Balance Balls for On-Task Classroom Focus?


Does sitting on a balance ball help children with ADHD in the classroom?

Guestpost from David Rabiner, Ph.D.
Dept. of Psychology & Neuroscience, Duke University
©
ATTENTION RESEARCH UPDATE; September 21, 2016

Let’s NOT discount the science

Could sitting on a balance ball help children with ADD/ADHD/EFD be more focused and on-task in the classroom?

While the idea may strike many as implausible, several small but interesting studies conducted since 2003 suggests there may be something to this.

Really?

Dr. Rabiner recently received a question from a long-time subscriber and teacher about whether there was any research to support a practice in her school of having children with ADHD sit on fidget cushions when seated on the floor or chair.

The idea behind this approach is that children with ADHD may benefit from more movement in the classroom because being in motion allows their brains to be more fully engaged.

He was not immediately aware of any research on this issue, and it initially struck him as a bit far fetched. When he searched the literature, however, he came across several small but interesting studies that yielded promising results.

Scroll DOWN for his excellent summary
of this small body of work.


Please feel free to forward this content to others you know who may be interested. If you would like to receive Attention Research Update on a regular basis, visit http://www.helpforadd.com for a no-charge subscription.

ABOUT:  I have been a huge fan of Dr. David Rabiner’s ATTENTION RESEARCH UPDATE since its inception in 1997. Not only do I count on his comprehensive, plain-English explanations of up-to-date research trends and developments as key resources in my drive to keep my information base current, I also archive them for future reference.

I urge any professional working with individuals with Attentional Spectrum deficits and struggles — whether teachers, counselors, coaches, therapists or physicans — to sign yourself up before the idea falls through the cracks.  (Parents and ADD/EFDers themselves can benefit too!)


mgh note: AGAIN, to answer to the many requests I have received for more information about non-pharmaceutal treatment alternatives, I chose to present the entire September issue instead of writing my own summary (my format & heading edits, with content otherwise intact).

ALSO NOTE: As an academic, Dr. Rabiner uses the DSM-5 official name, “ADHD,” rather than “ADD” or “ADD/EFD.” which I strongly prefer and otherwise use on this site (click HERE for why).  Please remember at ALL times that he uses this term to refer to the Inattentive and Combined subtypes as well as the Hyperactive subtype.

Madelyn Griffith-Haynie, CTP, CMC, A.C.T, MCC, SCAC

Why sitting on a Balance Ball might possibly be helpful

A hypothesis proposed by Julie Schweitzer, a professor of psychiatry and behavioral sciences at the MIND Institute at the University of California, Davis is that ‘fidgeting’ and frequent movement may help children with ADHD sharpen their mental control.

The idea underlying this suggestion is that frequent movement may increase mental arousal for children with ADHD, much as stimulant drugs do, thus making it easier for them to stay focused.

One way to test this idea would be to have children sit on balance balls at school, rather than on regular chairs, and observe whether this improved important aspects of their behavior.

Balance balls are somewhat squishy rubber balls that are large enough to sit on and replace a regular desk chair. Because the ball is unstable, remaining seated requires nearly continuous small movements to readjust one’s balance in response to motion of the ball. As theorized above, this frequent physical activity might increase mental arousal and make it easier for children with ADHD to focus.

Three small studies that tested this hypothesis

In the earliest study, 3 4th grade children with ADHD were systematically observed over 12 weeks during which they switched every 3 weeks from sitting in a regular chair to sitting on a balance ball [Schilling et al., (2003). Classroom Seating for Children With Attention Deficit Hyperactivity Disorder: Therapy Balls Versus Chairs. The American Journal of Occupational Therapy, 57, 534-541].

During this time, they were observed by research assistants trained to reliably code whether the child was seated during each 10 seconds of the daily observation period. Writing samples were also collected each day and the percentage of legible words the child produced was computed.

This study follows what is called an A-B-A-B design in which the same individual is tested under alternating conditions.

Although the sample is small, this is a powerful design because if in-seat behavior and legible word production increase when children switch to the ball, decline when they switch back to the chair, and improve again when they switch back to the balls, a strong inference can be made that sitting on the balance ball caused the observed improvements.

This is exactly what was found for all 3 children.

Study Two

Results from this initial study are interesting but the sample was very small which makes generalizing the results to other children difficult. In addition, being seated is not the same thing as engaging in what one is supposed to be doing, i.e., being on-task.

A more recent study partially addressed these issues by observing a slightly larger sample, i.e., 8 4th and 5th grade students with ADHD [Fedewa et al., (2011). American Journal of Occupational Therapy, 65, 393-399]. In addition, these researchers not only coded in-seat behavior but also examined whether children were on-task.

Children were observed over 14 weeks, with observations occurring 3 days a week for 30 minutes across language arts, math, and social studies classes.

During a 2-week baseline period, children were observed sitting in regular classroom chairs; for the remaining 12 weeks, they switched to the balance balls. Unlike the prior study, there was no reversal back to regular chairs.

Each child’s on-task and in-seat behavior improved steadily and substantially over the 12 weeks.

  • Prior to the switch, children were seated during only 45% of observations and on-task during only 10%.
  • At the end of 12 weeks, they were seated over 90% of the time and on-task almost 80% of the time.

These are dramatic improvements.

As with the prior study, however, the sample is too small to be confident about generalizing the results. In addition, because the design did not include a reversal to regular chair sitting, one can’t conclusively rule out that the change simply reflected the passage of time. Finally, because no assessment was made of academic work, the impact of ball sitting on this important outcome is unknown.

Study Three

A final relevant study was conducted with 29 elementary school children from Taiwan, 15 of whom were diagnosed with ADHD. In this study, children’s reaction time and EEG activity in response to different auditory tones was measured while they sat in a regular chair or on a balance ball. Children were instructed to press a button as quickly as possible when they heard the ‘target’ tone, but not in response to any other tone.

When tested during ‘chair sitting’, children with ADHD had significantly slower reaction times than other children; they also showed differences in EEG parameters related to the efficient allocation of attentional resources and attention shifting.

When tested on the balance ball, differences between children with and without ADHD were no longer evident.

Summary and Implications

Results from these studies provide initial research support for the practice of having children with ADHD sit on balance balls in the classroom. Rather than being distracted by the frequent small movements required to stay seated on a balance ball, this actually helped the small number of children with ADHD who participated in these studies.

In addition to support from the classroom observation data, improvements associated with balance ball sitting were also found in lab measures of reaction time and EEG activity. This is consistent with the hypothesis noted above that frequent small movements may increase mental arousal for children with ADHD, thus making it easier for them to stay focused and on-task.

Although these are intriguing findings, it should be emphasized that the sum total of research I could find on the use of balance balls for children with ADHD included a grand total of 26 participants. This is certainly insufficient to draw any conclusions about the generalized utility of this approach.

In addition, none of these studies were randomized, controlled trials which are generally considered necessary to establish the efficacy of an intervention. Thus, while the results reported are promising and intriguing, additional research is clearly necessary for this approach to be adequately evaluated.

Worth a Try at Home?

With this caution in mind, having a child sit on a balance ball seems like a low-risk thing to try, especially since the balls are available for under $25.00. Trying this with a child at home when he/she needs to complete homework, and seeing if it seems to make a difference, strikes me as a reasonable thing to try.

A concern about trying this at school would be potential issues associated with a single child in the class using such a ‘chair’ and how this would be regarded/accepted by peers; note that in the classroom studies summarized above, all children in the class sat on balance balls. If the balance ball proved to be helpful, however, this hardly seems like an insurmountable challenge, just something to be sensitive to.

Where’s More Research?

An important issue raised by this research is why so few studies on using balance balls and possibly other sensory stimulating methods to assist children with ADHD have been conducted.

  • I do not know how many studies of medication treatment there are but it is certainly in the hundreds.
  • Meanwhile, there has been almost no work on this low-risk approach that has yielded promising results in preliminary studies and that has what some would consider to be plausible theoretical underpinnings.

That is disappointing and the reasons for this would make for an interesting study in and of itself, particularly since there are many other understudied areas when it comes to understanding the development of ADHD and how it can be most effectively treated.

—————
© 2016 David Rabiner, Ph.D


This issue of Attention Research Update is sponsored by Attention Point – their support helps me maintain the newsletter as a free resource. If you use behavior rating scales in your ADHD evaluations and treatment monitoring, please take a moment to learn about their service called DefinPoint as I truly believe you will find it to be helpful.

Additional info and a link to where you can watch a 3-minute video introduction to DefiniPoint can be found below. I encourage to become familiar with the benefits of this new system.

Thanks again for your ongoing interest in the Attention Research Update newsletter. I hope you enjoyed the above article and found it to be useful to you.

Sincerely,
David Rabiner, Ph.D.; Associate Research Professor
Dept. of Psychology & Neuroscience; Duke University; Durham, NC 27708


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About Madelyn Griffith-Haynie, MCC, SCAC
Award-winning ADD Coach Training Field founder; ADD Coaching field co-founder; [life] Coaching pioneer -- Neurodiversity Advocate, Coach, Mentor & Poster Girl -- Multi-Certified -- 25 years working with Executive Functioning struggles in hundreds of people from all walks of life. I developed and delivered the world's first ADD-specific coach training curriculum: multi-year, brain-based, and ICF Certification tracked. In addition to my expertise in ADD/EF Systems Development Coaching, I am known for training and mentoring globally well-informed ADD Coach LEADERS with the vision to innovate, many of the most visible, knowledgeable and successful ADD Coaches in the field today (several of whom now deliver highly visible ADD coach trainings themselves). For almost a decade, I personally sponsored and facilitated seven monthly, virtual and global, no-charge support and information groups The ADD Hours™ - including The ADD Expert Speakers Series, hosting well-known ADD Professionals who were generous with their information and expertise, joining me in my belief that "It takes a village to educate a world." I am committed to being a thorn in the side of ADD-ignorance in service of changing the way neurodiversity is thought about and treated - seeing "a world that works for everyone" in my lifetime. Get in touch when you're ready to have a life that works BECAUSE of who you are, building on strengths to step off that frustrating treadmill "when 'wanting to' just doesn't get it DONE!"

25 Responses to Balance Balls for On-Task Classroom Focus?

  1. Wendy says:

    I wonder if this would help adults. They could use a balance ball at work. hmm. Maybe I should get hubby a balance ball for his office.

    Like

    • Funny you should ask – I’m thinking of getting one myself! I’m hoping some adult who uses one will comment before I spend the bucks (and dedicate the floor space).

      Interesting for you: the area of the brain supposedly strengthened is implicated in balance. No real proof tho’.

      xx,
      mgh

      Like

      • Wendy says:

        Maybe I should get one for ME!

        Like

        • Couldn’t hurt, I imagine, and might help. If you go for one of the cheaper ones you could try it out, then upgrade if you liked it. They have more than a few forms of these “active sitting” dealies.

          There are the cheaper balls themselves (in several sizes), and there are balls that sort of perch in roll-around chairs. They also sell floor rings that keep the simple balls from rolling all over. (click the “Found HERE” under the child reading – above).

          Let me know if you decide to give it a trial.
          xx,
          mgh

          Liked by 1 person

  2. Debbie says:

    HI Madelyn,

    I can certainly vouch for this methods efficiacy. I’ve taught kids who have been able to concentrate much better and not interupt the class by using the bouncing ball strategy. It has remarkable effects.

    I didnt know then about the brain and etc. Unfortuanly whilst most teachers are incredibly dedicated, there are some who are more focused on classroom control than whether EVERY child is learning to their optimum.
    Great artilce, thanks. 🙂

    Liked by 1 person

    • Thanks for letting us ALL know of your experience with these things. I am going to edit your comment format so that it stands out so nobody misses it.

      Of course it is impossible to teach a class where there is NO control, but I agree with you that control itself misses the greater objective. My belief is that all teachers start out incredibly dedicated, but only those strong enough to overcome the lack of support with increasing class size and administrative demands are able to remain so (without losing their minds 🙂 )

      It remains a sadness to me that teachers are handicapped by class size – that we don’t prioritize education with funding for more and better compensated teachers and teaching assistants, with supply closets stocked with all the materials that that would make “no child left behind” more than a stupid slogan to justify teaching to the test!

      Politicians setting educational policy (and budgets) is one of my soapboxes. 🙂
      xx,
      mgh

      Like

      • Debbie says:

        thanks Madelyn. :)/ “Control” can be gained by respect and negotiation, yet that word ‘respect’ seems to be remarkably out of fashion these days. Class sizes? I live in China, where public schools have up to 70 kids in a class. Mindbogglng. I agree with you though, these slogans ‘no child left behind’ sound great, but when one looks at the reality of education funding cuts, and yes class sizes etc…. it’s a whole other story.
        Social pressure is another issue. I once taught a preschooler who the doctors decided to label with ADD – before they drs in their wisdom added another letter H to the label – and prescribed the four year old Ritilin. Ritilin’s chemical composition, quite frankly, i bascially similiar to speed. For a four year old? HIs very brave mother decided to not take the doctors advice, and use diet to manage her child’s behaviour. I lived in a small country town then and the pressures and social ostracization of that woman were immense. That’s why I say she was brave. so brave to not let the pressures of this narrowmnded countrytown people get to her.

        In many instances its ‘big pharma’ and drug companies profits that come before real health care. Obviously provision of a bouncing ball is not the be all and end al of dealing with this health issue, but its a great start. Nutrition and careful diet management can be another strategy..

        Its great you brought up this important social issue.

        Liked by 1 person

        • Thanks for ringing in here.

          What a great many people don’t realize is that certain food allergies have cognitive effects – and when you remove those from a child’s diet, many (sometimes most) of their symptoms subside.

          BUT – that does not mean that diet will always work or will work for everybody with ADD/EFD affect – just as some diabetics can manage with diet alone while others will require an insulin-like medication for life (or until science finds a cure).

          Nothing works for everyone – and most people need to try a few things at once (and adjust the combo several times).
          xx,
          mgh

          Like

          • Debbie says:

            exactly, Madelyn. It can be a matter of trial and error and people have to find out what works for them. Apples – who’d have thought – was very effective when taken out of the diet of another boy I taught. It can be very individualised. Enjoy whats left of your weekend 🙂

            Liked by 1 person

            • You too! Apples? That’s a new one for me. xx, mgh

              Like

  3. mrs fringe says:

    This is very interesting, I’m going to mention it to the principal at my daughter’s school, thank you!

    Like

    • Good luck. Read my response to Kate McClelland re: fine motor hyperactivity. Even if your daughter’s school won’t justify the cost for balance balls, they can at least learn to understand that many students “fidget to focus” – so expecting them to LOOK like they are paying attention might be the very thing keeping them from it.

      Thanks for reading & ringing in.
      xx,
      mgh

      Liked by 1 person

      • mrs fringe says:

        Thanks, I will check your reply. They might spring for it. The principal recently mentioned trying something new for the kids who have a hard time with traditional chairs, so it could happen 🙂

        Liked by 1 person

        • Many kids hate sitting still in hard chairs, so getting away from those (along with a bit of “wiggling” support) might be a large part of what’s going on that helps attention and learning.
          xx,
          mgh

          Liked by 1 person

  4. How interesting. I don’t have ADHD But I was a constant ‘jiggler’ when at school (still am) I always thought it helped me concentrate if I was allowed to wiggle my feet, or twiddle my pencil. But kept getting told to sit still, stop twiddling etc. It took a lot of concentration NOT to ‘jiggle’ and it always made me feel uncomfortable. I can understand how having a balance ball would help. It sounds a daft idea, but if there could be further study and confirmation of the same outcome, then wouldn’t it be better having them rather than using chemicals to control a child? I think so.

    Liked by 1 person

    • What you are describing is called “fine motor hyperactivity” – which is not the same as ADHD, btw, tho’ quite a few ADDers exhibit FMH – one of the three ways that “energy overdrive” presents. (Gross Motor is what everybody thinks hyperactivity IS, and cognitive hyperactivity is a brain in overdrive, which can also make the person seem spacey/dreamy ’cause their focus is internal).

      Other things I ask about as an ADD Coach are a history of nail biting, pencil chewing, hair twoozling, chewing gum smacking, etc. — all designed to improve focus by giving the brain something to focus *around* (not exactly the same as autistic stiming, but sort-of in that ballpark, brain-wise).

      The dumbest thing a teacher can do is to tell a child to sit STILL and pay attention. Many will be able to do one or the other – and do we really want kids “paying attention” to sitting still rather than what they need to be learning?

      I was/am an unconscious foot jiggler and swivel back and forth in my ergonomic desk chair as I write or coach, and used to be a nail biter.

      My HS algebra teacher, a Miss Waigond (or some such, at the time), was downright cruel about insisting that I sit still and sit straight forward, even though my unusually long legs made me extremely uncomfortable in those school desks with chair attached to writing surface unless I swiveled sideways. (Even today, I avoid sitting in a restaurant booth because I need more leg room.)

      She mortified me by intentional embarrassment and ruined math for me forever — and I was an excellent student before her attacks.

      xx,
      mgh

      Liked by 1 person

      • Awww poor Madelyn! I was also a nail biter, hair chomper, pencil and pen chewer, dreamer, doodler. The teacher used to made me sit so still I felt like I was in a straight jacket! I still can’t sit still hahaha so she lost :0)

        Like

        • I’m really not suffering as the result of that teacher’s ignorance, but thanks for the empathy.

          I repeat the story, hoping to reach current parents and educators, so that perhaps that stupid “cognitive straight-jacket” practice will STOP.

          Who said we HAD to sit still in order to learn? I swear, vanilla memes are not only neurologically ignorant, they’re cruelly bullying.

          xx,
          mgh

          Liked by 1 person

          • I agree. It’s more about power and rigid obedience than learning or assisting the student

            Like

            • How pathetic that an educator (or educational institutions) would feel like they need to exert power over students – or that rigid obedience meant anything at all besides pernicious control. I swear, from my reading today I hate the entire world of those who crave domination of any sort.

              It must be time to call it quits for a bit!

              Liked by 1 person

            • To be honest I’ve thought for a while that the ‘education system’ is about obedience, training people for jobs and not about education, The teachers are forced to concentrate on reaching targets and conditioning children to be quiet, be obedient that real teaching gets a back seat. I am not blaming the teachers of today, they are desperate to teach and are being stopped from doing o effectively. I always think of that song in the sixties/seventies called ‘Little Boxes’ ‘Little boxes made out of ticky tacky. They all went to university and they all went to live in boxes, little boxes all the same’.

              Like

            • I share your thoughts — including the industrialist-fueled ticky-tacky imperatives.

              I don’t blame the teachers either – to me it seems that MOST of them are angels on earth to be willing to deal with the nonsense of educational administration, hoping to reach and teach the next generation.

              In all my time in many schools (moved yearly for most of my young life), I only came across ONE Miss Waigond. The rest were kind and wonderful to me, and granted me a great deal of latitude as the chronic “new girl.” The teachers I’ve met since – at conferences mostly – were desperate to learn anything that would help “their kids.” But the one quarter of an appalling college educational curriculum left me running for my life! And that was YEARS ago.

              My colleague Peggy started out as an elementary school teacher, so I’ve heard many tales of what they could do for kids back then compared to what teachers are forced to do now. She has spoken of the antics of one teaching colleague & a particular principal (who was rapidly replaced) who seem to me to have been diagnostically sadistic.

              The problem, as I see it, is that teachers have no mechanism to report the bad seeds in their ranks – at least not one that would do much beyond putting their own jobs on the line. Parents need to take a more active role if anything is going to change in that regard – but they are fearful of making things worse for their kids, I suppose. Still, they could make formal complaints once their children were out of that teacher’s classroom.

              It’s all very depressing – and looks likely to continue to worsen. Sad, sad, sad.
              xx,
              mgh

              Liked by 1 person

  5. Reblogged this on Kate McClelland.

    Like

    • Thanks again, Kate – practically before I posted it, too! I want your brain! 🙂
      xx, mgh

      Liked by 1 person

      • Hahahaha!

        Liked by 1 person

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