder, (ODD) Conduct Disorder (CD) often comorbid,
and often comorbid with Depression, Anxiety, Emotional Disorder.
Disruptive behaviour and disorders have serious
personal, social and educational implications (WicksNelson & Israel, 2003; DET, 1998), affecting peers,
teachers, family and community.
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3
RESEARCH PLAN
Wait- List Control Randomised Study
Participants- Referred by paediatricians
 Control group =7 boys (mean age= 9 years 2 months). All
except one stabilised on medication.
 Yoga group n=11 boys (mean age=10 years 5 months). All
except one stabilised on medication.
Measures
Pre and post test measures of symptoms of ADHD using : Conners Parent and Teacher Behaviour Rating Scales R-L.
 Test of Variables of Attention – TOVA
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1-3 October 2016
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RESEARCH PLAN
Procedure
• Yoga groups attended 1 hour class per week for
between 14 to 20 weeks at Educational Unit at
Westmead Hospital.
• Boys expected to practise yoga daily and record
practice in diary provided.
• Control group attended cooperative games session
for 1 hour once a month for 20 weeks.
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YOGIC PRACTICES IN PROGRAM
• A Manual of Practices was created by the researcher.
• The weekly program was based on this.
• Each family was given a manual which included
recommended home practice and record sheet.
• The Program included:
• Asanas (Postures) (active component) for body awareness,
control and physiological benefits
• Pranayama (Breathing Practices) – Deep Breathing, Nadi
Shodan, Bhramari, Kapalbhati,
• Concentration Exercises- Trataka
• Relaxation Exercises- Yoga Nidra
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Record sheet of Weekly Yoga Class
DATE
BREATHING EXERCISES
1 STANDING
A
JOINT EXERCISES (ankles, knees, hips, fingers, wrists, elbows,shoulders, neck).
B
HANDS IN 7 OUT BREATHING X5
C
FOREWARD / BACKWARDS / SIDEWAYS STRETCHING BREATH X3
D
WARRIORS POSE HOLD FOR X3 LONG BREATHS
2
A
B
C
D
SITTING
DOG BREATHING X15
TIGER BREATHING X5
THE DOG X3 LONG BREATHS
THE COBRA X3 LONG BREATHS
E
BACKSTRETCH X3 THEN HOLD X3 LONG BREATHS
F
THE WHEEL HOLD X3 LONG BREATHS
3
INVERTED POSES
A
B
C
THE CLOWN HOLD X3 BREATHS
SHOULDER STAND HOLD X3 BREATHS
THE HEADSTAND HOLD X3 BREATHS
4
BALANCE - TREE POSE HOLD X3 BREATHS
5 SALUTE HOLD X3 BREATHS
SECTIONAL BREATHING
A DIAPHRAMATIC BREATHING X5
B THORACIC (chest) BREATHING X5
C
UPPER LOBAR OR CLAVICULAR BREATHING X5
D
FULL YOGIC BREATHING X5
PRANAYAMA
1 KAPALBHATI (20 times R, 20 L, 20 B).
2
CANDRA ANULOMA VILOMA (LEFT NOSTRIL BREATHING) X5 SLOW DEEP BREATHS
3
SURYA ANULOMA VILOMA (RIGHT NOSTRIL BREATHING) X5 SLOW DEEP BREATHS
4
NADI SHODANA (ALTERNATE NOSTRIL BREATHING). X5
5
BHRAMARI (HUMMING BREATH)
TRATAKA
1
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CONCENTRATION & FOCUSING ON COLOURED SHAPE OR WORD
YOGA NIDRA
3 TO 10 MINS
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Typical Classes
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BACKGROUND RESEARCH
Neurological effects of yogic breathing techniques and
implications for neurological dysfunction in ADHD
The manipulation of the nasal cycle
effects:-
ADHD Dysfunction
• Increase in oxygen consumption/
glucose metabolism (Telles et al,
1994)
• Lower oxygen consumption/
glucose metabolism (Zametkin
et al, 1990)
1-3 October 2016
Compared to controls
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Neurological effects of yogic breathing techniques and
implications for neurological dysfunction in ADHD
The manipulation of the nasal
cycle effects:-
ADHD Dysfunction
Compared to controls
• Changes in cognition
functioning (Naveen et al,
1997)
1-3 October 2016
• Cerebral laterisation deficits
(Heilman et al, 1991)
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Neurological effects of yogic breathing
techniques and implications for neurological
dysfunction in ADHD
• The manipulation of the
nasal cycle and
relaxation techniques effects :
• Changes in brain wave
activity. (Hoffman 1998)
• ADHD Dysfunction
Compared to controls
• Differences in brain
wave bands (Mann et
al,1991)
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Neurological effects of yogic breathing
techniques and implications for neurological
dysfunction in ADHD
The manipulation of the nasal
cycle effects:-
ADHD Dysfunction
Compared to controls
• Changes in neurotransmitter
activity and in autonomic
activity.(Kennedy et al, 1986)
• Neurotransmitter dysfunction
(Pliszka et al, 1994)
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13
Neurological effects of relaxation training
techniques and implications for neurological
dysfunction in ADHD
Relaxation Training
• Decreases anxiety (Rauhlal
et al, 1990)
ADHD Dysfunction
Compared to controls
• Comorbid anxiety disorder
• Medication can increase
anxiety levels ( Tannock et al,
1995)
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14
CPRS-Oppositional
Pre and post test scores
76
74
72
70
68
66
GROUP
64
Yoga
62
Control
1
2
REPEAT
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CPRS - Global Index (Restless/Impulsive)
Pre and Post Test Scores
82
80
78
Mean Scores
76
GROUP
74
Yoga
72
Control
1
2
Time
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CPRS-Emotional Lability
Pre and post test scores
76
74
72
70
68
66
GROUP
64
Yoga
62
Control
1
2
REPEAT
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CPRS - Global Index Total
Pre and Post Test Scores
80
78
Means Scores
76
74
GROUP
72
Yoga
70
Control
1
2
Time
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CPRS - DSMIV Symptoms- Inattentive
Pre and Post Test Scores
6.0
5.5
5.0
Mean Scores
4.5
4.0
GROUP
3.5
Yoga
3.0
Control
1
2
REPEAT
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Connors Parent Ratings for DSM IV Inattentive
Symptoms
Conners' Parent Rating Scale DSM IV Symptoms Subscale Inattentive
10
"Pre Yoga"
"Post Yoga"
9
8
7
6
5
4
3
2
1
0
1
2
3
4
5
6
7
8
9
10
11
"Pre Control"
Symptom Score Above 5 suggestive of possible DSM IV diagnosis.
Symptoms Score Above 5 suggests possible DSM IV Diagnosis
10
Conners' Parent Rating Scale DSM IV Symptoms Subscales Inattentive
"Post Control"
9
8
7
6
5
4
3
2
1
0
1
2
Subjects
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3
4
5
6
7
Subjects
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CONCLUSIONS
• Given the limitations of this study- ie. small
numbers and relatively short intervention and high
needs population sample, the results do indicate
some significant changes in the behaviour of boys
with ADHD.
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The Second Study:
The Impact of Yoga on Children and
Adolescents with Disruptive Behaviour
Disorders
Addressed limitations of previous study
• larger number of participants (n=87),
• more supervised yoga practice -Up to 40 sessions over
a 14 week period)
• and a broader range of measures – 11 measures
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Disruptive Behaviour Disorders (DBD)
 On the increase in the school age population in
Australia.
 The effects of these disorders impact on the total
wellbeing of the sufferer and those in contact with
them (Beiderman et al, 1995).
 Current treatments fall short of adequately treating
these disorders.(Greenhill et al, 1996).
 Research indicates a neurological basis for ADHD
with genetic and environmental factors
contributing to all DBD’s and AD’s(Cantwell 1996).
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25
Design
• Participants aged 8-16 years
• Diagnosed or displaying DBDs and comorbid EDs and
ADs
• Students (n=87) enrolled at NSW Department of
Education and Training (DET) schools for students with
disruptive behaviour and emotional disturbance
(Behaviour Schools with enrolments of approximately 20
students)
• 30- 40-minute sessions three days a week, over a
fourteen-week period, to groups of 2 to 6 students, in 9
schools, over a 19 month period.
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Measuring
 Breathing patterns during relaxation session (Summit 2000).
 Self-reported Physical, Emotional and Mental States (Jensen 2005)
 Self-reported Feelings of Happiness, Calmness, Enjoyment and Competency.
(Checklist post yoga classes -Jensen 2004)
 Behavioural Observations in Classroom and in Yoga classes using computerized
Behavioral System (BASC- AGS Publishing 2003) plus observation notes by
Classroom Teacher or Aide.
 Parent and Teacher’s Perception of Behaviour (CTRS –R-L & CPRS-R-L Conners,
1997)
 Anxiety (STAI/C – (Spielberger, 1983, 1973)
 Yoga survey –(Jensen 2004)
 Attention -Sustained and Selective. (TEACH -Manly, Nimmo-Smith, Anderson,
1999)
 Self Esteem (Self-Description Questionnaire-SDQ- 1& 2 -Marsh 1990)
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Students’ Background
• Students’
backgrounds
include
domestic violence; sexual, emotional,
physical abuse and neglect; multiple
parents or guardians; economic
hardship; and family pathology
including parental substance abuse,
criminal activity and mental health
disorders.
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28
Effects of Background
• Such circumstances have adverse effects on
• Physical body (muscle tightness; digestive problems;
excretory problems etc),
• Emotional state (anxiety, depression, anger, etc)
• Social functioning (anti –social behaviour)
• Mental functioning (confusion;arrogance,
stubbornness, dullness; controlling; inflexibility)
• causing disturbances in anatomical, physiological,
psychological, neurological functioning.
1-3 October 2016
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Benefits of Yoga
• Yoga postures stretch, flex, tone, strengthen and relax
the muscular system, lubricate joints and massage the
body; stimulate and relax the digestive and excretory
systems ; release tension in an overstimulated nervous
system, and regulate the respiratory and circulatory
system.
• Yoga relaxation calms the nervous system, relaxes
muscles and quietens the mind.
• Yoga breathing practices can influence oxygen
consumption and the functioning of the brain.
• Yoga mind sound resonance deepens the breath,
focuses and quietens the mind.
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How Yoga was introduced to the
students.
• Yoga works on your
mental, physical and
emotional self.
• Ancient to modern
Yoga.
• Animal to Human Yoga
• Sportspeople and
teams who practise
yoga
Tom Carroll, surfing champion.
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Access,Recruitment and Assessment
• Ethics Approvals
• Locating Special
Schools(n=11 in Sydney
Region)
• Gaining approval from
Principals and cooperation
from staff
• Permission from parents
• Organise assessments pre
and post program with
teachers, parents and blind
assessors.
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32
Various reasons why students didn’t practise
yoga in classes taught.
•
•
•
•
•
•
•
Suspended or ion –school suspension
TAFE course
Home school intervention
Work experience
Sick or truanting
Asked to leave because too disruptive
Too lazy or couldn’t be bothered
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When attending Yoga class:
• Can eat breakfast or lunch before
session
• Can be talkative
• Can react to others
• Can be chaotic and restless
• Can be uncooperative
• Can refuse to participate
• Can be lethargic
• Can be sore and stiff
HOWEVER
• Often do follow the program
• Often enjoy the postures
• Often do relax
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How the class was conducted
• Short relaxation
• Pawanmuktasana -Joint
Warm Ups
• Spinal warm ups
• Variety of postures- forward
bends, backward bends, sideways,
upwards, twists, balances (no
inversions) and sequences.
• Breathing practices
• Chanting sounds
• Relaxation
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Results
Nil Effect
• Standardised
psychometric tests with
pre and post testing
over 12 week period
attributed to small
dose, no control over
other aspects of life.
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Effect
• Self report before and after
yoga classes on physical,
mental and emotional
states.
• Feelings checklist after class
1x week.
• Observations of behaviour
during yoga classes.
• Breathing patterns Pre,
during and Post Yoga Nidra.
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Feelings Checklist
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Feelings Of Happiness, Calmness, Enjoyment and Competency
after weekly Yoga Class ( n= 61)
Happiness
5
Rating Average:5 highest
4
Calmess
3
Enjoyment
2
1
Competency
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Week in Yoga program
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SELF REPORT PHYSICAL STATE - UP TO 12 PARTICIPANTS
PRE AND POST YOGA CLASSES
12
AVERAGE RATING :0-10
10
8
PRE PHYSICAL STATE
POST PHYSICAL STATE
6
4
2
0
1
1-3 October 2016
2
3
4
5
6
7
8
9
10
YOGA CLASS
NUMBER
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Jensen
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11
12
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SELF REPORT EMOTIONAL STATE-UP TO 12 PARTICIPANTS PRE
AND POST YOGA CLASSES
12
AVERAGE RATINGS;1-10
10
8
PRE EMOTIONAL STATE
POST EMOTIONAL STATE
6
4
2
0
1
2
3
4
5
6
7
8
9
10
11
12
YOGA CLASS NUMBER
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SELF REPORT MENTAL STATE-UP TO 12 PARTICIPANTS
PRE AND POST YOGA CLASSES
12
AVERAGE RATING :1-10
10
8
PRE MENTAL STATE
POST MENTAL STATE
6
4
2
0
1
2
3
4
5
6
7
8
9
10
11
12
YOGA CLASS NUMBER
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One minute screen shots of breathing effort pre, during and post Yoga
Nidra for individual student with Conduct Disorder, Learning Disorder and
Emotional Disorder
Pre Yoga Nidra
1-3 October 2016
Pauline
Jensen
PostDrYoga
Nidra
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During Yoga Nidra
42
Teachers Observations of Students Doing Yoga
• 3249 positive comments eg. joined in, participated, did
posture, relaxed , settled did well.
• 775 negative comments eg. Silly, unsettled restless,
not participating.
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Survey completed by primary students after
yoga program n=27
•
•
•
•
•
•
•
•
Question
Yes %
Do you have more energy?
74.1
Are you a calmer person?
66.7
Are you more flexible?
77.8
Do you feel stronger?
80
Are you able to relax easier?
63
Do you have less mood swings? 46.2
Do you experience less anger?
63
1-3 October 2016
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No %
25.9
33.3
22.2
20
37
53.8
37
44
Trust, Co-operation and Fun
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Group Endeavour and Support
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Determination and Togetherness
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Peace
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References
Biederman, J., Milberger, S., Faraone, S.V., Kiely, K., Guite, J., Mick, E. et al. (1995). Impact of adversity on functioning and
comorbidty in children with attention deficit hyperactivity disorder. Journal of the American Academy of Child and
Adolescent Psychiatry, 34 (11), 1495-1503.
Cantwell, D.P. (1996). Attention deficit hyperactivity disorder: A review of the past 10 years. Journal of the American
Academy of Child and Adolescent Psychiatry, 35(8), 978-987.
Greenhill, L., Halperin, J.M. & Abikoff, H. (1999) Stimulant medication. Journal of the American Academy of Child and
Adolescent Psychiatry, 38(5), 503-512.
Heilman, K.M., Voeller, K.K. & Nadeau, S.E. (1991). A possible pathophysiologic
Hoffman, E.(1998) Mapping the brains activity after Kriya Yoga. Bindu, 12, 10-12. Scandinavian Yoga School. Sweden
Kennedy, B, Ziegler, G.C., Shannahoff-Khalsa, D.S. (1986). Alternating lateralisation of plasma catecholamines and nasal
patency in humans. Life Sciences, 38, 1203-1214.
Mann, C.A., Lubar, J.L., Zimmerman, A, W., Miller, C.A., Muenchen, MS. (1991). Quantitative analysis of EGG in boys with
attention deficit hyperactivity disorder controlled study with clinical implications. Paediatric Neurology, 1, 30-36.
Nagendra, H.R., Mohan, T., Shriram, A. (1998). Yoga in education. Vivekananda Kendra Yoga Prakashan. Bangalore India
Naveen, K.V., Nagarathna, R., Nagendra, H.R. & Telles S.(1997). Yoga breathing through a particular nostril increases spatial
memory scores without lateralised effects. Psychological Report, 81, 555–561.
Plizska, S.R., Maas, J.W., Javors, M.A., Rogeness, G.A. & Baker, J. (1994). Urinary catecholamines in attention deficit
hyperactivity disorder with and without comorbid anxiety. Journal of the American Academy of Child and Adolescent
Psychiatry, 33(8), 1165-1173.
Rauhala, E, Alho, H., Hanninen, O. & Helin, P. (1990.) Relaxation training combined with increased physical activity lowers
the psychophysiological activity in community home boys. International Journal of Psychophysiology, 10, 63-68.
Saraswati, S.S. (1983). Asana, Pranayama, Mudra, Bandha. Bihar School of Yoga, Munger, Bihar.
Tannock, R., Ickowicz, A. & Schachar, R. (1995). Differential effects of methylphenidate on working memory in ADHD
children with and without comorbid anxiety. Journal of the American Academy of Child and Adolescent Psychiatry, 34
(7), 886-896.
Telles, S., Nagararthna, R.& Nagendra, H. (1994). Breathing through a particular nostril can alter metabolism and
autonomic activities. Indian Journal of Physiology, Pharmacology, 38(2), 133-137.
Zametkin, A., Nordahl, T.& Gross, M. (1990) Cerebral glucose metabolism in adults with hyperactivity with childhood
onset. New England Journal of Medicine, 323, 1361-1366.
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