The Effectiveness of the Get Ready to Learn Program in Improving Executive Functions in Children With Disabilities

SIGNIFICANCE: Myriad challenges can affect the learning ability of a child with a disability—that is, a child with a learning disability, emotional disturbances, speech impairment, or mild-to-moderate cognitive or developmental disability. These challenges become even more complex when children with multiple disabilities are grouped together within the same classroom. A child’s behavior greatly influences learning, and behavioral interventions (e.g., behavior modification) decrease inappropriate classroom behaviors. Special education professionals in the school setting use a variety of conventional strategies to help children with disabilities improve their academic performance and learn appropriate social behaviors, such as differentiated instruction and individualized education programs. Interventions that increase cognitive components—such as attention, working memory, flexibility, self-control, and self-regulation—also have a marked positive effect on both the academic development and behavioral outcomes of students with disabilities.

Within occupational therapy practice, these same cognitive components are an important area of concern. In an effort to support the academic success of students with disabilities, occupational therapists in the school setting use an assortment of interventional approaches to address attention, self-regulation, and learning. One approach used by occupational therapists focuses on movement-based activities, such as Brain Gym and sensory integration. Movement not only contributes to physical health, social development, cognitive performance, and motor and sensory development but also enhances overall learning. Numerous forms of current movement-based approaches incorporate yoga. This mind–body approach is used throughout American classrooms to enhance a student’s behavioral and academic functioning. For example, the New York City public school system currently uses Get Ready to Learn (GRTL), a standardized yoga-based program. GRTL is a daily classroom-based preparatory curriculum utilizing specific yoga principles of developmentally targeted breathing exercises, postures, and relaxation techniques to enhance the functional and academic performance of students with a variety of disabilities.

Occupational therapists are increasingly using yoga as a therapeutic medium. Although most available research studies illustrate its promising interventional effects, they have extensive limitations, including multiple practice patterns, lack of adequate description of the yoga interventions used in the study, small sample size, no testing for implementation fidelity, and lack of a comparison/control group. Furthermore, we have been unable to locate any studies that look at the effects of a manualized or standardized yoga-based program on executive functions of children with disabilities. In the current study, we help to fill this gap in the literature.

We examined the effects of a consistent and structured manualized yoga program (GRTL) on the executive functions—including working memory, inhibition, and attention—in a sample of children aged 5 to 12 yr with disabilities in regular, special, or inclusive education classrooms. On the basis of evidence that students with attention-deficit/hyperactivity disorder (ADHD), dyslexia, and autism spectrum disorder (ASD) have impaired executive functions and that exercise and mindfulness positively influence executive functions, we hypothesized that this yoga-based program may facilitate executive functions in children with disabilities. The results will not only encourage evidence-based practice in the field of occupational therapy but will also provide practicing occupational therapists with a proven therapeutic modality to address executive functions in children with disabilities.

INNOVATION: The number of students with disabilities who are served under the Individuals With Disabilities Education Act (IDEA), Part B, has increased dramatically, from 8.3% to 13.2% of total enrollment in public schools from 1976–1977 to 2008–2009, respectively. As reported by the National Center for Education Statistics (NCES), 38% of all those children and youths who receive special education services under IDEA have dyslexia or learning disabilities. Children with dyslexia, ASD, and ADHD commonly show deficits in executive functioning. It is crucial to promote healthy executive functions early in a child’s development to reduce the impact of executive function deficits on the adaptive behavior and academic performance of a child with a disability.

Mindfulness practices and yoga are recognized as approaches that can be incorporated into school curricula to address executive function deficits in children. However, there is a huge gap in the literature when it comes to studies completed to support or evaluate the effects of a yoga-based interventions on the executive functions—specifically, working memory and inhibition—for children with disabilities. With a call to move toward evidence-based practice as a basis for every type of intervention, a careful examination is necessary to establish the yoga-based GRTL program’s effectiveness as a modality to improve the executive functions of the pediatric population. By examining the effects of the GRTL program on a larger sample of children with a manualized program including groups randomly assigned to an intervention or waitlist condition, and by utilizing psychometrically valid outcome measures, this research contributes to evidence on the effectiveness of a yoga-based program on improving executive functions of students with disabilities.

From a theoretical point of view, there is a need to increase current understanding of yoga to explore its use as a therapeutic intervention for improving executive functions in children with disabilities. For the current study, we chose a theoretical framework that was considered most likely to inform the pathways of executive function improvement after participating in a yoga-based GRTL program. It seems reasonable that yoga works to improve functions by reducing stress and anxiety and by promoting relaxation. However, there is lack of empirical evidence to support this viewpoint. In this study, we not only examine the effect of a GRTL program on executive functions but we also explore the role of anxiety as a mediator.

RESEARCH HYPOTHESIS: Students participating in the GRTL program will show an increase in working memory, inhibition, and attention as compared to the control group, controlling for age and gender.

RATIONALE/BACKGROUND: Yoga positively influences and enhances students’ behavioral and academic functioning, such as attention, concentration or focusing ability, impulse control, strength, motor coordination, and social skills. Its gentle and slow movements help them not only to improve learning and memory but also to reduce their behavioral and emotional symptoms by increasing self-awareness and self-control. Yoga also provides multimodal learning for students with disabilities. For example, it is ideal for visual learners, including students with ASD, because the teachers positions him- or herself in the students’ visual field, using his or her body movements to sustain attention. On the basis of the research findings that yoga improves behaviors and learning in students of different ages and disabilities, it is important to explore the effectiveness of a yoga-based GRTL program as a therapeutic approach to improve executive functions in young children with disabilities through a well-controlled study.

This study will clarify whether the yoga-based GRTL intervention improves executive functions (working memory, inhibition, and attention) in students with disabilities, which significantly influence a child’s ability to learn effectively and function adaptively—a major concern within the occupational therapy practice. It is important to note that in this study we focused on children aged 5 to 12 yr, given that many areas of executive function identified as “potentially impaired” in a diagnosis such as ADHD develop and change rapidly within this age range. Unlike the majority of yoga studies that either include interventions with multiple practice patterns or lack an adequate description of the yoga interventions, in this study we incorporate a consistent, structured, and manualized yoga program that is administered every morning.

With a detailed description of the program used, it is easy to compare and replicate the study to validate results. Previous yoga studies involving children have had significantly weak study designs, including small sample size and lack of a comparison group. In the current study, we include a sample of 115 children with disabilities and a waitlist control group. Additionally, we examine the implementation fidelity of the GRTL program to ensure that the program is delivered as intended.

DESIGN: This is a pre–post experimental control study with a nested design in which we assessed the changes in working memory, inhibitory control, and attention at baseline before the start of the GRTL program and after the implementation of a 12-wk GRTL program. The students were nested within classrooms, and classrooms were nested within schools.