Therapeutic Eurythmy—movement therapy for children with attention deficit hyperactivity disorder (ADHD): a pilot study

Abstract

This paper considers Therapeutic Eurythmy (TE) as a possible therapy for children with attention deficit hyperactivity disorder (ADHD).

ADHD manifests as a complex psychological disturbance in which deficit of attention such as forgetfulness or distraction is the main symptom. It would seem that a growing number of children seem to be affected by this syndrome and an increasing number of alternative approaches to treatment are being sought.

Therapeutic Eurythmy is a movement Therapy in the context of anthroposophical medicine. As a holistic therapy TE affects both physical and spiritual aspects of illness. TE entails the practice of movement exercises learned from a trained therapist.

In this exploratory study, the effects of TE on behavioural functioning were examined.

This paper addresses five single cases where the therapy induced positive changes to client's attention span, concentration, tempo of work and motor skills such as coordination, dexterity and social behaviour. Standard psychological tests parameters for movement, and for attention were used to assess aspects of performance.

A positive shift was observed with reference to concentration and development of movement skills. Results were less pronounced but showed positive improvements on working speed and social behaviour problems. Hyperactivity also diminished to some extent. Generally, children were considered to be more mature in their development after therapy. The results of these case studies suggest that TE may be helpful for children with ADHD. However, more systematic research is warranted.

Introduction

ADHD belongs to an area of psychological disturbances in which the deficit of attention is the main symptom. Remschmidt¹ and Sass² describe key characteristics of this syndrome to be lack of attention (forgetfulness, distraction), impulsiveness (rash, risky behaviour), and hyperactivity (restless activity); restlessness does not always occur.

From a psychological perspective, attention is a cognitive strategy,³ with effectiveness determined by the ability of an individual to suppress conflicting or disturbing activity, to plan and persevere in their goal (e.g. by self-instructional strategy). Additionally, an ability to focus on the task at hand and to pursue it even if not perceived as interesting is an important characteristic.

A disorder of attention can present as a disorder of concentration, as a performance disorder, or as an attention-deficit syndrome.

There are many theories about causes of the deficit. Lauth⁴ suggests it is a combination of biologically determined reactivity of the nervous system, inability to self-regulate and environmental disturbances. Children who cannot concentrate, are restless and evoke negative reactions of the environment can initiate perceptions of social rejection. Repeated experiences of failure at school combined with the vulnerability of the nervous system are thought to create a negative perception evoking compensatory behaviour, for example, aggressive clown behaviour or dreamy, lonely and depressive states. In order to reduce such symptoms, the creation and maintenance of a supportive and caring home environment would seem to be significant. Children must have a feeling of being accepted, and be able to develop trusting relationships and a belief that there are ways in which they can be helped. This situation can be rather difficult to achieve where parents exhibit problems similar to their children. ADHD problems appear not only limited to childhood and family dynamics may influence may cause the condition to persist.

There are many different therapy forms used for the children with ADHD. The most widespread one is the medicinal treatment using the drug Ritalin, which can be effective in certain cases as an immediate remedy.5., 6. Ritalin^R (Methylphenidate) must be taken at least once a day before going to school, since it is effective in suppressing the symptoms for only a few hours. It is typically given in a dosage of 1 mg/kg body weight; however, very often a more individual dosage is necessary, depending on symptoms. For the same reason, it does not offer a permanent cure. The children usually have to take it until puberty. In addition it is notable that only 10–20% of children appear to react positively to Ritalin and side effects can manifest in the form of loss of appetite, sleeping problems, mood instability, headache, abdominal pain, dizziness, rebound hyperactivity after effect loss, triggering or aggravation of existing tics, transient growth inhibition.⁷ In Switzerland, Ritalin is the predominately given drug against ADHD. In a few cases it is replaced or complemented by Tofranyl^R (Tryptizole), especially in cases of strong impulsivity and sleeping problems. However, over dosages are quickly reached and can lead to severe side effects, e.g. extra pyramidal motor problems. It is therefore important to look for other therapeutic measures to treat ADHD.

A review of the literature between 1963 and 1998, identified 23 different types of therapy associated with the treatment of ADHD.⁸ This indicates the complexity of the problem. The most popular non-medicinal therapies are occupational therapy,⁹ play therapy³², sensory integration,¹⁰ and kinesiology¹¹ and these have often been used in combination with the medicinal therapy. Diet modification and a restriction in consumption of foodstuffs containing phosphates can also help ameliorate ADHD symptoms.

Despite growing acceptance of movement as therapy, there is still no scientifically based system of movement therapy. Movement therapy is based, like many pedagogical interventions, on sensory-motor activity.¹² In 1975, Eggert¹³ was able to demonstrate that psychomotor treatment could reduce perceptions of fear, frustration and aggression in children with selective ability disturbances.

More recently in 1998, the first congress on movement therapy in Germany¹⁴ has increased acceptance of the value of movement therapy in relation to ADHD. The latest treatment of ADHD propagates sport as an alternative to prescribing Ritalin.¹⁵ This approach advocates body training and walks in natural surroundings such as gardens or woods every day. It is claimed that this can enhance cognitive processes and free tensions in feelings.

More recently, interest has focused upon the processes that regulate human directional behaviour. By identifying and creating cognitive strategies, an individual can be helped to achieve their goals more easily. Barkley⁵ has suggested a self-regulation strategy which facilitates a component of will or free determination. Thus, the development of attention is promoted through the development of behavioural inhibition whereby disturbing impulses are suppressed.

The deficiencies in the development, structure, and function of prefrontal cortex and its connections with other brain regions, especially with the striatum, are assumed to be the reason why there is a lower behavioural inhibition in children with ADHD.5., 16. Such a theory however, relies on mechanisms that are acknowledged or perceived to be deficient in the child, and it leaves it little scope for monitoring the effectiveness of any strategies that are introduced.

In this respect, movement therapy offers a number of advantages. It promotes outer motor activity that is relatively easy to control by a child with ADHD, and the public character of the movement enables a relatively direct control over the adequacy of performance.

The central question is whether one can expect improvement in motor skills to lead to enhanced cognitive performance such as increased attention span?

There is however, a growing body of evidence that motor training results in development of specific cortical structures related to it.17., 18., 19. For instance, the training of a hand movement can result in cerebral changes. There is also evidence indicating a relationship between motor training and cognitive performance.20., 21., 22. Thus, movement therapy may have a beneficial effect on some forms of cognitive performance, possibly via transfer of morphological and/or functional neurological increments achieved via direct stimulation of relevant cortical centres in the course of self-generated motor activity.

Therapeutic Eurythmy (TE) is a form of movement therapy that involves cognitive, emotional, and volitional elements and which may also have an impact on psychoneurologic interactions. Historically, TE was developed in 1921 by Rudolf Steiner³³, the founder of anthroposphy and anthroposophic medicine.

Anthroposophic medicine can be characterised as a holistic method, involving the soul and spiritual element of the human being in addition to conventional scientific treatment.²³ This approach expands the traditional division of the human being from soma and psyche to four discernible elements: physical body, life body, astral body (soul) and self (spirit). Health and disease are viewed as the result of a harmonious or disharmonious interaction of these elements in the respective systems of the organism.

The word Eurythmy (Greek) means harmonic, beautiful rhythm in movement. TE is a specific therapeutic transformation of the art movement called Eurythmy. This therapy highlights speech and musical activity in relation to movement. The basic elements of the therapy focuses upon the development and use of vowels and consonants in speech and tones and intervals in music. These are described as “visible singing or speech”.²⁴

Each time we speak or sing, we inwardly perform these movements, and by making them outwardly visible one arrives at a highly dynamic and aesthetically appealing interpretation of poems or a piece of music—Eurythmy as an art.

One can transform these movements by making them conscious and explicit actions promoting their therapeutically effectiveness. The practice relies upon a belief that there are inner laws of resonance by which rhythms of speech and music are linked to life processes. How these movements are executed is highly significant since equal value is afforded to the mechanics of the movements and their inner quality and the attention and emotion with which they are performed.

In a therapeutic situation, the child is taught to imitate patterns of movement shown by the therapist and how to repeat them several times a day until they are executed in a joyful, concentrated and precise way. When used with people with ADHD, the therapy aims to develop an individual's ability to concentrate and be aware of feelings in a controlled, coordinated and skilful manner. In turn, this promotes psychosocial development.