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Movement-Based Mindfulness Training for Children with ADHD: A Feasibility Study

Principal Investigator:
Stewart
Mostofsky

Attention Deficit Hyperactivity Disorder (ADHD) has tremendous individual and societal impact. Current standard treatments can provide short-term reductions in symptom severity; however, there remains tremendous need for novel treatment approaches that could remediate the core features of ADHD and thereby contribute to sustained improvements in behavioral control. 

There is 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 (excessive impulsivity, hyperactivity, distractibility). Motivated by these findings, we will examine the feasibility of a movement-based mindfulness training approach for children with ADHD (using Tai Chi), targeting improvements in well-established behavioral and physiologic measures of motor control, and with this, improvements in control of impulsive, hyperactive, and distractible behavior. 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.

Aim #1 Evaluate target engagement with a movement-based mindfulness training program. Hypothesis: After participating in a Tai Chi program, children with ADHD will show improvements in behavioral and physiologic measures of motor control, in particular demonstrating enhanced cortical motor inhibition during TMS.

Aim #2 Assess patient and parent response to movement classes and interest in continuing practice as a form of long-term therapeutic support. Hypothesis: Exit surveys will indicate significant positive attitudes towards the Tai Chi course and significant interest in continuing training. Moreover, participant and parent feedback will provide us with the means to further improve our movement training protocols.

Aim #3 Evaluate impact of Tai Chi training on measures of ADHD severity. Hypothesis: Movement-based training will result in improvements in the core features of ADHD, resulting in subsequent decreases in hyperactive, impulsive, and distractible behavior as well as Research Domain Criteria (RDoC) measures of cognitive control. 

We further hypothesize that changes in motor system measures will precede changes in ADHD symptom severity, observable as earlier motor system changes at midpoint assessment.

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