Attention deficit and hyperactivity disorder (ADHD) is a neurobehavioral developmental disorder characterized by inattention, distractibility, hyperactivity, and impulsivity (American Psychological Association [APA], 2000). The incidence and diagnosis of ADHD in children has reached record numbers. ADHD is more common in boys than girls, who account for only 5% of the diagnosed population (Brown, 2009). It is estimated that 30-70% of children with ADHD experience symptoms through adolescence into adulthood (Barkley, Murphy, O’Connell, Anderson, & Connor, 2006).
Although there is no single definitive treatment for ADHD, the most popular treatment is stimulant medication. Despite the prevalence of this treatment, research suggests that medication alone is not enough to treat ADHD. Furthermore, controversies exist regarding the ethics of administering powerful drugs to nonconsenting minors and the risk factors associated with this treatment model. Given the prevalence of ADHD in the United States, the difficulties that accompany the disorder, and the controversy surrounding its treatment, there is a need to explore nonpharmaceutical treatment alternatives for this disorder (Barkely, 2001).
Behavioral health professionals have suggested that martial arts can be effective as a behavior modification technique for children with ADHD (Lakes & Hoyt, 2004). It has been suggested that martial arts can be used as part of a multimodal treatment approach to help children learn to manage and cope with ADHD symptoms (Graham, 2007; Lakes & Hoyt, 2004), but that contention has not been systematically studied. The purpose of my study was to explore the efficacy of martial arts training as a form of behavior modification used to teach self-management skills to children with ADHD.
Barkley (2001) posited that the behavioral symptoms of ADHD result from an inability to self-modulate, caused by deficits in executive function. Such deficits commonly result in an inability to use time effectively or predict the consequences of actions and impulses. Barkley and Shelton (2000) proposed that through behavior modification strategies that teach children self-control, they can learn to manage their behavior.
Martial Arts for ADHD
One form of behavior modification is martial arts training, which has been described as providing both physical and psychological benefits for children with ADHD (Lakes & Hoyt, 2004; Richmand & Rehberg, 1986). Among these benefits are discipline, focus, attention, concentration, and acquisition of physical skills (Hiter, 2008). According to Graham (2007), martial arts training focuses on the holistic development of mind and body, and Ripley (2003) argued that such an emphasis distinguishes it from other sports and physical activities. Eastern philosophies, which permeate martial arts, promote good character and nonviolent conflict resolution (Back & Kim, 1978). According to Becker (1992), the philosophical principles behind martial arts help practitioners by providing guidance for daily life.
Weiser, Kutz, Kutz, and Weiser (1995) studied the psychotherapeutic dimension of martial arts and found that the discipline promotes relaxation, concentration, assertiveness, and honest communication, resulting in enhanced self-esteem, self-perception, and self-control. Egan (1993) cited additional psychological benefits, including greater self-confidence and self-acceptance. McDiarmid (2007) studied the effects of martial arts training on school performance and found increases in self-control and decreases in the need for disciplinary action.
Duthie, Hope, and Baker (1978) found that participation in martial arts training reduced aggression in practitioners. That finding was confirmed by Cooper (2005), whose participants also showed reduced impulsivity, inattention, and hyperactivity. Felmet (1998) studied the effects of martial arts training on concentration and impulsivity in children ages 7-12 and found significant behavioral improvement. According to Trulson (1986), martial arts also help practitioners manage depression and anxiety, both of which are comorbid disorders of ADHD.
Researchers have distinguished between traditional and modern martial arts, which differ in training modality and environment, as well as instructional style. Traditional martial arts use meditation and emphasize stylized movements, which are deemphasized in most modern martial arts instruction (Nosanchuk & MacNeil, 1989; Trulson, 1986). Several researchers have concluded that traditional martial arts instruction is superior to the modern version in achieving psychological and behavioral benefits (Egan, 1993; Regets, 1990; Trulson, 1986; Twemlow & Sacco, 1998).
Hapkido training focuses on the holistic development of mind and body (Walters, 1997), and Ripley (2003) argued that the holistic nature of martial arts makes these disciplines distinctive compared to other sports and physical activities. Strayhorn and Strayhorn (2009) considered martial arts training as part of an eclectic model of clinical intervention that combines motivational enhancement, goal-oriented guidelines, positive reinforcement, prompting, and redirection. Winkle and Ozmun (2003) suggested that for children with ADHD who are frustrated by their inability to excel in other activities, martial arts can be a dynamic, enjoyable, healthy, challenging, and rewarding extracurricular activity.
Hapkido accomplishments are based on a youth's physical skill, ability to process information, dedication, and hard work (Winkle & Ozmun, 2003). Unlike most group sports, noted Lakes and Hoyt (2004), in Hapkido training participants can progress at their own pace. This freedom reduces the stress inherent in team competition, where a child with disabilities may be ridiculed by classmates.
Hapkido practice can provide a sense of purpose, commitment, and pride in accomplishment not found in other recreational activities (Reynes, & Loran, 2002). Further, Hapkido training has significant similarities with treatment strategies used in behavior modification and other modalities of ADHD treatment. For example, Hapkido trainers often use external cues, prompts, and reminders to help elicit positive behavioral responses. Such strategies should help children with ADHD acquire the skills necessary for self-regulation (Cooper, 2005).
According to Graham (2007), through Hapkido strength-based training, youth learn important life and social skills, and they build self-esteem through physical activities, group activities, relaxation training, concentration, and assertiveness training. Ripley (2003) noted that Hapkido training programs use behavior modeling and positive reinforcement to establish the expected behavior and state of mind of practitioners. According to Walters (1997), the challenging physical techniques of Hapkido are taught alongside philosophical, meditative, and spiritual components that are the essence of Hapkido.
Hapkido training emphasizes conflict-resolution skills as a way to avoid physical confrontation (Daniels & Thornton, 1990). Reynes and Loran (2002) stated that meditation practices, breathing exercises, and mind-body focus exercises help youth develop emotional modulation, self-control, and anger management. By providing repetition and a highly structured environment, students learn to harness their inner resources to control hyperactive and impulsive behaviors. Hoyt and Lakes (2004) found that Hapkido training affects behavior related to academic success, self-esteem, and self-respect. Boding and Martinsen (2004) found that Hapkido training helps people manage clinical depression and anxiety, comorbid disorders common to individuals suffering from ADHD.
Results of Dr. Marquez Studies
Youth with ADHD often have trouble with emotional, behavioral, social, and psychological functions. Many have serious problems in school, struggle to reach developmental milestones and life goals, and have difficulty establishing and sustaining relationships (Fischer & Barkley, 2006). The results of Master Marquez study suggest that regular and sustained Hapkido training can help youth with ADHD learn to manage difficulties associated with the disorder . Therefore, Hapkido training can serve as an alternative to aggressive and potentially harmful psychostimulant interventions (Ripley, 2003).
To address the first research question—whether Hapkido training has an effect on self-regulation skills of children with ADHD—data were gathered from 11 analyses that measured the self-regulation of children and youth with ADHD. Of these, five used treatment and control groups, and six assessed data at pretest and posttest. A decrease from pretest to posttest indicated improvement. The average effect size was 0.73, indicating a medium effect size. Meditation practices, breathing exercises, and mind-body focus exercises are used to teach emotional modulation, self-control, and anger management (Brown, 2004; Lakes & Hoyt, 2004; Reynes & Loran, 2002). Given the results of the current study, it would seem that the practice of Hapkdio has a positive effect on self-regulation skills of children with ADHD.
The importance of courtesy, respect, and self-discipline is consistently emphasized during Hapkido training (Daniels & Thornton, 1990; Strayhorn & Strayhorn, 2009), and Hapkido practitioners are taught conflict-resolution skills (Daniels & Thornton, 1990; Hiter, 2008). To address the second research question—the effect of martial arts training on aggression in children with ADHD—data were gathered from four analyses. Of these, three analyses used treatment and control groups and one assessed data at pretest and posttest. A decrease from pretest to posttest indicated improvement. The average effect size was 0.61, indicating a medium effect size. These results support the hypothesis that Hapkido training helps decrease aggression in children with ADHD.
Children with ADHD often have serious problems in school. Some suffer from comorbid learning disabilities and have trouble concentrating and focusing on academic tasks. Many fall behind in school and have to repeat grades. As they grow older, they are prone to truancy and school desertion.
To address the third research question—the effect of Hapkido training on the academic performance of children with ADHD—data were gathered from two analyses, both of which used treatment and control groups. The average effect size was 4.55, indicating an effect size that was larger than expected. The results suggest that Hapkido training—in combination with special education, functional behavior assessments, and behavior intervention plans—may be beneficial for ADHD children in the school setting (McDiarmid, 2007). School-based educational and mental health professionals will find that these results support the use of Hapkido as an alternative intervention for ADHD.
In the analysis summarized above, one significant difference between the treatment and control groups was homework completion. For the treatment group, the mean was 85.7%, and for the control group it was 37.1%, a 48.6% differential. For academic performance the treatment group mean was 81.6%, compared to 39.6% for the control group, a difference of 32%. The analysis addressing the third research question is noteworthy because it is based on actual measurements of academic achievement, rather than self-reports or teacher observation, thus providing a more reliable measure of effect size.
Limitations in the literature made it impossible to assess the fourth research question and its related hypothesis. Nosanchuk (1981) hypothesized that youth with anger and violence issues would not benefit from martial arts—that the combat skills taught in martial arts would worsen their behavior. Instead, his study revealed that martial art training does not increase aggressiveness and that it gives aggressive children a venue where they can safely channel their aggression. Several researchers have concluded that traditional martial arts instruction is superior to the modern version in achieving psychological and behavioral benefits (Egan, 1993; Regets, 1990; Trulson, 1986; Twemlow & Sacco, 1998).
The MMA/UFC arena, as portrayed in popular media, presents a style of martial arts that is reduced to one criterion: winning the fight (Telander, 2006). The canon of traditional martial arts—their philosophy, spirituality, and meditative practices—is replaced by intensive cross-training, and full-contact sparring. The quintessential MMA competitor is depicted as a brawler with limited impulse control (McNamara, 2007).Although this characterization is mainly a creation intended to boost television ratings, it has influenced the younger generation of martial arts enthusiasts. MMA has created a new martial arts market, and traditional martial arts schools are losing students (Jackson and Andrews, 2005).
MMA culture is replacing the long heritage of traditional martial arts schools (McNamara, 2007). However, MMA has not been sufficiently studied to form a research base against which to compare traditional martial arts regarding the effects of each on the behavior of children with ADHD. The current study has confirmed that traditional martial arts instruction is beneficial to children with ADHD (Cooper, 2005; McDiarmid, 2007; Ripley, 2003). Given the prominence and growth of MMA, and the differences between MMA and traditional martial arts, the question of whether MMA could provide similar benefits should be explored.
Results of this meta-analysis confirm the study’s hypotheses and suggest that Hapkido training can have positively affect aggression, hyperactivity, focus, and impulsivity in children with ADHD. Results of the current study are consistent with previous research in this area. Those results suggest that the physical activities, group activities, relaxation training, concentration, and assertiveness training that are part of martial arts can help alleviate the symptoms of ADHD (Moran, 2004). Further, the findings of this meta-analysis support the effectiveness of Hapkido as an alternative treatment modality for ADHD, worth including in individualized treatment plans. Finally, the results suggest that martial arts can be effective in helping children with ADHD improve school performance.
Throughout history the martial arts have been pivotal in the development of many nations. They have been widely associated with the Asiatic cultures of China, Korea, and Japan. What make Asian martial arts different from other forms of martial disciplines are its philosophical and spiritual components. Widely influenced by Taoist, Zen, and Confucian philosophies, Asian martial arts developed with rigorous standards of self-discipline, personal growth, and spiritual and mental development.
By working as a martHapkido instructor for the past 18 years, I have been able to witness firsthand the positive effects that Hapkdiotraining has in children and youth with emotional and behavioral problems, including many who have been diagnosed with and take medication for ADHD. My interest in this area is a result of 33 years of study and instruction in the martial arts (Marquez, 2007), as well as personal experience regarding the effect that ADHD has in the lives of children, adolescents, and adults.
As a Hapkido trainer, I have seen changes in children’s personal interactions with one another, parents, and adults, as well as a more positive self-perception. They gain a sense of belonging, accomplishment, and pride in what they are capable of doing. I have witnessed many changes in behavior: improved self-control, personal discipline, and appropriate social conduct, especially in those who have earned a black belt, the ultimate achievement for a martial arts practitioner.
Children and youth who achieve the rank of black belt become an example to those who dream of getting to that point. Their demeanor changes noticeably; they become more aware of people around them, how they are perceived, and how they relate to others. They become examples of control, good behavior, and kindness. It is impressive to observe a child who was once disruptive and unable to sit still in class acting as a mentor and teacher to those lower in rank. It is also impressive how proud and sure of themselves they become when telling others how they should behave in the dojang, how they should approach seniors and peers with kindness and respect. It is also impressive to see how they are able to walk into the class and be models of what they preach in their actions and words. The practice of martial arts gives one a sense of purpose and a strong base for personal commitment and accomplishment. Finally, unlike group sports, Hapkido practice can proceed at an individual pace, based on one’s individual aptitude.
Link to Dr. Marquez Dissertation