Adolescents with attention deficit hyperactivity disorder benefit from massage therapy

Adolescence, Spring, 1998 by Tiffany M. Field, Olga Quintino, Maria Hernandez-Reif, Gabrielle Koslovsky

Attention deficit hyperactivity disorder (ADHD) is a condition affecting as many as 3 to 6 percent of all youth, and is characterized by developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity. Overactivity is typically the most prominent feature (DSM-III-R, American Psychiatric Association, 1987; Anderson, Williams, McGee, & Silva, 1987).

Treatment is made more difficult by the comorbidity of ADHD with other disorders, such as conduct disorder, anxiety, learning disability, and depression (Biederman, Newcorn, & Spirch, 1991). Treatment usually includes drug therapy and training parents and teachers in behavior modification techniques. Drug therapy features psychostimulants, such as methylphenidate or d-amphetamine, which alter the concentration and physiology of catecholamines, namely dopamine (Barkley, 1989; Evans, Gualtieri, & Hicks, 1986). This stimulates the frontal and striatal regions of the brain, which are associated with attention., arousal, and inhibition and help regulate these processes (Evans et al., 1986). Although drug therapy improves ADHD symptoms in over three-fourths of the cases, it is not a curative measure, its effects lasting only as long as medication is taken. Another drawback of drug therapy is the occasional side effects, such as appetite loss and insomnia (Barkley, McMurray, & Edelbrock, 1990).

Behavior modification by parents and teachers involves such techniques as adjusting the time, amplitude, and frequency of consequences for the child's actions, rearranging home and classroom settings to facilitate attention, breaking down tasks into smaller sub-tasks that can be completed within the child's attention span, and setting up schedules to aid the child in overcoming organizational problems (DSM-III-R, American Psychiatric Association, 1987). Behavior modification is a way to adjust the surroundings to facilitate the ADHD child's performance. However, as with drug therapies, behavior modification is only effective during the time that it is administered.

Alternative forms of therapy, namely massage therapy and relaxation therapy, were investigated in the present study because they have been effective with children and adolescents with attention problems. For example, relaxation therapy (Platania-Solazzo, Field, Blank, Seligman, Kuhn, Schanberg, & Saab, 1992) and massage therapy (Field, Morrow, Valdeon, Larson, Kuhn, & Schanberg, 1992) were found to reduce anxiety and activity levels in child and adolescent psychiatric patients. In addition, following massage they had more organized sleep and lower stress hormone (cortisol and norepinephrine) levels. Massage therapy has also been noted to decrease off-task behavior in children diagnosed as autistic (Field, Lasko, Mundy, Henteleff, Talpins, & Dowling, 1996). It was hypothesized here that massage therapy would lower the activity level of adolescents with ADHD.

METHOD

Subjects

Twenty-eight adolescents (mean age = 14.6 years) were recruited from self-contained classrooms for emotionally disturbed adolescents. All subjects were male, 90% were middle socioeconomic status, 29% were nonwhite Hispanic, and 71% were white. All were diagnosed with ADHD according to DSM-III-R criteria. They were randomly assigned to massage therapy or relaxation therapy based on a stratification procedure to ensure, equivalence between groups on background variables.

Procedure

Massage therapy. Fourteen subjects received a 15-minute massage after school for 10 consecutive school days. The massage consisted of moderate pressure and smooth strokes for 5 minutes in each of three regions: up and down the neck, from the neck across the shoulders and back to the neck, and from the neck to the waist and back to the neck along the vertebral column. The 15-minute sequence was composed of 30 back-and-forth strokes per region, at 10 seconds each.

Relaxation therapy. Fourteen subjects participated in 15-minute relaxation sessions after school for 1.0 consecutive school days. During the progressive muscle relaxation sessions, a therapist asked the adolescents to tense and relax the same body parts that were massaged in the massage therapy group.

Assessments. Pre/post therapy session measures included the Happy Face Scale, completed by the adolescents, and an assessment of fidgeting based on a behavioral observation made by an observer who was blind to the adolescents' group assignment. The Happy Face Scale is a series of 5 drawings, ranging from unhappy to happy faces, which is 'used as a "barometer" to depict the adolescents' feelings before and after the sessions. Fidgeting, one of the most characteristic problems of this group of adolescents, was rated on a 3-point scale. Interrater reliability for the fidgeting behavior was determined for one-third of the sessions (kappa = .83).

First day/last day assessments included self-report measures of depression and empathy, since depression and antisocial behavior are often comorbid with ADHD (Biederman et al., 1991). The 20-question Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977) was used to rate depressive symptoms over the past week. The Empathy Scale (Bryant, 1982) required the adolescents to indicate whether they agreed or disagreed with each of 22 statements designed to tap empathy, defined as the ability to take another person's perspective (e.g., "It's hard for me to see why someone else gets upset").