Yoga Gets into Med School

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Yoga Gets into Med School

Students learn to relax patients, and themselves

Source: BU Today • Leslie Friday 12.08.2011
BU medical students hold a position called downward dog. Photos by Vernon Doucette

 

Emily Holick thought yoga was for sissies. But as a graduate student hoping to reduce stress, she gave it a try. And hated it. What irked the former college tennis player most was her inability to do a move that everyone else had perfected—the wheel, a complex pose that contorts the body into an upside down bridge. Holick says it was only her competitive spirit that kept her going.

Four years later, Holick (MED’14) believes that yoga has transformed her life. Although her first year of medical school was brutal, leaving her depressed and questioning whether she wanted to be a doctor, her yoga practice helped her cope. Then a curious string of events pulled her out of the abyss.

Holick took a healing arts class with Robert Saper, a School of Medicine associate professor of family medicine and director of integrative medicine, known for his research involving yoga and lower back pain relief. He recommended that she meet Heather Mason, a yoga therapist and trainer interested in creating a class for medical students, an idea Holick had toyed with herself.

“We met in a coffee shop in Cambridge and started dreaming,” Holick says. “It was amazing to meet someone who independently said this is something that medical students need.”

That java-infused dream has become a reality since, as Mason, Holick, and a team of medical students lobbied for its creation. Starting spring semester, MED will offer an elective called Embodied Health: Mind-Body Approaches to Well-Being. Mason will lead a weekly hour-long yoga session, followed by a half hour discussion of the practice’s medical benefits. The class will also be part of a research study led by Saper, Mason, and Allison Bond (MED’14) that will attempt to document changes in the students’ mental health. A pilot of the elective, called MED Yoga, or Mind-Body Education and Development Yoga, ran this semester, quickly attracting a following of 30-plus students.

While yoga sessions for med students are not unique (the University of Connecticut Medical Center and Georgetown Medical School both offer them), teaching students about yoga’s physiological and neurological effects is. Saper, who will be one of several guest speakers addressing issues from positive thinking to the neurobiology of stress over the 11 weeks of class, says the class “targets the unique challenges and stressors medical students face as well as offers a fairly advanced level of intellectual content appropriate for the medical students.”

And there are stressors: according to a 2009 study in Academic Medicine, nearly 25 percent of medical school students will be depressed at some point during their education. The Journal of the American Medical Association published a study in 2010 showing that the empathy medical students feel decreases as they progress through their four years.

Yoga therapist Heather Mason leads a breathing exercise before a yoga session designed for medical students at the School of Medicine.

 

Mason believes that yoga can be a powerful antidote. On a recent Wednesday late afternoon, she tinkered with speakers that send a low chime through the airy space of the MED student lounge where the class was meeting. While she adjusted the sound, nearly three dozen students unfurled yoga mats toward a bank of windows facing the setting sun. Some had come directly from cramming at the library for a pulmonology exam the next day.

Mason, a petite 35-year-old brunette, spent three years in Southeast Asian monasteries as an out-of-the box method of battling chronic depression. That experience led her to earn master’s degrees in Buddhist studies and psychotherapy, and another now in progress in neuroscience.

The New York native paces methodically as she leads the class into a rhythmic ujjayi breath, a diaphragmatic breathing technique. “The chime is like an anchor bringing you back to the breath,” she says. “Inhale, lift, and open your heart center.”

Some students stumble from move to move; others slide into position as if into a second skin, eyes forward, bodies steady. After an hour, Mason directs them to close their eyes, lie down, and relax. Their limp bodies rest on a rainbow of yoga mats.

Mason asks them to count their breaths per minute. She knows that the ideal count of five or six has been shown to increase heart rate variability, which can ameliorate problems like depression, epilepsy, post-traumatic stress disorder, and cardiac disease.

Breaths counted, Mason segues from the practice of yoga to a short dissertation on the neuroscience of yoga, something that has been studied by Chris Streeter, a MED associate professor of psychiatry and neurology. In one study published in the Journal of Alternative and Complementary Medicine, Streeter used magnetic resonance spectroscopy to explain why yoga practitioners report a greater improvement in mood and a decrease in anxiety than people who simply walked for relaxation. Streeter found that the yoga group had higher levels of the neurotransmitter gamma-amino butyric acid, or GABA, the likely cause of positive mood changes.

Mason explains to the class how the ujjayi breath and the chiming work together, medically, to bring about a healthful biological balance of breath, heartbeat, and other functions. When the lecture ends, Mason bows, and thanks her class with a namaste, a customary gesture on parting.

Mason says the first goal of MED Yoga was to let doctors know how yoga could help their patients, but then she realized how it could help the doctors themselves.

That message resonates with Holick, who says she is no longer depressed and has renewed faith in her career choice. The past year has “made me realize that I can make medicine my own thing,” she says. “It’s an amazing profession that I really can help people in. Sometimes I really lose sight of these bigger things.”

Yoga Poses for Better Sleep

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Yoga poses for better sleep

Struggling for a few hours of sleep every night? You should give yoga a shot.

Restorative yoga is regarded as one of the best cures for insomnia as it helps relax your mind and body to induce better sleep. Moreover, the deep breathing techniques and gentle stretching helps better regulate your body’s systems. This improves the supply of oxygen and blood to your brain. However, be sure to consult your physician prior to adopting any yoga session for insomnia in case the root cause of your sleep-related problem is deeper than mere stress or anxiety. So, here they are – 7 yoga postures to help you sleep better.

Corpse body or savasana: This may look simple but Savasana is a very important yoga posture to attain total body and mind calmness. All you need to do is lie flat on your back on a yoga mat. Allow your hands and feet to splay outwards with your palms facing up. With your eyes closed, allow your mind to drift from the top of your head to the tip of your feet. As you do this, allow each part of your body to relax completely while you focus on that part. This technique can be performed during any part of the day for around 5-6 minutes per session.

Adho mukha svanasana: This technique is popularly known as the downward facing dog. Place your palms and knees on the yoga mat with your knees aligned directly under your hips and your hands a little ahead of your shoulders. This posture should be such that your toes are facing upwards. Now, exhale and slightly lift your pelvis away from the floor. Do not allow your head to dangle freely and hold it firmly in between your arms. Maintain this posture for minute or two and then relax. Repeat this for a total of 5-6 times per session.

Uttanasana or standing forward bend: This posture is very useful for soothing the mind and promoting stress relief. Besides this, it also facilitates an intense extension in your spine and legs by releasing the hamstrings. To do this posture, stand in front of your bed with your hands on your hip. Inhale deeply and while exhaling, slowly bend your body from your hips until your head rests on the bed. If you face any kind of stiffness initially, use some pillows on your bed. Take a deep breath again and lift your kneecaps up. Maintain this posture for as long as possible. However, ensure that you do not over arch and strain your back.

Viparita karani: This posture is alternately known as Legs-up-the-wall pose. With your back on the yoga mat, gradually extend your legs up the wall. Keep your arms on the floor with your palms facing upwards. Close your eyes and then gently stretch your heels by extending it towards the ceiling. Ensure that you take long and steady breaths while performing this technique.

Sarvangasana or shoulderstand: This posture should be done only after a person has achieved a certain amount of flexibility. Any kind of uncomfortable sensation and you should immediately skip this step. To do this posture, inhale and then with a moderate sudden movement, lift your legs up in the air. Use your hands to stabilize your hips as you perform this. In case you find this difficult, you can even use the walls for extra support. You can also start initially with a half shoulder stand of about 45 degrees and then proceed to the full posture.

Pranayama: Usually this is done in a sitting posture and involves steady-controlled breathing. However, you may also start with a lying posture as this will enable you to really feel your breath moving through your body due to the floor contact. The sitting posture is done in a comfortable, cross-legged position. Start the natural inhalation-exhalation process and try not to engage your mind in different thoughts. Always keep in mind to inhale only though your nose without involving your mouth. On inhalation, fill your belly with air and then gradually exhale using your nose. Repeat the process for around 5-6 breaths and then relax.

Yoga Effective in Treating Psychiatric Disorders

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photo source: healthquestions.net

Yoga Effective in Treating Psychiatric Disorders

September 20, 2011

Many see yoga as a fad or simply a health enhancer. But a number of scientific studies have found it effective as a therapy in treating mental and psychiatric disorders.

“Some believe that yoga should be used only for prevention and health promotion and not as a therapy for illnesses,” said B.N. Gangadhar, who heads the psychiatry department at the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore.

“The reality is that it is being increasingly used as a method for treating various disorders, either alone or as in addition to other therapies, including psychiatric ones,” Gangadhar, also director, Advanced Centre for Yoga at NIMHANS, told IANS.

A study co-authored by Gangadhar and three associates examined the effect of yoga as a therapy supplementing medical treatment of schizophrenia, a severe mental condition, which registers failure rates as high as 50 to 60 percent. The condition is ranked as the ninth leading cause of mental disability worldwide.

Roughly half of 61 schizophrenia patients were randomly assigned to yoga therapy and the other half to physical exercise for four months. Ten from each group had dropped out during the therapy.

The yoga therapy group showed significantly greater improvement in mental or behavioural disorders than those in the physical exercise group. The yoga group also performed better in social and occupational functioning.

Some of the symptoms of schizophrenia are hallucinations (hearing voices), delusions (often bizarre) and disorganized thinking and speech, which render the patient’s life chaotic and distressful.

Another study led by Gangadhar found that Sudarshan Kriya Yoga (SKY) significantly lowered stress by bringing down high plasma cortisol levels among patients, which indicate stress or illness.

SKY is a method of breath control pioneered by Sri Sri Ravi Shankar’s Art of Living Foundation.

Similarly, M. Javanbakht, a psychiatrist at Iran’s Islamic Azad University, and others found yoga eased mental conditions such as depression and anxiety in women.

Participants in Iran were assigned to two groups: one that went through two yoga sessions of 90 minutes each every week for two months and another which did not do any yoga. Women in the yoga group registered a significant decrease in anxiety and depression levels.

Complementary and alternative medicine (CAM), which includes yoga, is now being increasingly used for easing anxiety, stress and depression. Some studies suggest that the percentage of patients availing themselves of CAM could be as high as 60 percent, said Gangadhar.

“A functional brain imaging study at NIMHANS demonstrated that chanting of Aum deactivated certain brain areas bearing on our emotions, particular anger and fear, (and producing a calming effect),” said psychiatry associate professor Shivarama Varambally.

“This indicates that Aum chanting may help in emotional control and reduce negative emotions,” Varambally added.

Johns Hopkins University’s Arthritis Centre reports that scientific studies on the effect of yoga on rheumatoid arthritis and osteoarthritis are “promising,” with results showing “some improvement in joint health, physical functioning, and mental/ emotional well-being”.

The centre suggests that such studies show yoga is a “safe and effective” way to increase muscle strength and improve flexibility, areas of core interests to arthritis sufferers. Besides, yoga can increase mental energy and help a patient develop positive feelings and help keep negative feelings in check.

Yoga, derived from a Sanskrit word meaning ‘yoke,’ is designed to integrate one’s body, mind and soul so that the entire system functions harmoniously.

“Many might argue that such a time-tested practice does not require any proof, but contemporary medicine can accept yoga only after thorough validation through scientific tests,” Gangadhar concluded.

Focusing on A.D.D

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Focusing on A.D.D.

By Fernando Pagés Ruiz • Yoga Journal
September 7, 2011

Adults and children living with Attention Deficit Disorder know the daily struggles of hyperactivity, social isolation, and drug side effects. But yoga may help control these symptoms as well as reduce long-term dependency on medication.

When 8-year-old Clayton Petersen began taking yoga, he had a hard time staying focused. He would assume a posture and then get distracted. His teacher, Kathleen Randolph, had to recapture his attention about once every minute, guiding him back to the center of the room and then into the next asana. She recalls these first lessons, staged within the confines of her small basement studio, were “like being inside a pinball machine.” Clayton bounced from wall to wall, scattering his considerable energies throughout the studio in a way any parent of a hyperactive child with Attention Deficit Disorder (ADD) would immediately recognize.

The clinical label ADD describes one of the most commonly diagnosed behavioral impairments of childhood, affecting an estimated 3 to 9 percent of the school-age population and 2 percent of adults. While most outgrow their hyperactivity in adolescence, about two-thirds carry other symptoms like distractibility into adulthood.

ADD’s core symptoms include inattention, difficulty following directions, poor control over impulses, excessive motor activity in many but not all cases, and difficulty conforming to social norms. But low intelligence is not among these, despite the fact that ADD can hamper learning. On the contrary, a great majority of those diagnosed enjoy above-average intelligence. Bonnie Cramond, Ph.D., associate professor of education at the University of Georgia, authored a provocative paper comparing the symptoms of ADD with creativity. She found that children diagnosed with ADD share traits with such innovators as Robert Frost, Frank Lloyd Wright, and Leonardo DaVinci.

Since the 1940s, psychiatrists have used various labels to describe children who seem inordinately hyperactive, inattentive, and impulsive. These labels have included “minimal brain dysfunction,” “hyperkinetic reaction of childhood,” and, since the 1970s, “Attention Deficit Hyperactivity Disorder” (ADHD). But it turns out that certain children are inattentive and easily distracted without being hyperactive. These quiet, spaced-out kids don’t disrupt class and often go unnoticed.Today the simpler label Attention Deficit Disorder has gained favor to acknowledge attention deficits that come with or without hyperactivity.

For decades, doctors blamed ADD on bad parenting, character weakness, refined sugar, and a host of other causes. Recent research, however, using sophisticated brain-scanning technology suggests a subtle neurological impairment. Studies report that several brain regions in ADD appear underdeveloped, most notably the right prefrontal cortex—an area of the brain associated with inhibition. It turns out that inhibition acts as a precursor to concentration.

One’s ability to concentrate emerges from restraining mental distractions in a process neurologists call “neural inhibition”—a description that squares with Patanjali’s definition of concentration as “quieting the mind of its compulsions.” Here’s how it works: As you read this sentence, your brain intensifies the neural circuits related to language by suppressing competing stimuli like ambient sounds, peripheral vision, and extraneous thoughts. The contrast created between the circuits highlighted and those inhibited allows you to focus your concentration. In the ADD brain, the inhibiting portion of the system malfunctions. ADD brains get flooded with competing stimuli and lack the means to sort them out; each internal voice shouts as loudly as the others.

Looking for a New Drug

Understanding what causes ADD is child’s play compared with knowing how to treat it. There is no cure, so learning how to control the condition is the focus of treatment. And when it comes to ADD treatment, medication has long been accepted as the best medicine.

Stimulant drug use for hyperactivity dates to 1937, when Charles Bradley, M.D., discovered the therapeutic effects of the amphetamine Benzedrine on behaviorally disturbed children. In 1948, Dexedrine was introduced and shown to be just as effective, without such high dosages. This was followed by Ritalin in 1954. Ritalin had fewer side effects and, since it’s not an amphetamine, less potential for abuse. It soon became the best-known and most prescribed psychoactive drug for ADD children—as well as the most scrutinized: By now hundreds of studies have backed its safety and effectiveness.

But nowadays, Ritalin has taken a back seat to generic versions of methylphenidate—Ritalin’s active ingredient—and ADDerall. A “cocktail” drug of amphetamines, ADDerall offers greater dosage flexibility, works more gradually and on a broad spectrum of symptoms, and eliminates the peaks and valleys of methylphenidate.

Still, these drugs are what continue to make ADD treatment controversial. The greatest fallouts with any stimulant medication are lifelong dependency and possible side effects from such long-term use. General use of ADD drugs can trigger some immediate reactions, such as loss of appetite, insomnia, weight loss, delayed puberty, irritability, and the unmasking of latent tics.

Yet these symptoms are said to be manageable with dosage modifications or by discontinuing the use of medication. And although several studies have shown most side effects are mild and short-term, many researchers add that there are insufficient long-term studies to confirm the safety of these drugs over an extended period.

Then there is the ongoing debate regarding the effectiveness of ADD medication beyond a certain time frame. Enid Haller, Ph.D., a specialist in ADD and director of Behavioral Arts in New York City, considers psychopharmaceuticals a short-term intervention at best. “These drugs stop working after six months to a year, and you have to switch medications or change the dosage,” she says. “Unless the individual with ADD learns to compensate for their deficiencies and exploit their mental strengths, medication alone won’t help in the long term.”

Today, more health-care professionals recommend a multidisciplinary, multimodal approach to the treatment of ADD, which includes medication but also therapy and dietary changes as well as a host of mind-body approaches, such as biofeedback, neurofeedback, and yoga. These treatments work to help ADD sufferers learn how to control their symptoms and relieve both emotional and physical stress. But as is the case with most complementary treatments, lack of scientific evidence keeps them from being more accepted and widely used. They tend to get stuck in a gray area: Either they have strong testimonials but no clinical trials to support them, or they have encouraging preliminary research to back their claims but no follow-up studies.

Take EEG neurofeedback and EMG biofeedback, for example. EEG (electroencephalography) represents a computerized training that teaches children how to recognize and control their brain waves. Researchers have observed that those with ADD have higher rates of theta waves (associated with low stimulation, dreaming, and inattentiveness) and lower rates of beta waves (associated with concentration and attention). A computer game controlled by the production of beta waves teaches children the “feel” of a beta wave state until they can eventually reproduce it at will.

In one controlled open trial led by Michael Linden, Ph.D., in 1996, children with ADD showed a 9-point IQ increase over a 40-week period using EEG. EEG appears to work best for inattentive ADD children, but it involves undergoing many sessions and can be expensive, at a cost of about $50 per session. However, on the plus side, there are no adverse physical or psychological side effects.

EMG (electromyography) works similarly to EEG, except it trains deep muscle relaxation instead of brain waves. When muscles relax to a desired degree, a computer generates a tone. By learning to control this tone, subjects can learn deep relaxation. This treatment is not as popular as EEG, but substantial scientific literature supports its effectiveness. It also represents an important therapy because it works with the most troublesome group of ADD sufferers, hyperactive boys. A study published in Biofeedback and Self-Regulation (1984; 9:353–64) found junior high hyperactive boys attained significantly higher reading and language performance after just six 25-minute EMG-assisted relaxation sessions.

Another study, published in the Journal of Clinical Psychology (1982; 38:92–100), which focused on hyperactive boys aged 6 to 12, found significant improvement in behavior observations, parent ratings, and psychological tests after 10 relaxation training sessions. But this data also revealed something interesting: The effect of EMG biofeedback closely resembles the type of neural relaxation work that occurs in yoga. Why is this important? Some experts now believe a combination of physical and mental discipline may be the best approach in treating ADD safely and effectively for the long term.

According to John Ratey, M.D., coauthor of Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood (Simon & Schuster, 1995), exercise that integrates both the body and mind engages the attention system more readily than meditation alone. “[Many studies have shown that] the greatest yield of nerve growth factors happens when the body engages in complex movement patterns,” says Ratey.

The Yoga Connection

It’s important to realize, though, that while yoga may help those with ADD, it is not a miracle worker. It requires time and discipline—concepts that can be difficult for those with ADD to master. In many cases, it takes a year or more for the effects of yoga to make any difference, while medication works in minutes. But the benefits of medication wear off along with the prescription. The effects of yoga—which include suppleness, poise, and better concentration—are much longer lasting: They develop gradually through a type of learning that transforms the entire person. There is no learning or transformation involved in taking a pill.

Mary Alice Askew can relate to this. She learned she had ADD in high school, and like many girls, her symptoms did not include hyperactivity, which made the diagnosis less obvious but no less debilitating. A bright, capable student, her grades and social relations did not match her potential. Though she studied diligently enough to get straight A’s, she instead got C’s and D’s. During class, Askew reeled between two extremes, either “spaced-out or hyperfocused, with no happy medium,” she says.

With her attention system out of control, the transitions from one class to the next were especially hard. Unable to switch activities without getting “mentally disorganized,” she felt inadequate and confused. She knew she could perform as well as her peers, but something got in her way.

To determine what, her parents arranged for a battery of psychological tests that led to the diagnosis of ADD. Treatment began immediately, with stimulants for mental clarity and behavioral training to help her get organized. Her symptoms and grades improved, and she went on to college.

Askew thought she would remain dependent on psychopharmaceuticals for life, but a sudden twist of fate brought her to yoga—a breakthrough that redefined her personal therapy and eventually her career. She discovered yoga in her early 20s, after a car accident left her body wracked in pain. Her physical therapist recommended yoga as part of a comprehensive pain management program. She began to study with her physical therapist and also began to practice at home for up to 90 minutes every day.

The asanas helped reduce her pain and yielded a surprising side effect: Her symptoms of ADD improved too. “I noticed that standing postures put me into the perfect mental state for listening and learning,” she says. So Askew began standing in Tadasana (Mountain Pose) at the back of the classroom. “It gave me something to do with my energy, besides fidgeting,” says Askew. “It helped me stay in the academic moment.”

After graduating with a master’s degree in counseling, Askew began treating students with ADD at a public school in North Carolina. She taught them yoga and meditation to prepare for exams. Today, Askew works as a hypnotherapist and incorporates yoga into her work at Haller’s Behavioral Arts and Research Clinic in New York City. She says yoga provides several benefits for those with ADD:

  • SELF-AWARENESS. People with ADD lack it, notoriously underreporting their own symptoms. The ADD brain, struggling with an overload of sensory stimuli, lacks the mental space for introspection. By emphasizing physiological self-perception, yoga strengthens self-awareness, which can represent the first step in self-healing. “I used to feel hyper-aware of everything but myself,” says Askew. “But yoga helped me get comfortable within my own skin.”
  • STRUCTURE. Many with ADD leave considerable creative potential unfulfilled because they can’t seem to organize their creative energies. Therefore, positive, life-enhancing routines that establish order can be a very important part of ADD management. Systematic patterns of movement help organize the brain. A highly systematized approach, like Ashtanga Vinyasa Yoga, for example, provides consistent, reliable patterning along with the progressive challenges that ADD people require to sustain long-term interest in an activity.
  • COORDINATION & PHYSICAL FITNESS. Children with ADD frequently miss out on physical education—not because of physiological limitations but because their inability to “play by the rules” makes them anathema to coaches and unpopular with their peers. Consequently, ADD kids don’t develop the same level of physical coordination as other children. Therapists often recommend martial arts for their ADD patients because it offers a disciplined, athletic outlet without the pressures of a team sport.
    Yoga, though, goes one step further, providing physical fitness without competition. The relative safety of yoga allowed Askew to explore her body and gain a sense of physical self-confidence, thus shedding the feeling of awkwardness she’d suffered most of her life. “Having my posture in alignment makes it easier to move in a fluid way, shifting attention without stress,” she says.
One Child’s Class

It takes a special yoga teacher to work with ADD kids. “The teacher must have access to a variety of specialized techniques for dealing with anger, distractibility, and impulsivity, as well as a solid foundation in yoga,” says Sonia Sumar, author of Yoga for the Special Child (Special Yoga Publications, 1998). Sumar trains and certifies yoga teachers, like Randolph, to work with developmentally challenged children. Randolph combines Sumar’s special education approach with 30 years of hatha yoga practice in her classes with Clayton.

She works patiently, often one-on-one for several months, before integrating a child with ADD into a group setting, which includes two or three kids at the most. “These kids can be very intense,” says Randolph. “A yoga teacher who works with children with ADD must develop patience, boundless energy, and a keen focus herself. These children need someone who can think faster and more creatively than they do; otherwise, they soon get bored.”

Every Thursday, Clayton steps into Randolph’s studio at The Yoga Center in Reno, Nevada. “Sometimes it’s a struggle to get him there,” says his mother, Nancy Petersen, “but in the end, he’s always glad he went.” Children with ADD struggle with transitions, so Randolph enlists a brief ritual, including candles and incense, to help Clayton shift into yoga mode. The structure of Clayton’s classes generally follows the same basic pattern every week, with a few alternating poses chosen for variety.

ADD children do best in a well-organized environment, as their internal sense of structure lacks coherence. The Yoga Center has a sunny room with large windows and mirrored walls, but Clayton’s classes take place in Randolph’s basement studio, where the ivory-yellow paint and sienna carpet keep distractions to a minimum. Since the ADD brain functions too slowly while processing sensory information, concentration comes more easily when the stimulation level remains low.

To encourage body awareness, Randolph begins by asking Clayton how tight his body feels and how much warm-up he needs. Depending on the answer, Randolph begins with Suryanamaskar (Sun Salutation) in either a 12- or 28-posture sequence. This cycle challenges Clayton’s ability to focus and helps increase his attention span. Learning a complex series like Sun Salutation “recruits a lot of nerve cells in the prefrontal cortex,” says Ratey. “The brain is like a muscle: When you strain it, you strengthen it.” But purely intellectual endeavors, like learning multiplication tables, don’t promote what Ratey jokingly calls “neurological Miracle-Gro” to the extent that complex movement patterns do.

Following Sun Salutation, Randolph leads Clayton through a succession of forward bends, lateral bends, triangle poses, and backbends. In addition to their psychological benefits, these yoga poses help children with ADD learn to coordinate their bodies in space, which is important since they tend to have higher injury rates than their peers. Similar to the work of a physical therapist, carefully performed asanas engage alignment, balance, and coordination to train a child’s sensory-motor system. Balancing poses like Vrksasana (Tree Pose) are Clayton’s favorites, and he frequently practices them outside of class. Says Randolph, “Kids gravitate toward play that involves balance,” such as skateboards, pogo sticks, swings, merry-go-rounds, and tumbling, because it excites what physiologists call the vestibular system. The inner ear’s vestibular system allows you to judge your position in space and informs the brain to keep you upright.

But beyond its role in physiological equilibrium, researchers are discovering that the vestibular system plays a vital role in behavioral and cognitive stability. “There’s a fundamental kind of coordination that patterns behavior so it makes sense and flows together, which is believed to be deficient in those with ADD,” says Eugene Arnold, M.Ed., M.D., an ADHD specialist at Ohio State University and formerly with the National Institute of Mental Health.

To this end, Randolph employs asanas like Tolasana (Scales Pose) and an exercise she’s dubbed Roll Asana, in which the student rocks back and forth on the floor like a teeter-totter. Each new position in yoga provides a different plane of stimulation for the neurological circuits of the vestibular system. Inverted positions, such as Sirsasana (Headstand) and Salamba Sarvangasana (Supported Shoulderstand) are especially beneficial because they also calm the nervous system and help curb hyperactivity while training the attention system. Near the end of class, Randolph guides Clayton through a series of relaxation poses to calm his breath, quiet his mind, and prepare for meditation. Meditation lasts approximately one minute—which can seem like a lifetime for ADD children.

After four months of yoga, Clayton can finally complete a half-hour yoga session, flowing from one posture to the next with minimum interruption. Though Clayton’s significant progress in yoga has not yet translated into better concentration at school, it’s difficult to imagine that the focus he has developed in yoga would be confined to the sticky mat. On at least one occasion, Clayton says he used techniques learned in meditation to train his attention during a mathematics exam. On another, his mother spotted him practicing Bakasana (Crane Pose) in the outfield during Little League—although, unfortunately, he wasn’t paying much attention to the game.

His yoga teacher accepts this gradual pace as a fact of life. “Quieting the mind is a long haul for any of us,” says Randolph. “It can be an epic journey for those with ADD, but they need it most.” Talking with Clayton about his yoga practice, one gets the sense that he’s found something important and personal at which he can excel—a refuge for his spirit and a tool for establishing harmony between his body and mind.

After several years of yoga, Askew knows it takes that kind of full-time commitment to manage the symptoms of ADD. Maintaining a healthy lifestyle that includes yoga has helped Askew cope with her condition. It gives her confidence to know she can gain mental clarity on her own—without a pill. “Yoga,” says Askew, “involves learning how to manage attention and learning how to move fluidly from focusing on the details to the big picture.”

Contributing Editor Fernando Pagés Ruiz wrote “What Is Consciousness?” in the September/October 2001 issue of Yoga Journal. He lives and writes in Lincoln, Nebraska, and can be reached at [email protected].