Ongoing Tai Chi Training for Children With ADHD
| Status: | Enrolling by invitation |
|---|---|
| Conditions: | Psychiatric, ADHD |
| Therapuetic Areas: | Psychiatry / Psychology, Other |
| Healthy: | No |
| Age Range: | 8 - 15 |
| Updated: | 10/14/2018 |
| Start Date: | November 2, 2017 |
| End Date: | December 2022 |
Effects of Ongoing Movement-Based Mindfulness Training for Children With ADHD
Attention Deficit Hyperactivity Disorder (ADHD) has tremendous individual and societal
impact, and the effectiveness of current standard treatments is limited. Thus, there are
potential public health benefits for novel behavioral training programs that could remediate
the core features of ADHD and contribute to sustained improvements in behavioral control.
There is mounting evidence that children with ADHD show difficulties with motor control, and
that these motor deficits are strongly associated with the core behavioral features of ADHD.
Based on this information, the CNIR initiated a feasibility trial of a movement-based
intervention, utilizing Tai Chi practice, targeting improved behavioral control through
engagement of the motor system and results are highly promising. The investigators therefore
will employ an extension of our ongoing Tai Chi programs for children with ADHD, beginning
with children who have already completed one of the previous Tai Chi sessions. This program
will provide the basis for studying the long-term effects of mindful movement, as well as
creating a foundation for exploring the way that such interventions can be expanded into a
more realistic support setting for the community.
Hypothesis: After participating in the ongoing Tai Chi program, children with ADHD will show
improvements in behavioral measures of motor, cognitive, and attentional control. The
investigators further expect movement-based training will result in decreases in ADHD symptom
severity.
impact, and the effectiveness of current standard treatments is limited. Thus, there are
potential public health benefits for novel behavioral training programs that could remediate
the core features of ADHD and contribute to sustained improvements in behavioral control.
There is mounting evidence that children with ADHD show difficulties with motor control, and
that these motor deficits are strongly associated with the core behavioral features of ADHD.
Based on this information, the CNIR initiated a feasibility trial of a movement-based
intervention, utilizing Tai Chi practice, targeting improved behavioral control through
engagement of the motor system and results are highly promising. The investigators therefore
will employ an extension of our ongoing Tai Chi programs for children with ADHD, beginning
with children who have already completed one of the previous Tai Chi sessions. This program
will provide the basis for studying the long-term effects of mindful movement, as well as
creating a foundation for exploring the way that such interventions can be expanded into a
more realistic support setting for the community.
Hypothesis: After participating in the ongoing Tai Chi program, children with ADHD will show
improvements in behavioral measures of motor, cognitive, and attentional control. The
investigators further expect movement-based training will result in decreases in ADHD symptom
severity.
Persistent poor outcomes for individuals with ADHD make it imperative to explore intervention
approaches beyond medication, particularly interventions that could provide sustained
improvements in control of hyperactive, impulsive and distractible behavior. Two lines of
evidence converge to support a movement-based mindfulness training intervention as a
potential stand-alone or adjunct treatment for the treatment of ADHD symptoms. First, decades
of research, including from the CNIR, has established that many children with ADHD show
impairments in motor control that parallel impairments in behavioral and cognitive control.
Second, there is mounting evidence that movement-based mindfulness interventions are
effective for enhancing behavioral control in adults, although there has been limited
examination in children. Pediatric applications of mindful movement training remain
under-utilized and under-investigated. Critically, there is currently no solid evidence
regarding the long-term effects of mindfulness-based approaches for children with
developmental challenges. By engaging in extended practice, the investigators expect to
effect more readily quantified changes in motor system targets that mediate changes in
cognitive ADHD symptoms. These lines of evidence suggest an outstanding opportunity for
development of long-term novel treatment approaches for ADHD through engagement of the motor
system.
In this application the investigators propose to examine the efficacy of a specific
movement-based mindfulness intervention for children with ADHD - Tai Chi. This approach was
chosen for a number of reasons: 1) extensive documentation in the research literature, 2)
engagement afforded by a martial approach to mindful movement, and 3) scalability given the
existing availability of Tai Chi instruction in the United States and the ease of performing
gentle Tai Chi movements even in the presence of physical limitation. The CNIR has evaluated
the impact of Tai Chi training on specific motor behavioral (e.g., motor overflow, motor
impersistence) and physiologic (TMS assessment of SICI) measures, as well as direct measures
of clinical severity. Interestingly, while robust changes in ADHD symptoms have been
observed, motor system targets have proven more challenging to characterize via laboratory
methods in spite of obvious development of proficiency in tai chi movement skills. The
investigators will therefore engage in a follow-on intervention of greater duration that may
help elucidate changes that were difficult to detect following an initial 8-week tai chi
intervention. By extending the intervention, markers useful in targeting and monitoring
intervention may be better identified, with the overarching long-term goal of optimal use of
Tai Chi and other movement-based approaches to help children with ADHD gain increased control
of impulsive, hyperactive, and distractible behavior. The results of this investigation will
lay the groundwork for future clinical trials evaluating movement training as an effective
intervention for ADHD that could bolster (supplement) or even replace current standard
treatments.
Overview of intervention
Tai Chi is a form of exercise with a variety of components and a strong cultural tradition.
In consultation with experienced teachers of Tai Chi, the investigators have received
consistent feedback that "martial applications," and specifically push hands, will likely be
a valuable component of training for children with high distractibility. Central to the
martial practice of Tai Chi is a collaborative game called "Push Hands," in which partners
attempt to push one another off balance without the use of strong effort. Push hands, and
other Tai Chi inspired "games" will be used to motivate engagement in slower, more focused
movement training: Tai Chi warm-up, postural and breathing exercises, and a section of a Tai
Chi form. These components are expected to collectively drive learning and development of
behavioral control in the motor domain, with high potential for impact on other features of
ADHD.
The mindful movement instructors have extensive experience with youth instruction, as well as
a keen understanding of the relationships between Tai Chi and other mindful movement
practices (i.e. yoga). An assistant instructor will additionally be engaged to assist with
maintaining class focus. All instructors will be certified for ethical treatment of human
subjects, as well as standards for youth physical education. Sessions will be held in an
athletic facility on the Kennedy Krieger Institute (KKI) Greenspring campus. The athletic
facility was designed and equipped for children with a range of abilities as part of the LEAP
Program (Life-skills and Education for Students with Autism and other Pervasive Behavioral
Challenges). It is advantageously located on a campus that is very convenient for most
Baltimore area families. The facility moreover has a high-impact floating rubber floor. This
environmentally friendly and slip-resistant flooring provides cushioning, which reduces
fatigue and potential for injury to the participants during physical activities.
Recruitment and testing
Participants will be recruited on a continuous and ongoing basis. During the intervention
training, children will participate in the movement-based Tai Chi training for one hour twice
a week. Up to ten students will participate per class. Students' families will be allowed to
participate in the Tai Chi training & will therefore cap the total amount of people at each
class at 20. It is expected that some students will be unable to successfully complete the
study. Enrollment procedures will be adapted if necessary. As per the "intent to treat"
approach, children will be included in primary analyses irrespective of adherence to protocol
(i.e., attendance). However, children may be requested to leave the class if their absence
becomes disruptive.
Pre-intervention data collection will occur at the start of participation in the
intervention. Further data collection will continue on a rolling basis with expected data
collection every six months following at a Kennedy Krieger Institute facility. In total, it
is anticipated that 50 participants complete the training and data collection.
approaches beyond medication, particularly interventions that could provide sustained
improvements in control of hyperactive, impulsive and distractible behavior. Two lines of
evidence converge to support a movement-based mindfulness training intervention as a
potential stand-alone or adjunct treatment for the treatment of ADHD symptoms. First, decades
of research, including from the CNIR, has established that many children with ADHD show
impairments in motor control that parallel impairments in behavioral and cognitive control.
Second, there is mounting evidence that movement-based mindfulness interventions are
effective for enhancing behavioral control in adults, although there has been limited
examination in children. Pediatric applications of mindful movement training remain
under-utilized and under-investigated. Critically, there is currently no solid evidence
regarding the long-term effects of mindfulness-based approaches for children with
developmental challenges. By engaging in extended practice, the investigators expect to
effect more readily quantified changes in motor system targets that mediate changes in
cognitive ADHD symptoms. These lines of evidence suggest an outstanding opportunity for
development of long-term novel treatment approaches for ADHD through engagement of the motor
system.
In this application the investigators propose to examine the efficacy of a specific
movement-based mindfulness intervention for children with ADHD - Tai Chi. This approach was
chosen for a number of reasons: 1) extensive documentation in the research literature, 2)
engagement afforded by a martial approach to mindful movement, and 3) scalability given the
existing availability of Tai Chi instruction in the United States and the ease of performing
gentle Tai Chi movements even in the presence of physical limitation. The CNIR has evaluated
the impact of Tai Chi training on specific motor behavioral (e.g., motor overflow, motor
impersistence) and physiologic (TMS assessment of SICI) measures, as well as direct measures
of clinical severity. Interestingly, while robust changes in ADHD symptoms have been
observed, motor system targets have proven more challenging to characterize via laboratory
methods in spite of obvious development of proficiency in tai chi movement skills. The
investigators will therefore engage in a follow-on intervention of greater duration that may
help elucidate changes that were difficult to detect following an initial 8-week tai chi
intervention. By extending the intervention, markers useful in targeting and monitoring
intervention may be better identified, with the overarching long-term goal of optimal use of
Tai Chi and other movement-based approaches to help children with ADHD gain increased control
of impulsive, hyperactive, and distractible behavior. The results of this investigation will
lay the groundwork for future clinical trials evaluating movement training as an effective
intervention for ADHD that could bolster (supplement) or even replace current standard
treatments.
Overview of intervention
Tai Chi is a form of exercise with a variety of components and a strong cultural tradition.
In consultation with experienced teachers of Tai Chi, the investigators have received
consistent feedback that "martial applications," and specifically push hands, will likely be
a valuable component of training for children with high distractibility. Central to the
martial practice of Tai Chi is a collaborative game called "Push Hands," in which partners
attempt to push one another off balance without the use of strong effort. Push hands, and
other Tai Chi inspired "games" will be used to motivate engagement in slower, more focused
movement training: Tai Chi warm-up, postural and breathing exercises, and a section of a Tai
Chi form. These components are expected to collectively drive learning and development of
behavioral control in the motor domain, with high potential for impact on other features of
ADHD.
The mindful movement instructors have extensive experience with youth instruction, as well as
a keen understanding of the relationships between Tai Chi and other mindful movement
practices (i.e. yoga). An assistant instructor will additionally be engaged to assist with
maintaining class focus. All instructors will be certified for ethical treatment of human
subjects, as well as standards for youth physical education. Sessions will be held in an
athletic facility on the Kennedy Krieger Institute (KKI) Greenspring campus. The athletic
facility was designed and equipped for children with a range of abilities as part of the LEAP
Program (Life-skills and Education for Students with Autism and other Pervasive Behavioral
Challenges). It is advantageously located on a campus that is very convenient for most
Baltimore area families. The facility moreover has a high-impact floating rubber floor. This
environmentally friendly and slip-resistant flooring provides cushioning, which reduces
fatigue and potential for injury to the participants during physical activities.
Recruitment and testing
Participants will be recruited on a continuous and ongoing basis. During the intervention
training, children will participate in the movement-based Tai Chi training for one hour twice
a week. Up to ten students will participate per class. Students' families will be allowed to
participate in the Tai Chi training & will therefore cap the total amount of people at each
class at 20. It is expected that some students will be unable to successfully complete the
study. Enrollment procedures will be adapted if necessary. As per the "intent to treat"
approach, children will be included in primary analyses irrespective of adherence to protocol
(i.e., attendance). However, children may be requested to leave the class if their absence
becomes disruptive.
Pre-intervention data collection will occur at the start of participation in the
intervention. Further data collection will continue on a rolling basis with expected data
collection every six months following at a Kennedy Krieger Institute facility. In total, it
is anticipated that 50 participants complete the training and data collection.
Inclusion Criteria:
- Children must meet diagnostic criteria for ADHD, based on information from previous
participation in "Movement-Based Mindfulness Training for Children with ADHD: A
Feasibility Study." Additionally, children must meet criteria on the parent and
teacher Conners-3
- Comorbid oppositional defiant disorder (ODD) and anxiety disorders are permitted
- Stimulants, psychoactive medications, or no medication are allowed
Exclusion Criteria:
- diagnosis of Intellectual Disability, Developmental Language Disorder, Reading
Disability, or Autism (screened for using the Social Competence Questionnaire (SCQ)
- neurologic disorder (e.g., epilepsy, cerebral palsy, traumatic brain injury, Tourette
Syndrome)
- documented hearing impairment ≥ 25 dB (decibel) loss in either ear.
- a Full Scale IQ (Intelligence Quotient) score on the WISC-IV (Wechsler Intelligence
Scale for Children) below 80
- a standard score below 85 on the Word Reading Subtest, regardless of IQ score
- foster care
- Female participants will be excluded if they are pregnant or may be pregnant
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