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

Anxious-passive behaviors measured by the Conners scale also decreased for the massage therapy group in the present study. This is consistent with another massage therapy study in which child and adolescent psychiatric inpatients displayed fewer internalizing behaviors following massage (Field et al., 1992). However, unlike previous studies by Field and colleagues which noted decreased stress hormones, no decrease in cortisol levels was found here. This may have been due to the time of sampling. In the present study, saliva samples were obtained during the mid-afternoon, a time when cortisol levels are at their lowest and thus difficult to reduce further. Moreover, decreases in salivary cortisol are not necessarily related to reduced activity level (Field et al., 1992). Specific relationships between physiological responses and massage therapy may be more difficult to establish in children due to variability of responses--shaped differentially by environmental events. There is also some evidence that the hypothalamic-pituitary-adrenal (HPA) axis may be underactive in neuropsychiatrically disordered children. In one study, salivary cortisol was significantly lower in a comorbid ADHD/ODD group compared with healthy controls (Kariyawasam, Zaw, & Handley, 2002); this finding suggests underarousal in behaviorally disturbed children. Nevertheless, other, longer-term measures of stress, such as urinary cortisol and norepinephrine levels, might have revealed significant changes in the present study.

In this investigation, initial group means for depression and anxiety did not fall within the clinical range. Therefore, comorbidity was not a salient issue. In future studies, it would be useful to ascertain whether massage therapy is effective in ameliorating not only short-term mood state in ADHD students, as the present study demonstrated, but also chronic mood disorders.

While teachers and school staff in general supported the use of massage therapy for students, concerns were also raised about how these youths would respond to extensive touch, since those with ADHD usually do not remain still for prolonged periods of time. For example, a few of the children were initially fidgety at the beginning of the massage, whereas the adolescents seemed more comfortable with the procedure. However, the younger participants became less fidgety with time.

Although massage therapy appears to improve short-term mood state and decrease problem behaviors in the classroom in students with ADHD, its efficacy needs to be compared with other treatments such as tai chi therapy, which has also been effective with ADHD children (Hernandez-Reif, Field, & Thimas, 1999). In addition, assessing whether the massage therapy effects generalized to other settings would have been an important outcome to explore (e.g., using the Conners Parent Rating Scale to document the effects of massage therapy in the home). Nonetheless, the findings from both teacher ratings and self-reports suggest that massage therapy could be an important tool in the multimodal management of ADHD.