Balance Balls for On-Task Classroom Focus?
Thursday, September 22, 2016 25 Comments
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.
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.
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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.
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.
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.
David Rabiner, Ph.D.; Associate Research Professor
Dept. of Psychology & Neuroscience; Duke University; Durham, NC 27708
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- Is Your Child on the TEAM (also by David Rabiner)
- CBT Promising for ADD Teens (also by David Rabiner)
- Medications vs. Non-Pharm Alternatives
- ABOUT Non-Medical Alternatives
- Medication Fears
- LinkList: The Diagnosis and Treatment Series
Related Articles ’round the ‘net
- Stability Balls in the Classroom Cut the Wiggles & Increase Learning
- Combination of medicine and therapy can help students with attention deficit disorder (islandpacket.com)
- Study: Adaptive Working Memory Training Can Reduce ADHD-related Off-Task Behavior (sharpbrains.com)
- Update: From “Does Brain Training Work?” To How, When, for Whom It Can Work (sharpbrains.com)
- More Delays in Brain Growth Seen With ADHD (news.health.com)
Sponsor’s Message from DefiniPoint
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Dr. Rabiner’s Note – Because I am a paid consultant for DefiniPoint, my opinion of the program may be biased. I thus encourage you to review the video and see what you think.