NEW HORIZON THERAPY CELEBRATES NEW OCCUPATIONAL THERAPY GYM LAUNCH

IMG_0323.jpg
IMG_0300.jpg

Tempe - New Horizon Therapy is a speech, language, and occupational therapy practice with a focus helping children to achieve their optimal potential.  Armida Carr, certified bilingual speech language pathologist, is the visionary behind New Horizon Therapy.  She believes in making the world a more expressive, articulate (and fun!) place to shine, one patient at a time.

On July 1 after one year in business Ms. Carr is expanding her occupational therapy services to include a new sensory gym for children.  This sensory gym includes a monkey bar and monkey ring set, zip line with crash pads, multiple swing hooks for calming and alerting vestibular input for your child's sensory needs. Two beautiful rock walls are matched at each end of the zip line for your child to motor plan and develop their own great obstacle course! They can climb the rock wall to get to the trapeze, and fly along the zip line and crash into the crash pad at the other end. This beautiful gym is padded with foam flooring for all the sensory adventures that await.  Bethany DeJarnatt, MOT, OTR/L is at the helm and eagerly looks forward to helping children of all ages achieve their optimal potential. 

Along with individualized treatments in the sensory gym, yoga techniques within occupational therapy treatment can have a large impact on the child's proprioceptive system and body awareness as weight bearing activities provide added input to joints and muscles, relaying the information to the child's brain. Heavy work tasks are frequently utilized during therapy treatments to assist the child with body awareness and self regulation. Activities such as jumping on a trampoline, swinging on a trapeze bar to crash into a crash pad or ballpit, moving along monkey bars, animal walks, pushing heavy barrels, catching weighted balls or self propelling on a scooter board are all frequently used activities. When asked about how yoga impacts overall wellness, Ms. DeJarnatt replied, "Yoga can provide a very important focus on emotional regulation and mindfulness techniques through techniques such as deep breathing, focusing on the changes in heart rate or breathing rate and how it relates to emotions. If we are angry, or have "hot" emotions, we generally have a higher breath rate and heart rate. Combining yoga with sensory integration techniques can amplify the benefits of heavy work and body awareness, having a greater impact on the child's ability to be more self aware of their body and when they are starting to feel upset. With yoga techniques, I also incorporate emotional regulation programs that have very effective visual strategies to provide a clear way for the child to describe their feelings and use calming techniques to calm down when upset." 
 
Recent pediatric research articles note yoga can have a very positive impact on a child's emotional growth and ability to self regulate themselves if they are distracted or upset. The article researching yoga benefits with children with ADHD reveal "beneficial effects of yoga exercise on the core symptoms of children with ADHD, such as sustained attention and discrimination ability" (Chou and Huang, 2017). Ms. DeJarnatt also shared that working as a pediatric occupational therapist, "this is a very positive modality to utilize with children with any delay, as it encourages independence and confidence."  New Horizon Therapy group yoga classes will also be starting soon! 
 
Learn more about the sensory gym and the team at New Horizon Therapy by visiting their website @ www.newhorizontherapyaz.com.

Effects of an 8-week yoga program on sustained attention and discrimination function in children with attention deficit hyperactivity disorder

Chien-Chih Chou and Chung-Ju Huang
Graduate Institute of Sport Pedagogy, University of Taipei, Taipei, Taiwan

ABSTRACT
This study investigated whether a yoga exercise intervention influenced the sustained
attention and discrimination function in children with ADHD. Forty-nine participants
(mean age = 10.50 years) were assigned to either a yoga exercise or a control group.
Participants were given the Visual Pursuit Test and Determination Test prior to and
after an eight-week exercise intervention (twice per week, 40 min per session) or a
control intervention. Significant improvements in accuracy rate and reaction time of
the two tests were observed over time in the exercise group compared with the control
group. These findings suggest that alternative therapies such as yoga exercises can be
complementary to behavioral interventions for children with attention and inhibition
problems. Schools and parents of children with ADHD should consider alternatives
for maximizing the opportunities that children with ADHD can engage in structured
yoga exercises.

Subjects Clinical Trials, Cognitive Disorders, Psychiatry and Psychology
Keywords Executive function, Cognitive benefits, Physical exercise

INTRODUCTION

Attention deficit hyperactivity disorder (ADHD) is a neurobiological condition that
commonly occurs among school-aged children, with approximately 5–8% of children
being affected. Moreover, the symptoms of the disorder persist into adulthood in up to
60% of childhood cases, meaning that roughly 4% of adults suffer from ADHD (Barbaresi
et al., 2002; Froehlich et al., 2007). The disorder is characterized by inappropriate attention,
impulsivity and/or hyperactivity which may cause a variety of problems including academic
difficulties, impaired social skills, and strained parent–child relationships (Harpin, 2005).
In regard to underlying mechanisms of ADHD, several models have been proposed such
as maturational lag, cortical hypo-arousal, and developmental deviation (Barry, Clarke &
Johnstone, 2003). Given that long-term medications can ameliorate ADHD symptoms but
may have negative side-effects such as sleep disturbances, reduced appetite, and mood
disorders (Pliszka, 2007), physical activity can serve as a low-risk treatment for ADHD
symptoms. A recent systematic review has suggested that physical activity shows promise
as an effective treatment, reporting improvement in measures of interference control, set
shifting, consistency in response speed, vigilance and impulsive control among individuals with ADHD (Halperin, Berwid & O’Neill, 2014). Therefore, further examining beneficial
effects of different forms of physical activity on attention performance in children with
ADHD can extend the current understanding of the association between physical activity
and cognition function of individuals with ADHD.

Yoga exercise has been found to be a feasible school intervention for children with
emotional and behavioural disorders and can be effective in ameliorating the symptoms
that also pervasively occur in children with ADHD, such as inattention and bad adaptive
skills in class (Steiner et al., 2013). Different from normal physical exercise, yoga practicing
steers individuals to master certain breathing techniques, postures, and cognitive control
which can help promote self-control, attention, body awareness, and stress management
(Kimbrough, Balkin & Rancich, 2007). Previous studies have demonstrated that yoga shows
promise as an intervention for a variety of social, emotional, behavioral, and cognitive
ailments (Diamond & Lee, 2011). Although previous research regarding the effects of
yoga on ADHD symptoms is somewhat limited, several studies have been conducted. Some
studies employing yoga as a treatment for ADHD reported beneficial effects such as reduced
hyperactivity, inattention, and anxiety, and improved peer relationship quality and sleep
patterns (Harrison, Manocha & Rubia, 2004; Jensen & Kenny, 2004). However, no control
group design and a small sample size brought to weaken the validity of these positive effects
of yoga intervention on ADHD children’s behavior and cognition. By utilizing a larger
sample with a symptom-match compared group, the benefits of yoga exercise on alleviating
the cognitive deficits of ADHD can be further identified.

Physical activity intervention has been found to derive positive changes in behavioral
structures and cognitive function among children with ADHD, which are reflected in
reduced impulsivity, anxiety, and improved attention (Chang et al., 2014; Huang et al.,
2014; Smith et al., 2013; Verret et al., 2012). Additionally, for children with ADHD, even a
single bout of exercise has been found to contribute to response preparation (Chuang et al.,
2015) and task switching (Hung et al., 2016), and physical fitness has been associated with
baseline cortical activity (Huang et al., 2015) and inhibitory ability (Tsai et al., in press).
The mechanisms of physical activity effects on ADHD children’s cognitive function may
be due to brain structure changes, enhanced neurotransmitters, and arousal regulation
(Lustig et al., 2009; Tang et al., 2008). Like physical activity, yoga has been found to have
beneficial impacts on neurological and physiological activity and behavior in a range
of populations. The reported benefits of yoga include increased slow-frequency brain
wave activity (Arambula et al., 2001); favorable profiles on heart rate (HR) variability,
depression, perceived stress, and superior aerobic fitness (Satin, Linden & Millman, 2014);
and significant decrement of cortisol and increment in brain-derived neurotropic factor
(BDNF), serotonin, and dopamine (Pal et al., 2014). In essence, the practice of yoga exercise
elicits reduced activation of the sympathetic nervous system and increased activation of
the parasympathetic nervous system resulting in a sense of equilibrium into the body and
mind, and increased emotional self-regulation (Streeter et al., 2012). Given that abnormal
attention and over-impulsivity characteristics have been considered as major symptoms
of ADHD, these previous studies provide compelling empirical evidence for using yoga
exercise in ADHD treatment.

Although a few studies have reported potential associations between yoga exercise
and improved cognitive functions of children with ADHD (Jensen & Kenny, 2004),
these findings are required to be replicated to warrant the use of yoga as an effective
complementary treatment for this population. Based on evidence revealing deviant patterns
in behavioral impulsivity, memory retrieval, sustain attention, stimuli differentiation, and
decision making are relevant to ADHD (Barkley, 1997; Bellgrove, Hawi & Robertson, 2006),
the current study further examined the effects of yoga exercise on the sustained attention
and discrimination functions among ADHD children. Any changes in sustained attention
and discrimination function observed after yoga exercise could be used to identify the effects
of yoga on improved ADHD symptoms. Given the results of the studies briefly reviewed
above, physical activity including yoga exercise could contribute to reduced hyperactivity
and inattention (Harrison, Manocha & Rubia, 2004; Jensen & Kenny, 2004; Steiner et al.,
2013), as well as increased interference control, attention shifting, and consistency
in response speed among individuals with ADHD (Halperin, Berwid & O’Neill, 2014).
Reduced hyperactivity, increased attention and response consistency could contribute
to better sustained attention while increased interference control and attention shifting
should enhance discrimination function which involves inhibition and selective attention.
This study hypothesized that yoga exercise could benefit the sustained attention and
discrimination function of children with ADHD by using the Visual Pursuit Test and the
Determination Test. The Visual Pursuit Test is usually used to assess visual perception
involving sustained attention and the Determination Test is used to evaluate the ability
to determine multiple-choice reaction requiring inhibitory ability and selective attention.
Although the two tests have not been utilized among individuals with ADHD, their
availability has been reported in clinical populations (Kober et al., 2013) and young athletes
(Dogan, 2009). Such a study could be critically important in laying the ground work for
both scientific research and clinical application.

METHODS

Participants
Fifty participants were recruited via flyers posted in relevant locations, referrals given to the
children’s parents by their elementary schools, and a number of orientations conducted
to introduce the project. All participants were from schools located in suburban areas
of a city where most families were the middle to high socioeconomic populations. The inclusion criteria were as follows: children aged between eight and 12 years old who had been diagnosed with ADHD by their own psychiatric physicians and had been confirmed by school pediatricians. All the various subtypes of ADHD (inattentive, hyperactivity/impulsivity, combined) were included regardless of whether he or she was receiving medication for ADHD symptoms. The exclusion criteria were as follows:
(a) comorbid conditions such as conduct/oppositional defiant disorder, autism spectrum
disorders, or serious affective disorders; (b) a personal history of brain injury or neurological
disorders; and (c) currently taking sedatives or other mood altering medications other than
the stimulants typically prescribed for ADHD. All the children were assigned to one of
two groups according to their school districts: the yoga exercise group (n = 25) and the control group (n = 25). One participant withdrew from the yoga exercise group due to
personal consideration. Figure 1 shows the flow diagram for the progress of all participants
through the study. Participants were instructed to refrain from medications and caffeine
intake for at least 24 h prior to undergoing the various tests administered as part of the
study. Written informed consent was provided by the parents and the children following
a full explanation of the study, which was reviewed and approved by the Research Ethics
Committee of National Taiwan University prior to the experiment.

Screen Shot 2018-06-12 at 8.25.16 AM.png

Measures

Visual pursuit test
The Visual Pursuit Test of the Vienna Test System (Schuhfried GmbH, Austria), a
computerized psychological assessment tool well established in psychological diagnostics
(Schmid et al., 2005), was used in this study. It is designed as a line tracking test and used
for the registration of concentrated targeted perception and selective attention in the visual
area. Hence, the performance in this test requires the ability of selective and sustained
attention. It consisted of 54 different items; in each item, an array of nine entwined dark
lines leading to nine different endpoints was presented on a light background computer
screen. The starting point of one out of the nine lines was marked and the participant
was asked to follow this line with their eyes to find the corresponding endpoint as quickly
as possible by pressing one of nine number buttons on a response panel. The screen was
shown for four seconds and then disappeared. Therefore, items to which the participant did
not answer correctly or did not respond within the four seconds were reported as incorrect
responses. The performance of the participant was scored automatically, considering the
number of correct answers and mean RT for correct answers. The test duration for each
participant was approximately 10 min per run.

Determination test
The Determination Test has been used to assess the discrimination ability for reaction
speed, attention deficits, and reactive stress tolerance in the presence of continuous but
rapidly changing acoustic and optical stimuli (Shmygalev et al., 2011). In this study, the
participant’s task was to react as quickly as possible to visual or acoustic stimuli by pressing
the corresponding buttons on the response panel. There were five visual stimuli colored
white, yellow, red, green and blue, which appeared in an upper and a lower row on the
screen. The reaction buttons assigned to these five colors were arranged on the response
panel in such a way that the participant could use both hands. There were two additional
visual stimuli, in the form of white, rectangular, visually distinct fields that appeared in
the bottom left- and right-hand corners of the screen, to which the participant had to
react by pressing the corresponding (left or right) foot pedal. Two acoustic stimuli (high
and low tone) were assigned to the two ‘‘sound’’ buttons in the middle of the panel. The
lower, rectangular black button was pressed for a low tone and the upper rectangular grey
button for a high tone. The visual stimuli were presented on the screen and the acoustic
stimuli were presented via headphones. The duration of stimulus presentation depended
on the respondent’s mean RT for the previous eight trials. If the response to a stimulus
was not correct, the RT was doubled for the purpose of calculating the duration of the
next stimulus. This test contained 180 trials with 20 trials for each stimulus. The number
of correct trials was utilized to calculate the accuracy rate and RT of each correct response
was reported. The duration for the test was approximately 10 min for each participant.

Physical fitness
The participants were instructed to not engage in any intense physical activity or take
any stimulant medication on the day before the evaluations. In addition to weight and
height, the physical fitness of each participant was estimated, including flexibility, muscular endurance, power, and cardiovascular fitness. The fitness assessment includes measures of flexibility (sit and reach test), muscular endurance (sit-ups in 1 min), power (standing long jump), and cardiovascular fitness (a half-mile run in the fastest possible time). The four subsets of fitness assessment of all the participants were converted into standardized
T-scores, and the physical fitness score was computed as the mean of the scores on these
fitness subsets.

Yoga exercise intervention
The manipulation of yoga activity followed the American Physical Therapy Association
guidelines for working with children (Galantino, Galbavy & Quinn, 2008). Each lesson
for yoga activity lasted for 40 min, twice a week for eight weeks, was led by a nationally
certified yoga instructor, and was conducted in a dance studio with an average temperature
of 24–26 ◦C. The yoga activity session consisted of a 10-minute stretching and warming-up
period followed by a 20-minute yoga activity, which included concentration and balance,
improved attention, and breath and body awareness. Finally, each session ended with a
10-minute cooling-down period including balancing, flexibility, and relaxation exercises.
This clinical trial was approved by the Chinese Ethics Committee of Registering Clinical
Trials. During the entire session, each participant’s HR was recorded at one-min intervals
by using a Polar HR monitor (Mode ZW 60 GT5; Cardiosport, Waterlooville, United Kingdom). The HR values during the periods of warming-up, main activity, and cooling-
down were calculated respectively. The intensity of the main activity was set at 50–60% of maximal HR (HRmax) according to the previous study suggesting that this intensity
level of aerobic exercise is beneficial to baseline cognition function of children with ADHD
(Huang et al., 2014). The HRmax was estimated using a formula ‘‘220–age’’ and then the
target HR for each participant was calculated. To monitor the intensity of the main activity,
the researchers examined the HR data of each participant during the period of main activity
after the completion of each lesson. For all the lessons, the participants reached at least
50% and did not exceed 60% of their HRmax during the main activity. The instructor was
recommended to maintain her prescribed activity and intensity.

To test for exercise intensity manipulation, one-way analysis of variance (ANOVA) was
conducted to compare the HR differences among the periods of warming-up, main activity,
and cooling-down. The results showed a significant increase in HR during the period of main activity for yoga exercise (105.21 ± 4.24 bpm), compared to the periods of warming-
up and cooling-down (78.38 ± 3.23, 84.87 ± 3.18 bpm), F(2,46) = 306.04,p < .001, and partial η
2 = 0.93. During the main activity for the yoga exercise, the intensity of exercise
was approximately 53% of HRmax. Briefly stated, the exercise intensity of yoga activity
reached a moderate level.

Procedure
The participants were invited to come to the laboratory with their parents on two separate
days. The children who were undergoing medical treatment were asked to refrain from
medication for at least 24 h prior to the experiment. On the first visit, the participant’s
parent(s) and the participant signed an informed consent form, provided a health history, and filled out a demographics questionnaire. Each eligible participant then entered the
pre-test stage, which consisted of performing the Visual Pursuit Test and the Determination
Test and a physical fitness assessment. Prior to the physical fitness tests, the participants and
their parents were verbally inquired to assess their or their children’s physical readiness for
the tests. For those participants who expressed they were not physically well-prepared to take the physical fitness tests, we rearranged the tests for them on other visits as soon as possible. The order of the Visual Pursuit Test and the Determination Test was counterbalanced. For the Visual Pursuit Test, the given participant was asked to find the end of a specified line as rapidly as possible by pressing the corresponding number buttons on the response panel. Before the formal test, eight trials were provided for practicing. If over three trials for which the responses were in error, the participant was asked to repeat the practicing trials until they were familiar with the test. Then, the formal trials were administered.

For the Determination Test, the participant was instructed to perform according to
the various color stimuli and acoustic signals presented by pressing the corresponding
buttons on the response panel. At the instruction phase, step-by-step instructions gave
the participants the necessary information regarding the test. The instructions started
by explaining the colored buttons on the response panel. The participants were then
introduced to the visual stimuli and sounds; samples of these could be seen and heard
by pressing the corresponding buttons. The instruction phase was followed by a practice
phase. If more than three errors were made or if no response was made within 45 s
on three successive occasions, the practice phase was automatically interrupted and the
respondent was instructed to consult the test administrator. The administrator could, if
necessary, restart the instruction phase in order to ensure that the instructions were fully
understood. Then, the formal trials were conducted to the participants. As these two tests
were completed, the height and weight of the participants were measured and the fitness
assessment followed after warm-up exercises and detailed explanations of each testing
protocol. Participants were allowed to rest between each testing to avoid fatigue.

Participants in the yoga exercise group underwent an eight-week yoga exercise program
that consisted of two 40-min sessions per week as an after school program. In contrast to
the exercise group, the participants in the control group were simply instructed to maintain
their normal life without participating in regular physical activity programs. Within one
week of completing the yoga exercise program, all the participants were invited to visit the
laboratory for the second time. Each participant was asked to perform the Visual Pursuit
Test and the Determination Test again for the comparison of pre- and post-test scores.

Statistical analysis
To ensure that any potential confounds would be homogenous for both the exercise and
control groups, independent t-tests or chi-square tests were used to analyze for continuous
or discrete scales of demographic data, respectively, to compare between the two groups.
Next, the effects of yoga exercise on the performance in the Visual Pursuit Test and the
Determination Test were examined by 2 (Group: exercise, control) × 2 (Time: pre-test,
post-test) mixed design ANOVAs. Following the ANOVAs, multiple comparisons with
Bonferroni–Holm adjustments were applied to control for experiment-associated inflation 

Screen Shot 2018-06-12 at 8.32.19 AM.png

of type 1 error for small sample sizes. Effect size (ES) values were calculated according to
Cohen’s d and partial eta-square (η
2
) for the significant main effects and interactions. For
all statistical analyses, a significance level of .05 was used prior to the adjustment.
RESULTS
Demographic analyses
The analyses results indicated that there were no significant differences between the
groups in terms of weight, height, body mass index (BMI), age, intelligence quotient (IQ),
cardiovascular fitness, muscular strength, muscular endurance, flexibility, and total physical
fitness, t47 < 1.07, p > .05. In addition, in terms of gender, grade, type, and medicine intake
for both groups, x

2 < 2.69, p > .05, suggesting that the two groups were homogenous. Table
1 summarizes the demographic characteristics and physical fitness of the participants in
both groups.

Screen Shot 2018-06-12 at 8.35.22 AM.png

The visual pursuit test
As the accuracy rate of the Visual Pursuit Test presented in Table 2, a mixed design
ANOVA revealed no main effects of Group and Time. However, a significant interaction
of Group by Time was found, F(1,47) = 4.26, p = .045, partial η 2 = 0.08, exhibiting that
the yoga exercise group yielded a higher accuracy rate at the post-test than the control
group, t47 = 2.70, p = .010, d = 0.78, along with no group differences observed at the
pre-test. Furthermore, the exercise group reported an increased accuracy rate after the yoga
intervention, t23 = −2.12, p = 0.045, d = −0.69, while no change in the accuracy rate was
found for the control group, t24 = 0.86, p = 397.
For the RT data, the analysis reported a main effect of Group, F(1,47) = 12.85,p = .001,
partial η 2 = 0.22, revealing faster RT for the exercise group than the control group. Also,
a main effect of Time was observed, F(1,47) = 12.56,p = .001, partial η 2 = 0.21, indicating
faster RT at the post-test than the pre-test. A significant interaction of Group by Time was
found, F(1,47) = 8.20,p = .006, partial η 2 = 0.15, demonstrating that the yoga exercise group
yielded a faster RT at the post-test than the control group, t47 = −4.18, p < .001, d = −1.20,
along with no group differences observed at the pre-test. Additionally, the exercise group
reported a decreased RT after the yoga intervention, t23 = 4.12,p < .001,d = 1.29, while
no RT change was found for the control group, t24 = 0.54,p = .597.

The determination test
In terms of the response accuracy of the Determination Test presented in Table 2, ANOVA
revealed a main effect of Time, F(1,47) = 5.32,p = .026, partial η 2 = 0.10, indicating a higher
accuracy rate at the post-test than the pre-test. A significant interaction of Group by Time
was reported, F(1,47) = 17.48,p < .05, partial η 2 = 0.27, revealing that the yoga exercise
group yielded a higher response accuracy at the post-test than the control group, t47 = 3.74,
p < .001, d = 1.09, along with no group differences observed at the pre-test. Furthermore,
the exercise group reported an increased response accuracy after the yoga intervention,
t23 = −5.78, p < .001, d = 1.22, while no change in the response accuracy was found for
the control group, t24 = 1.15, p = 0.263.


For the RT data, the analysis revealed a main effect of Group, F(1,47) = 9.29,p = .004,
partial η 2 = 0.17, exhibiting faster RT for the exercise group than the control group. Also,
a main effect of Time was reported, F(1,47) = 4.45,p = .040, partial η 2 = 0.09, indicating
faster RT at the post-test than the pre-test. A significant interaction of Group by Time was observed, F(1,47) = 4.79,p = .034, and partial η 2 = 0.09, demonstrating that the yoga
exercise group yielded a faster RT at the post-test than the control group, t47 = −4.26,
p < .001, d = −1.25, along with no group differences observed at the pre-test. Furthermore,
the exercise group reported a decreased RT after the yoga intervention, t23 = 4.78, p < .001,
d = 1.26, while no RT change was found for the control group, t24 = −0.05, p = 964.

DISCUSSION

The findings of this study are consistent with previous research (Cerrillo-Urbina et al.,
2015), revealing beneficial effects of yoga exercise on the core symptoms of children with
ADHD, such as sustained attention and discrimination ability. With HR monitoring applied
to ensure a moderate level of exercise intensity, the results showed that the yoga exercise
program exerted a positive impact on RT and response accuracy at the Visual Pursuit Test
and the Determination Test, whereas no such influences were found for the control group.
The results were promising because this study reported the homogeneity of demographic
characteristics, intelligence quotient, and physical fitness between the exercise and control
groups at the baseline, confirming that these variables might not confound our findings.
Also, the participants were recruited from nearby residential areas where the average level
of socioeconomic status was similar. In particular, the present findings extend previous research by utilizing a larger sample, symptom-match counterparts, and a moderate-intensity yoga exercise that involved aerobic, flexibility, and perceptual-motor exercises.

In support of our hypothesis, the yoga exercise group demonstrated a faster RT and
higher response accuracy on the Visual Pursuit Test than the control group. The result that
yoga exercise enhanced selective and sustained attention in children with ADHD aligns
with the extant literature regarding effects of alternative therapies on ADHD symptoms
(Majorek, Tüchelmann & Heusser, 2004; Peck et al., 2005). These studies have reported the
facilitative impacts of yoga and massages on self-control, relaxation, and concentration
for children with ADHD. Yoga exercise typically conducts a variety of poses, deep breath,
concentration, and mental and physical relaxation which can positively regulate mental
states (Zipkin, 1985). It also tends to promote self-control, attention and concentration, self-efficacy, body awareness, and stress reduction (Peck et al., 2005). Recently, a meta-
analytical study has indicated that yoga exercise suggests substantial improvements such as alleviating impulsivity, anxiety, and social problems and a mild improvement in attention
and hyperactivity for individuals with ADHD (Cerrillo-Urbina et al., 2015). The present
findings are also supported by other research regarding physical exercise effects on children
with ADHD (Smith et al., 2013; Verret et al., 2012), reporting that sustained attention
improves with long-term physical exercise. Further, Palmer, Miller & Robinson (2013)
revealed that after engaging in a bout of movement program incorporating various motor
skills, preschoolers exhibited better ability to sustain attention compared to after being
sedentary. Their finding highlights the proposition that exercise requiring motor control is
more likely to enhance sustained attention for subsequent cognitive task because prefrontal
brain regions involved in sustained attention are activated after exercise (Budde et al.,
2008). Yoga exercise always requires participants to perform complex combinations of motor skills in a smooth and fluent manner, such as controlling body posture and relative
space using vestibular sense (Peck et al., 2005). Thus, the yoga program in the current
study, which involved posture control and motor skills, might facilitate ADHD individuals’
subsequent sustained attention performance of the Visual Pursuit Test by activating the
prefrontal cortex.

Moreover, the yoga exercise group exhibited a better performance on the Determination
Test than the control group, revealing that yoga exercise could be beneficial to children with
ADHD in terms of improving their discrimination ability. Given that the Determination
Test requires participants to quickly respond to different kinds of acoustic and optical
stimuli, better discrimination ability indicates that the participants exhibit greater inhibition
toward the interference of the previous stimulus, as well as faster and more accurate selection toward multiple stimuli and the corresponding reaction (Dogan, 2009). Previous studies have provided supporting evidence regarding the positive effects of yoga exercise on the inhibitory function in healthy children (Telles et al., 2013). Telles et al. (2013) assessed the
effects of yoga and physical exercise over three months and found that both interventions
improved performance in the Stroop task for healthy children. The cognitive mechanisms
involved in this task are attentional vitality and flexibility, as well as inhibition of a
dominant response. Therefore, similar to effects of physical exercise, yoga exercise has been
postulated to influence attention and inhibition, however, through different pathways.
Previous studies also support this notion, reporting that changes in bilateral putamen
volumes of the dorsal striatum and globus pallidus after a year long physical exercise were
associated with inhibition performance (Chaddock et al., 2012). On the other hand, the
findings of neuroimaging studies indicated that yoga practitioners exhibited increased
blood flow to the dorsolateral prefrontal cortex (Cohen et al., 2009). Hence, the benefits
of yoga practice in discrimination ability seem to be associated with specific changes in
particular brain areas.

Another possibility is that yoga exercise improves discrimination ability by improving
attention and information processing. Using a neuroelectrical approach, children with
ADHD that have greater motor ability exhibited better allocation of attentional resource
and superior efficiency of neuroprocessing than their counterparts with lower motor ability
(Hung et al., 2013). After an eight-week aquatic exercise program, children with ADHD
demonstrated an improvement in accuracy for a widely used cognitive task that assesses
behavioral inhibition (Chang et al., 2014). The mechanisms underlying these benefits may
involve complex neuro-chemical changes and modified functioning of brain areas within
the limbic circuit. For instance, yoga exercise was found to be associated with decreased
cortisol and increased BDNF, serotonin, and dopamine (Pal et al., 2014). These biological
mechanisms contribute to attention processing and inhibition in terms of regulating arousal
levels in fronto-striatocerebellar circuits and enhancing the control of executive function
(Del Campo et al., 2011). In animal studies, increased BDNF levels in the hippocampus after
exercise were found to be related to elevated learning and memory processes (Vaynman,
Ying & Gomez-Pinilla, 2004). Although further studies are still required to confirm these
findings, previous studies suggest that yoga exercise may result in improved cognitive
function in ADHD by the alteration of neuro-chemical expressions. motor skills in a smooth and fluent manner, such as controlling body posture and relative space using vestibular sense (Peck et al., 2005). Thus, the yoga program in the current study, which involved posture control and motor skills, might facilitate ADHD individuals’ subsequent sustained attention performance of the Visual Pursuit Test by activating the prefrontal cortex.

Moreover, the yoga exercise group exhibited a better performance on the Determination
Test than the control group, revealing that yoga exercise could be beneficial to children with
ADHD in terms of improving their discrimination ability. Given that the Determination
Test requires participants to quickly respond to different kinds of acoustic and optical
stimuli, better discrimination ability indicates that the participants exhibit greater inhibition
toward the interference of the previous stimulus, as well as faster and more accurate selection toward multiple stimuli and the corresponding reaction (Dogan, 2009). Previous studies have provided supporting evidence regarding the positive effects of yoga exercise on the inhibitory function in healthy children (Telles et al., 2013). Telles et al. (2013) assessed the
effects of yoga and physical exercise over three months and found that both interventions
improved performance in the Stroop task for healthy children. The cognitive mechanisms
involved in this task are attentional vitality and flexibility, as well as inhibition of a
dominant response. Therefore, similar to effects of physical exercise, yoga exercise has been
postulated to influence attention and inhibition, however, through different pathways.
Previous studies also support this notion, reporting that changes in bilateral putamen
volumes of the dorsal striatum and globus pallidus after a year long physical exercise were
associated with inhibition performance (Chaddock et al., 2012). On the other hand, the
findings of neuroimaging studies indicated that yoga practitioners exhibited increased
blood flow to the dorsolateral prefrontal cortex (Cohen et al., 2009). Hence, the benefits
of yoga practice in discrimination ability seem to be associated with specific changes in
particular brain areas.

Another possibility is that yoga exercise improves discrimination ability by improving
attention and information processing. Using a neuroelectrical approach, children with
ADHD that have greater motor ability exhibited better allocation of attentional resource
and superior efficiency of neuroprocessing than their counterparts with lower motor ability
(Hung et al., 2013). After an eight-week aquatic exercise program, children with ADHD
demonstrated an improvement in accuracy for a widely used cognitive task that assesses
behavioral inhibition (Chang et al., 2014). The mechanisms underlying these benefits may
involve complex neuro-chemical changes and modified functioning of brain areas within
the limbic circuit. For instance, yoga exercise was found to be associated with decreased
cortisol and increased BDNF, serotonin, and dopamine (Pal et al., 2014). These biological
mechanisms contribute to attention processing and inhibition in terms of regulating arousal
levels in fronto-striatocerebellar circuits and enhancing the control of executive function
(Del Campo et al., 2011). In animal studies, increased BDNF levels in the hippocampus after
exercise were found to be related to elevated learning and memory processes (Vaynman,
Ying & Gomez-Pinilla, 2004). Although further studies are still required to confirm these
findings, previous studies suggest that yoga exercise may result in improved cognitive
function in ADHD by the alteration of neuro-chemical expressions.

Source (https://peerj.com/articles/2883/)