By: Master Scott Downey, 7th Degree Black Belt and Child and Adolescent Psychologist (Registration #079), Janeway Child Health Center, St. John’s, Newfoundland and Labrador, CANADA
The purpose of this article is to, (a) Provide background information on ADHD (Attention Deficit Hyperactivity Disorder), (b) Provide a list of teaching strategies that are useful for teaching Taekwon-Do to ADHD children, and (c) Describe the positive effects of Taekwon-Do training on the symptoms of the disorder. I have been a Child Psychologist specializing in the area of ADHD for the past 20 years. I have been involved with the Martial Arts since age 12 and I have been teaching Taekwon-Do for the past 20 years in St. John’s, Newfoundland, CANADA. I have personally seen the positive effects of Taekwon-Do training on many children with ADHD. In addition, I am also an adult with ADHD and have a son (age 17) who has been diagnosed with ADHD. I hope that the information provided will help Taekwon-Do instructors understand the characteristics of ADHD, and maximize their ability to teach and positively influence the lives of their ADHD students.
ADHD is a very common condition that affects 5% to 12% of school aged children, making it the most commonly diagnosed disorder in childhood. This means that there are approximately 1 to 3 children in every class that has ADHD. It may appear that ADHD has been on the increase over the past 10-15 years. However, this is largely due to an increase in the awareness of the disorder by parents, teachers and other professionals. In the past the child may have been labeled as lazy, unmotivated, or just a “bad” kid. It is important to note that ADHD is the accurate medical term for a condition that had several other names in the past, including ADD.
What is ADHD? ADHD is comprised of three major symptoms: (1) Inattention, (2) Hyperactivity and (3) Impulsivity. For some children their primary symptom is “Inattention” and they do not have hyperactivity or impulsivity. These children have the diagnosis of ADHD (primary inattentive type). They are the “daydreamers”. For other children their primary symptoms are “hyperactivity and impulsivity”. These children would have the diagnosis of ADHD (hyperactive/impulsive type). Some children have a combination of inattention and hyperactivity and impulsivity and they would receive the diagnosis of ADHD (combined type). All three types of ADHD can be challenging for the Taekwon-Do instructor, especially if they do not have strategies for dealing with the special needs of these students.
In order to meet the criteria for the diagnosis of ADHD (primary inattentive type) the child must display at least 6 of the following:
1. Making careless mistakes or not paying attention to details
2. Not able to pay attention for a long period of time
3. Not listening well
4. Not finishing tasks
5. Not being well organized
6. Avoiding tasks that require a prolonged mental effort
7. Losing or misplacing toys, homework, books
8. Being easily distracted
9. Being forgetful
In order to meet the criteria for the diagnosis of ADHD (primary hyperactive/impulsive type) the child must display 6 of the following:
1. Fidgeting and squirming
2. Leaving seat
3. Running or climbing when it’s not the time or place
4. Difficulty with doing quiet activities
5. “On the Go” as if “Driven by a motor”
6. Talking excessively
7. Blurting out answers
8. Not being able to wait his or her turn
9. Intruding on others
If a child displays at least 6 symptoms from each of the two above categories then they would have the diagnosis of ADHD (combined type).
It is important to note that the above symptoms must:
1. Be more severe than what is typically seen in children of the same age.
2. Have caused impairment in social and/or academic function.
3. Be present in more than one setting (i.e., home and school)
4. Be present for at least 6 months duration.
It is important to note that not all children who misbehave are automatically diagnosed with ADHD. As a Psychologist on the Learning Behavior Clinic team for the past 20 years I have come to know the importance of a thorough assessment by a professional team before making a diagnosis of ADHD, including information from: (a) School (including information on social skills, academic functioning and behavior); (b) Parents (especially medical history and family history), and psychoeducational assessment results (intelligence and achievement testing results). We also get behavior rating scales from parents and teachers. Once we have all the necessary information we then meet with the child and their parents to discuss the possibility of the diagnosis of ADHD. A child who has a Learning Disability (LD): reading disability, math disability, written output disability, etc… may look as if they have ADHD but their symptoms are secondary to their Learning Disability and not primary ADHD.
They appear inattentive and easily distracted because they do not know how to do the work due to their LD. Once their LD is diagnosed and supports are put in place (oral testing and scribing, for example) they do well academically and their inattention is no longer an issue. We also ensure that the child’s hearing and vision has been assessed and that they have had a speech language assessment to rule out vision, hearing, and speech language issues. It is important to note that children may have both ADHD and an LD and this complicates the diagnosis and treatment. A “team approach” to the assessment and diagnosis of ADHD, which should include parents, school, Psychology and Pediatrics, is extremely important in these cases.
What are the causes of ADHD? ADHD is 99% genetic. This means that for the vast majority of children they will have inherited the disorder from their parents. It is not uncommon for the children that we see to also have a mother and/or father who also struggled in school and struggled with attention and focusing.
Many of these parents have struggled in school and despite having average to above average intelligence were not able to reach their potential in school or on the job. Many quit school and were never able to hold down a steady job. I could spend a great deal of time writing about ADHD in adults and the positive impact of Taekwon-do training on their lives but that will have to be another article. The 1% of children who have ADHD that is not genetically based are children whose mothers had significant complications during pregnancy or birth (pre-mature babies, and babies who were corded, for example). Corded, meaning that the umbilical cord was wrapped around the baby’s neck during the birthing process and decreased or stopped the oxygen supply to the baby’s brain. Other non-genetic causes could be drug and alcohol use during pregnancy, accidental poisoning, or a significant head injury. It is important to note that ADHD is not caused by a lack of will power or motivation, bad parenting, or too much sugar in the diet.
Now that you have a better understanding of what ADHD is, how is it diagnosed, and what causes it, we can now look at how Taekwon-Do training can have a positive impact on its symptoms (inattention, hyperactivity, and impulsivity). I would like to state that for some children who have ADHD, and their symptoms are severe, Taekwon-Do training alone may not be sufficient. These children do best with a more comprehensive approach to treatment including behavior management, individual counseling, significant school supports, family counseling, and medication management. As a result of parents and professionals knowing that I am a Child Psychologist specializing in ADHD, have a child with ADHD and also have ADHD myself, I tend to get a larger percentage of children with ADHD in my Taekwon-Do program than other Martial Art Schools. Unfortunately, some parents and professionals assume that Taekwon-Do training is a “cure” for ADHD because of my own success as a Taekwon-Do practitioner/ competitor/ instructor and Child Psychologist. They think that because I was successful that their child will also be successful. Unfortunately, this could not be father from the truth. I have had success with ADHD children, some great success, including children going on to become successful in various professions including various trades, nursing, medicine and the Police force. It is very rewarding when one of your students, who was diagnosed with ADHD and struggled through school, calls you or meets you in the community and tells you that they have a successful career and that you were part of the reason for their success. However, I have also had students with ADHD that were not able to benefit from my instruction. They are usually the children who had severe ADHD and whose parents were against medication management of ADHD, or those who were forced to come to Taekwon-Do training by their parents but had no real interest in Taekwon-Do or any type of Martial Arts training or organized activity.
The best success with ADHD students are with those who are (a) interested in learning Taekwon-Do, (b) those that have caring and supportive families and schools, and (c) those that receive medication treatment for their ADHD symptoms (where warranted). I have had ADHD children with severe symptoms who were not receiving medication treatment for their symptoms (inattention, distractibility, hyperactivity, and impulsivity) and their symptoms significantly interfered with their learning, even with small group and/or one on one instruction. Once they were medicated and their symptoms were under control, their success in Taekwon-Do significantly improved. They could now learn and retain information because they could finally focus on instruction. Now they can enjoy the activity, be successful at learning new skills, and develop mentally, physically, and spiritually. They can now benefit from learning the tenets of Taekwon-Do (courtesy, integrity, perseverance, self-control and indomitable spirit). For those with excess energy, they can now focus this energy into their Taekwon-Do training. It is important to note that many children who take medication may be taking “short acting” medication (3-4 hours per dose) and the medication may be worn off by the time they go to your class, especially if you have late evening classes. Some parents do not give medication to their children on the weekends and you may find their ability to focus and learn at these times is compromised. If the parent has confided in me that their child has ADHD and is on medication I can help them to decide on whether or not to have their child on medication during class time. The parents can then relay this information to the child’s physician and medication can be adjusted accordingly. In the past the main type of medication used to treat ADHD was Ritalin, and the therapeutic effect only lasted for 3-4 hours. The child therefore had to take the medication before going to school, at lunch time (had to go to the office for medication), and again at 3:30pm when they arrived home from school, to help with homework time. Today there are several long acting medications (12-14 hours) for ADHD. These medications include Concerta, Adderall, and most recently Vyvanse. These medications are much more convenient to take, and avoids the stigma of the child having to go to the office to get their medication.
For ADHD children with less severe symptoms they can often benefit from Taekwon-Do training without the use of medication, as long as they are (a) interested in learning Taekwon-Do, (b) have parents who are supportive of them learning Taekwon-Do and encourage consistent practice and attendance, and (c) we can keep them motivated through good teaching methods and plenty of positive feedback. I will now give you some effective strategies for teaching students with ADHD in your Taekwon-Do school.
Teaching Strategies for students with ADHD:
1. When you begin your class you can line up the students according to rank but, if possible, ensure that the ADHD child is next to other children who have good attention and focusing and are good role models. If you place an ADHD child next to another ADHD child, especially a child with ADHD (hyperactive/impulsive type) they will often “feed off each other” and aggravate each others symptoms.
2. When you give instruction to the group don’t “assume” that the ADHD child is listening to your instruction. They may “appear” as if they are paying attention and understand the instructions given, but this is often not the case. Children with ADHD are often distracted by their own thoughts or by sights and sounds around them (for example, a poster on the wall or the sound of a truck outside the building). If you have parents that watch the class or assistant instructors that are in the back of the room you need to ensure that they “whisper” to each other to avoid distracting the students in your class.
3. A child with ADHD will often have poor self-esteem and low self-confidence due to their difficulties with following rules at home, school and in the community, and they are also more likely to have other co-morbid issues such as learning disabilities, anxiety, depression, and difficulty establishing positive peer relationships. They require a very sensitive teacher who understands their needs and gives a lot of positive reinforcement for good behavior. With ADHD children we need to “catch them when they are good”, rather than focusing on punishing inappropriate behavior. If we as Taekwon-Do instructors can focus on what these kids do right and praise them for it, “Johnny, that was a great side kick. Good job”, then we can have a positive influence on their self-esteem and self-worth. Kids with ADHD get very few positive comments from adults in their lives due to their difficulty following instructions, following rules, and completing tasks. As Taekwon-Do instructors we need to be keenly aware of this and, as stated above, “catch them when they are good”.
4. The ADHD child can benefit from rules that are posted on the walls of the school, especially if the information is in the form of pictures. Many ADHD children are “visual” learners and not “auditory” learners and therefore, spending a lot of time verbally explaining rules may not be the most effective teaching strategy.
5. Children with ADHD learn best and focus better when they are able to be in close proximity to the instructor. If possible, and this may depend on the structure of the class, you should ensure that the ADHD child is close to you (for example, center of front row). This allows you as an instructor to closely monitor their behavior and give verbal and non-verbal cues as needed. Verbal cues could be a “clearing of the throat” made by the instructor. This is more preferable than always calling out the person’s name because this may be embarrassing for them, especially if done frequently. Non-verbal cues could be a touch on the shoulder. When I was a kid in school my teachers either threw something at me (sometimes a piece of chalk or a book) or quietly sneaked up on me and kicked my desk and sent the books on my desk flying. This was scary and very embarrassing and not the smartest way for a teacher to establish rapport with a struggling student.
6. Remember to “punish in private” and “praise in public”. By this I mean that if you have to talk to the child regarding their inappropriate behavior and give them instructions on how to change their behavior, it is better to do this in private. If you have something nice or positive to say about a student then say it to the entire group. This kind of strategy works well for all students but works especially well with ADHD kids, who seldom receive positive comments while participating in group activities, including the many hours each day that they spend in school classroom.
7. Use the PCP strategy (Praise/Correct/Praise). As a Taekwon-Do instructor you are continually trying to teach new skills to your students. ADHD children (due to their low self-esteem and lack of self-confidence) are very sensitive to criticism and what you think is just “constructive criticism” can be interpreted as an attack against their already fragile self-esteem. Your comments will likely make them feel anxious and uncomfortable and they may react in a way that you think is disrespectful, such as rolling their eyes or looking at you as if to say, “Who the hell do you think you are?” For the majority of children and adolescents their greatest fear is the “fear of embarrassment”, and for children with ADHD, who already have poor self-esteem, this fear is even greater. As Taekwon-Do instructors we need to be “mindful” of this when teaching ADHD children. To decrease the possibility that you will embarrass the child you should first praise their technique. For example, “Johnny, you have a good side kick but you can make it better by pivoting on your supporting foot and getting your entire body behind your kick.” You can then help them correct the error and then say, “Great job, Johnny, excellent side kick”. You initially praised the technique, then offered some help with how to improve the technique, and then praised them again for their efforts. If you use this strategy you will be a great teacher and students will respect you, not because you demand it from them, but because you have earned it. You have a good heart (character) and this, even more than your technical skill, will be your greatest asset.
8. Assistant instructors are very helpful at increasing the ADHD child’s chances of success in your Taekwon-Do program. They will provide an opportunity for you to teach your class with less disruption. If the ADHD child is having a particularly difficult day the Assistant Instructor can take the child to the back of the room and do some one on one instruction. Without the Assistant Instructor the Chief Instructor will feel the stress of having a difficult to manage ADHD child in their class. As a result of this stress the Chief Instructor will find it hard to stay calm and this will increase the chance that they will lose control of their emotions and possibly say or do something inappropriate and embarrass the ADHD child in front of their peers.
9. Be willing and able to say “I ‘m sorry” or “I apologize”. We all make mistakes. It is the human condition. However, in society as a whole we fail miserably at this simple, but powerful communication skill. For example, at the end of class you could say, “Johnny, I ‘am sorry that I got so angry at you in front of the group when you were not paying attention, I realize that you have difficulty paying attention for long periods of time and I should have been more understanding. I apologize.” Remember, you may be the only person in this child’s life that actually “apologized” for getting upset with them. They will remember your apology and you will have a much better chance at maintaining a healthy student/instructor relationship with the child.
10. Educate yourself about ADHD and what it is, and isn’t. You have already made the first step by reading this article. I would also recommend that you visit the following web site on ADHD to further enhance your knowledge: www.chadd.org
Benefits of Taekwon-Do training for ADHD Children:
1. Improved attention span and focusing: Due to the class structure, class rules, and the fact that the instructor is a “Black Belt” or “Marital Arts Master”, that the student often admires and looks up to, creates an “environment of learning” for the ADHD child. As a result of the child’s interest in learning a Martial Art and his respect for the instructor, the child with ADHD can excel in this environment. If the child can focus better in Taekwon-Do class and receive positive feedback from their instructor on their progress and their improved ability to focus and pay attention, this can often “generalize” to other environments, including home, school and the community. It is also important to note that the “crossings” used in Taekwon-Do (i.e., the correct “methods” for the various block and strikes) can have a positive impact on the “integration” of both the left and right hemispheres of the brain (i.e., they learn to communicate with each more effectively and efficiently), and this integration has been proven to have a positive impact on attention and focusing. Occupational Therapists trained in “Brain Gym” and “Educational Kinesiology” understand this concept and often recommend Taekwon-Do training for ADHD children in an attempt to improve their attention and learning.
2. Decrease in hyperactivity and impulsivity: The ADHD child who has a lot of energy and acts as if “driven by a motor”, can benefit greatly from the practice of Taekwon-Do. The anaerobic and aerobic exercises can help “burn off” their excess energy and the stretching exercises can help relax the body. Many ADHD children who are hyperactive and impulsive tend to be in a constant state of “fight/flight” mode and they tend to have extremely tight hamstrings. The stretching routines that are often used in the “warm-up” portion of the class, especially those that focus on stretching the hamstrings, can be very beneficial for the ADHD child. The “meditation” component of Taekwon-Do training is also very beneficial for ADHD children because it trains them to relax their mind and body and instills a sense of “self-control”.
3. Improved Self-Esteem and Self-Confidence: Children with ADHD often have difficulty finding success in the traditional classroom setting. Their inattention and distractibility interferes with learning and work completion and their hyperactivity and impulsivity interferes with their ability to sit still and stay on task, and interferes with social interactions. Therefore, they tend to find school very stressful and void of positive feedback. Teachers and parents are often angry and frustrated with their behavior and they tend to receive a great deal of negative feedback. This lack of positive feedback and positive interactions with adults and peers often results in lowered self-esteem and self-confidence and there is a tendency for the child to avoid school work and a desire to avoid going to school. Many ADHD children complain of headaches and stomach aches to avoid going to school. They are often investigated for various illnesses and diseases and all tests show up negative. A Taekwon-Do school and a positive instructor/ student relationship can have a profound positive impact on the student’s self-esteem and self-confidence. This can then generalize into other environments including home, school and the community. Our grading system (yellow strip, yellow belt, green stripe, etc…) provides a graduated step-by-step system of learning that starts with basic skills and gradually and systematically adds more complex skills. This system of teaching, and the sense of accomplishment as a result of achieving a higher rank, can result in a significant increase in self-esteem, and self-confidence, which can then generalize into all aspects of the child’s life. In addition, the ADHD child learns practical self-defense skills, learns how to maximize their power in their punching and kicking by implementing the “9 Training Secrets” and the “Theory of Power”, and they also get to experience their creation of power through board breaking. All these aspects of Taekwon-Do training can have a positive influence on self-esteem and self-confidence and lead to a feeling of self-efficacy (i.e., they have the power to produce results, not just in Taekwon-Do, but in their lives).
4. Improved Social Skills: Many children with ADHD have difficulty establishing and maintaining friendships. Their inattention and distractibility can impede social interactions because they struggle with focusing on conversation (unless it is interesting to them) and the person they are communicating with may feel like they are not interested in what they have to say, and therefore cease and desist further social interactions with the ADHD child. The ADHD child who has significant symptoms of hyperactivity and impulsivity will often say or do inappropriate things that frustrates and angers the potential friend. Their hyperactivity, although possibly entertaining and amusing in the initial stages of the relationship, can be quiet overwhelming for the non-ADHD child who will tend to seek friendships with other children who are less hyperactive. Since the ADHD child has no “filter” (i.e., they have difficulty thinking about the consequences of their actions before they say or do something) they tend to get themselves into trouble with parents, teachers and peers. Taekwon-Do training and it’s emphasis on “self-control”, proper etiquette and protocol, class structure, and rules of the school, all help to reinforce appropriate social interactions. The child also learns that in order to gain respect they must first show respect. This is done very effectively in Taekwon-Do because of the system of rank and hierarchy, and the respect that juniors show for their seniors. The use of the “bow” to show respect for your instructor, and words such as “Thank you sir/mam”, and calling each other by their sir name (for example, “Mr. Smith” rather than “Ronald”), all act to increase positive social interactions and respect for everyone regardless of age, gender, religion, or social status. In this environment, a child with ADHD can learn to accept and respect themselves and others and thereby improve their social skills in the dojang, at school, and in the community. Through drill practice (especially pad work) the ADHD child also learns about turn-taking and patience and learns to deal effectively with the frustration of waiting their turn. Again, this can generalize to all environments.
5. Improved Academic Performance: I have known many children with ADHD who have shown significant improvements in their academics as a result of Taekwon-Do training. This is not surprising given the significant positive changes already stated above. A child with an improved attention span, decreased hyperactivity/impulsivity, improved self-esteem and better social interactions, is much more likely to do better behaviorally, emotionally, socially, and academically. The decrease in excess energy helps them to stay still for longer periods of time and stay focused on the task at hand; the improvement in attention span and decrease in distractibility helps them to focus on instruction and learn more effectively; the improvement in self-confidence and self-esteem helps them to attempt tasks that they would have normally avoided in the past and helps them to persevere even when the task is challenging; and the improved social skills improves their ability to make and keep friends and these friends can also become helpful with regards to peer support for any difficulties that the ADHD child encounters academically. A non-ADHD friend can often act as a “buddy” and provide cues for the ADHD child to stay on task, provide copies of class notes when needed, remind them of an upcoming test or an assignment that has to be passed in, etc…
In conclusion, a child with ADHD can benefit behaviorally, emotionally, socially, and academically as a result of Taekwon-Do training. The benefits can be maximized by having a competent Taekwon-Do instructor who understands the difficulties that an ADHD child encounters and is knowledgeable regarding strategies for teaching children with ADHD. If the Taekwon-Do instructor can establish rapport with the ADHD child and keep them interested in learning Taekwon-Do, they will become one of the child’s greatest allies, and significantly improve the child’s chances of success in life.
Scott Downey, M.Ed, R.Psych (#079)
Child and Adolescent Psychologist
7th Degree Black Belt (ITF Taekwon-Do)