Martial Arts for Adhd

8/3/2019 Martial Arts for Adhd

1/17

ADHD

1

Martial Arts as a Potential Intervention for

Children with Attention Deficit Hyperactivity Disorder

Gregory Moody

Arizona State University

Child Counseling

April 8, 1998

Running head : ADHD


2/17

ADHD

2

Martial Arts as a Potential Intervention for

Children with Attention Deficit Hyperactivity Disorder

Introduction

Interventions for Attention Deficit with Hyperactivity Disorder (ADHD) are varied

both in kind and results. Child counselors will encounter this condition very often in any

practice with children because it is a prevalent problem - diagnosed in as many as 5% of

children. A child is exhibiting this behavior when they display inappropriate degrees of

inattention, impulsiveness and hyperactivity. (APA, 1994) Though most children display

this behavior to one degree or another depending on age, some require special

treatment to be able to function in the school system or at home and with their peers.

Both pharmacological and behavioral treatments are used, each having some success

and failure. We will examine the treatments currently being used and hypothesize that

attending a martial arts program may have some success as an alternate treatment. To

this end, we will examine diagnosis of ADHD, treatments currently being used (both

chemical and physical), and cross reference the treatments to decide whether further

research is warranted.

Diagnostic Features of ADHD - What Are We Looking At?

ADHD diagnosis is difficult because many of the ADHD symptoms may be

present in all kids to some degree (Essex & Schifani, 1992). It is very often

misdiagnosed as a learning disability, or even not diagnosed at all. Often parents say

Dont worry, shell outgrow it or Hes just being a boy. (Campbell, 1985, p. 3).


3/17

ADHD

3

Familiarity with the diagnostic criteria will also be helpful with those children who do not

fit the ADHD model completely (though the fourth revision of the DSM includes more

varied diagnosis options).

To diagnose Attention Deficit/Hyperactivity Disorder, the child must display a

persistent pattern of inattention and/or hyperactivity that is more frequent and severe

than is typically observed in individuals at a comparable level of development. Some of

these symptoms must be present before age 7, and some impairment from these

symptoms must occur in at least 2 settings (e.g. school and home). In addition, there

must be clear evidence of interference with developmentally appropriate academic,

social or occupational functioning. The problem must not occur exclusively during the

course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic

Disorder and are not better accounted for by another mental disorder (APA, 1994).

There are 3 subtypes of ADHD listed in the DSM-IV:

Predominately Inattentive Type: displays less hyperactive

symptoms.

Hyperactive-Impulsive Type: displays mostly hyperactive

symptoms and has fewer problems with attention

Combined Type: This is a patient that displays serious

symptoms of both hyperactivity and inattention. (APA, 1994).

Associated features of the disorder vary as a function of age. These include low

self-esteem, mood changes, low frustration tolerance and temper outbursts. These

students tend to do poorly in school. The course of the disorder varies considerably.


4/17

ADHD

4

Sometimes ADHD as a child can manifest problems later in adulthood or they may be

outgrown (APA, 1994).

Cause of ADHD

There are many suggested causes of ADHD - they are mostly physiological in

nature. Some suggest genetics such as a problem with chromosomal anomaly like an

extra Y chromosome in boys, and in girls the lack of their second X chromosome.

Another genetic based disorder, Neurofibromatosis (NF), which is not more prevalent in

either sex, may be related. Behavioral studies of parents of children with ADHD

revealed that a family history of the disorder is four times as common in parents of

children with ADHD than otherwise. There may be some prenatal causes such as

prolonged oxygen deprivation, extreme prematurely, intraventricular hemorrhages, and

hydrocephalus has been linked to later behavioral problems such as these. The most

common belief is that it is a neurological problem. Information moves through the brain

because nerve impulses are transmitted from cell to cell by neurotransmitters.

Neurotransmitters cause some nerve cells to fire while inhibiting others from firing. When

these are not working properly, various behaviors may result. Current research is

focused on the portions of the brain that may be related to ADHD. The present evidence

suggests that while it cannot be concluded that allchildren with ADHD have observable

evidence of neurological dysfunction, the accumulation of the data from the genetic,

biochemical, neurobehavioral, and neuroimaging studies strongly suggest that there is a

neurological cause in most children. While sugar and/or food additives have long been

proposed as a cause of ADHD, there is little or no documented effect on the behavior of

ADHD children (Hynd, Hern, Voeller & Marshall, 1991).


5/17

ADHD

5

ADHD Testing and Screening

Though the criteria for diagnosis are listed above (and in great detail in the

DSM-IV), screening for ADHD is not easy because it is a very complicated disorder that

manifests itself in many ways. There are many different assessment tools and none are

perfect - they have varying properties based on counselor involvement, length of test

and who is providing the information (parent, child, teacher, psychologist) There are 3

main categories of assessment:

1. Clinical Interviews. Barkley (1990) lists questions and formats for a

clinician doing a diagnosis. This is time consuming and requires a lot of

counselor participation.

2. Behavior Rating Scales. These scales are used to assist in the

evaluation of ADHD kids. They are efficient, and have reasonable reliability

(as high as .89). (Barkley, 1990, p. 296). There is considerable debate over

the results of the scales so they should be carefully applied and understood

from a psychometric perspective. (Power & Ikeda, 1996)

3. Tests and Observational Measures. These methods include the

Continuous Performance Test (CPT), the Freedom from Distractibility Factor

of the WISC-R, and many others. Some of these are tests developed for

other purposed and normed on and ADHD population. (Barkley, 1990)

All of these tests have pros and cons that must be considered when choosing an

assessment method for counseling, treatment or research.


6/17

ADHD

6

Prevalence of ADHD / Typical Clients with ADHD

ADHD is one on the most common behavior disorders we can see in children. It

is one of the most frequent reasons children are referred to mental health clinics in the

United States, accounting for as many as 50% of all child referrals to outpatient mental

health clinics. (Frick & Lahey, 1991, p. 163). As stated above, the DSM-IV states that

prevalence is estimated at 3%-5% in school-age children. (APA, 1994) (Note that the

1987 revision listed at only 3%) Some experts believe that it may be as high as 20%

(Taylor, 1990). It is estimated that 5 to 10 times as many boys exhibit this behavior as

girls (Hynd et al., 1991) though some studies have shown that girls dont appear as

frequently because they are not as flagrantly active or aggressive as their male

counterparts and are thus less likely to be referred for evaluation. (Hynd et al., 1991, p.

178)

Treatments - Medical and Psychological

While we are more interested in behavioral techniques to work with ADHD kids,

we need to be intimately aware of the medical interventions being used because they

effect the behavioral interventions that may be used. What follows is a summary of both.

Drug Treatments

The prescription of psychostimulant medications is the most frequent treatment

for ADHD, with approximately 750,000 children receiving these drugs annually. It may

seem paradoxical that the hyper children are prescribed stimulants, but these particular

drugs have been found to stimulate the parts of the brain that seem to be related to the


7/17

ADHD

7

disorder. The three most commonly employed are Ritalin, Dexedrine, and Cylert (listed

by brand names) with Ritalin (methylphenidate) accounting for more than 90% of these.

About 70 to 80% of the children treated with psychostimulants respond positively, while

the remainder require alternative medications such as antidepressants (DuPaul, Barkley

& McMurray, 1991). When the inattention and motor over-activity associated with ADHD

are diminished due to medication, learning difficulties are equally attenuated (Hynd et

al., 1991). When we have a student who is on medication we must be prepared to adapt

to their level of functioning due to the ADHD, the drugs helpful effects and the

challenges presented due to unwanted side effects.

Behavioral Treatments

These interventions are very important even if a student has responded

positively to medication. Behavioral methods often help us work with kids who may

otherwise be able to absorb little information. In addition, most of these strategies work

with kids without ADHD - allowing the teacher to be fair and consistent in the classroom.

One method is to work with adjusting the environment the student perceives. Some of

these require modification of the class environment such as seating or standing

arrangements or characteristics of the task (e.g., do activities along with other fun

games, instead of repetitive, boring tasks). More easily applied strategies are also used.

Contingent teacher attentionconstitutes the most universally employed set of classroom

management techniques. Frequent verbal feedback (both positive and negative), and

non-verbal feedback such as frowns, smiles and pats of approval are frequently used.

Classroom token economieswhere tokens or points are awarded to be exchanged later

for prizes, activities, or privileges, have been well documented as being excellent ways


8/17

ADHD

8

to motivate youngsters (ADHD and non-ADHD alike). These may or may not include loss

of the prizes, activities, or privileges when the student demonstrates inappropriate

behavior. A way to get parents involved is to agree on a checklist of behavioral goals

that the instructor can send home with the child to be signed by the parent. Then the

parent can provide appropriate reinforcement at home. Another method is the time-out

period where a student is removed from the group activity for a period of time. These

environmental modifications and reinforcements have been shown to be effective

(Abramowitz and OLeary, 1991).

Cognitive behavioral interventions teach students how to be their own managers

of behavior. These are broken down into two categories that teach self-monitoring and

self-reinforcement, and those that involve cognitive skills such as self-instruction and

problem solving. Self monitoring strategies teach children to observe their own behavior

while self-reinforcement involves teaching children to reward themselves based on the

self-monitoring. These are taught at the end of a token economy strategy to promote

maintenance of the idea (could also be at the end of a session where the student needs

to go home and continue to behave). With the self-instruction method, the student is

taught metacognitive skills to follow a series of steps in approaching a task (such as

repeating the instructions back, verbalizing how they may attempt the task, thinking

about the consequences of the approach, deciding how to proceed, performing the task,

reflecting upon their performance, and evaluating their own performance of the task).

Then these are changed to covert self-instructions through rehearsal. These may

provide promise that the student may learn to control their behavior on their own

(Abramowitz and OLeary, 1991).


9/17

ADHD

9

Comparing Suggested ADHD Interventions with Taekwondo Curriculum

Our hypothesis is that a good martial arts program will provide behavioral

interventions similar to the ones generally accepted as helpful to ADHD kids, and, in

addition, become itself an intervention that can help these children perform better in their

everyday lives. The system we will compare is called Karate for Kids . This is a

standardized method of teaching the martial art of Taekwondo in a structured and fun

way, developed by the American Taekwondo Association (ATA), and is being used in

over 800 locations around the United States. It is the largest single style martial arts

association in the world. (Lee, 1993) First we will describe the features of the Karate for

Kids program that apply to any child taking Taekwondo. Then we will use a table to

compare by cross-referencing the behavioral interventions suggested above to the

methods used.

Features of Karate for Kids

The features of the Taekwondo program are based on the concept that each

student is different and has different needs. Different methods are used to teach

students many things that will apply after the lesson is over. The building blocks for this

are based on 12 themes that are integrated into classes such as goal setting, self

control, courtesy, integrity, friendship, confidence, self awareness, self esteem,

perseverance, self improvement, respect, and dedication.

The instructors use the following 10 class management ideas in each class:

Set Mood and Tone of Class Create Positive Climate


10/17

ADHD

10

Use a Personal Approach Set Direct Goals

Give Thoughtful Feedback to Student Response Reinforce Positive Behavior

Give Realistic Praise Use Positive Correction Instead of Criticism

Refer to Student by Name Teach Concept of Personal Victory

Each child wears a V patch on their uniform. This signifies personal victory. Personal

victory means that their achievement is relative to them - not being better than their

peers. On this patch they put small star patches. Blue stars signify great performance in

class, at home or at school. Red stars are given when a child has to perform in public

(i.e. competition, oral book report, etc.). Gold stars are awarded when a child has great

school achievement.

A typical day will begin with a class bowing to show respect and self control. The

bow is also a promise not to hurt other people. The student says their student oath :

Each Day I Will Live By Honoring My Parents And Instructors, Practicing To The Best

Of My Abilities, And By Having Courtesy And Respect For Everyone I Meet. This is

discussed and provides a philosophy for how the student is expected to be in class and

everywhere.

During the main part of class, the student will be given positive feedback when

they are demonstrating not only the physical moves they are learning, but also when

they are following directions, staying on task, treating other students and instructors with

respect and by having a good attitude. Negative feedback (i.e. verbal, frowns, time outs,

etc.) are used occasionally as well. Positive feedback will come in many forms such as


11/17

ADHD

11

verbal recognition, stickers (happy faces, dragons, etc.), having a student lead class and

special written awards that are later exchanged for bigger awards.

The end of class contains an awards presentation where kids collect their stars

for their performance at home, at school, and in their martial arts class. These awards

are primarily to reinforce behavior outside of the martial arts school. In this way the

activity reaches into many areas of a childs life.

Cross Referencing Behavioral Interventions for ADHD with the Karate for Kids Program

See Table 1.


12/17

ADHD

12

Table 1 - Cross reference of Typical Behavioral Interventions and Karate for Kids


13/17

ADHD

13

Behavioral Method Suggested Above Taekwondo Equivalent Description

Adjusting the Students Environment Facility has specific layout for every class designed to provide consistency

and teach responsibility (student helps keep it straightened).

Contingent Teacher Attention Appropriate and Consistent Positive and Negative feedback.

Classroom token economy The star system does this on 2 levels. Direct award of stars when a student

meets the requirements (schoolwork, etc.), and students may get Karate for

Kids Papersthat have whatever positive thing they did written on it. If they

save 5 they get a Blue star patch.

Checklist of Behavioral Goals Students do a Karate for Kidsreport card for a week. They turn it in and get a

blue star in front of class, as well as verbal recognition from the instructor .

Time Out Used as well

Behavioral Method Suggested Above Taekwondo Equivalent Description

Self-Monitoring / Self-Reinforcement Students take responsibil ity for their behavior, their equipment, and their

appearance. This is tied in with the star system and the report card they do.

They discuss the parts of the report card that they are going to improve on,

and the parent makes sure they do it (otherwise the parent does not sign the


14/17

ADHD

14

card). This promotes maintenance of the philosophy at home.

Self Instruction In the process of learning, the student is taught how they can most effectively

learn. How to break done moves into pieces so they can learn. In addition, as

students progress, they learn how to help other students. This helps them

think about how to learn independently (they have to relate to how others think

and thus how they think). Many feel this will be translated to performance at

school and home.


15/17

Conclusions

We have discussed the causes, diagnosis, prevalence and treatment of ADHD.

While counselors clearly should be familiar with the effects of drug therapy on kids,

behavioral interventions are effective both in conjunction with drug treatments and on

their own. The Karate for Kidsprogram performs most of the interventions suggested for

ADHD. In addition, it works on extending the positive behaviors to school and home by

rewarding projects done in these other arenas. This causes both the student and the

parent to do, report and recognize good behavior on a regular basis. Considering all of

the similarities between the behavioral treatments and martial arts classes, I conclude

that it is very likely that a study would support the hypothesis that a good martial arts

program is an effective behavioral intervention for kids with moderate to severe cases of

ADHD.


16/17

Reference

Abramowitz, A. J., & OLeary, S. G. (1991). Behavioral Interventions for the Classroom:

Implications for Students with ADHD. School Psychology Review, 20, 2, 220-

234.

American Psychiatric Association. (1987). Diagnostic and Statistical Manual of Mental

Disorders (3rd ed., rev.). Washington, DC: Author.

American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental

Disorders (4th ed). Washington, DC: Author.

Barkley, R. A. (1990). Attention Deficit Hyperactivity Disorder: A Handbook for

Diagnosis and Treatment . New York: The Guilford Press.

Campbell, S. B. (1985). Early Identification and Follow-up of Parent-Referred

Hyperactive Toddlers. in L. M. Bloomingdale (Ed.), Attention Deficit Disorder:

Identification, Course and Treatment Rationale (pp. 1-16). New York: Spectrum

DuPaul, G. J., Barkley, R. A., & McMurray, M. B. (1991). Therapeutic Effects of

Medication on ADHD: Implications for School Psychologists, School Psychology

Review, 20, 2, 203-219.

Essex, N. L. & Schifani, J. (1992). Attention Deficit Disorder and the Principal, Principal,

71, 4, 30-32.

Frick, P. J., and Lahey, B. B. (1991). The Nature and Characteristics of Attention-Deficit

Hyperactivity Disorder, School Psychology Review, 20, 2, 163-173.

Hynd, G. W., Hern, K. L. Voeller, K. K. & Marshall, R. M. (1991). Neurobiological Basis

of Attention-Deficit Hyperactivity Disorder (ADHD), School Psychology Review,

20, 2, 174-183.


17/17

Lee, H. U. (1993). The Way of Traditional Taekwondo, Little Rock, AR: American

Taekwondo Association.

Power, T. J., & Ideka, M. J. (1996). The Clinical Utility of Behavior Scales: Comments

on the Diagnostic Assessment of ADHD. Journal of School Psychology, 34, 4,

379-385.

Schaughency, E. A. and Rothlind, J. (1991). Assessment and Classification of Attention

Deficit Hyperactive Disorder, School Psychology Review, 20, 2, 187-201.

Taylor, J. F. (1990). Helping Your Hyperactive Child. Rocklin, CA: Prima Publishing &

Communications.

Documents

Martial Arts for Adhd