Tai Chi 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. We examine a novel treatment that could remediate the core features of ADHD and thereby contribute to sustained improvements in behavioral control. This approach is motivated by 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. We employ Tai Chi, targeting improvements in well-established behavioral and physiologic measures of motor control, and with this, improvements in ADHD symptoms. The proposed study offers immense potential for the development of novel therapeutic approaches for ADHD with little risk of adverse reaction.
The over-arching goal of this proposal is to examine a movement-based mindfulness training as a therapeutic intervention for children with ADHD. This approach is motivated by two complimentary lines of evidence: 1) Children with ADHD show impairments in motor control that parallel (and correlate with) core deficits in behavioral control that define the disorder. 2) Gains in cognitive and behavioral control have been observed in adults learning Tai Chi, dance, or meditation. These lines of evidence provide substantial motivation for our proposed investigation of movement-based mindfulness training in children with ADHD. Specifically, we propose to evaluate an established Tai Chi-based intervention. We chose this approach for a number of reasons: 1) Tai Chi is among the most well-established movement-based interventions with documented therapeutic effects, including cognitive effects. 2) While many movement-based approaches show evidence of yielding cognitive improvements Tai Chi provides excellent opportunities for engagement of 8-12 year old children in the form of the collaborative game "push hands." 3) Tai Chi instruction consists of gentle movements that can be practiced even by those with physical limitations, and is readily available in the United States so the protocols developed in this study will be straightforward to deploy at a national level.
Hypothesis: After participating in a Tai Chi program, children with ADHD will show improvements in behavioral and physiologic measures of motor control. We further expect movement-based training will result in decreases in ADHD symptom severity.
|Study Design:||Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||Movement-Based Training for Children With ADHD: A Feasibility Study|
- Motor persistence score [ Time Frame: Change from baseline in total postintervention score, approx. 10 weeks ]
A total score combining NEPSY ("A Developmental NEuroPSYchological Assessment") statue task and lateral gaze fixation.
A halving of the distance from TD (Typically Developing) baseline for motor persistence measures (based on preexisting control data, and barring ceiling effects) will be regarded as a clinically meaningful change.
- TMS SICI (short-interval intracortical inhibition) [ Time Frame: Change from baseline in total postintervention score, approx. 10 weeks ]
SICI is obtained in paired pulse TMS trials, in which the first conditioning subthreshold pulse causes the subsequent suprathreshold pulse, on average, to evoke a smaller response in muscle. We expect this SICI effect to be diminished in ADHD preintervention (i.e., less of a reduction). Postintervention, we expect more robust SICI reduction in muscle response (i.e., more like the typically developing baseline).
This will be compared to results from stimulant medication, in which patients recovered approximately half-way towards typically developing baseline.
- Cognitive motor control [ Time Frame: Change from baseline in total postintervention score, approx. 10 weeks ]RDoC (research domain criteria) battery for cognitive control targeting response inhibition delivered via laboratory computer (flanker task, Go / No-Go, and Stop Signal). We expect significant improvements across RDoC relevant scores.
- Goniometer-based measures of sequential finger movements [ Time Frame: Change from baseline in total postintervention score, approx. 10 weeks ]Mirror overflow, speed, and rhythmicity will be assessed with goniometers during simple sequential finger movements. We expect reductions in overflow postintervention. We will report on changes in other measures, but these are not central to our hypothesis.
- Evaluation of Tai Chi performance [ Time Frame: Change from baseline in total postintervention score, approx. 10 weeks ]Students will be asked to perform a subset of Tai Chi movements from the training, which will be scored on a 0-2 point scale for each movement. We expect performance to improve over the course of the intervention.
- Clinical measures of ADHD symptom severity and motor coordination [ Time Frame: Change from baseline in total postintervention score, approx. 10 weeks ]We will administer Connors and DuPaul surveys (parent versions), the BASC-2 (Behavior Assessment System for Children, Second Edition, parent and child versions), and DCDQ (Developmental Coordination Disorder Questionnaire). We expect improvements on these measures over the course of the intervention. In particular, based on Hernandez-Reif, et al. (2001), we expect marked improvements on Connors subscales for Anxiety, Conduct, Daydream, Emotion, and Hyperactive.
- Behavioral assessments of basic motor control [ Time Frame: Change from baseline in total postintervention score, approx. 10 weeks ]We'll administer the PANESS (Physical and Neurologic Examination of Subtle Signs) and mABC-2 (Movement Assessment Battery for Children). We expect improvements over the course of the intervention.
- Surveys of expectations [ Time Frame: preintervention ]Prospective survey to assess expectations at outset. Results will be reported as descriptive statistics and representative text samples.
- Surveys of Satisfaction [ Time Frame: postintervention ]A retrospective survey to assess satisfaction and plans to continue with Tai Chi or other movement classes following the intervention. Results will be reported as descriptive statistics and representative text samples.
|Study Start Date:||September 2014|
|Estimated Study Completion Date:||June 2017|
|Estimated Primary Completion Date:||June 2017 (Final data collection date for primary outcome measure)|
Experimental: Tai Chi
Tai Chi instruction, 1 hour, twice per week Home Tai Chi practice with video, requesting 15-30 minutes, 3 times per week, monitored by practice log
Behavioral: Tai Chi
6-8 students will be enrolled in 8 weeks of Tai Chi instruction, with two 1-hour sessions per week. Students will be requested to practice from recorded materials at home three times a week for 15-30 minutes each session, and parents will be asked to keep a log of at-home practice.
Class sessions will consist of warm up (qi k'ong), postural and breathing exercises, Tai Chi form practice, and Tai Chi games (including push hands).
Practice will consist of warm up, followed by practice of selected pieces of the form.
Children on stimulant medications will remain on these medications during the training period (though they will be asked to stop medications one day prior to motor and cognitive testing pre-, mid- and postintervention).
Show Detailed Description
Please refer to this study by its ClinicalTrials.gov identifier: NCT02234557
|Contact: Stewart Mostofsky, MDfirstname.lastname@example.org|
|Contact: Kristie Sweeney, MSemail@example.com|
|United States, Maryland|
|LEAP Facility at Kennedy Krieger Institute||Recruiting|
|Baltimore, Maryland, United States, 21211|
|Principal Investigator: Stewart Mostofsky, MD|
|Principal Investigator:||Stewart Mostofsky, MD||Hugo W. Moser Research Institute at Kennedy Krieger, Inc.|