Professional Documents
Culture Documents
Focus Question: What is the effectiveness of yoga for reducing negative stress behaviors in children?
Rationale for inclusion/exclusion criteria applied to determine which articles should be included in the evidence table: Level IIII articles, English only, full-length publications in peer-reviewed journals, child and adolescent populations only
Author/
Year
White
(2012)
Study
Objectives
Level/Design/
Subjects
Intervention and
Outcome Measures
Results
Study
Limitations
Implications for OT
To investigate
the efficacy of
an 8 week
mindfulness
stress-reduction
program through
Level I
Intervention:
Weekly one hour
class that met
immediately after
school; Mindful
Awareness for Girls
No significant
differences were
found between
the intervention
and control
group for
Sample selection
bias
Randomized
control trial
Large number of
participants in
yoga with
school-age girls
to reduce
perceived stress,
enhance selfesteem, coping
abilities, and
self-regulation.
through Yoga
program was adapted
from the principles
from the MBSR
program developed
by Kabat-Zinn and
focused on the yoga
portion.
Outcomes:
- The Feel Bad Scale
- The Childrens
Coping Strategies
Inventory
-The Global SelfWorth subscale of
the SelfPerception Profile
for Children
-The Healthy SelfRegulation subscale
of the Mindful
Thinking & Action
Scale for
perceived stress,
coping
frequency, selfesteem, or selfregulation
sessions may
have affected the
receipt of the
intervention
because of
behavioral
disturbances,
lack of adequate
space, and
limited
individual
attention
cautioned by the
evidence that there were
no significant
improvements.
Program development:
A yoga intervention can
easily be incorporated as
an after-school program
but class sizes should be
small to increase
individual attention and
minimize distractions.
Adolescents
Refinement, revision,
and advancement of
factual knowledge or
theory: Mindfulness
meditation and yoga in
children and adolescents
remains unclear and
requires further
investigation.
Hagins,
Haden, &
Daly,
(2013)
To test the
hypothesis that a
yoga program
would provide a
significant
reduction in
stress reactivity
in 6th grade
students
compared to that
provided by a
standard
physical
education class.
Level I
Randomized
control trial
30 sixth grade
student
randomized to
15-week
treatment yoga
group or PE
control group
Intervention:
Yoga & physical
education (PE)
occurred for the
same duration (50
min each, 3 times a
week) at the same of
day
No statistically
significant
difference
between the
groups for stress
reactivity (BP or
HR)
Small sample
size
Outcome
measures taken
in a noncontrolled
environment
Program development:
seated meditation,
closing ritual of
guided relaxation in
Savasana
N/A
PE class used
common games such
as soccer &
volleyball, 75% of
total time spent in
physical activity,
25% being
physically inactive
Outcomes: Heart
rate and blood
pressure
Thygeson,
To explore the
Level III
Intervention: The
Refinement, revision,
and advancement of
factual knowledge or
theory: Further studies
are needed to prove
efficacy of yoga
compared to other
physical activity
interventions.
Convenience
Hooke,
Clapsaddle,
Robbins, &
Moquist,
(2010)
feasibility of a
single yoga
session for
children and
adolescents
hospitalized
with cancer or
other blood
disorders and/or
their parents
To determine if
patients &
parents
experience a
significant
decrease in
anxiety after the
yoga session
Nonrandomized
before & after
16 children and
33 parents
participated in a
single yoga
session
no significant
change in their
anxiety sense of
well-being
Adolescent
cohort
experienced a
significant
decrease in
anxiety with an
improved sense
of well-being
Parent cohort
had a significant
decrease in
anxiety and an
increased sense
of well-being
sample
Only 1 treatment
session
Intervention
included both
parents and
children in the
same room
instead of
offering separate
sessions.
Program development:
A yoga intervention can
be used in an inpatient
setting to reduce stress
among adolescent
patients but caution
should be taken with
child patients. A greater
frequency of sessions
would also be favorable.
Societal Needs:
Hospitalized children
and their parents
experience a great
amount of stress which
could compound the
effects of illness and
prolong healing. Yoga is
feasible to do in an
Refinement, revision,
and advancement of
factual knowledge or
theory: More research
should be done to
To identify
which
psychological
constructs to
include in future
studies to
evaluate the
psychological
benefits of an incurriculum yoga
program in
secondary
school
adolescents.
Level I
Randomized
control trial
121 students in
7th, 11th, and 12th
grade at a
Massachusetts
rural secondary
school were
randomized to
either a yoga
Intervention: 4x/wk
for 11 weeks, typical
30-min yoga sessions
included: 5 min
initial relaxations, 5
min warm up, 15
min of yoga poses, 5
min of closing
relaxation taught by
certified instructors.
Each session had a
talking point that
was discussed by the
instructor including
mind-body
Significant
difference in
change between
the groups
BASC-2
BASC-2 is
designed for
identifying
psychopathology
in adolescents,
however the
participation
population was
largely
normative, the
outcome
measure may not
have been able
to identify subtle
Program development:
treatment group
or PE control
group
interactions &
awareness, body
systems, stress
management,
discipline, decision
making, values &
principles,
commitment, and
acceptance.
PE was taught as
usual 3x/wk for 11
weeks
subscale anger
control: yoga
group decreased,
while the control
increased.
Fatigue/Inertia:
yoga showed
insignificant
decrease, while
control showed
significant
increase
improvements
N/A
PE has similar
psychological
and physical
benefits as yoga,
therefore a
different design
may yield
stronger
improvements in
yoga
Statistical
analysis did not
include
adjustments for
intention to treat
or for multiple
comparisons
Lack of blinding
of subjects
Refinement, revision,
and advancement of
factual knowledge or
theory: The use of yoga
for stress reduction in
children remains
inconclusive and
requires further
Jensen, &
Kenny,
(2004)
To evaluate the
use of yoga
exercises as a
complementary
treatment to
pharmacological
therapy in
reducing the
behavioral and
attentional deficit
symptoms of
ADHD in boys
Level I
Randomized
control trial
19 boys were
randomized to
either a yoga
treatment group
or a cooperative
activities control
Positive
Psychological
Attitudes-32 R
There were no
statistically
significant
changes in other
measures
Number of
irregularities in
the study
execution due to
variable lengths
of intervention,
session
frequency,
duration of
sessions, late
acquisition of
some outcome
measures, and
canceled
sessions.
investigation.
Intervention:
Yoga group
showed significant
improvements on
five subscales of
the Conners
Parents Rating
Scales (CPRS):
Oppositional
behavior,
emotional lability,
restless/impulsive
and ADHD Index.
Small sample
size
20 weekly 1-hour
traditional yoga
classes
Co-intervention
(already
stabilized on
medication)
group
Outcomes:
-The Conners Teacher
Rating Scale- Revised:
Long (CTRS-R:L)
-Test of Variables of
Attention (TOVA)
Control group
showed significant
improvement on
three CPRS
subscales:
Hyperactivity,
Anxious/Shy, and
Social Problems.
Program development:
Since there was some
improvement, a yoga
program can be
combined with a
cooperative activities
group to treat stress in
boys with ADHD.
Both groups
improved
significantly on
CPRS
Perfectionism,
DSMIV
Hyperactive/Impu
lsive, and DSM
IV Total.
Refinement, revision,
and advancement of
factual knowledge or
theory: N/A
Noggle,
To test feasibility
Level I
Intervention: A
Profile of Mood
Uneven groups
Steiner,
Minami, &
Khalsa,
(2012)
of yoga within a
high school
curriculum and
evaluate
preventive
efficacy for
psychosocial
well-being
Randomized
control trial
51 high school
students who
registered for PE
were clusterrandomized by
class 2:1 yoga: PE
as usual
Kripalu-based yoga
program of physical
postures, breathing
exercises, relaxation,
and meditation was
taught 2-3 times a
week for 10 weeks by
2 lead yoga instructors.
PE-as-usual class
period met for 30 to 40
minutes, 2-3 times a
week over the course
of the 10-week yoga
program
Outcomes:
States-Short Form
(POMS-SF)
Tension-Anxiety
subscale and total
mood disturbance
improved in yoga
students and
worsened in
controls.
Although positive
affect remained
unchanged in
both, negative
affect significantly
worsened in
controls while
improving in yoga
students.
-Yoga Evaluation
Questionnaire (YEQ)
-Profile of Mood
States-Short Form
(POMS-SF)
-Positive and Negative
Affect Schedule for
Children (PANAS-C)
-10-item Perceived
Other outcomes
were not
significant.
Small sample
size
community-based
practice of OT: Yoga
for the purpose of stress
reduction could serve as
a complementary
intervention, while the
child is also receiving
school-based or private
therapy services.
Program development:
Yoga should be used as
part of a larger program
of stress reduction in
school.
-25-item Resilience
Scale (RS)
Refinement, revision,
and advancement of
factual knowledge or
theory: Larger, more
definitive trials should
be done to compare
yoga and PE.
-State-Trait Anger
Expression Inventory2 (STAXI-2)
-Child Acceptance and
Mindfulness Measure
(CAMM)
To assess the
impact of yoga
intervention in a
group of Israeli
school children
residing in the
region affected
by the Second
Lebanon War
Level III
Nonrandomized
before & after
122 school children
aged 812 years in
two elementary
schools in Safed
and their teachers
participated in 13
yoga training
sessions
Intervention:
Trained yoga
teachers taught 13
after-school yoga
sessions over the
course of 4 months
Outcomes:
-Conners
Abbreviated
Symptom
Questionnaire
-WHO (Five) WellBeing Index
-Satisfaction
Teachers reported
many statistically
significant
improvements in
the childrens
concentration,
mood, and ability
to function under
pressure, although
the children
themselves were
unaware of any
change in their
behavior.
Lack of control
group
Inconsistency
between selfassessment &
external-observer
results
Children in war-torn
countries may require
complementary
interventions to
alleviate the stress from
the impact of war.
questionnaire
potentially positive
role and effect of yoga
in the management of
children in post-stress
situations but further
research is needed.
Venkatarama
na,
Poomalil, &
Shobhasree,
(2008)
To investigate the
influence of Yoga
on academic
stress of high
school students
Level I
RCT
Intervention:
Yoga practice
(consisting of asanas
Students (n=139)
& breathing
enrolled in two
exercises) for one
schools: the United hour a day for a
Public School & Sri continuous period of
Prakash
90 days.
Vidyaniketan. The
The experimental
group showed a
significant
decrease (at the .
01 level) in
personal
inadequacy, fear
of failure,
A detailed outline
of the intervention
was not included
It is possible that
the results could
have been
accomplished with
any physical
Outcomes:
Student Academic
Stress Scale
interpersonal
difficulties,
teacher pupil
relationships &
inadequate study
facilities. .
Stress levels of
the experimental
group of subjects
decreased while
the stress levels
of the control
group increased
significantly (at
the .01 level).
The posttest
comparison
between the
groups indicated
highly significant
differences
between the
groups (.01 level)
in personal
inadequacy, fear
of failure &
inadequate study
facilities. At the .
05 level,
differences were
found in the
activity performed
for an hour, for 90
days.
students.
Program
development: The
article supports the
use of yoga to
decrease academic
stress. Based on these
findings, yoga should
be offered as a daily,
90 minute class option
to students during
school or as an after
school program.
Societal Needs:
According to author
of the study, academic
stress is cited as a
high-risk stimulator
for the onset of
behavior problems
and low success rates
among the educated
youth of their county.
Therefore, lowering
the academic stress of
the students should
increase the success
rates of the youth.
These successful
youths will likely
become successful
interpersonal
difficulties. No
significant
difference was
found in the area
of teacher pupil
relationship.
contributing members
of their society.
Healthcare delivery
and policy: Yoga is a
low cost medium to
reduce the stress of
students. Therefore,
these findings support
school policy
mandating that yoga
be offered to students.
Education and
training of OT
students: The study
supports yoga as an
effective intervention
for the management
of academic stress.
Refinement, revision,
and advancement of
factual knowledge or
theory: This study
supports the theory
that yoga can lower
academic stress in
youth.
Level III
Intervention:
TLS- universal
(using unadjusted
means & std.
Lack of control
group, reliance on
Nonrandomized
before & after
All students
(n=49) were
enrolled a single
alternative school
for at risk youth in
CA.
Students were
refereed by their
home school
because of faculty
concerns regarding
the presence of one
or more risk factors
9th grade (12.2%),
10th grade (22.4)
11th (57.1%) & 12th
(8.2%)
54.4 % female
33.3 black
33.3 Hispanic
4.2 native American
6.2 Asian
2.1 while
20.8 mixed
classroom-based
program for use with
adolescents in
middle/high school
settings
-lessons divided into 4
units (stress
management, body &
emotional awareness,
self-regulation &
building healthy
relationships
-each unit includes 12
lessons
-afterward, students
engage in the ActionBreathing Centering
Activities ( ABCs)
student engage in yoga
postures, focused
breathing, & centering
meditation
TLS lessons were
integrated into 1st
period homeroom
classes 3-4 days per
week during the 1st
semester of the school
year
-30 min each
-regular classroom
setting
-instructors were
certified yoga teachers
who had specialized
deviations) No
statistical sig
pre/post on
measures of
positive
affect/negative
affect
(after adj. p values
for multiple
comparisons) Stat.
Sig & meaningful
improvements
found on measures
of student anxiety,
depression, &
global symptom
index
Sig & substantive
improvements on
involuntary action,
rumination,
intrusive thoughts,
physical arousal,
emotional arousal
Sig reductions in
revenge
motivation &
reported hostility
practice of OT:
The study supports
the inclusion of TLS
as an effective
measure to decrease
involuntary stress
actions in at-risk
students. Therefore,
at-risk youth may
benefit from the
inclusion of TLS in
alternative schools.
Program
development: The
program that has been
developed, TLS, is a
valid yoga based
program for students.
Societal Needs:
Adolescents ability to
modulate their
emotional responses
to stress in being
recognized as an
important skill for
ensuring mental
health, academic
success, and healthy
transition into
adulthood.
.
Healthcare delivery
and policy:
Given the link
between the intensity
of involuntary stress
responses and later
onset and progression
of clinical anxiety &
depression, the
findings suggest that
yoga-based programs
in school will have a
positive impact on
youth mental health.
Therefore policy
should make the TLS
program available to
all students.
Education and
training of OT
students: The study
supports the use of
yoga to decrease
problematic
involuntary stress
responses like
rumination,
involuntary actions,
and intrusive
thoughts, physical &
emotional arousal. An
OT working with
students can utilize