Massage therapy improves mood and behavior of students with attention-deficit/hyperactivity disorder

Adolescence, Winter, 2003 by Sonya Khilnani, Tiffany Field, Maria Hernandez-Reif, Saul Schanberg

The underlying mechanism by which massage therapy decreases hyperactivity and increases attentiveness is not clear, although physiological and biochemical data from the Field et al. studies suggest some possibilities, including that brain waves are altered in the direction of heightened alertness (see Field et al., 1996). In addition, increased vagal tone (and thus increased parasympathetic activity) has been noted during massage therapy, and this increase is often associated with enhanced attentiveness and a more relaxed state (Porges, 1991). Massage therapy may enhance vagal control of the heart by improving a deficient physiological inhibitory system. This, in turn, might help hyperactive or learning disordered children to mediate and inhibit spontaneous activity and thereby increase their level of attentiveness. Those with each subtype of ADHD are expected to benefit from massage therapy given that the attentional deficit is considered the primary symptom underlying hyperactivity-impulsivity (Dykman, Ackerman, Clements, & Peters, 1971). The restlessness is assumed to be secondary and reflective of diffuse patterns of sensory discharge in the brain (activating motor areas).

In the present investigation, massage therapy was selected as an additional treatment for those receiving ongoing intervention, because prior studies found that it exceeded the effects of relaxation therapy and other stress management treatments used in various clinical samples, including youths with ADHD (Field et al., 1992, 1998). Previous massage studies also reported increases in vagal tone during massage therapy (Field, 1995). It would follow that massage therapy might improve attention in those with ADHD by promoting vagal control of heart rate.

The present study explored the effects of massage therapy on behavioral, emotional, and physiological functioning in ADHD children/adolescents who were receiving special education. The calming effects of massage therapy were expected to ameliorate common behavioral symptoms of ADHD, including restlessness, inattention, and impulsivity. Emotional correlates, such as depressed mood, were also expected to decrease. Specifically, the following hypotheses were tested: (1) students in the massage therapy group would rate themselves as happier and feeling better postmassage on both assessment days when compared to those in the wait-list control group; (2) students who received massage therapy would show a significant decrease in salivary cortisol (a measure of stress) postmassage on both assessment days when compared to those in the wait-list control group; (3) the massage therapy group would show a significant reduction in behavioral problems in the classroom, specifically hyperactivity and inattention (based on teacher ratings), when compared to the wait-list control group; and (4) the massage therapy group would show a significant decrease in depressed mood when compared to the wait-list control group.

METHOD

Participants

Parental consent forms were distributed to all students attending a learning center for children and adolescents with academic and behavioral problems. The sample consisted of the first 30 students who returned signed consent forms and who met the following criteria. Each participant had a current DSM-IV diagnosis of ADHD. Students with other complex medical issues, such as cerebral palsy or a known organic brain dysfunction, were excluded from the study. In addition, all participants had initial T scores in the subclinical to clinical range (i.e., 60 or above) on the hyperactivity and/or inattention subscales of the Conners Teacher Rating Scale to confirm that they were currently displaying symptoms associated with ADHD. Students whose T scores fell below 60 were excluded from the study to ensure a truly clinical sample. Fifty-seven percent of the entire sample scored in the subclinical to clinical range (i.e., 85th percentile or above) on both hyperactivity and inattention. At intake, group means for depression and anxiety did not fall within the clinical range. Therefore, comorbidity was not a salient issue in the present study.