Yoga as an effective complementary therapeutic intervention for children & adolescents with ADHD and/or Autism

Within the UK, approximately 5% of children (708,000) have a diagnosis of ADHD; 3.62% are boys & 0.85% are girls; with 4 times as many boys diagnosed as girls.  There continues to be a lot of discussion around whether female ADHD is under diagnosed and the reasons for that.  Various studies globally suggest that the ratio of autistic males to females ranges from 2:1 to 16:1. The most up to date estimate in the UK is 3:1.  It is thought that 65% of children will retain some impairments into adulthood. Currently 1.9 million adults have an ADHD diagnosis in the UK; globally this is thought to be between 2-7% of the population.  This is a rough estimate however as some countries look for prevalence to diagnose, whereas some look for impairment.  Within Tyne & Wear there is an 11% prevalence rate & between a 1-6% impairment rate, based on a scale of severe, moderate & low.

Within the UK 1 in every 100 children have Autism, and as with ADHD 4 times as many boys are diagnosed as girls.  For every 3 children diagnosed there are thought to be 2 more undiagnosed, equating to approximately 300,000 children who have not yet been identified.

Between 10-70% of children with ADHD are reported to also have Autism. Estimates vary substantially as before 2015 children assessed using the DSM (Diagnostic and Statistical Manual of Mental Disorders) could not by definition, receive a dual diagnosis of Autism and ADHD.

Within the UK children & Adolescents tend to be referred to their GP, having been identified as displaying traits of ADHD and/or Autism by their school or their parents/carers; the GP will then make a referral to CAMHS (Children & Adolescent Mental Health Service).  

CAMHS is a NHS provided service to support children up to the age of 18 years with emotional and behavioural difficulties.  CAMHS clinicians include a range of therapeutic disciplines such as Psychiatry, Psychology, Psychotherapy, Nursing and Social Work.  Each local CAMHS service is run differently, in accordance with its funding by the Clinical Commissioning Group (CCG).  There are currently significant wait times for children & adolescents to be assessed for ADHD and/or Autism by CAMHS.  Within Tyne & Wear their aim is to see everyone within 12 weeks, however from experience I have known this run into a number of years.

Generally no other interventions are provided to the child or parents/carers during this wait time.  There is then a further waiting list to meet with a key worker after diagnosis.  This period of limbo as well as the eventual diagnosis of ADHD and/or Autism can impact a child’s home and school life significantly. Anxiety is often associated with both conditions. Upon diagnosis medication is then typically sold as the only option.  Literature suggests medication for ADHD and anxiety is usually the first intervention and isn’t always necessary.

There is extensive literature on the benefits of yoga and yoga therapy for adults with ADHD and/or Autism.  More research is now being conducted on the paediatric population, including those with special needs.

Low GABA levels correlated with anxiety have been seen to increase with yoga and show similar effects to medication prescribed for anxiety.  Research has revealed the potential for yoga to reduce stress and anxiety and increase health, wellness and emotional regulation in both adults and adolescents.

Yoga interventions measured within schools have been shown to:

  • calm children, 
  • improve behaviour, 
  • reduce discipline problems, 
  • decrease anger, 
  • strengthen concentration,
  • enhance imagination 
  • improve academic performance & grades,
  • increase physical health,
  • boost self-attitude.

In boys with ADHD yoga has demonstrated improvements in attention and emotional control and reductions in emotional lability, restlessness and impulsive behaviour; the results of which were further increased when also practising at home.

Research also confirms that restorative yoga can sharpen memory and brain function as well as support rest and healthy sleep patterns.  Getting more rest can have a significant impact on a child’s expression of emotions, coping skills and overall wellness. Restorative yoga targets the vagus nerve, supporting deep relaxation, providing a feeling of being safe and supported and a sense of letting go.  

Therapeutic yoga interventions work to address and improve the core symptoms associated with ADHD & Autism, including:

  • Low vagal tone
  • Low interoceptive awareness
  • Poor executive functioning
  • Lack of focus & concentration
  • Poor emotional regulation, tolerance, resilience
    • with excessive reliance on screens to regulate/self soothe
  • Lack of care and attention to detail including with school work
  • Inability to work independently
  • Lack of self-esteem & self-confidence

Interestingly a 2013 study found that 74% of children with ADHD were found to be hypermobile vs 13% of their peers.  A 2016 study showed that people diagnosed with hypermobility were 7.4 times more likely to have Autism.  Low muscle tone is also associated with Autism and can impact posture. Autistic people may find difficulty in sitting up straight and not rounding their shoulders; this can be further exacerbated by excessive screen time, especially in children & adolescents.

Having conducted research of my own on restorative yoga for children & adolescents with a diagnosis of, or awaiting an assessment for, ADHD and/or Autism, I found statistically significant improvements in hyperactivity, focus & concentration, peer relationships, executive functioning and self esteem.  An increase in emotional regulation with less reliance on screens was also observed.  Most importantly there was a significant decrease in the overall impact that both conditions were having at school and at home.  If you would like access to my full study please contact me at ella@navayogatherapy.co.uk.

Overall yoga therapy research shows promising results on the positive effects of yoga.  It has the potential to support children and adolescents with ADHD and/or Autism at home and at school as well form an adjunct therapy within the CAMHS service. This may even negate the need for medication in certain circumstances.

As ADHD and Autism may present alongside other postural, sensory or emotional challenges, the beauty of yoga therapy is that practices given can be adapted and scaled to each individual child.  

A therapeutic at-home yoga practice can provide an affordable, easily replicable intervention for desperate parents who currently have no other accessible options available to them to help their child. 

In gratitude and recognition of my teachers Jenny Orona & Shawnee Thornton-Hardy for their contributions to the world and me, which feature not only within this piece of writing but in my continuing growth as a Yoga Therapist.  

And mostly in gratitude and recognition of my greatest teacher, my son who relentlessly teaches me everyday how to be a better human, whether I want to learn or not.

Sources:

ADHDuk.co.uk

Ali, M. (2021). The relationship between restorative yoga and executive function (Unpublished thesis). Texas State University, San Marcos, Texas.

Cahn BR, Polich J. Meditation states and traits: EEG, ERP, and neuroimaging studies. Psychol Bull. 2006 Mar;132(2):180-211.

Centre for Educational Neuroscience http://www.educationalneuroscience.org.uk/resources/neuromyth-or-neurofact/is-the-number-of-children-with-adhd-in-uk-schools-increasing/#:~:text=Estimates%20vary%20substantially%2C%20but%20somewhere,diagnosis%20of%20autism%20and%20ADHD.

Child Outcomes Research Consortium https://www.corc.uk.net/outcome-experience-measures/revised-childrens-anxiety-and-depression-scale-rcads/

Childress, T., Harper, J.C. (2015) Best practices for yoga in schools. Atlanta, GA: Yoga Service Council, Omega Publications

Diamond A. Executive functions. Annu Rev Psychol. 2013;64:135-68. doi: 10.1146/annurev-psych-113011-143750. Epub 2012 Sep 27.

Ehleringer, J. (2010) “Yoga therapy in practice. Yoga for children on the autism spectrum.” International Journal of Yoga Therapy 20, 131-139.

Evans SW, Langberg JM, Egan T, Molitor SJ. Middle school-based and high school-based interventions for adolescents with ADHD. Child Adolesc Psychiatr Clin N Am. 2014 Oct;23(4):699-715.

Hagen I, Nayar US. Yoga for Children and Young People’s Mental Health and Well-Being: Research Review and Reflections on the Mental Health Potentials of Yoga. Front Psychiatry. 2014 Apr 2;5:35.

Harper, J.C. (2010) “Teaching yoga in urban elementary schools”. International Journal of Yoga Therapy 1, 1, 99-109.

Jensen PS, Kenny DT. The effects of yoga on the attention and behavior of boys with Attention-Deficit/ hyperactivity Disorder (ADHD). J Atten Disord. 2004 May;7(4):205-16. doi: 10.1177/108705470400700403. PMID: 15487477.

Kaley-Isley, L., Wambolt, M., McDunn, C. and Fury, M. (2009) “Eight week manualized yoga intervention for adolescents with anxiety, depression and medical illness” International Journal of Yoga Therapy 19, 1, 37-54

Kaley-Isley LC, Peterson J, Fischer C, Peterson E. Yoga as a complementary therapy for children and adolescents: a guide for clinicians. Psychiatry (Edgmont). 2010 Aug;7(8):20-32.

Khalsa, S., Cohen, L. et al. Principles and Practice of Yoga in Health Care 2016

Kim, J.A., Szatmari, p., Bryson, S.E., Steiner, D.L. and Wilson, F.J. (2000) “The prevalence of anxiety and mood problems among children with autism and Asperger syndrome.” Autism Journal 4, 2, 117-132

Koenig, K. Practical social skills for autism spectrum disorders: Designing child-specific interventions. 2012 APA Psychnet

Mason, H., Birch, K., Gangadhar, B., McCall, T., Arnsby-Wilson, L. Yoga for Mental Health 1st Edition 2018

Mehta S, Mehta V, Mehta S, Shah D, Motiwala A, Vardhan J, Mehta N, Mehta D. Multimodal behavior program for ADHD incorporating yoga and implemented by high school volunteers: a pilot study. ISRN Pediatr. 2011;2011:780745.

Minchin, Dr S., Yoga Therapy for Child & Adolescent Mental Health Services (CAMHS). 2022 theyogapsychologist.uk

National Autistic Society Autism.org.uk

Orona, J., YT 307.14 Integration: Experiencing Therapeutic Mantra and Japa (2019)

Radhakrishna S, Nagarathna R, Nagendra HR. Integrated approach to yoga therapy and autism spectrum disorders. J Ayurveda Integr Med. 2010 Apr;1(2):120-4.

SDQ https://www.sdqinfo.org/a0.html

Streeter CC, Jensen JE, Perlmutter RM, Cabral HJ, Tian H, Terhune DB, Ciraulo DA, Renshaw PF. Yoga Asana sessions increase brain GABA levels: a pilot study. J Altern Complement Med. 2007 May;13(4):419-26.

Streeter CC, Whitfield TH, Owen L, Rein T, Karri SK, Yakhkind A, Perlmutter R, Prescot A, Renshaw PF, Ciraulo DA, Jensen JE. Effects of yoga versus walking on mood, anxiety, and brain GABA levels: a randomized controlled MRS study. J Altern Complement Med. 2010 Nov;16(11):1145-52.

Thornton-Hardy, S (2015) Asanas for Autism & Special Needs. London, UK: Jessica Kingsley Publishing.

Thornton-Hardy, S (2022) “Creating Inner Peace: 6 Benefits of Yoga for Children with Autism.” Autism Parenting Magazine 01/21/2022.

https://www.transformationpartnersinhealthandcare.nhs.uk/wp-content/uploads/2018/11/Children-and-young-people-with-austism-spectrum-disorder-case-for-change-Oct-2017.pdf

Wamboldt, M., Kayley-Isley, L., Fury, M., Hansen, P. (2019) ” A Manualized Yoga Intervention for Adolescents with Co-Occurring Physical and Psychiatric Conditions Shows Improvements in Mental and Physical Health.”    Journal of Yoga and Physiotherapy 6