Some people tend to think of the mind and the body as being separate, but they are not. The brain and the body are in constant, dynamic communication. Mind–body practices include a wide variety of techniques that combine physical and mental activities. Although many different schools have evolved, in this chapter we use the general term yoga to include them all. The following example shows how a very simple practice called coherent breathing solved the problems of inattention, school failure, anxiety, and inability to sleep in a child with ADD (inattentive type).
Like his father, Alex had the inattentive type of ADD. Like his mother, he had generalized anxiety disorder. He would get extremely anxious under pressure, such as when taking tests or having to give a talk in front of the class. His parents were determined not to put him on medication because they were concerned about side effects, and he seemed to be doing well enough. Since Alex was not hyperactive, he was generally well behaved, cooperative, and sociable. In the lower grades he was able to pick up enough information in class and dash off small amounts of homework well enough to get by. However, the more demanding curriculum in fourth grade was overwhelming. He could not focus or sustain his attention long enough to complete reading or writing assignments. Although math had been his best subject, having to read word problems now became an insurmountable obstacle. Being unprepared for classes and tests set off anxiety to the point where his stomach ached. He could not sleep at night because he was worrying about school the next day. A trial of biofeedback (see Chapter 6) was of no help.
Alex’s mother turned to Dr. Brown for advice. He taught her a calming breath practice, coherent breathing, and she then taught Alex so that they could practice together at home. They listened to a CD with chime tones that timed their breathing to five breaths per minute. The first time he tried it, Alex felt calmer. He began by practicing with his mother, but soon learned to use the CD himself every night at bedtime. One month later, Alex’s mother checked with Dr. Brown to see if it was all right that he was breathing with the CD for an hour at bedtime. His anxiety was much better during the day, and he was sleeping well at night. Since Alex really liked doing coherent breathing and it seemed to be helping, Dr. Brown suggested that she just let him continue and see what would happen. With no other interventions, over the next 3 months Alex felt better and better. With improved focus, he could study, finish assignments, and do well on tests. Free from anxiety, he was able to sleep at night. Alex felt a lot better about going to school and about coming home with the A’s and B’s he deserved.
In Chapters 1 and 2, we discussed the symptoms of ADHD, inattention, hyperactivity, and impulsivity, as well as hypoarousal, reward deficiency, and emotional self-regulation problems. Mind–body practices can be extremely helpful for all of these symptoms of ADHD. Yoga practices that improve alertness, attention, mental clarity, calmness, emotional self-regulation, physical self-control, and awareness of oneself and others are beneficial for children and adults with ADHD.
When people think of yoga, they tend to visualize people holding odd poses or postures, but yoga began as a complete system for physical, mental, and spiritual development. Many of the more popular schools of yoga, such as Kripalu, Shambhala, Iyengar, Kundalini, Ashtanga, Anusara, Shanti, and Sudarshan Kriya, stem from the “eight limbs of yoga” described by Patanjali (200 C.E.). The eight limbs (Feuerstein, 1998) included:
1. Ethical and moral standards
2. Study of scriptures
3. Physical yoga postures with meditation on the body to experience the self
4. Yoga breathing techniques
5. Turning attention away from the senses toward the inner world of self-experience
6. Concentration to focus attention
7. Meditation with mental clarity and total calmness
8. The happiness that occurs when one is reunited with the true self, universal energy, or the divine.
Modern yoga studios often focus on the physical aspects, mainly yoga postures, which can be beneficial, but there is much more to be gained if we mine the wisdom of thousands of years of yogic evolution.
Yoga was and is a science of the mind. Picture the ancient yogis sitting hour after hour, day after day, year after year. What were they doing? They were experimenting, trying different ways to alter the functioning of their minds through body movements, breathing, and meditation. In the process, over thousands of years, they discovered myriad ways to change how their minds and bodies worked. For example, they could change their heart rate or their ability to tolerate pain (think of those beds of nails and the hot coals). They could change their mental focus, how thoughts flowed, their emotional reactions, and their state of consciousness. Modern scientists have discovered that adept yogis and Buddhist meditators can change the pattern of their brain waves at will, activate and deactivate parts of their brains, and even influence the development of certain brain structures (Lazar et al., 2005). Many of these ancient practices can be used therapeutically to help the ADHD mind by improving alertness, attention, processing, coherence, integration, impulsivity, over reactivity, mood, and calmness.
Most mind–body programs include some form of movement, breathing, and meditation. There are differences in specific techniques and in the emphasis placed on each of these essential components. Rather than trying to review hundreds of mind–body practices, we focus on a select set that is supported by evidence and that we have found to be particularly beneficial in working with people who have ADHD, with or without other concurrent diagnoses.
Starting with movements helps to release the physical tension, frustration, and excess energy that tend to build up in people with ADHD. Maintaining yoga postures and redirecting attention to physical sensations experienced during these postures improves attention, self-awareness, and physical self-control. Performing the postures slowly helps the individual learn to slow down, gain control over physical actions, and improve balance and motor skills. Synchronizing movements with breathing enhances the effects. In general, we breathe in with rising movements and breathe out with descending movements.
Although intense physical yoga can provide many health benefits, yoga programs that entail slow, gentle movements are more beneficial for calming the system and focusing the mind. It is best to learn yoga postures from an instructor. If you cannot get access to yoga classes, there are many DVD programs. The Namaste Yoga television program is a good example of calming practices.
In the section below on yoga programs in schools we describe and illustrate a set of basic movements and postures suitable for children and adults. We recommend starting yoga with movement practices, especially for people with ADHD who need to reduce their level of restlessness in order to relax. See the Resources section at the end of the chapter for more information.
Specific breathing practices can be used to increase alertness, calm the mind, quiet distracting thoughts, focus attention, reduce anxiety, improve emotion regulation, and improve memory and other brain functions. There are hundreds of different breathing practices. We have selected a few that we find to be easy to learn, rapidly effective, and safe: coherent breathing, resistance breathing, breath moving, and “ha” breath.
The ideal breath rate for balancing the stress response system can vary with age, height, and physical condition. On average, for most adults, it ranges between five and six breaths per minute. Coherent Breathing is simply slow, gentle, relaxed breathing at five to six breaths per minute using equal time for inhalation and exhalation. This special rate also optimizes cardiovascular function and oxygenation (Bernardi, Porta, Gabutti, Spicuzza, & Sleight, 2001). Coherent Breathing is a modern adaptation of ancient practices known to Qigong masters and Zen Buddhist monks. Qigong can be thought of as Chinese yoga. Studies show that for each person there is an optimal breath rate using equal lengths of inspiration and expiration for balancing the stress response system and calming the mind. This breath rate has been used by Paul Lehrer’s research group in a technique called resonant breathing (Song, & Lehrer, 2003; Vaschillo, Vaschillo, & Lehrer, 2006).
The resonant breath rate for most adults and adolescents is between four and a half and six breaths per minute. For people over 6 feet tall, it is about three or three and a half breaths per minute. Coherent Breathing, using a rate of five breaths per minute, falls in the middle of the resonant breath range, and works well for most people over the age of 10. Younger children have higher resonant breath rates depending on their age and size. Formal studies on the optimal breath rates for children have not been published. However, we find that children under the age of 10 can comfortably breathe between 6 and 10 breaths per minute.
How to Learn Coherent Breathing Coherent Breathing is a safe way to reduce anxiety, insomnia, depression, fatigue, anger, aggression, impulsivity, inattention, and symptoms of posttraumatic stress disorder (PTSD). It is easy to learn how to breathe at five breaths per minute by listening to sound tracks on The New Science of Breath Respire 1 CD (see Resources). On one track a voice tells the listener when to breathe in and breathe out. On another sound track the breathing is paced by bell tones. On one bell tone you breathe in and on the next bell tone you breathe out. You can relax, close your eyes, breathe in through the nose and out through either the nose or the mouth, and let the bells pace your breathing. It is important to relax completely and breathe gently and slowly without forcing or straining to get the best results. Eventually, you can learn to breathe at five breaths per minute even without the bell tones. Those who are able to learn resistance breathing (described below) can use the Respire 1 CD for even greater effects.
How to Use Slow Breath Practices Safely Coherent breathing is safe for children, adults of all ages, people with medical illnesses, and during pregnancy. However, some people with severe or acute asthma may find that when they first try to do coherent breathing, their breathing becomes more difficult. If they are taught to add a special modification, called Breath Moving, their airways will remain open and they will breathe more easily. You can learn breath moving by taking one of our Breath∼Body∼Mind workshops. Alternatively, you can learn a basic form of Breath Moving from our book, The Healing Power of Breath (Brown & Gerbarg, 2012).
Also called Ujjayi, victorious breath, or ocean breath, resistance breathing uses a slight contraction of the upper throat muscles to produce a sound like the ocean while breathing through the nose. This increases stimulation of the vagus nerve and helps to control the rate of airflow more precisely. Another form of resistance breathing is lip pursing. The pursed lips partly obstruct airflow during exhalation only. In Qigong and in Resonant Breathing, resistance is created by exhaling through pursed lips. It is best to learn resistance breathing from a teacher who can check to be sure you are doing it correctly to avoid straining.
Using the imagination to move the breath in circuits to different parts of the body can be found in Qigong, Hawaiian breathing, yoga, and martial arts. Developed to the highest degree by Russian Orthodox Christian monks, it was used to prepare for “The Jesus Prayer” and to attain deep states of prayer and meditation. The monks also taught breath moving to Christian knights to enhance strength, endurance, and skill while defending the realm from invaders. Traces of these practices are still part of Russian Special Forces training (Vasiliev, 2006).
How to Use Breath Moving Breath moving can be combined with coherent breathing and resistance breathing. It reduces distracting thoughts, improves mental focus, and relieves stress. It is also especially helpful in people who have asthma. When people with asthma first do slow breathing, their initial reaction can be difficulty breathing due to narrowing of the airways. However, when they use the technique of breath moving, this does not occur and they are usually able to perform coherent breathing without difficulty. In the long run, daily practice of these breath techniques improves respiratory function and awareness.
Many traditions use some form of “ha” breathing, that is, forceful exhalations while saying “ha” loudly and sharply. There are many ways to do “ha” breathing. Here is one that is simple and effective.
Stand up straight, bending the elbows, palms pointed upward, curve the fingers into a loose fist (see Figures 5.1 and 5.2). Inhale breath deeply through the nose while retracting the elbows behind the back, palms facing upward, hands in fists. As you exhale sharply, say the sound “ha!” loudly, extend the arms and throw the hands forward, letting the palms turn downward as though you are flinging water off the tips of your fingers. Inhale deeply, bending the elbows, palms upward, hands in fists. Exhale sharply with the “ha” sound, repeating the same movements. This should be done briskly at approximately one breath per second. It can be done for 15 repetitions (about 15 seconds) or for up to a maximum of 3 minutes continuously, depending on your physical capacity and on how much is needed to activate your system. For example, it is useful when you need to study or do intellectual work for a prolonged time and find that your mind is getting “fuzzy” or unfocused. This type of breathing will tend to increase mental alertness. For most people we recommend using only short bursts of “ha” breaths, as brief as 30 seconds and no longer than 2 minutes.
Figures 5.1 and 5.2
How to Use Forceful Breathing Practices Safely Rapid breathing with forceful exhalation can immediately improve attention and alertness by stimulating the sympathetic nervous system. This should be done only for very short periods of time, just a few minutes. We described a forceful breathing practice call “ha” breathing above. Another fast, forceful breathing practice, Kapalabhati, is a widely used stimulating practice that can be done at different rates. A study using Kapalabhati for 5 minutes at a rate of 120 breaths per minute in healthy adults showed improvements in attention, concentration, and accuracy on standard testing (Telles, Raghuraj, Arankall, & Naveen, 2008).
Rapid or forceful breathing practices should not be done by people who have uncontrolled hypertension, seizure disorder, asthma, obstructive lung disease, recent surgery, or who are pregnant. Also, rapid breathing can trigger panic attacks in patients with panic disorder, flashbacks in people with PTSD, or manic episodes in those with bipolar disorder. Healthy adults can benefit from Kapalabhati or “ha” breath. However, it is important to learn correct techniques from a qualified instructor and to limit the amount of time doing this practice.
Some of these breath practices are taught in a wide range of yoga and other mind–body courses. All of these practices are included in our Breath∼Body∼Mind programs for reducing stress, anxiety, depression, insomnia, and PTSD. They can also be learned from our book, The Healing Power of the Breath (Brown & Gerbarg, in press).
Breathing techniques can be used in conjunction with other treatments such as stimulant medications. Here is an example of a patient who used coherent breathing and “ha” breath along with medication to successfully overcome the problems caused by her ADHD.
Jenna was in a panic because she was on the brink of failing her first year at a prestigious college. She could not concentrate enough to write her final papers or complete her art projects. She was terribly upset and crying as she told me that her professors thought she wasn’t trying. They didn’t know that she had to lock herself in her room for 10 hours just to write one page of an assignment. Jenna wanted desperately to please her professors and felt deeply hurt that they thought she didn’t care about her work. She had not told them about her ADHD. The constant worry and anxiety made her even more distracted and disorganized.
I (Dr. Gerbarg) asked how she had managed to do well enough in high school to get admitted to such a competitive college. She explained, “My mother always sat at the table while I did my homework. She would explain anything I didn’t understand, keep me focused, and help organize my essays. I had good ideas but I couldn’t express them in writing without her help. They were really my ideas, I’m not stupid. I just needed help to write them down clearly. When I got to college, I just couldn’t do it all myself.”
When I asked whether her family knew she had ADHD, she nodded, “Oh, yes. It’s just that they don’t believe in using medication. Even though I wanted it, they wouldn’t let me. But now, I need it or else I will lose my scholarship and everything.” I agreed to write her a prescription for Adderall because it would work quickly, hopefully in time to salvage her semester, but I also suggested she learn some breath practices. Jenna’s face showed relief and gratitude. I also counseled her to tell her teachers that she was just starting treatment for her ADHD.
Over the next few weeks, Jenna’s concentration got much better. By spending long hours in the studio, she was able to catch up and complete her projects in time to get credit and even praise. Three of her four teachers were very understanding and supportive when they discovered that it was the ADHD and not a lack of motivation that had caused her poor performance. The fourth teacher was unsympathetic, viewing the ADHD as just another excuse. Unlike the other three, he made no accommodations for her problems. They were willing to give her extra time to complete her tests and projects if needed.
Jenna learned to do “ha” breathing before sitting down to study and every few hours whenever she became tired or distracted. “Ha” breathing is energizing; it wakes up the brain and sharpens mental focus. She practiced coherent breathing to the point where she could do it with her eyes open while listening to the chime track on her CD. She used coherent breathing while working on her computer, reading, writing, or even painting. It kept her calm and focused. During vacations, Jenna took a break from Adderall and just used the breath practices as needed. As soon as she had to study or produce work, she resumed her integrative regimen of Adderall combined with coherent and “ha” breathing.
Jenna’s case illustrates the benefits of integrative treatments. If she were living in a different situation, say on a farm in the 1800s, Jenna would not have needed to take Adderall to succeed in planting, harvesting, feeding chickens, milking cows, cooking, etc. But in the 21st-century, heading for a college degree and a competitive career, she needed the medication to fulfill her ambitions. The breathing practices further enhanced her response to the medication by reducing anxiety and distraction to the point where she was able to do challenging intellectual work.
Relaxation techniques and meditation help to calm, balance, and strengthen the nervous system. Meditation and guided imagery can be used to reduce negative thinking and increase self-esteem as well as positive emotions. Many people with ADHD find it difficult to meditate because they cannot focus their mind enough to attain a meditative state. For people interested in meditation, breathing practices and yoga movements may help to settle the mind and bring the person to the threshold of meditation, making it possible for him or her to meditate more easily. ADHD often impairs the ability to relax and to concentrate. By first using movement and breathing to release physical tension and focus the mind, it becomes easier to relax, concentrate, and meditate.
Meditation may involve emptying the mind of all thoughts, focusing the mind on one word or one image, or moving through a series of visualizations. It can be challenging for anyone to empty the mind of all thoughts or to maintain focus on one word or one point—for people with ADHD it can be extremely difficult. We do not recommend these forms of meditation for beginners unless the person is intensely motivated and willing to devote a great deal of time. For the majority of people with ADHD, it is easier to meditate by listening to a teacher or a CD providing a sequence of images, or by shifting the focus to different parts of the body—for example, by tensing and relaxing different muscle groups, by walking while meditating, or by doing a simple body scan (see Brown & Gerbarg, in press). This kind of approach is more dynamic and holds the attention better. Another deeper form of attention practice, called Open Focus Meditation, uses a sequence of mental exercises to develop the ability to shift between a narrow and a wide focus of attention (Fehmi and Robbins, 2007). Maureen Murdock’s (1987) book Spinning Inward contains guided imagery exercises that can be fun for adults as well as children.
Mindfulness uses focused attention to develop awareness of thoughts, feeling, and sensations. Increasing awareness is a first step towards developing the capacity to observe one’s internal reactions without self-criticism rather than being flooded and caught up in those reactions—and to become better able to choose how to respond (Siegel, 2011). Mindfulness is a challenging practice, particularly for people with ADHD in that it requires long periods of maintaining mental focus. By shortening the length of time focusing on each object, it may be easier for people with ADHD to learn these practices. Furthermore, when mindfulness is directed toward enhancing awareness of the body during yoga postures and awareness of the breath during breathing practices, then it serves to increase their effectiveness and prepare the mind for deeper meditation. We think that cultivating the conscious awareness or mindful focus on breath and postures complements the input from sensors that register changes in the internal states of the body (interoceptions) to the brain (see the discussion of interoception below), leading to more powerful and long-lasting effects from the yoga practices. For more information on meditation and mindfulness, see the Resources section.
Q: Do I have to meditate many years to change my brain?
A: No, in fact, brain scans of people who had never meditated before showed that after participating in a mindfulness-based stress reduction program for 8 weeks, there were changes in the concentration of gray matter (reflecting increased density of neurons) in areas of the brain involved in learning, memory, emotion regulation, and perspective taking. These areas included the hippocampus, posterior cingulate cortex, temporoparietal junction, and cerebellum (Hölzel et al., 2011).
While studying the use of yoga for anxiety, depression, and PTSD, we became fascinated with the way breathing can affect the mind. People in extreme states of distress often don’t respond to words—their own or those of other people who are trying to help. When your mind is worrying at warp speed, words such as calm down, relax, don’t worry, or it will be fine won’t make it so. We have to find a different way, a nonverbal way, to communicate with the emotional mind because words do not compute when we are in a state of panic. This is where an alternate network comes into play, the body’s own communication Internet.
Most people know about the five senses: sight, smell, hearing, taste, and touch. But there is another set of internal sensors that contribute to interoception—the perceptions of subtle feelings that come from inside the body, including the sense of heat, cold, vibration, hunger, fullness, pain, cramps, stretching sensations, air hunger (the sense of not getting enough air), and more. Interoception includes everything that occurs within our bodies from moment to moment. There are literally millions of sensors throughout the body that register every little change and send micro-messages through the interoceptive system to tell the brain what’s happening. Most of this information travels through two nerves, the right and left vagus nerves (parasympathetic system). Their branches innervate all organs and tissues of the body, where they pick up messages and carry them directly into the brainstem. These messages pass through relay stations that send them on to the major areas of the brain where they influence our emotions, feelings, perceptions, thoughts, decision-making, and behavior (see Figure 5.3). We could say that interoception provides input from the body that the brain needs to make up its mind about how to feel, how to react, and what to do (Craig, 2003; Critchley, 2005; Porges, 2001).
Figure 5.3 Vagus Nerve Pathways between the Body and the Brain
Information travels up and down through two nerves, the right and left vagus nerves. Their branches innervate all organs and tissues of the body where they pick up messages to carry directly into the brainstem. These messages go through relay stations and are delivered to the major areas of the brain where they influence our emotions, feelings, perceptions, thoughts, decision-making, and behavior.
Suppose the stomach is telling the brain that it’s hungry, and the throat is telling the brain that it’s thirsty, and the lungs are telling the brain that they need air—all at the same time. What will the brain pay attention to first? If your brain chose to listen to your stomach when your lungs needed air, you would be dead within a few minutes. The brain has to listen to what is most critical for survival first—breathing. If we are choking or drowning or suffocating, our brain has to pay immediate attention and devote all of its efforts to getting enough oxygen to survive. Fortunately, the design of our interoceptive system makes sure that the connections between the respiratory system and the brain are very fast and strong. This may be one of the reasons why input from the respiratory system can have profound, rapid effects on how the brain is working.
Breathing is the only autonomic function that most people can control at will. Breathing is usually automatic, but we can easily change the rate, pattern, and depth of our breathing. Breathing is our portal, our way of accessing the interoceptive messaging system and sending the messages we want to send to our brains—messages that reach all parts of the cognitive and emotion regulation centers of the brain—messages that the brain cannot ignore. We can “log onto” the body’s internal Internet and send messages in the form of respiratory information in a nonverbal, body-based language that the brain understands.
When words fail, when logic fails, we can use coherent breathing and other slow breath practices to convince the mind that we are safe, that it is time to stop worrying and just relax. Specifically, slow breathing stimulates the vagus nerves, the main pathways of the soothing, healing, recharging (parasympathetic) part of the nervous system. We can send nonverbal messages through the portal of breath into the parasympathetic and other regulatory systems of the body up to the brain centers that determine how we feel, how we think, and how we react. Because these messages are in the language of the body, the whole brain—even the nonverbal, emotional, unconscious, and automatic parts of the brain—will understand and respond to these messages. This is particularly important for modulating reactions of the autonomic and stress response systems.
The autonomic nervous system, which is responsible for all of the automatic functions of the body, has two main counterbalancing branches involved in stress response and recovery: the sympathetic and the parasympathetic. The sympathetic system drives the stress response. Once the threat is gone, the parasympathetic system soothes the mind and recharges the body. A simple way to think of the sympathetic system is that it gets you ready to fight or run away (fight–flight) when you feel threatened. The sympathetic system developed during a time in the distant past when most of the day was taken up with slow, tedious activities such as gathering nuts and berries. Long periods of sameness were broken up by sudden life-threatening dangers, such as the appearance of a tiger. As soon as we saw that tiger, the sympathetic system turned on and sent messages to increase the heart rate, speed up respirations, and divert blood flow to the muscles of the arms and legs—all preparations for fight or flight. When the danger was over, the sympathetic system turned off and the parasympathetic system turned on, sending messages to slow the heart and respirations, relax the gut, redistribute the blood flow, calm the mind, restore energy reserves, repair any damage to the body, and reduce inflammation. The problem today, particularly for people with ADHD and concurrent diagnoses, is that the autonomic system is often out of balance. One or both branches may be underactive, overactive, slow to react, or erratic.
Q: What are the consequences of imbalance in the stress response system?
A: The short-term consequences involve feeling tense, worried, fearful, overly sensitive, overly reactive, under-reactive, irritable, and fatigued. These imbalances can worsen problems of inattention, cognitive processing, emotion regulation, anger, and sudden aggression. The long-term consequences are acceleration of diseases such as cardiovascular disease and other stress-related conditions (Thayer & Brosschot, 2005).
Q: What kinds of imbalances occur in the stress response system in ADHD and how can we address these problems?
A: The relationship between specific imbalances in the stress response system and ADHD are only beginning to be studied. So far, it appears that different kinds of imbalances in the stress response systems may be associated with different symptoms in people with ADHD.
People with ADHD who experience agitation, aggression, and problems with impulse control tend to benefit from practices that are calming. For example, the activity of the parasympathetic system was studied in children ages 12–17 years, including 17 with ADHD, 20 with aggressive conduct disorder (CD), and 22 who had neither ADHD nor CD. Those with ADHD or CD showed underactivity of their vagal parasympathetic system (Beauchaine, Katkin, Strassberg, & Snarr, 2001). They also had lower thresholds for fight–flight reactions and were at increased risk for aggressive behavior. In other words, it didn’t take much to trigger them to either become combative (fight) or run away (flight). This is an example of a parasympathetic system being too weak to counteract the influence of a sympathetic system in overdrive.
Along these lines, an open pilot study using autonomic nervous system biofeedback (see Chapter 6) found that improvements in symptoms of ADHD correlated with increases in parasympathetic nervous system activity (Eisenberg, Ben-Daniel, Mei-Tal, & Wertman, 2004). In ADHD, the parasympathetic system is underactive, while the sympathetic system can be overactive or erratic (usually underactive, but at times overactive). We usually use calming practices that increase parasympathetic function. However, when a person with ADHD is having difficulty focusing attention on a task, we find that a more stimulating breath practice such as “ha” breath can be helpful. In our treatments we combine coherent breathing, resistance breathing, and breath moving to balance and strengthen the stress response system and to improve symptoms of ADHD.
Numerous studies have found that mind–body practices such as yoga, breathing, and meditation increase activity of the parasympathetic system and decrease activity of the sympathetic system, thus balancing the stress response system (Bernardi et al., 2001; Brown & Gerbarg, 2005a; Raghuraj, Ramakrishnan, Nagendra, & Telles, 1998; Telles, Gaur, Balkrishna, 2009).
Since 1995, a group of researchers in China and the U.S. have been studying integrative mind-body training (IMBT), a program combining body-mind techniques derived from ancient Chinese practices with aspects of meditation and mindfulness. The techniques include body relaxation, breathing adjustment, mental imagery, and mindfulness training with comfortable background music. It is designed to reduce the need the struggle to control thoughts while learning to improve attention and the ability to control stress. Programs are designed for children and adults. In a randomized controlled study of 80 Chinese college students, those who were given a twenty-minute session of integrative mind-body training (IMBT) for 5 days showed greater improvements in attention, self-regulation, and conflict compared to those who were given relaxation training only. The IMBT group also had lower scores on anxiety, depression, anger, and fatigue as well as significant decreases in stress-related cortisol levels (Tang, Yinghua, Junhong, et als., 2007).
A second randomized study of 86 Chinese college students used heart rate variability (a measure of the activity of the parasympathetic and sympathetic systems), electroencephalogram (recordings of brain wave activity) and brain scan (single photon emission computed tomography—SPECT) to evaluate the effects of the 5-day IMBT. Students who were given IMBT showed better regulation of the autonomic nervous system (sympathetic and parasympathetic systems) compared to those given relaxation training only. (Tang, Yinghua, Fan, et al, 2009)
Two small controlled meditation studies on children with ADHD found improvements in attention, particularly in the classroom (Arnold, 2001). These studies were presented as dissertations, but not published in a peer-reviewed journal. While they provide encouraging data, larger studies that have gone through the rigorous scrutiny of the peer review process are needed to provide stronger evidence of efficacy. A review of meditation therapies for ADHD was inconclusive because there were too few studies and most were not of adequate quality (Krisanaprakornkit, et al. 2010). More studies of higher quality would have to be published for the scientific evidence supporting the use of meditation for ADHD to reach a level that would be considered conclusive.
More and more studies are showing that mind–body practice such as yoga, Qigong, and Tai Chi can improve stress, anxiety, mood, and attention (Brown & Gerbarg, 2005b, 2009; Brown et al., 2009; Descilo, et. al. 2010). Evidence indicates that some of the ways that mind–body practices improve attention, cognition, emotion regulation, and behavior are through balancing the autonomic system—activating the parasympathetic system and increasing or stabilizing the activity of the sympathetic system (Brown et al., 2009).
Mind–body practices such as yoga breathing combined with yoga postures calm the mind, improve mental focus, and reduce aggressive behavior. Cyclical meditation is one such practice that alternates yoga postures with guided relaxation. Shirley Telles and colleagues found that cyclical meditation improved attention, concentration, memory, and anxiety in normal adults (Sarang, & Telles, 2006, 2007; Subramanya, & Telles, 2009)
In a small open study of 19 boys with hyperactive/impulsive ADHD, ages 8–13, a program of yoga postures, yoga breathing, and relaxation led to significant improvements on standardized ADHD tests. The degree of improvement correlated with the number of yoga sessions attended and with the amount of home practice each student performed (Jensen & Kenny, 2004).
In a randomized controlled study, 19 children with ADHD were assigned to either a yoga program or a conventional program of motor exercises. The yoga training was superior for all outcome measures, including attention scores and parent ratings of ADHD symptoms (Haffner, Roos, Goldstein, Parzer, & Resch, 2006).
Inattentive behaviors range from mild to severe even in children without a diagnosis of ADHD, and research has shown that children without ADHD who are easily distracted can benefit from mind–body practices. A small study of 10 elementary school children (ages 6–10) with documented attention problems but without ADHD (i.e., these children did not fulfill all of the required diagnostic criteria) were selected for this study, based on observations that they spent less than 80% of their classroom time on task (Peck, Kehle, & Bray, 2005). Time on task meant time when the students made eye contact with the teacher or the task and performed class assignments. Twice a week for 3 weeks the students watched yoga videotapes, Yoga Fitness for Kids Ages 3–6 (Gaiam, 2002) and Yoga Fitness for Kids Ages 7–12 (Gaiam, 2001), that led them through deep breathing, physical postures, and relaxation with guided imagery. Time-on-task measures improved significantly during the 3-week intervention but dropped off gradually after the program ended. This study demonstrated the feasibility of using a brief yoga intervention to improve attention as well as the need to have an ongoing program to maintain the benefits. Although the children in this study did not have symptoms severe enough to warrant a formal diagnosis of ADHD, their inattention was interfering with their ability to finish assignments, listen to directions, concentrate, and organize their work. While they clearly benefited from the videotape intervention, more symptomatic children with ADHD would probably need a live instructor and a longer program.
Everyone can benefit physically and emotionally from participating in yoga classes. However, for yoga to be the most therapeutic for individuals with ADHD, only instructors who have a deep understanding of, and sensitivity to, the emotional and psychological needs of their students should teach it. The qualities of the most effective yoga teachers are compassion, love of people, commitment, and awareness of their own emotional issues as well as those of their students. Setting the tone, creating a “safe container” of caring, gentle, noncritical support is essential, especially when working with children or adults who may have ADHD as well as other emotional challenges. The work must be done slowly and without pressure, ideally with a trained yoga therapist (Williams, 2010; see also the Resource section at the end of this chapter). It requires great patience.
Yoga therapy is developing at the crossroads of yoga and mental health as well as yoga and medical treatments. Yoga therapists include psychotherapists who want to incorporate yoga into their work with patients as well as yoga teachers who want use psychotherapeutic knowledge in their work with students and clients. Joy Bennet, a registered yoga teacher (ITY 500), exemplifies the sensitive and skillful use of therapeutic yoga. Trained as a Kripalu instructor, she studied Integrative Yoga Therapy with Joseph LePage and LifeForce Yoga® with Amy Weintraub. Founder of Joyful Breath Yoga in Providence, Rhode Island, Joy uses yoga therapeutically for individuals with emotional challenges. She also developed a program for teaching yoga to boys with ADHD and other disorders who were sent to a special school because they could not be managed in the public school system. I (Dr. Gerbarg) had an opportunity to interview Joy, who embodies the essential qualities of a yoga therapist.
Joy Bennett’s work shows that yoga practices can be adapted even for children with extreme behavioral problems due to ADHD. As we describe some of Joy’s teachings, you may look at Figures 5.4 through 5.9 for illustrations of the poses.
I sat facing Joy in her quiet office. She made sure I was comfortable by placing a folded blanket under my feet, then she sat in her simple cotton dress waiting for my first question. “Would you tell me exactly how you teach yoga to a class of boys with attention-deficit disorder?”
She closed her eyes a moment to collect her thoughts. “Twice a week I teach two groups, grades 1–3 and grades 4 and 5 with 11 in each group. You understand that they come from very difficult situations—broken homes, foster families and some from the local orphanage. Besides ADD, they have learning disabilities, emotional problems, and one has Asperger syndrome. Five adults assist in the room.”
“I must be mentally ready, very centered and calm, before they are brought into the room and taken to their mats. To provide a stable presence, I stand still, allowing the other teachers to help settle the children on their mats. I make silent eye contact with them as they come in and nod slightly to greet them. I create a holding container by using a steady, compassionate voice.”
“I start with, ‘Coming to a seated position, inhale while you …’” “Wait,” I interrupted, “Is that what you actually say? How can they understand what you mean by inhale?” “You see,” she smiled, “we teach them the words they need for a yoga class using a diagram of Dan-the-Man. They like Dan. I ask them, ‘Can anyone show me your hip?’ Some point to their knee or their ankle. One boy points to his hip. ‘Good, Charlie, can you come up and show us where Dan-the-Man’s hip is?’ They love that, being able to come to the board and show what they know.”
Figures 5.5 and 5.6. Mountain Pose
“If they come in all charged up, sprawled all over the mats, I have to get them moving. I begin with Mountain Pose: ‘Coming to a seated position, fingertips to the earth, inhale as you bring your arms up, up over your head. As you exhale, arms float back down to earth.’” As she spoke, Joy’s graceful arms moved up and down with her breath (see Figures 5.5 and 5.6).
Joy teaches a sequence of movements for the spine. She prepared the boys for this by first teaching them about the spine. Using a Halloween skeleton and Dan-the-Man, the boys discovered where the spine is located and how it moves.
Spinal movements are part of core yoga and Qigong practices for adults. They are illustrated in many yoga books, such as Yoga for Depression by Amy Weintraub (2006), and can be learned in yoga classes or from DVDs. Joy adapted these yoga movements for children by incorporating images to which they could relate and by keeping the atmosphere playful but calm.
Spinal movements begin in a seated position: “Bringing awareness to your left hand and allowing that hand to glide along the floor to the left side, on the next exhale, your right arm comes up, trying to touch the ceiling … moving your hand (she makes a rotating motion at the wrist). Take a big breath in and exhale as you come back to the middle.” These movements are then repeated on the other side (see Figures 5.7 and 5.8).
Next come spinal twists, forward bends, shoulder rolls forward and backward, and the cow and cat tilt (see Figures 5.9 and 5.10). Since children enjoy imitating animals, they easily come into a “table position” with hands and knees on the floor. Joy reminds them to keep their hands directly under their shoulders and both knees under their hips: “As we inhale, bring that tail bone up toward sky and let the belly hang down toward the earth. Looking forward, we exhale, coming into cat tilt, bringing chin to chest, and arching the back towards the ceiling. Again, bring your tail up, coming into your cow, face forward. Let me see your shining faces. Let’s bring sounds into the cow this morning. What does your cow say?” Many moos are heard. “What does your cat sound like? Let’s hear those cat sounds.” Making sounds is a good release for excess energy.
Figures 5.7 and 5.8. Spinal Movements
Figures 5.9 and 5.10. Cat and Cow Tilt
Within yoga traditions, different sounds are believed to stimulate specific energy centers called chakras. From a modern scientific viewpoint, making these sounds creates vibrations in different parts of the body. Sensors throughout the body register these vibrations and transmit this information through the interoceptive system we described earlier. As these messages reach the brain, they help to induce calmness and mental clarity. It is also possible that the vibrations produce healing effects in the body organs and tissues, but this has not yet been explored through modern science.
From the cat pose, it is easy to lower down in the child pose. Joy continued: “‘Move your body back, bringing your hips all the way back to your heels, stretching arms forward and bringing your fore-head down to the mat. Let’s use that sound of the letter m. Big breath in … and … m-m-m-m-m-m-m-m-m-m-m-m-m-m-m-m-m-m-m-m-m’” (see Figure 5.11).
“‘Bringing your body back up to table position, your head coming up to your shoulders, let’s curl our toes under our feet. Whenever you’re ready, lift your hips toward the sky, grounding your hands, getting your arms long, stretching. Your knees can be soft as you lower one heel down, then the other. One heel, and then the other, three times (see Figure 5.12). What kind of dog do you want to walk today?’ They shout out, ‘Beagle!—St. Bernard!—I’m walking my puppy!’” Joy continues: “‘Now let’s bring that dog into stillness. Let’s be as still as a statue dog. Who can be the most still with their statue dog? Beautiful. Look between your hands. Walk your hands to your feet, your feet to your hands. Hanging like a rag doll, rotate slightly to your left, your right, and back to center. Let your head be heavy, your arms limp and loose, like noodles in your soup.’”
Figures 5.11 and 5.12. Child Pose and Downward Dog
“They love to make sounds. All day long people tell them to be quiet. So I have them extend their arms up, up, and hold the breath, hold it then exhale with a whistle. Boys love to whistle.” Joy demonstrated another pose used to blow off excess energy and focus attention. From a sitting pose, she leaned forward letting out the sound, “ha!” She explained, “Many of the boys don’t talk about what has happened to them. They suppress it and as a result, they may have tightness in the throat. This helps.”
In yoga, grounding—feeling connected to the ground—promotes a sense of being anchored, secure, steady. For people with ADHD, whose thoughts and bodies tend to fly all over the place, grounding techniques help them feel more centered within their own body and more connected to the place where they are here and now. Joy continued: “Grounding through your feet, knees soft, begin to rise up, rise up, coming to stand, rolling shoulders back, opening the heart space. Grounding through your feet, lift up all the toes and allow them to spread. Slowly bring toes back down to earth.”
In Eastern traditions, the energy of the life force has many names. In yogic traditions it is prana, in Qigong it is chi, in Aikido it is ki. Whatever the name, this energy is intangible. Yet we are able to sense when we are more energetic and when we have lost our get-up-and-go. Our bodies generate and run on microvolts. In a sense, we are all living batteries of energy. However you conceptualize the energy in your body, awareness of that energy can be used in mind–body work for ADHD. Children with ADHD tend to be unaware of their own bodies, and this lack of awareness contributes to incoordination and lack of control over their physical actions. When children can think of the energy in the body as “The Force,” they become interested in learning about it, feeling it, and using it—just like a Jedi knight.
Joy increases her students’ awareness of energy by saying this: “Close your eyes in standing position. Feel The Force moving in your body. Maybe your fingers feel sparkly or your face feels warm or maybe another feeling. Just notice that.”
Joy described how she concludes her class: “We finish with each boy lying down with his breathing buddy—a Beanie Baby placed on the navel. On the inhale, they give the Beanie Baby a ride up, on the exhale, a ride down (see Figure 5.13). At first I only used Beanie Babies with the lower grades, but when the older boys saw, they wanted Beanie Babies, too, even the 12-year-olds. I have them imagine they are someplace special: ‘Imagine you are lying in a park or on a cloud, just you and your Beanie Baby.’ As I count slowly backward from 15 to 1 we make the image more real, watching the birds or the blue sky. Then I let them rest. Sometimes they roll to one side and just lie there holding onto their Beanie Baby” (see Figure 5.14).
Children are willing to do things that make them feel good. For the child with ADHD, feeling good could mean having a calm, quiet mind free from constant inner chatter; being able to keep track of what is going on instead of becoming confused or overwhelmed; having a small success that is recognized by praise; or feeling soothed, comforted, loved, happy, or safe. The key to yoga therapy is much more than instruction in techniques. It involves forming a bond of trust and closely observing each child’s needs and responses to discover what makes him or her feel good enough that he or she wants to try more and more. Over time, starting with very simple brief activities, until the child’s attention and physical skills improve, a complete program can be built to guide the child to better levels of mental, emotional, and physical functioning.
Figure 5.13. Breathing Buddies
Figure 5.14. Rest
Over the past 20 years, more and more schools have been adopting yoga programs. For children who respond to yoga classes with improved attention, calmness, and self-control, these benefits tend to carry over into their regular classrooms. Teachers note increased abilities to focus on schoolwork, complete assignments, behave appropriately in class, and relate to their classmates (Slovacek, Tucker, & Pantoja, 2003). Classroom teachers who participate in the children’s yoga classes can learn how to use the same methods to help students calm down, maintain self-control, reduce impulsive behaviors, and sustain the focus they need to complete tasks. Yoga interventions in the classroom may take just a few minutes and can prevent having to deal with disruptive behaviors.
Kim Sutherland, MEd, has been a special education teacher for 16 years. She worked with Joy Bennet for 2 years in a school for children with special needs. The boys in her fourth- and fifth-grade classes have ADHD, and most also have PTSD from emotional or physical abuse and neglect. Their behaviors are extreme. They have very little or no ability to regulate their emotional states or control their sudden impulses. These children often lose control, becoming violent, scream, throw chairs, assault others, and require physical restraint. They require so much attention that each class has six students and three teachers. Fortunately, most children with ADHD are able to attend regular schools. Although they may engage in disruptive behavior, it is usually to a lesser degree. Kim’s description of the effects of yoga on severely affected children highlights the potential benefits for children who have milder forms of ADHD.
Kim explained: “Joy’s yoga program helped the kids in many more ways than we imagined. We teachers took the classes with them. By watching the teachers do yoga in class, kids saw the teachers in a more collaborative way. We try to engage the kids to create a sense of community where we are all working together, students and teachers, towards educational and social developmental goals. Unfortunately, there are times when a child loses control, and we have to pin him or her down with physical restraint. As a result, kids tend to see teachers more as wardens than as educators, even though we are careful to process those experiences. In the yoga class students felt more comfortable and less intimidated by teachers. They wanted to sit near the teachers. It helped them to see us trying, getting frustrated with our own efforts to do the yoga, and having to find strategies to deal with our stress.”
She continued: “Yoga was an equalizer. Everyone can do yoga—it doesn’t matter what shape you’re in, or how smart you are or aren’t, or your level of learning and development. The yoga class was non-competitive and fostered acceptance of each person regardless of his or her level of performance. Kids thrive on consistency. Yoga was so consistent and calming. They have no control over the rest of their lives, which are often noisy, scary, and chaotic. Children with abuse histories do not feel safe in their bodies. One way they may develop to protect themselves during abuse is to disconnect or dissociate from their bodies in an attempt to escape painful physical sensations. This disconnection can become habitual, creating unawareness, mistrust, and loss of control of the body. Yoga enables kids to feel safe in their bodies with gentle physical activities in a safe environment. At the same time, yoga helps develop directed focus. A simple example would be, ‘Wiggle your toes. Now wiggle your hands.’ This simple exercise requires mental focus and enhances body awareness. Within the structure, they have freedom to move. Your mat is your space. You stay in your space. You can move in your space. With yoga they became more aware of their bodies. They become better able to control their bodies and impulses, rather express their feelings by acting out physically, for example, by running, hitting, or kicking. Many kids required less frequent physical restraint, and when it was needed, they regained control more quickly.
“In regular class, these children are usually distracted, restless, tapping their pencil or kicking the wall. Physical postures release and channel excess energy while encouraging mental focus. By the end of the relaxation practices, they are calm and still. When their minds wander, they may think of something distressing from the past. Trauma memories can overtake their minds, triggering fear, trembling, rage, or physical violence. In Joy’s class, whenever we noticed a child starting to become agitated, we could often prevent a meltdown by having him or her do yoga breathing for a few minutes. If a child started to get frustrated with schoolwork, we would offer him or her a chance to practice yoga in a separate place, either alone or with a teacher. The children usually calmed down quickly with yoga breathing or sometimes by doing whatever yoga postures they liked. Processing and praise would follow: ‘You did a really good job calming yourself down. How do you feel?’
“The kids really enjoyed and looked forward to the yoga sessions. They asked for a way to practice at home. Joy created a booklet for them with pictures of the different poses to guide them. Some families bought their children yoga mats. Others were given a mat by the school. The teachers also looked forward to yoga as a time to relax and decompress during their very wearing work day. They also learned from the yoga teacher new ways to observe, understand, and help the children. Joy’s ability to create a compassionate atmosphere supported the school community.”
As the parent of a child with ADHD, you may not have easy access to skilled yoga teachers or special schools. We wanted to give you an example of what can be achieved by a gifted yoga therapist working in a school with dedicated teachers willing to fully participate in her work in order to help extremely dysfunctional children. For children with milder forms of ADHD and for children with attentional problems in general, school yoga programs can be very beneficial. Let’s look at current and future directions in research on yoga and the teaching of mental health hygiene in schools.
Most adults and children with mild ADHD can participate in yoga classes. However, a period of individual instruction may be necessary for those who have more severe inattention, hyperactivity, over-reactivity, or concurrent diagnoses such as anxiety disorders, PTSD, obsessive–compulsive disorder, learning disabilties, neurodevelopmental problems, or Asperger syndrome (an autism spectrum disorder). These individuals first need private sessions to attain better levels of attention, physical control, and mastery of basic techniques before taking on the challenges, distractions, and stimulation of being in a group class.
Parents, teachers, and administrators are looking for new and practical methods to improve the abilities of children to cope with stress, regulate their emotions, reduce anger, focus attention, gain more self-esteem, develop better relationships, and achieve greater academic success. Rather than waiting until a child is far behind or in deep trouble, it makes more sense to take a preventive approach to foster positive emotional development and robust stress resilience.
Based on studies of the relaxation response (Benson, 1976; Benson and Klipper, 1982, 2000), mindfulness (developing the skills to concentrate on the activity one is performing and bring the attention back to that activity when distractions occur), and yoga, a program called Yoga Ed was developed and evaluated in elementary and middle schools (Slovacek et al., 2003). Classes included movement and awareness of breath, thought, emotion, behavior, and the environment. Students who participated in yoga class 1 or 2 hours per week over the course of 1 year showed improvements in self-esteem, behavior, physical health, academic performance, and attitudes toward school. Although there were limitations in this study, it gave support for further program development. Yoga Ed programs are now offered in many schools.
Sat Bir Khalsa, PhD, assistant professor of medicine at Harvard Medical School, and Jessica Noggle, PhD, Harvard Medical School Research Fellow, are studying methods to introduce effective yoga programs into school systems. Their long-range vision is to make education in stress resilience and emotional hygiene part of every child’s education. Emotional hygiene includes methods to maintain mental health throughout life and to prevent the detrimental effects of stress and adversity. Funded by the Institute for Extraordinary Living at Kripalu Center for Yoga and Health (see Resources), Drs. Khalsa and Noggle completed a preliminary study of yoga in a suburban high school (Noggle & Khalsa, 2010). In this controlled study, 120 students in grades 9–12 were randomly assigned to either a Kripalu yoga class or regular physical education (PE) two to three times a week for about 45 minutes each session for one semester. The Kripalu program included a standard set of yoga postures, breathing practices, and relaxation/meditative techniques.
By the end of one semester, significant differences were found between the two groups. Students in the regular PE group showed increases in scores for negative mood, fatigue, inertia, tensions, anxiety, and confusion. At the same time, they showed a drop in scores for stress resilience and anger control. In contrast, students in the yoga group maintained or slightly improved their scores in these areas. In other words, the yoga intervention protected the students from whatever adverse experiences and stressors were wearing down the comparison group. This study suggests that a regular yoga program could prevent the decline in mental health and stress resilience seen in many high school students. In other words, yoga could serve as a method for mental hygiene.
Dr. Khalsa’s group and others are conducting larger studies in schools with more diverse populations as part of their efforts to adapt programs to the needs of a wide range of students and to scientifically demonstrate the short- and long-term benefits of yoga. Funding is needed to study the effects these programs may have on the children’s lives not only while they are in school, but also as they enter adult life. It is possible that by teaching stress resilience and emotion regulation from elementary through high school, children might have a significantly better chance to maintain their mental health, control their anger, improve their relationships, and attain greater success at school and at work. If this is so, as preliminary studies suggest, then we need to support the research efforts that are necessary to determine if yoga programs should be implemented in our schools.
Mind–body practices provide multiple benefits for all of the symptoms of ADHD we described in Chapters 1 and 2:
• The core symptoms of ADHD: inattention, hyperactivity, and impulsivity
• The three faces of ADHD: hypoarousal and impulse control problems, reward deficiency, and disorders of emotional regulation
Children learn to focus attention and awareness on their bodies in order to perform yoga postures. Learning to stay on a yoga mat and hold each position for a period of time helps reduce hyperactivity and impulsivity. The effect of yoga on the mind is to create a state of calm alertness that is a healthier, more balanced state of arousal. The effects of yoga practice are positive, pleasurable feelings, including a sense of peacefulness, relief from anxiety, and a sense of mastery. These good feelings, combined with positive feedback and praise from the yoga teacher, provide the rewards that motivate continued practice. By quieting and balancing the stress response system, yoga and breathing practices improve emotional regulation. For these reasons, we recommend that everyone with ADHD get involved in yoga and breathing practices, and we advise practitioners to consider adding mind–body practices to their ADHD treatment plans. Combining these practices with the complementary treatments described in the other chapters is even more effective.
Physical yoga should be slow-paced, calming, and at a level appropriate for each person’s physical abilities. A combination of regular daily calming breath practices and intermittent stimulating practices (as needed for work and study) is effective for many people.
To move forward toward improvement through mind–body practices, we recommend the following steps:
1. Learn more about the different types of yoga programs available in your area.
2. Discuss your ideas about starting yoga with your doctor or your child’s pediatrician or therapist. Make sure that you have no physical limitations that might be contraindications. Find out what your health care providers knows about your local mind–body teachers. Check the yellow pages and the Internet for programs.
3. Finding a teacher or program that’s right for you or your child may require some time.
4. Interview the yoga teacher and observe a class. This will help you assess not only the level of the class, but also the personal style and character of the teacher. Look for a trainer who is patient, calm, kind, supportive, and available to talk.
5. If you or your child has special needs, discuss these with the yoga teacher and create a plan to address these needs.
4. Once you find a good teacher, it may take time—perhaps weeks or month—to see results. Be patient and stay with it.
5. Making time to practice yoga every day is also challenging, especially if you have children or are busy with schoolwork and activities. You may be able to manage it only three times a week. That would be a strong start. Make 7 days a week your goal, but give yourself flexibility on those inevitable impossible days.
6. Talk with your family about why you want to practice yoga and how you hope it will help. You may need your family’s cooperation to help you carve out time for regular yoga practice.
7. If you find it difficult to stay with your practices, as many people do in the beginning, participate in a class at least once a week to give yourself support and reinforcement. You can also talk with your yoga teacher or therapist about ways to increase your motivation and remove obstacles to your practice.
If your school does not offer yoga, bring it up at PTA meetings and with the school counselors and administrators. You are likely to find others who will agree that such a program would enrich the school. Form a committee to develop a program. There may be a teacher in your school who is already trained in yoga practices.
If your school has a yoga program, you could discuss your child’s special needs with the yoga teacher to find ways for your child to participate in the available classes or to develop a special class for those who are not ready to join an established group. With increased interest and support from parents and educators, more yoga teachers will be trained to work with children, including those with ADHD.
Many organizations all over the world have developed yoga programs for children and adults. You will find a list of some of these in the following Resources section. Finding yoga therapists experienced in ADHD and programs specifically designed for children with ADHD is more challenging.
The following resources provide information on mind-body practices through websites, organizations, journals, and books.
Atlantic Canada’s Yoga Teachers Association: www.yogaatlantic.ca.
Central resource for yoga within Atlantic Canada, fosters professional yoga training through a network of yoga teachers representing all traditions and styles of yoga.
Art EXCEL Course: All Round Training in Excellence: www.artofliving.org.
Self-development programs for children ages 8–13.
British Yoga Teachers’ Association: www.britishyogateachersassociation.org.uk.
Place to find yoga teachers and yoga teacher training in the UK.
The Center for Mind–Body Medicine: www.cmbm.org
Global Trauma Relief Program trains mind-body teachers and community leaders to deal with stress and trauma of war and natural disasters. Offers training in mind-body medicine, nutrition, and integrative oncology (cancer treatment).
International Association for Human Values: www.iahv.org.
International humanitarian, educational, non-governmental organization (NGO) partners with governments, educational institutions, other NGOs, corporations, and individuals, to develop programs for personal development and to encourage the practice of human values. Offers disaster relief programs worldwide.
International Association of Yoga Therapists: www.iayt.org.
supports research and education in Yoga, a professional organization for Yoga teachers and Yoga therapists worldwide.
The International Yoga Federation and The World Yoga Council: www.worldyogacouncil.net/members.html.
Provides information on leading yoga teachers and organizations.
Kripalu Yoga Center for Health and the Institute for Extraordinary Living: www.kripalu.org.
Provides courses, workshops, teacher training, and research.
Mind & Life Institute: www.mindandlife.org.
Non-profit organization that seeks to understand the human mind and the benefits of contemplative practices through integrating knowledge from the world’s contemplative traditions with findings from contemporary scientific study to relieve human suffering and advance well-being. This approach includes publication of dialogues with the Dalai Lama, research and training institutes.
Yoga Teachers’ Association of Australia: http://www.yogateachers.asn.au/join-ytaa/benefits.html.
Professional yoga teacher association promotes high standards of teaching.
Yoga Alliance: www.yogaalliance.org.
Online community for registered yoga teachers to connect and communicate.
Youth Empowerment Seminar: www.youthempowermentseminar.org.
Yoga self-development programs for youth ages 14–18.
Coherent breathing site by Stephen Elliot offers Respire-1 CD with tracks for pacing respirations at five breaths per minute. Offers additional aids to enhance effects on the autonomic system.
Website for Gaiam Yoga: yoga videos and DVDs for adults and children).
Website of Dr. Richard P. Brown and Dr. Patricia Gerbarg provides information on Breath∼Body∼Mind training, courses, mind-body programs for disaster relief, Integrative psychiatry, updates, and a free newsletter.
Joy Bennett offers individual and group yoga therapy and yoga programs for children and adults.
Systema training in Russian martial arts with Vladimir Vasiliev.
Les Fehmi provides courses and CDs for training in open focus meditation and biofeedback.
Elixer Light Gigong Master Robert Peng provides Qigong teachings, courses, DVDs.
Yoga Ed. produces health/wellness programs, trainings and products for teachers, schools, parents, children and health professionals that improve academic achievement, physical fitness, emotional intelligence and stress management.
Amy Weintraub’s Yoga for Depression and LifeForce Yoga® site offers DVD programs at all levels, courses, newsletter.
Heather Mason’s Yoga for the Mind offers classes, private consultations, a CD set of breathing practices, and a YouTube video on how to do ocean breath (Ujjayi): http://www.youtube.com/watch?v=PqR_HSDXuEk.
Brown, R.P., & Gerbarg, P.L. (in press). The Healing Power of the Breath. Boston: Shambhala.
Book and CD teach basic breath practices from our Breath∼Body∼Mind program. Readers learn how to use breathing practices for emotional self-healing, stress reduction, relationships, and enhanced performance at work and at play.
Feuerstein, G. (1998). The Yoga Tradition: Its History, Literature, Philosophy, and Practice. Prescott, AZ, Hohm Press. Classic comprehensive volume on yoga.
Murdock, M. (1987). Spinning Inward. Using guided Imagery with Children for Learning, Creativity, & Relaxation. Boston: Shambhala.
Contains many appealing visualizations that add a creative dimension to practices for children.
Sumar, S. (1998). Yoga for the Special Child. Evanston, Il: Special Yoga Publications. A therapeutic approach for infants and children with Down Syndrome, cerebral palsy and learning disabilities.
Weintraub, A. (2004). Yoga for Depression. New York: Broadway Books.
Inspirational description of Amy Weintraub’s development of yoga practices for depression. Clear and scholarly presentation of yoga practices.
Williams, N. (2010). Yoga Therapy for Every Special Child. Philadelphia: Singing Dragon.
Excellent descriptions of teaching yoga to children of all ages.
ADDitude: www.additudemag.com.
Excellent newsletter that covers many topics relevant to home, school, work, parenting, and relationships.
Australian Yoga Life: www.ayl.com.au.
Magazine and website offers stories and articles about yoga. Information about yoga retreats, schools, teachers, and teacher training in Australia.
International Journal of Yoga Therapy: www.iayt.org/
Peer-reviewed Journal of the International Association of Yoga Therapists includes scientific research and articles by yoga teachers and researchers.
The Yoga Journal: www.yogajournal.com.
A yoga magazine with articles on yoga practices, music, and celebrities.
1 The authors wish to thank Joy Bennet, Kim Sutherland, Amy Weintraub, Master Robert Peng, Stephen Elliot, and Sat Bir Khalsa for their support in the preparation of this chapter.
