Investigation of the Effect of Yoga on Balance, Reaction Time and Agility in Children With Attention Deficit and Hyperactivity Disorder: A Randomized Controlled Trial

Introduction According to the fifth revision of the diagnostic and statistical manual of mental disorders (DSM-5), attention deficit and hyperactivity disorder (ADHD) is a heterogeneoud disorder that causes behavioral problems in at least two domains of life, lasting at least 6 months. Behavioral disorders usually manifest themselves in the school period and are characterized by hyper-motor skills, increased distractibility and attention disorders, impulsivity, and psychosocial adjustment disorders.

It is known that many children with ADHD have impairments in executive functions such as working memory, attention, emotion regulation, and inhibitory control. In addition to the cognitive function problems that are widely known and frequently emphasized in the literature, it is known that children with ADHD also have difficulties in activities that require motor coordination, such as handwriting. Several studies have found that children with ADHD perform poorly on motor skills tests assessing fine and gross motor areas.

Cho et al. (2014) stated that 30-70% of children with ADHD have motor control problems and these problems cause problems in their neurobehavioral development. School-age children with motor problems may face many problems such as the desire to avoid physical activity, obesity, lack of concentration, low self-esteem, school performance and inadequacy in social relations. Motor impairment, which causes problems with cycling, dressing, tying shoelaces and/or writing, may cause problems in children's social participation, peer relationships, and adaptation in daily life. Therefore, early detection and intervention of motor delay can reduce feelings of inadequacy, depression, frustration, and anxiety in children with ADHD and prevent long-term negative effects on social development and academic achievement.

The most commonly used treatment options for ADHD are pharmacological and psychosocial interventions. Parents may not prefer pharmacological methods because of their stimulating effect on the general health of their children. It is known that the effects of behavioral interventions cannot be generalized to non-target environments and behaviors. Considering these limitations, there is a trend towards different complementary methods for the treatment of ADHD. Among the complementary treatment options, there are methods such as meditation, yoga, massage, homeopathy, acupuncture, neurofeedback, nutritional supplements, and few foods diet.

In recent years, yoga programs for children have been widely used as a mind-body supplement and alternative medicine intervention to improve physical and mental health conditions, as the benefits of yoga practice in promoting general health are recognized. Yoga has many comprehensive types, and child yoga, one of them, is a fairly new type of yoga that can increase children's mental focus by providing mind, soul and body awareness, improve their enjoyment of life, social relationships, self-esteem and self-confidence levels. Kids yoga consists of compositions such as games, stories, postures, breathing exercises, imitations of living things in nature, memory games. While physical exercises (asanas) can increase the physical flexibility, coordination and strength, breathing practices and meditation are used to increase awareness and reduce anxiety and improve children's quality of life. Other beneficial effects include reduction of blood pressure, and improvements in endurance, mood, and metabolic regulation.