yoga mindfulness autism study final.1 · radhakrishna s, nagarathna r, nagendra hr. integrated...
TRANSCRIPT
EFFECTOFTHEEDUCATE2BYOGAANDMINDFULNESS
PROGRAMONCHILDRENWITH
AUTISMSPECTRUMDISORDERINTHESCHOOLSETTING
PresentedBY:JillHorbacewiczPTMAPhD-DirectorPTDept.TouroCollege
AllisonMorganMA,OTR,E-RYT–FounderZensationalKids,LLC
LEARNINGOBJECTIVES
1. DefineAutismspectrumdisorder(ASD)andtheeducationalchallenges
2. ExplainthebenefitsofyogaandmindfulnesswithASD3. DescribetheEducate2BProgram4. Summarizepilotstudyfindingsontheeffectsofthe
Educate2BprogramonchildrenwithASD5. Discusspotentialfuturedirectionsforresearchingthe
effectsofyogaandmindfulnessonthispopulation
DISCLOSURESTATEMENT
AllisonMorganMA,OTR,E-RYT-DirectorofZensationalKidsandauthoroftheEducate2Bprogram.Norelevantfinancialrelationshipstodisclose.
JillSHorbacewiczPTMAPhD:Norelevantfinancialornon-financialrelationshipstodisclose
PRESENTATIONOVERVIEW
INTRODUCTION
METHODS
RESULTS
DISCUSSION
INTRODUCTIONBACKGROUND-ASD
AreasaffectedbyASD
Communication
Behavior
Motorperformance
SocialSkills
Sensory
Academic
AutismSpectrumDisorder(ASD)isageneraltermforagroupofcomplexdisordersofbraindevelopment.
(DSM-5)(Autismspeaks)
INTRODUCTIONBACKGROUND-ASD
STATISTICS: AccordingtotheCDCasof2012,1in68childrenwerediagnosedwithASD(1in42boysand1in
189girls)
INTRODUCTIONBACKGROUND
YOGA Formofexercisethatcombinesvariousbreathingtechniques,bodypostures,meditationandrelaxation
MINDFULNESS Praticeofnoticingthepresentmomentwithoutjudgement
INTRODUCTIONBACKGROUND-YOGA/MINDFULNESSFORASD
Reducingstress(Goldberg,2004); Increasingattendingskillsandself-regulationskills(Behar,2006) Decreasingchallengingbehaviorsandincreasingabilitytoconcentrate(Rosenblattetal.,2011)
Increasingcompliancebehaviorsanddecreasinghyperactivity(Koenig,Buckley-Reen&Garg,2012)
Increasingimitationskills(Radhakrishna,2010)
RESEARCHFINDINGS:
INTRODUCTIONREVIEWOFTHELITERATURE
Effectsofyogaontypicallydevelopingchildrenintheclassroom
Poweletal,2008
TheSelfDiscoveryProgram
• 126childrenwithemotional,behaviour,andlearningdifficulties
• 45minutesofyogatherapy
• ↑attentionspan,listeningskills,andrelaxation
Bergeretal,2009
TheBentonLearningProgram
• 32childrenin4thand5thgrades
• 1sessionperweek• ↓aggressionandimprovedwell-being
Bubelaetal,2012
YogawithPreschoolers
• 27childrenbetweenthreeandfiveyearsold
• 20minutesession1x/wkfor6weeks
• ↑staticbalance,functionalLEstrength,flexibilityandcoordination
Conclusion:Yogahaspositiveeffectsonbehaviorandmotorskills
INTRODUCTIONREVIEWOFTHELITERATURE:EFFECTSOFYOGAONCHILDRENWITHASD
Buckley-Reenetal,2013GetReadytoLearn
Program
• 51childrenwithdisabilities,includingASD
• Participatedin20minutesessionintheclassroom ↑independence,attentionspanandself-regulation
Radhakrishnaetal,2010Yogaandpreschoolers
• 2010-6subjects8-14yrs
• 45minute1:1yogainterventioninanopenfielddaily ↑ incommunication,behaviorandmotorcontrol
Conclusion:Yogahaspositiveeffectsonbehaviorandmotorcontrolinchildrenwith
ASD
INTRODUCTIONPROBLEMSTATEMENT
PracticalinterventionsareneededtohelpchildrenwithASDintheclassroomdueto↑ prevalence
GapintheliteratureregardingtheeffectsofyogaonbehaviorandmotorskillsinchildrenwithASD
CurrentyogaprogramsforASDarenotpracticalfortheclassroomsettingeitherduetotime,space,and/orknowledgeofteacher
StudiesthusfarforASDhavesmallsamplesizesornocontrolgroups,orbiasoftheraters
INTRODUCTIONBACKGROUND-EDUCATE2B
30BREATH,MOVEMENTandMINDFULNESSscriptedexercisestohelpstudents:Calm,energize,focus,positivelyconnectwithcompassionandkindness(tothemselvesandothers),strengthendevelopmentalreadinessskillsforlearningCompletedasshort2minutebreaksthroughouttheschoolday(seatedorstanding–nomatsneeded)
To examine the effect of two minute yoga and mindfulness based sessions within the classroom setting on motor performance and social-emotional skills on elementary school children with ASD
INTRODUCTIONPURPOSE
PRESENTATIONOVERVIEW
INTRODUCTION
METHODSSubjectsFunctionalOutcomemeasuresProceduresDataAnalysis
RESULTS
DISCUSSION
METHODSSUBJECTS
InclusionCriteria
• DiagnosedwithASD• Grades2-6
ExclusionCriteria
• Unabletoparticipateinphysicalactivitybasedonschoolcriteria
• Overage12• Noparentalconsent
METHODSFUNCTIONALOUTCOMEMEASURES:DESSA-MINIESSA-MINI
DDEESSSSAA--
mmiinnii Optimisticthinking
Self-management
Goal-directedbehavior
Self-awareness Social-awareness
Personalresponsibility
Decisionmaking
Relationshipskills
MeasuresSocio-emotionalcompetenceofChildren.8measures.
METHODSFUNCTIONALOUTCOMEMEASURES:DESSA-MINI
Excellentinternalreliability(range=.924)andisgoodconstructvalidity9
METHODSFUNCTIONALOUTCOMEMEASURES:MABC-2
Measuresfineandgrossmotorfunctioninchildrenages3-17
Thesecondageband(ages7-10)wasusedinthisstudy
Eightitemscategorizedinto3subsets:ManualDexterity Catchingand
AimingBalance
METHODSFUNCTIONALOUTCOMEMEASURES:MABC-2
Test-retestReliability:InterclassCorrelationCoefficientof0.9710
Thesecondageband(ages7-10)wasusedinthisstudy
Intherapeuticpractice,thesecondagebandoftheMABC-2hasconstructvalidity11
METHODSPROCEDURES
IRBapproval(HSIRB1509) Informedconsentfrom:
ThesuperintendentoftheBergenCounty,NJschoolsystem
Teachers Parents,alongwithdemographicquestionnaire
Verbalassentfromchildren Approvalfromschoolattorneys
METHODSPROCEDURES
Twoclasseswereassignedtoeachgroup
9studentsinexperimentalgroup11incontrolgroup
TeachersofexperimentalgroupwereTrainedintheEducate2BprogrambyparticipatinginafulldayEducate2Bcourse
xxxxx
xxxx
xxxxx
xxxxxx
METHODSPROCEDURES
Teacherswereinstructedtoselectfromapoolof15oftheEducate2Btechniques-5breath,5movementand5mindfulness
Eachactivitylasted2minutes,andwasgiven3x/daywitha6minutecommitmentperday
Keptalogofwhichstrategiestheychosetouseeacheachday
METHODSPROCEDURES
TOOL / ACTIVITY M T W TH F BEHAVIORAL OBSERVATIONS
Center (belly) Breath
Sun Breath
Power Breath
Dragon Breath
Candle Breath
Twisters
Balance: Tree or Airplane
Folding Star
Melting Butter
Healing Heart
Floating Balloon
WorksheetforteacherstodocumentwhichtechniqueswereutilizedwiththestudentsreceivingtheEducate2BYogaandmindfulnessintervention
METHODSPROCEDURES
ParticipantswereassessedtwiceusingtheDESSA-miniandMABC-2 Pre-testatbeginningofschoolyear
Post-test11weekslater
O1,2X1O1,2O1,2O1,2
METHODSPROCEDURES
DESSA-minigradedbyparticipants’teachers
TeachersblindedtoDESSA-minibeingpartofstudy
MABC-2gradedbyphysicaltherapist
PTwasblindtocontrolvs.experimentalgroup
METHODSDATAANALYSIS
Descriptivestatisticstodescribeandanalyzedemographicdataandvariables
SPSSVersion22 Alldatawasanalyzedatthe.05levelofsignificance. Mann-WhitneyUtest:determineddifferencesbetweengroups
Wilcoxon-signedranktest:determineddifferenceswithingroups
INTRODUCTION
METHODS
RESULTS
DISCUSSION
RESULTS
18M2F LevelofAutism
3SEVERE 6MILD
11MODERATE
RERESULTSSULTS:DEMOGRAPHICS
3
12
4
1
Other
Caucasian
Asian
AfricanAmerican
Ethnicity
RESULTS
1
3
9
4
21
7 8 9 10 11 12
AGE
RESULTS:DESSA-MINI
Nosignificantdifferencebetweentheexperimentalgroupandcontrolgroup(p>0.05)
8.91 10.91
15.33 17.56
PRE-TEST POST-TEST
DESSA-MINII
ControlGroup ExperimentalGroup
RESULTS:DESSA-MINI
Significantdifferencewithintheexperimentalgroupfrompre-topost-testDESSA-mini(p=0.034)
15.33
17.56
PRE-TEST POST-TEST
DESSA-MINIEXPERIMENTALGROUP
RESULTS:MABC-2
Significantdifferencebetweengroupspost-test(p=.035)
7.68
7.41
12.36
12.79
PRE-TEST POST-TEST
MABC-2ControlGroup ExperimentalGroup
INTRODUCTION
METHODS
RESULTS
DISCUSSIONFindingsClinicalRelevanceLimitationsFutureStudiesConclusion
DISCUSSIONKEYFINDINGS-MOTORCONTROL
Therewasasignificantdifferencebetweengroupswhencomparingthecontrolandexperimentalgroupsinpretestandtheninposttest
Theexperimentalgrouphadnosignificantdifferencefrompretopost
Thecontrolgroupexperiencedadecreaseinscore
DISCUSSIONKEYFINDINGS-SOCIAL-EMOTIONALCOMPETENCE
Therewasnosignificantdifferencebetweengroupswhencomparingthecontrolandexperimentalgroupsinpretestandtheninposttest.
Whenlookingatthescoresoftheexperimentalgroupedfrompretopost,therewasasignificantdifferencewithanincreaseinDESSAscores.
RESULTS
Significantdifferencebetweencontrolandexperimentalgroups
postinterventionfortheMABC-2withdecrease
incontrol
Radhakrishnaetal,2010,founda
significantincreaseingrossmotorskills
RESULTS
SignificantimprovementwithinexperimentalgroupfortheDESSA-mini
Significantincreaseintheattention,socialbehavior,and
emotionalstabilityofchildrenwhoreceivedayogaintervention
Rosenblattetal,201112Radhakrishnaetal,
20107 Buckley-Reenetal,20136
DISCUSSION-
MABC-2instructionsaredifficultforchildrenwithsevereASDtofollow
Sampleofconvenience
Smallsamplesize
Teacherswerenotblindedtowhichgroupreceivedtheintervention
Teachersdidnotreturnactivitylogs Therewasnocontrolofthetherapiestheparticipantsreceivedinandoutofschool
EXP
CNTRL
MILD MODSEVMOD
DISCUSSIONFUTURESTUDIES
Controlforlevelofseveritysogroupsaremoreequivalent
Largersamplesize
MABC-2bestforchildrenabletofollowinstructions
DISCUSSION:CLINICALRELEVANCE
ChildrenwithASDhavecognitiveimpairments
thatimpedetheirabilitytolearnintheclassroom
• Thisinterventionmayimprovebehaviorandmotorfunctiontooptimizelearning
• Educate2BYogaandMindfulnessProgramisapracticalintervention
Existingyogainterventionsforchildren
withASDarenotconducivetotheclassroomsetting
REFERENCES
Factsaboutautism.CenterforDiseaseControlandPrevention.2014.Availableat:http://www.cdc.gov/ncbddd/autism/facts.html
GalantinoML,GalbavyR,QuinnL.Therapeuticeffectsofyogaforchildren:Asystematicreviewoftheliterature.PediatrPhysTher.2008;20(1):66-80
PowelL,GilchristM,StapleyJ.Ajourneyofself-discovery:Aninterventioninvolvingmassage,yogaandrelaxationforchildrenwithemotionalandbehaviouraldifficultiesattendingprimaryschools.EurJSpecNeedsEducation.2008;23(4):403–412
BergerDL,SilverEJ,SteinRE.Effectsofyogaoninner-citychildren'swell-being:Apilotstudy.AlternTherHealthMed.2009;15(5):36-42
Bubela,D,Gaylord.S.Acomparisonofpreschoolers’motorabilitiesbeforeandaftera6weekyogaprogram.JYogaPhysTher.2014;4(2):158
Buckley-ReenA,GargS,AlexanderLetal.Theeffectivenessofmanualizedyogainterventiononclassroombehaviorsinelementaryschoolchildrenwithdisabilities:Apilotstudy.JOccupatTher,Schools&EarlyIntervention.2013;6:158-164
RadhakrishnaS,NagarathnaR,NagendraHR.Integratedapproachtoyogatherapyandautismspectrumdisorders.JAyurvedaIntegrMed.2010;1:120–4
MorganA,ZensationalKids.Educate2BYogaandMindfulnessProgram.
NaglieriJ,LeBuffeP,ShapiroV.Universalscreeningforsocial-emotionalcompetencies:AstudyofthereliabilityandvalidityoftheDESSA-mini.PsycholSch.August2011;48(7):660-671.
WuangYP,SuJH,SuCY.ReliabilityandresponsivenessoftheMovementAssessmentBatteryforChildren-SecondEditionTestinchildren.
REFERENCES
KingM,BearmanP.Diagnosticchangeandtheincreasedprevalenceofautism.IntJEpidemiol.2009;38(5):1224-34.withdevelopmentalcoordinationdisorder.DevMedChildNeurol.2012;54:160–165. WagnerMO,KastnerJ,PatermannF,BösK.FactorialvalidityoftheMovementAssessmentBatteryforChildren-2(ageband2).ResDevDisabi.2011;32:674-680. RosenblattLEetal.Relaxationresponse-basedyogaimprovesfunctioninginyoungchildrenwithautism:Apilotstudy.JAlternComplementMed.2011;17(11):1029-1035DowneyR,RapportJK.Motoractivityinchildrenwithautism:Areviewofcurrentliterature.PediatrPhys.Ther.2012;24:2–20.
GreenD,CharmanT,PicklesA,etal.Impairmentinmovementskillsofchildrenwithautisticspectrumdisorders.DevMedChildNeurol.2009;51(4):311-6.
FlookL,SmalleySL,KitilMJ,etal.Effectsofmindfulawarenessonexecutivefunctioninelementaryschoolchildren.JApplPschol.2010;26(1):70-95.
Ehleringer,J.Yogaforchildrenontheautismspectrum.InternationalJYogaTher.2010;20:131-139.
StückM,GloecknerN.Yogaforchildreninthemirrorofthescience:Workingspectrumandpracticefieldsofthetrainingofrelaxationwithelementsofyogaforchildren.EarlyChildDevCare.2005;175(4):371-7.
M
REFERENCES
Mandanmohan,JatiyaL,UdupaK,BhavananiAB.Effectsofyogatrainingonhandgrip,respiratorypressuresandpulmonaryfunction.IndianJPhysiolPharmacol.2003;47(4):387-392.
MendelsonT,GreenbergMT,DariotisJK,GouldLF,PhoadesBL,LeafPJ.Feasibilityandpreliminaryoutcomesofaschool-basedmindfulnessinterventionforurbanyouth.JAbnormChildPsychol.2010;38:985–994.
LindenW.Practicingofmeditationbyschoolchildrenandtheirlevelsoffielddependence-independence,testanxiety,andreadingachievement.JConsultClinPsych.1973;41(1):139-143.
NapoliM,KrechPR,HolleyLC.Mindfulnesstrainingforelementaryschoolstudents:Theattentionacademy.JApplSchoolPsychol.2005;21(1):99-125.
RadhakrishnaS.Applicationofintegratedyogatherapytoincreaseimitationinchildrenwithautismspectrumdisorder.IntJYoga.2010;3:26–30.
