Effect of Yoga Among Children and Adolescents.2
Effect of Yoga Among Children and Adolescents.2
DOI: 10.4103/ijoy.ijoy_227_23
Quick Response Code:
This is an open access journal, and articles are
distributed under the terms of the Creative Commons How to cite this article: Patra BN, Khandelwal K,
Attribution‑NonCommercial‑ShareAlike 4.0 License, which Sagar R, Sharma G. Effect of yoga among children
allows others to remix, tweak, and build upon the work and adolescents diagnosed with psychiatric
non‑commercially, as long as appropriate credit is given and disorders: A scoping review. Int J Yoga 2024;17:3-9.
the new creations are licensed under the identical terms. Submitted: 23‑Nov‑2023 Revised: 16‑Jan‑2024
Accepted: 15‑Feb‑2024 Published: 13-May-2024
For reprints contact: [email protected]
fitness (6‑min walk). A significant proportion shifted in A randomized waitlist‑controlled trial tested a 6‑week yoga
their readiness to change “How I deal with stress” from intervention in preschoolers with ≥4 ADHD symptoms
“Contemplative” to “Action” stage. Parents reported on the ADHD Rating Scale‑IV preschool version.
improved child functional ability, improvement in anxiety, Group 1 (n = 12) practiced yoga first and Group 2 (n = 11)
depression, and somatization symptoms. A manualized practiced yoga second. The findings indicate that at
8‑week integrated yoga intervention for adolescents baseline, there were no significant differences between
achieved clinically significant outcomes with moderately Groups 1 and 2 on any measure. At T1, Group 1 had
high adherence.[4] faster reaction times on the KiTAP (Test of Attentional
Performance for Children) Go/No go task, fewer
The effect of yoga as a sensory regulation tool in
distractibility errors of omission, but more commission
reducing adolescent distress in an acute care psychiatric
errors than Group 2. Children in Group 1 with more
hospital. The population consisted of a convenience
severe symptoms at baseline showed improvement at T1,
sample of 75 adolescent mental health unit inpatients and
which was not seen in Group 2 on parent‑rated strengths
partial‑hospitalization patients 12–18 years of age who
and difficulties questionnaire hyperactivity‑inattention and
participated in two or more yoga sessions. Findings indicate
inattention on the ADHD Rating Scale. HRV measures did
that yoga sessions significantly improved patient pulse and
not differ between groups. It can be concluded that yoga
self‑reported distress ratings regardless of gender or sensory
was associated with modest improvements in an objective
profile levels. It implies that research on the therapeutic
measure of attention (KiTAP) and selective improvements
effects of yoga as a sensory regulation intervention in the
in parent ratings. Yoga may be a promising treatment for
treatment of psychiatrically hospitalized adolescents. Yoga has
ADHD symptoms in preschoolers.[7]
the potential to help adolescents in an acute care psychiatric
hospital learn to soothe themselves, regulate their emotions, The effect of combined yoga and meditation with
and find relief from emotional distress while hospitalized.[5] multimodal behavior therapy program for children aging
6-11 years found that. It was a 6‑week program and results
Yoga for attention‑deficit hyperactivity disorder
showed 90.5% of children improved as measured by their
A total of 38 female children aged between 6 and 10 years performance impairment score, a measurement of academic
participated in this study with a single group pre‑ and performance. Parent and teacher evaluations of behavior
posttest design. The data analyses showed significant also found improvement as 25 of the 64 children (39.1%)
improvement in the attention level at both the Parent improved into the normal range as measured by the
Assessment Scale and the Teacher Assessment Scale. This Vanderbilt questionnaire. Moreover, children could
pre‑ and post‑single group study suggests that 8 weeks successfully learn both yoga and meditation from high
of yoga practice gradually increases the attention level of school students irrespective of their age, ADHD type, or
orphan female children. Additional well‑designed studies initial performance impairment. The results demonstrate the
with larger samples and complex designs are recommended efficacy of a multimodal behavioral program incorporating
for generalization.[6] yoga and meditation. The use of high school volunteers
from schools in the area demonstrates an effective low‑cost self‑esteem, and relationship quality. Children described
and universally applicable approach.[8] benefits at home (better sleep patterns and less anxiety)
and at school (more able to concentrate and less conflict).
To studied boys diagnosed with ADHD by specialist
Parents reported feeling happier, less stressed, and more
pediatricians and stabilized on medication, randomly
able to manage their child’s behavior. Indications from this
assigned to a 20‑session yoga group (n = 11) or a control
preliminary investigation are that SYM may offer families
group (cooperative activities; n = 8). Boys were assessed
an effective management tool for family‑oriented treatment
pre‑ and postintervention on Conners parent Rating Scale
of childhood ADHD.[11]
(CPRS), the test of variables of attention (TOVA), and
the motion logger actigraph. Results revealed significant To investigate the effects of yoga on sustained attention
improvements from pretest to posttest were found for the in three groups of children with syndrome ADHD, ADHD
yoga but not for the control group on five subscales of predominantly inattentive, and ADHD predominantly
CPRS, oppositional, global index emotional lability, global hyperactivity. The number of 120 students (7–13 years
index total, global index restless/impulsive, and ADHD old) with symptoms of ADHD were selected by CTRS,
index. Significant improvements from pre‑ to posttest and parent rating‑children symptom inventory, in common
were found for the control group but not the yoga group both forms and were organized in two groups of yoga
on three CPRS subscales: hyperactivity, anxiety/shy, and and control. Continuous performance test was done to
social problems. Both groups improved significantly on evaluate sustained attention. The Yoga group was given a
CPRS perfectionism, diagnostic and statistical manual of 30‑session course on yoga training and control group, not.
mental disorder, fourth edition (DSM–IV) hyperactive/ The results of this study indicate the efficiency of yoga in
impulsive, and DSM‑IV total. For the yoga group, positive increasing sustained attention in all subgroups of children
change from pre‑ to posttest on Conner’s Teacher Rating with symptoms of ADHD. Based on these findings, we
Scale (CTRS) was associated with the number of sessions concluded that Yoga can affect and help in attention
attended on the DSM–IV hyperactive‑impulsive subscale improvement. Verification of such effects can be used to
and with a trend on the DSM‑IV inattentive subscale. Those design effective nondrug therapies, such as the effect of
in the yoga group who engaged in more home practice yoga therapy on symptoms of ADHD.[12]
showed a significant improvement in TOVA response time
Yoga for autism
variability with a trend on the ADHD score and greater
improvements on the CTRS global emotional lability To examine the effect of yoga training program (YTP)
subscale. Results from the motion logger actigraph were on the severity of autism in children with high‑function
inconclusive. Although these data do not provide strong autism (HFA). Twenty‑nine children aged 7–15 years
support for the use of yoga for ADHD, partly because the were randomly allocated to either yoga or control
study was underpowered, they do suggest that yoga may group. The participants in the yoga group received an
have merit as a complementary treatment for boys with 8‑week (24 sessions) YTP. Parents or caregivers of
ADHD already stabilized on medication, particularly for participants completed an autism treatment evaluation
its evening effect when medication effects are absent. Yoga checklist (ATEC) at baseline and the end of the intervention.
remains an investigational treatment, but this study supports The results of the analysis showed that there were significant
further research into its possible uses for this population. differences between the two groups with regard to all ATEC
These findings need to be replicated in larger groups with a subscore except ATEC I (speech/language/communication).
more intensive supervised practice program.[9] This study provides support for the implementation of a
YTP and identifies specific procedural enhancements to
The results found in studies that have examined yoga
reduce the severity of symptoms in children with autism.[12]
interventions delivered outside of school settings that
aimed to improve ADHD‑related variables showed Yoga for learning disability
improvement in ADHD symptoms such as inattentiveness
To examine the effects of 1 h, twice‑weekly Tai Chi
and hyperactivity, as shown through parent reports.[10]
Chuan sessions on state anxiety and mood of children
To investigate meditation as a family treatment method with severe learning disabilities. The participants were
for children with ADHD, using the techniques of Sahaja three upper elementary children. The intervention lasted
Yoga Meditation (SYM). Parents and children participated 10 weeks. The state‑trait anxiety inventory for children
in a 6‑week program of twice‑weekly clinic sessions A‑State Scale, a 28‑item mood inventory, and CTRS‑39, a
and regular meditation at home. Pre‑ and posttreatment scale used to assess whether a child has attention deficits
assessments included parent ratings of children’s ADHD and/or hyperactivity, were given at intervals during the
symptoms, self‑esteem, and child–parent relationship pretreatment baseline (A1), treatment (B), and posttreatment
quality. Perceptions of the program were collected through baseline (A2). Results suggest that the intervention had
parent questionnaires and child interviews. Results the strongest effect on the participants who presented with
showed improvements in children’s ADHD behavior, hyperactivity and heightened anxiety. The findings support
the benefits of using a single‑case research design with this Moreover, pre/posttest design study, repeating testing may
population.[13] increase/decrease scores for participants as they anticipate
questions from answers ahead of the time.[7]
Discussion
The opportunity to measure the effects of more than
To our knowledge, this is one of the first scoping two yoga sessions was limited because patients were
reviews about psychiatric conditions among children frequently discharged shortly after consent was obtained.
and adolescents about the benefits of yoga. The studies It is a vulnerable population and in crisis at admission to
focused on holistic intervention, including significant
the hospital. Therefore, consent forms were not presented
psychoeducation about stress, how the autonomic nervous
to parents upon admission. Instead, a limited number of
system functions, and how yoga practices help move
trained clinical staff obtained consent from parents and
the balance toward parasympathetic control rather than
patients later in the patients’ stay. Earlier consent would
sympathetic control. However, these studies did not
extend the capacity of this type of study to judge the effects
separately evaluate the impact of this education. Moreover,
of three or more yoga sessions. This study was limited
the youth seemed to respond well to a fairly structured
intervention that provided rationale as well as experiential to adolescents with English‑speaking parents/guardians.
learning.[4] We did not include adolescents of non‑English‑speaking
parents/guardians because we could not be sure that they
The strength of the above studies is that they are fully understood the consent and self‑reported measures.
randomized design. Moreover, by including parent and All of the yoga classes were conducted by the same person.
teacher reports of children’s behavior, clinical assessments This provided standardized yoga instruction for all subjects
as well as qualitative data documenting the perceived in the study. However, it leaves the question of whether
changes and feasibility of the yoga intervention, contributed different yoga instructors would produce the same results.
to a holistic measurement approach.[7] Moreover, the studies only measured the immediate effects
Along with yoga and meditation, the play therapy was used of yoga. However, short‑term effects are important in
among school‑aged peers to increase their motivation to the psychiatric hospital setting, where stabilization is the
participate in the yoga. The improvements seen from the goal.[5]
program showed sustained effect in the long term, and it
Scheduling was also a limitation present in the study. Due
resulted in an effective and low‑cost approach to address
to student and teacher absences, scheduled school days
the needs of children with ADHD.[8] Moreover, the use of
off, in‑school assemblies, weekends, and the ever‑present
yoga as a complementary treatment for boys with ADHD
scheduling changes found in elementary school classrooms,
appears to have some merit, especially for its evening
effect when medication effects wear off.[9] observation and intervention periods could not be scheduled
as regularly as the researchers would have preferred.[10]
Some studies did not provide a control group. High
adherence rate to yoga intervention was because of In parent‑rated questionnaires and that the reported
enough parental support for transportation to classes. In improvements in child outcomes and child–parent relationship
addition to the integrated and structured yoga practice, might be ascribed to parents wanting to present themselves
other components used in the intervention that may have and their child in the best light. If this were the case, however,
been beneficial were not part of the analyses such as group one would expect to see similar levels of change across the
support, active problem‑solving, and positive bonding three parent‑rated questionnaires, whereas results showed that
with an adult leader. These covariates were not analyzed improvements in ratings of self‑esteem were independent of
separately.[4] improvements in ADHD symptoms and relationship quality.
This suggests that parents were not reporting a nondiscriminate
In pilot and feasibility studies, a smaller sample size
or overly positive picture of their child but were giving an
was used, and it impacted power calculations. Moreover,
accurate report based on observed behavior.[11]
there was a short intervention period, missing data due to
unreturned or incomplete rating scales, the inability of some For future studies, a large sample size to examine yoga
children to complete self‑reported measures, refusal of benefits more, assessing the long‑term versus acute effects
some children to wear equipment measuring physiological of yoga, examining other relaxation strategies as compared
parameters, the change in location of school yoga between to yoga can be studied.
groups, and changes in teachers rating the participant’s
behavior. Many mindfulness and yoga interventions lack Conclusion
randomized assignment, statistical power, active control Overall, yoga intervention showed significant results in
groups, and holistic measurement approaches.[9] children and adolescents diagnosed with psychiatric illness.
Despite excellent results, some studies could not be Hence, the use of yoga as nonpharmacological intervention
generalized to inpatient or typically developed samples. must be recommended by the clinicians.
Ethical statement and the relationship between those effects and the patients’
sensory‑processing patterns. J Child Adolesc Psychiatr Nurs
Ethical approval was not required for this study as it a 2014;27:175‑82.
scoping article where data was obtained retrospectively. 6. Indudhar L, Murthy S, Vijay Kumar BA, Venkatram R. Effect
of yoga on attention level of orphan girls with ADHD. Int J Adv
Financial support and sponsorship Res 2018;6:316‑22.
Nil. 7. Cohen SC, Harvey DJ, Shields RH, Shields GS, Rashedi RN,
Tancredi DJ, et al. Effects of yoga on attention, impulsivity, and
Conflicts of interest hyperactivity in preschool‑aged children with attention‑deficit
hyperactivity disorder symptoms. J Dev Behav Pediatr
There are no conflicts of interest. 2018;39:200‑9.
8. Mehta S, Mehta V, Mehta S, Shah D, Motiwala A, Vardhan J,
References et al. Multimodal Behavior Program for ADHD Incorporating
1. Gururaj G, Varghese M, Benegal V, Rao GN, Pathak K, Singh LK Yoga and Implemented by High School Volunteers: A Pilot
and NMHS collaborators group. National Mental Health Survey Study. Int Sch Res Netwo 2011.
of India 2015-16: Summary. Bengaluru, National Institute of 9. Jensen PS and Kenny DT. The effects of yoga on the attention
Mental Health and Neuro Sciences, NIMHANS Publication No. and behavior of boys with Attention-Deficit/hyperactivity
128, 2016. Disorder. J Atten Disord 2004;7:205.
2. Naveen GH, Varambally S, Thirthalli J, Rao M, Christopher R, 10. Petsche A. The Effect of Yoga on Attention in Students
Gangadhar BN. Serum cortisol and BDNF in patients with major Diagnosed with ADHD. Doctoral Dissertations 2016;2016:1141.
depression-effect of yoga. Int Rev Psychiatry 2016; 28:273-8. 11. Harrison LJ, Manocha R, Rubia K. Sahaja Yoga Meditation as
3. Sotoodeh MS, Arabameri E, Panahibakhsh M, Kheirodin F, a Family Treatment Programme for Children with Attention
Mirdozande H, Ghanizadeh A. Effectiveness of yoga training Deficit-Hyperactivity Disorder. Clin Child Psychol and
program on the severity of autism, Complementary Therapies in Psychiatry 2004;9;200410:479-97.
Clinical Practice 2017. doi: 10.1016/j.ctcp.2017.05.001. 12. Khanjani Z, Nazari MA, Karami A. Study on Effectiveness of
4. Marianne Z W, Lisa C K-I, Michelle F, Patricia H. A Manualized Yoga Training on Sustain Attention in Sub-groups of ADD,
Yoga Intervention for Adolescents with Co-Occurring Physical HD and ADHD Children. Psychology and Behavioral Sciences
and Psychiatric Conditions Shows Improvements in Mental and 2016;5:77-82.
Physical Health. J Yoga and Physio 2019; 6:555698. 13. Barona LJ and Faubert C. The role of Tai Chi Chuan in reducing
5. Re P, McConnell JW, Reidinger G, Schweit R, Hendron A. state anxiety and enhancing mood of children with special needs.
Effects of yoga on patients in an adolescent mental health hospital J Bodyw Mov Ther 2005;9:120-33.