School of Occupational Therapy

Touro University Nevada

OCCT 643 Systematic Reviews in Occupational Therapy

Critically Appraised Topic Project

EVIDENCE TABLE
Name: Madeline Dunlap and Mallory Viveros
Date: 9/10/2015
Focus Question: In children (ages 8-19) with mental illnesses, does relaxation techniques, yoga, and Mindfulness-Based
Interventions help improve self-confidence and increase social communication?

Rationale for inclusion/exclusion criteria applied to determine which articles should be included in the evidence table: The
articles utilized met the P, I, and O of the focus question provided above. Published peer-reviewed journal articles were chosen, along
with published articles written in English within the last 10 years, and outcome based research of Level I and III. Exclusion criteria
included articles which did not address the specific focus question, were non-English, and Level IV, V reports, dissertations, and thesis
were excluded as well. The specific populations excluded from the table included participants that were over the age of 19 years old
and participants that did not have a mental health problem such as behavior, depression, anxiety, etc. Interventions included
mindfulness-based interventions, relaxation techniques, stress reduction interventions, physical exercise, and yoga. Exclusions of
interventions included studies that did not involve mind-body interventions.

Author/
Year

Study Objectives

Level/Design/
Subjects

Intervention and
Outcome Measures

Results

Study
Limitations

Implications for OT

Biegel,
Brown,
Shapiro, &
Schubert,

- Assess the
effects of
mindfulnessbased stress

- Level I
- Experimental
- 2 by 3 mixed
factorial design

- Post-test: 8 weeks
after end of study
- Follow up: 3
months following

- Before
analysis, results
were skewed for
medication and

- Sample was
largely female
-Wait-list control
group

The clinical and

community-based
practice of OT:
- Mindfulness-based

(2009).

reduction
(MBSR)
intervention
among
psychological
symptomatic
adolescents
- Hypothesis
was that MBSR
would positively
impact stress
related
symptoms such
as: depression,
anxiety, sleep
disturbances,
and low-selfesteem

- Group receiving
MBSR as an
adjunct to current
psychiatric
treatment, control
group/wait list for
MBSR and
receiving
treatment as usual
(TAU).
- N= 102 after 2
participants were
non-compliant with
study procedures.
- Age 14-18.
Experimental
group:
- 50, 3 dropped out
before start of
intervention, and 8
dropped out during
intervention
Control group:
- 52, 6 dropped out
during intervention
Demographics:
- 73% female, 45%
Caucasian, 28%
Latino, Asian 5.9%,
African-American
2.9%, and 1%
Native American.
- Average age:
15.35

the post-test
List measures used:
- Self-report
measures assessing
diagnostic change
in the number of
diagnoses rather
than severity.
- State-Trait Anxiety
Inventory- present
- State-Trait Anxiety
Inventory- past
- Perceived Stress
Scale
- Rosenberg SelfEsteem
Symptom Checklist90
Outcome areas:
- Cohens d used for
effect size
estimates for
clinical significance
of observable
change
8 weekly classes 2
hours/day
- Instructors: 2
masters degree
level instructors
trained in MBSR
- Participants
encouraged to bring
to treatment:
intention, attention,

hospital visits.
- Reliable
change index
found by
subtracting the
follow-up score
from the pretest score.
- There was a
p<0.05 when
RCI scores
exceeding 1.96
(improvement)
were subtracted
from -1.96
(worsening)

- Brief follow up
period
-Bias: MBSR
participants
may be more
prone to provide
positive
feedback
because they
were receiving
attention and
time in
treatment than
those in TAU
group.

interventions such as
mindfulness-based
stress reduction
(MBSR) is effective
for multiple mental
and physical health
disorders. MBSR has
been shown to
reduce symptoms of
depression, anxiety,
distress, and helped
increase self-esteem
and sleep quality.
Program
development:
- MBSR was
developed to help
the adult population
with mental and
physical disabilities.
Recent studies have
now started to use
MBSR with the
adolescent
population.
Mindfulness involves
sustained attention
to the present
moment.
Societal needs:
- Implementation of
MBSR in the schools
can help with
facilitate social
participation and self-

and attitude
Intervention:
- Formal and
informal
mindfulness
practice.
- Formal included:
body-scan, yoga,
sitting and walking
meditation. Informal
included: mindful
attention to daily
routine

esteem in
adolescents.
Additionally, OT
needs to be more
involved in MBSR so
prevention can take
place prior to
adulthood.
Health care delivery
and health policy:
- Due to the growing
number of
adolescents suffering
from mental
illnesses,
mindfulness based
interventions such as
MBSR can help
relieve some of the
symptoms associated
with the illness.
Education and
training of OT
students:
- MBSR requires
certification and
additional training to
be able to practice it
in therapy.
Refinement, revision,
and advancement of
factual knowledge or
theory:
- Future research
should include a

Ciesla, Reilly,
Dickson,
Emanuel, &
Updegraff.
(2012).

- Hypotheses
included: high
levels of
mindfulness
(nonjudment,
nonreactivity,
and acting with
awareness) will
buffer the
effects of life
stress on
changes in
dysphoric mood,
(b) high levels
of mindfulness
(nonjudment,
nonreactivity,
and acting with
awareness) will
buffer the
effects of life
stress on
changes in state
rumination, and
(c) increases in

- Level III
- Pre and post,
baseline and post
score after 7 days.
- Appropriate
design, compared
baseline to post
treatment
outcomes to
measure
effectiveness
- 101 participants
recruited
- 23 participants
dropped for not
completing at least
3 days of the study
- Final N=78
- 14-18 years old
high school
students
- Mean age 16.1
years old
Demographics:
- 61% female

- Outcomes were
assessed daily for 7
days after baseline
List measures used:
- FFMQ- Five Facet
Mindfulness
Questionnaire
- The Positive and
Negative Affect
Schedule; Sadness
Scale (PANAS-S)
- Daily stress
Outcome areas:
- FFMQ is a 39 item
questionnaire that
measure five
distinct facets of
train mindfulness
- PANAS-S consists
of five items (sad,
blue, downhearted,
unhappy, lonely) to
assess daily
dysphoric affect
- Daily stress asked

- Multilevel
modeling
analyses
revealed that
facets of
mindfulness
(i.e., nonreactivity and
nonjudgment)
were associated
with lower
levels of
dysphoric
mood.
- Mindfulness
interacted with
daily stress to
predict later
dysphoria; less
mindful
individuals were
particularly
vulnerable to
the negative
effects of stress

- Exclusive selfreport due to

possibility of
mono-method
bias
- Study focused
on prediction of
negative affect
over a 1-week
period
- Assessment of
daily stress
relied on a
single openended item
- Not ethnically
diverse
- Mono-method
bias due to use
of single
measure
- Participants
reimbursed up
to $15 for
participating

larger sample size on

the effects of MBSR
to be able to
generalize the
results. Overall,
results of MBSR
showed to be
effective and
decrease the
negative symptoms.
The clinical and
community-based
practice of OT:
- Mind-body
interventions can be
used in high schools
to help with attention
and awareness of
present to overall
help with mood,
health, and quality of
life.
Program
development:
- Using mind-body
interventions along
with teaching coping
strategies can help
suppress negative
thoughts, deal with
stressors, and bring
awareness to the
present.
Societal needs:
- Children need to be

daily state
rumination will
mediate the
interactive
effects of
mindfulness and
stress on
dysphoric affect

- 94% Caucasian,
2% biracial, & 4%
Native Americans

the participants to
report the number
of stressful life
events that
occurred that day
Intervention:
- Mindfulness-based
interventions are
being adapted to
younger and
younger populations
- Focus was to see if
mindfulness had
high effects on
psychological and
physical health
- Intervention was
given every day for
7 days based on
three measures:
daily stress,
dysphoric affect,
and state
rumination
- It was delivered
via internet where
there was a
computer at the
participants high
school if they
needed to access it
or through their
personal computer

- Results of the
three models
tested the
interaction
between stress
and nonreactivity,
nonjudgment,
and acting with
awareness
- Each model
accounted for
significant
variation in
dysphoric affect
- Effects of life
stress would be
moderated by
mindfulness
- Non
reactivity ( p < .
001)
- Nonjudgment (p = .
02)
- Acting with
awareness (p
= .12)
- Daily
rumination
predicted by
interaction of
stress with
- nonreactivity

more mindful of their

own thoughts,
feelings, and
behaviors to help
decrease ruminating
thoughts and stress,
and increase
attention, awareness,
and overall health
Health care delivery
and health policy:
- Children experience
high levels of stress
due to family
situations, demands
of school, and
friendships that can
impact their mood
and overall physical
health.
Education and
training of OT
students:
- Mindfulness
requires additional
certification to be
able to use in
therapy, which is
important for OT
students to know
after becoming a
registered OT.
Refinement, revision,
and advancement of
factual knowledge or

(p=0.4),
nonjudgment (p
< .001)
- awareness
( p < .001)
- At low levels of
non-reactivity,
stress was
strongly
associated with
increases in
state
rumination (p
<.001).
- At high levels
of nonreactivity, daily
stress remained
associated with
increases in
daily
rumination,
though this
effect was
diminished
(p<.01)
- At low levels of
nonjudgment,
stress was
strongly
predictive of
state
rumination
(p<.001), but at

theory:
- The results and
findings of mind-body
interventions
suggests that it is
beneficial to the
children. Most
research of
mindfulness has
been done in the
adult population
suggesting that
further research
needs to be done to
obtain more reliable
results

Khalsa,
HickeySchultz,
Cohen,
Steiner, &
Cope. (2012).

- The purpose of
the present
study was to
employ a
preliminary,
exploratory
evaluation to
identify which
psychological
constructs may
be useful to
evaluate the
psychological
benefits of an

- Level I
- Participants were
randomly assigned
by class to a
physical
education-class-asusual group (no
treatment control;
three classes) or to
a yoga group
(active treatment;
four classes).
- Adolescents in
7th grade from 11

- Research staff
administered a
battery of selfreport
questionnaires to all
classes in two
sittings prior to the
start of the yoga
program in midSeptember, 2008,
and shortly after the
end of the yoga
program in midDecember

high levels,
stress was only
marginally
associated with
dysphoric mood
(p=.08).
- At low levels of
awareness,
stress was
strongly
associated with
increases in
rumination
(p<.001),
- Effect on
stress for
individuals high
in awareness
was only a
marginal trend
(p=.06).
- The amount of
change in
resilience as
measured by
the RS was
significantly
different
between the
yoga and
control groups
(p=0.014).
- There was a
significant
difference in

- Duration of
intervention
was only one
semester long
and perhaps
insufficient to
yield more
significant
outcomes
- Yoga ed
sessions
overlapped with
physical
education

The clinical and

community-based
practice of OT:
- Yoga programs have
shown to be effective
on adolescents
mood, anxiety,
perceived stress,
resilience, etc. OTs
can use this in
treatment to help
facilitate
engagement in
various occupations.

in-curriculum
yoga program in
secondary
school
adolescents

and 12 classes in a
Massachusetts
rural secondary
school
- 90% white
student body
- 17% low-income
population
- No exclusion
criteria
Demographics:
- 121 students (51
females and 70
males) ages 15-19
years and
randomly assigned
74 students in 4
classes to the Yoga
Ed group (34
females and 40
males)
- 47 students in 3
classes to control
group (17 females
and 30 males)

List measures used:

- Self-Report of
Personality (SRP)
- The Profile of Mood
States short form
(POMS-SF)
- The Resilience
Scale (RS)
- The Perceived
Stress Scale (PSS)
- The Inventory of
Positive
Psychological
Attitudes- 32R
(IPPA)
Outcome areas:
- SRP provides
insight into
thoughts and
feelings.
- POMS-SF provides
a total mood
disturbance score
as well as subscale
score for six mood
states
- RS measures the
degree of individual
resilience the
moderates the
negative effects of
unmanaged stress
and enhances
individual
adaptation.

change
between the
groups for the
BASC-2
subscale of
Anger Control
(p= 0.028)
- The yoga
group
decreased from
48.6 (SD=7.9)
to 47.6
(SD=7.6),
(p=0.123),
whereas the
control group
increased from
49.2 (SD=7.2)
to 50.9
(SD=8.1),
(p=0.132)
- A statistically
significant
between-group
difference over
time was
observed in the
Fatigue/Inertia
subscale of the
POMS-SF
(p=0.022); the
yoga group
showed a strong
decrease in
fatigue from 9.1

classes which
could both have
psychological
and physical
benefits
- Small number
of total classes
limited
comprehensive
investigation of
a number of
potentially
important
within-class
factors

Program
development:
- The Yoga Ed
program was
developed to help
students control their
mood, anxiety, and
stress.
Societal needs:
- Yoga Ed program
needs to be
implemented in all
schools to help
children with and
without mental
illnesses alleviate the
negative symptoms
often brought on by
school.
Health care delivery
and health policy:
- Due to the increase
number of students
with anxiety and
stress in school, Yoga
Ed program should
be utilized to help
students with mental
illnesses.
Education and
training of OT
students:
- Although extensive
training and
certification is not

- PSS measures
perception of stress.
- IPPA measures
self-confidence
during stress and
life purpose and
satisfaction
Intervention:
- Attendance of two
to three yoga
sessions per week
during the 11-week
program during
which either 23, 25,
31, or 32 sessions
were held
(depending upon
the class).
- Yoga sessions were
30 min (three
classes) or 40 min
(one class) were
held either 2 times
(2 classes) or 3
times (2 classes)
per week
- Secular yoga
program includes
simple yoga
postures, breathing
exercises,
visualization, and
games with an
emphasis on fun
and relaxation and

(SD=4.5) to 7.7
(SD=3.9),
(p=0.009),
whereas the
control group
showed a
statistically
insignificant
increase from
7.7 (SD=4.5) to
8.5 (SD=5.0),
(p=0.344)
- Yoga session
attendance data
for students in
the yoga
intervention
group showed
significant
positive
correlations
with the change
in IPPA total
score (r=0.25,
p=0.041) and
the change in
IPPA Life
Purpose and
Satisfaction
subscale score
(r=0.26,
p=0.035).
- Three
constructs were
identified with

required to
implement yoga in
treatment, a good
understanding of the
positions and
associations of yoga
should be familiar
prior to using it.
Refinement, revision,
and advancement of
factual knowledge or
theory:
- Yoga Ed program
showed statistically
significant results in
the reduction of
anxiety, stress, and
negative moods.

Lee, Semple,
Rosa, &
Miller. (2008).

- The purpose of
this study was
to evaluate the
feasibility,
acceptability,
and helpfulness
of MindfulnessBased Cognitive

- Level III
- Open trial design
conducted into two
phases.
- 25 children
- Participants were
matched according
to age and gender,

minimizing risk
without unduly
complex or
physically athletic
or demanding
techniques.
- Yoga instructors
underwent a formal
Yoga Ed training
course along with
having to undergo a
200 hour yoga
teacher training
program
- Typical 30-min
Yoga Ed sessions
were structured to
include a 5-min
initial relaxation or
time in, a 5-min
warm-up, 15 min of
yoga poses, and a
5-min closing
relaxation (times
were extended for
the 40-min
sessions).
- Pretest measures
for all participants
taken immediately
before participation
in the MBCT-C
program
- Posttest measures
taken immediately

statistically
significant
improvements
among yoga
participants
versus controls:
Anger (BASC-2
Anger Control
subscale),
resilience (RS),
and
Fatigue/Inertia
(POMS-SF)

- Cohens d to
determine
effect size
(small, medium,
large)
- Small effect:
low (.25 for
Intent-to-

- Treatment
contamination
- Financially
compensated
for participation
in study
- Absence of
another group

The clinical and

community-based
practice of OT:
- Mindfulness-based
cognitive therapy
(MBCT) is used in
practice to train
children with

Therapy for
Children (MBCTC) for the
treatment of
internalizing
and
externalizing
symptoms in a
sample of nonreferred
children.

then randomly
assigned to one of
the two groups.
- Children were
selected as an
ecological sample
representative of
children from inner
city with academic
problems.
- No power
analysis conducted
Demographics:
- Ages 9-12 (9-10
morning group, 1112 afternoon
group)
- Hispanic, African
American, and
Caucasian
- 15 females, 10
males
- Low-income
minority children

after participation
were compiled for
all participants
- One-tailed
dependent sample t
tests were
conducted to test
for differences
between pre and
posttest on
outcome variables
using an alpha level
of .10
List measures used:
- Child Behavior
Checklist: Parent
Report Form (CBCL)
- Multidimensional
Anxiety Scale for
Children (MASC)
- State-Trait Anxiety
Inventory for
Children (STAIC)
- Reynolds Child
Depression Scale
(RCDS)
Outcome areas:
- CBCL= There is an
externalizing
problem scale, an
internalizing
problem scale and a
total problem scale.
A checklist for
parents to identify

Treat, .19 for

Completers)
- Medium effect:
moderate (.78
for Intent-toTreat, .62
Completers)
- Large effect:
high (.98 for
Intent-to-Treat, .
93 Completers)
- CBCL
assessment
results:
Significant
reduction of
externalizing
problems
among the
Completers p= .
07, no
significant
reduction of
anxiety among
Completers
p=.14,
depression
p=.35 for
completers / no
significance
- No significant
difference in
results among
the immediate
arm and

intervention
comparison that
could assess the
nonspecific
factors of MBCTC
- Small sample
size
- Lack of power
to detect effects
through a
between-group
analysis

depression how to be
mindful of their own
thoughts, feelings,
and body sensations
in the present
moment
Program
development:
- MBCT can be used
in various settings
among various
populations with
different diagnoses
to help alleviate
stress, ruminating
thoughts, and
depression having an
overall impact on
health and well-being
Societal needs:
- Understanding the
benefits of MBCT can
help decrease the
prevalence of mental
illnesses in children
and exposure to the
benefits of MBCT
Health care delivery
and health policy:
- Depression moods
and negative
thoughts are
common in children
and should be
addressed early to

problem behaviors
representative of
internalizing and
externalizing
problems
- MASC= self-report
4 point Likert scale
measuring a variety
of anxiety
dimensions
- STAIC= self-report
measuring 2
constructs related
to anxiety (state
anxiety- how they
feel at a particular
moment and trait
anxiety- how they
feel generally)
- RCDS= self-report
screening for
depressed mood
Intervention:
- 12 week program,
90 minute sessions
- 2 arm test: the
second round was
delayed, but did not
benefit from the
intervention that
was first delivered
to participants in
the immediate arm
study.
- Brief sitting

delayed arm.

prevent the overlap

into adulthood. The
results of the study
suggest the need for
MBCT programs to be
implemented early in
a childs life.
Education and
training of OT
students:
- Although MBCT
cant be used in
treatment without
the certification,
aspects of the
program can be used
in interventions. OT
students must be
educated on the
options for MBCT
training and the
different techniques
that can be learned
within the program.
Refinement, revision,
and advancement of
factual knowledge or
theory:
- Further research
needs to be done on
MBCT and children to
assume more reliable
results with the
effects of the
program.

Powell,
Gilchrist, &
Staple.
(2008).

- The aim of the

study was to
evaluate the
Self-Discovery
Programme(SDP
) in terms of

- Level II
- The study was a
controlled trial;
children were
allocated to either
an Intervention or

meditation, review
of the previous
week, group
discussion of
homework
exercises, and
multisensory
experiences
- Goal was to help
children become
more aware of their
thoughts, feelings,
and body sensations
as separate but
interrelated
phenomena that
interact to influence
their perceptions of
day-to-day
experiences
- 7 research
assistants delivered
intervention and
was blinded of the
participants
- Community clinic
in Harlem and
Washington Heights
in New York City
- Data was collected
via two sources: 1.
Behavioral profiles
of children
completed by
teachers prior to the

Additionally, testing
MBCT on populations
that have not been
tested would be
beneficial.

- A greater
percentage of
children in the
Intervention
group exhibited
self-talk,

- Children in
intervention
were older than
children in
control group by
approx. 7

The clinical and

community-based
practice of OT:
- Early intervention is
key to preventing
mental illnesses and

changes in
childrens selfesteem, social
competencies
and behavior
compared with
a control group

Control group
according to their
age and class
- Pre and post
intervention
- Power analysis of
80% to determine
medium effect size
- 126 children with
special educational
needs, emotional,
behavioral, or
learning difficulties
and those on edge
of being excluded
were invited to
participate in the
study
- 107 total children
ages 8-11 years
completed the SDP
and all measures
Demographics:
- Intervention
group- n =53
divided into seven
groups of 8
children and one
group of 7 children
- 93% were white
European, 57% or
30 were boys and
23 girls and two
children were
reported to be on

program 2. A
standard instrument
to measure
behavior completed
by teachers prior to
program and at
follow-up 7 months
later
- Age was
significantly
different between
the Intervention and
Control groups (P
<0.001) and was
therefore entered as
a covariate in all
subsequent
analyses.
- Baseline
established then a 7
month follow up
- Baseline mean
SDQ and child
behavior profile
scores were
compared using ttests for the
Intervention and
Control groups
- Change scores of
baseline and the
seven month followup were compared
between the
Intervention and

enhanced
listening skills,
increased
attention span,
use of positive
touch, breathing
techniques and
less fidgeting in
class and were
more relaxed.
- No differences
between groups
emerged in
numbers of
children
happier in
themselves.
- On completion
of the SDP the
numbers of
children using
massage
techniques
during
school/class
differed
significantly
different
between the
Intervention and
Control groups
(P<0.001), with
greater
numbers
observed in the

months on
average
- No control for
other variables
that may
facilitate
change in
children in both
groups due to
external
agencies

behavior problems.
Self-discovery
Program (SDP) can
be implemented in
practice to help
children with
behavioral and
emotional difficulties
by helping them
discover their self
and enhance
emotional well-being
through skills such as
yoga, breathing,
massage, and
relaxation.
Program
development:
- SDP helps children
identify their self to
help increase selfefficacy and provide
techniques to
increase confidence
and self-regulate
their emotions.
Societal needs:
- By implementing
SDP, it can improve
eye contact, selfcontrol, being calmer
in class, and use of
relaxation techniques
during stressful
situations in school,

medication. 28%
or 15 were
reported to be a
receipt of support
internally or from
an external agency
during school
hours
- Control group- n
= 54 (96% white
European, 54% or
29 were boys and
25 were girls and
one child reported
to be on
medication, 24%
or 13 children
were reported to
be a receipt of
support internally
or from an external
agency during
school hours)

Control groups
using univariate
analysis of
covariance, with
age as a covariate
- SDP responses
were compared
using Fishers exact
test.
List measures used:
- Behavioral profiles
- Strengths and
Difficulties
Questionnaire (SDQ)
Outcome areas:
- Behavioral profiles
include information
such as self and
social confidence,
communication, and
interaction abilities,
ability to control
themselves with
school/classroom,
and attention span
- SDQ is a
questionnaire that
looks at 4 subscales
(emotional
symptoms, conduct
problems,
hyperactivity, and
peer relationship
problems)
Intervention:

Intervention
group, as would
be expected
- Compared with
the Control
group, a
statistically
significant
improvement in
total difficulty
score was
observed in the
Intervention
group
(P=0.031), with
a medium effect
size of 0.41.
- Compared with
the Control
group, the
Intervention
group had
significant
improvements
in mean scores
on selfconfidence
(P=0.029),
social
confidence with
teachers
(P=0.042),
communication
with peers
(P=0.050),

which will overall

help childrens selfesteem, social
competencies, and
behavior.
Health care delivery
and health policy:
- There is an increase
in children that are
suffering from mental
illnesses and SDP can
alleviate some of the
symptoms to help
increase quality of
life.
Education and
training of OT
students:
- When working with
children experiencing
behavior problems,
SDP can be beneficial
and should be
utilized in treatment
to help alleviate
these problems. SDP
training is 6 months
long. OT students
must be familiar with
yoga, relaxation, and
massage techniques
to teach children the
techniques in order
for the program to be
effective.

Rosenblatt,
Gorantla,
Torres,
Yarmush,
Rao, Park,
Denninger,
Benson,
Fricchione,
Bernstein, &
Levine.
(2011).

- The purpose of
the study was to
develop and
objectively
assess the
therapeutic
effect of a novel
movementbased
complementary
and alternative
medicine

- Level III
- A within subject
analysis
comparing pre and
post test scores on
two standard
measures of
childhood behavior
problems.
- The
demographics of
all 23 participants

- SDP was delivered

in a room that was
made available by
each school
- Three holistic
therapists were
recruited as tutors
to deliver SDP
- SDP consisted of
12 sessions
delivered weekly
lasting approx. 45
minutes.
- Focus was to
facilitate childrens
self-discovery
(senses, feelings,
and psychological
and physical wellbeing)

communication
with teachers
(P< 0.001) and
contributions in
the classroom
(P < 0.001)

- Pre and post

questionnaire
provided to parents
- Pre-test of BASC-2
given to
participants to
assess selection
bias.
- Post-test of
measurable
outcomes
List measures used:

- Latency aged
children
improved on
Irritability scale
p=.06
- BASC-2 & ABC
Irritability,
atypicality
p=.024
- Behavioral
Symptom Index
(BSI pretest

- Small sample
size
- Predominately
male
participants
- Measures are
all self-reported
data rather than
clinical
observation

Refinement, revision,
and advancement of
factual knowledge or
theory:
- SDP made small
changes among
children within the
study and this can
support the notion of
early intervention
and how addressing
these problems early,
can prevent them
from rolling over into
adulthood.
Additionally, further
research with a
longer length and
randomization of
participants needs to
be obtained to
measure greater
change.
The clinical and
community-based
practice of OT:
- The study proved
that yoga and
relaxation responses
helped children with
ASD improve their
behavioral problems.
This is important to
note, as OTs can
utilize these

approach for
children with
autismspectrum
disorder (ASD).

were not
mentioned.
- The median age
was 8.9 years old
and ranged from 3
to 18. 22 years
old; only 2/23
participants are
girls.
- This appears to
be a limitation, but
there is a higher
prevalence rate of
ASD among boys.
- Sample
generated via two
methods of
recruitments: 1.
Children with ASD
referred to
outpatient practice
and 2. Response to
a list serve to
parents with
children with ASD.
- 36 responses
from the referral,
but only 23 were
selected. 200
received list serve,
but only 24 replied
and only 10 were
selected.
- Original sample
size was 33, but

- Behavioral
Assessment System
for Children (BASC2), self-report
- Aberrant
Behavioral Checklist
(ABC)
- Combined BASC-2
& ABC Irritability
scale.
Outcome areas:
- BASC-2 measures
a range of
psychiatric function
in 3-21 year olds
including:
aggression, anxiety,
attention problems,
atypicality, conduct
problems,
depression, hyperactivity,
somatization, and
withdrawal
subscales.
ABC assesses
problem behaviors:
irritability, lethargy,
hyperactivity,
stereotypy, and
inappropriate
speech
determine
aggregate score
(adding the scores

mean 67.84 and

post-test 64.70,
with -3.17
decrease in
behavior
problems. This
is the most
significant
change among
all 3 BASC-2
measures.

techniques in
practice to help
facilitate
engagement from
the child diagnosed
with ASD and
decrease associated
behavioral problems.
Program
development:
- OTs can use the
relaxation response
(RR) program when
working with children
with ASD who are
experiencing
behavior problems.
With RR, OTs can
target the unique
sensory systems that
children with ASD
have to help
decrease anxiety,
depression,
withdrawal, attention
problems, etc.
Societal needs:
- The need for
regulating behavioral
problems in children
with ASD is very
important and needs
to be understood
within all professions
across the board. If

only 24 completed
the study.
- No power
analysis
mentioned,
therefore it is
assumed that the
sample size is not
justified.

of several matches),
specifically
irritability
Intervention:
- 8 treatment
session of 45
minutes each
- Taught by licensed
clinician
(psychologist) with
a certification in
yoga and dance
therapy.
- Format goal- to
create
predictability,
familiarity, and
reduce anxiety.
Sequence:
breathing
techniques for
relaxation response
for 10 minutes (RR),
yoga postures for
10min, music and
dance for 20
minutes, and typical
yoga practice for 5
minutes
- Yoga poses were
provided verbally
and supplemented
with visual
examples
- 2 groups were

relaxation response
and yoga can help
alleviate some of the
behavior symptoms,
this can overall help
the society as a
whole.
Health care delivery
and health policy:
- The prevalence of
ASD is high and
continues to rise,
thus health care
professionals should
be aware the
behavioral problems
that are associated
with this diagnosis.
Behavioral problems
are common issues,
which need to be
addressed not only
for the client, but
their caregivers,
siblings, peers, and
teachers as well.
Understanding what
works for these kids
and what does not
work is key.
Education and
training of OT
students:
- OT students should
be trained on what to

formed with mixed

age ranges, but
researchers avoided
placing toddlers
with older children

expect when working

with children who
have ASD and the
common symptoms
and problems they
present with.
Although there is no
specific training to
teach yoga and
relaxation
techniques, the OT
should be familiar
with the diagnosis
and population.
Refinement, revision,
and advancement of
factual knowledge or
theory:
- Due to rising
numbers of ASD
prevalence, future
research should
include a larger
sample size including
more female
participants. The
study showed that
relaxation techniques
yoga, and music
therapy had positive
effects on children
with behavioral
problems, thus more
research should
assess each

SchonertReichl,
Oberle,
Lawlor,
Abbott,
Thomson,
Oberlander,
& Diamond.
(2015).

- The aim of the

study is to
measure
cognitive
control, stress
reduction,
promotion of
well-being and
prosociality, and
production of
positive school
outcomes as a
result of adding
mindfulness to a
social and
emotional
learning
program(SELP).

- Level I
- Active control
group of fourth
and fifth graders
received a
business as usual
(BAU) social
responsibility
program was used
in comparison with
the intervention
group receiving
MindUP the social
emotional learning
program.
- Examined group
differences
measuring:
executive
functions,
hypothalamicpituitaryadrenocortical
regulation, socialemotional
regulation, and
end of year math
grades
- Recruited 100
fourth and fifth
graders
- One student
dropped out due to
moving out of the

- Pre and post tests

were administered
by research
assistants that were
blind to teacher and
student study
conditions
- Teachers
administering
MindUP completed a
daily survey to
measure dosage
and quality of the
intervention
- Participants
completed a selfreport and peer
evaluation one time
during a 45 minute
class session.
- Saliva was
collected pre and
post intervention
three times in one
day at 9:00am,
11:30am, and
2:30pm
List measures used:
- Flanker taskcomputer based
- Hearts and flowers
tasks- computer
based
HPA axis activity

- No significant
difference in
baseline scores
for executive
functions
between groups
- MindUP
participants had
significantly
higher cortisol
secretion at
morning arrival
than the BAU
group.
- Significant
main effect for
MindUP group
p= .04
MindUP p=.04
for peer
nominated
prosocial
behavior
- Math scores
were higher in
MindUP group
p=.07

- Clustering
children within
the classroom,
which leads to
contamination.
- Empathy
subscale scores
at baseline were
significantly
different at
baseline.
- No follow-up
after the
completion of
the program.

technique separately.
The clinical and
community-based
practice of OT:
- OTs working in
school settings can
collaborate with
educators to
implement SELP to
improve academic
performance of
students with stress
and decreased
cognitive control
Program
development:
- OTs in school
settings can work
with an
interdisciplinary team
to promote MindUP
or other SELPs within
the school
Societal needs:
- SELPs can help
improve academic
performance in low
socioeconomic status
schools because
students in this
population may not
otherwise be
exposed to
mindfulness based
SELPs, which help

area
- Age range 9.011.16 years old
- 66% reported
English as their
first language
- 84% lived in a
two-parent home
- Mind UP n=48
- BAU n= 51

- Child self-report
measures
- Interpersonal
Reactivity Index
- Resilience
Inventory
- Marshs SelfDescriptive
Questionnaire
- Seattle Personality
Questionnaire for
Children
- Mindfulness
Attention Awareness
Questionnaire
- Social Goals
Questionnaire
- Peer report
Outcome areas:
- Flanker taskcomputer based:
measures executive
functional skills:
remembering the
rule for the task,
regulating attention,
inhibiting distraction
from the flanker
fish.
Hearts and flowers
tasks-computer
based: measures
working memory,
response inhibition,
and cognitive

decrease stress
Health care delivery
and health policy:
- Mental health
symptoms of stress
and decreased
cognitive control
greatly affect a
childs ability to
concentrate in
school, therefore it is
important to
decrease these
symptoms especially
due to the rise in
stress among
children
Education and
training of OT
students:
- OT students should
be trained in
identifying stress
among children as it
may not be the rehab
diagnosis, but may
be greatly impacted
the childs
occupational and
academic
performance
Refinement, revision,
and advancement of
factual knowledge or
theory:

flexibility
- HPA axis activity:
measures cortisol in
saliva 3 times in
one day
- Child self-report
measures
- Interpersonal
Reactivity Index:
measures childs
empathy and
perspective taking
- Resilience
Inventory: optimism
and emotional
control
- Marshs SelfDescriptive
Questionnaire:
School self-concept
- Seattle Personality
Questionnaire for
Children:
Depressive
symptoms
- Mindfulness
Attention Awareness
Questionnaire
- Mindfulness
Social Goal
Questionnaire:
Social responsibility
- Peer report:
measured childrens
level of acceptance

- To fully understand
the impact of SELPs
in schools future
research should be
conducted with a
multidisciplinary
approach to better
identify the effects of
the intervention

by peers.
Intervention:
- MindUP is a 12
session mindfulness
based SEL program
that consists of 4050 minute lessons.
- Purpose is to focus
on ones breathing
and attention to a
single resonant
sound.
- Curriculum
included lessons to
promote executive
functions: mindful
smelling and
tasting, socialemotional
understanding
(using literature to
promote empathy),
and positive mood
(learning optimism).
- Social
responsibility
programrepresented by the
BAU condition and
guided by British
Columbias Ministry
of Education
because social
responsibility is
identified as an

Semple, Lee,
Rosa, &
Miller. (2009).

- To test if
children would
show greater
reduction in
attention
problems,
anxiety
symptoms, and
behavioral
problems as a
result of
mindfulness
based cognitive
therapy for
children (MBCTC)

- Level I
- First matched by
age and gender
then randomly
assigned to one of
the four
independent
groups
- A power analysis
was conducted to
determine the
number of
participants
needed to
reasonably detect
significant mean
group differences
- The design was
appropriate
comparing
treatment groups
with control groups
and the control

educational
standard for
students in British
Columbia.
- Assessed
classroom
communication,
peacefully solving
problems, valuing
diversity, and
practicing
democratic rights.
- Pre-test, post-test
and a 3 month
follow-up to see if
the improvements
were maintained
List measures used:
- Child Behavior
Checklist: Parent
Report Form (CBCL)
- Multidimensional
Anxiety Scale for
Children (MASC)
- State-Trait Anxiety
Inventory for
Children (STAIC)
Outcome areas:
- CBCL: is looking at
emotional and
behavioral problems
- MASC: is a selfreport about anxiety
related thoughts,
feelings, and

- Using a linear
regression
analysis the
result was
statistically
significant p < .
001 indicating
that pre-test
behavioral
problems were
predictive of
posttest
behavioral
problems
- Looking at
attention
change, the
pretest
predicted
attention
change with p <
.001 indicating
that pretest

- The potential
of one member
of the group
having either a
positive or
negative effect
on another
member of the
group
- Participants
werent
prescreened for
anxiety
disorders
- Financial
compensation
- Travel
reimbursement

The clinical and

community-based
practice of OT:
- MBCT-C should be
used by OTs working
with children with
mental illnesses to
help reduce attention
problems, anxiety
symptoms, and
behavior problems.
Program
development:
- OTs can be trained
in MBCT-C and utilize
this intervention in
therapy to help
children with mental
illnesses be more
mindful of their
behaviors and
increase emotional
regulation when

groups are wait

listed for
treatment
- Within one
phase, termed
winter, there were
two groups as well
as for phase 2, the
spring group, there
were also two
groups.
- Additionally, they
also explored the
study as an open
trial by examining
data from all four
groups crosslagged
- 39 participants
were invited
- 29 enrolled in the
study
- N= 25
participants began
the program
- 20 participants
completed the
study
Demographics:
- 15 girls ages 9-13
and - 10 boys ages
9-13
- Study included:
African American,
Caucasian, and

actions. Factor
scores include
Physical Symptoms,
Social Anxiety,
Harm Avoidance,
and Separation
Anxiety
- STAIC: self-report
questionnaire to
assess state and
trait anxiety in
children in grades 46.
Intervention:
- The focus of MBCTC for children with
attention, anxiety,
and behavioral
problems involved
simple sensory
exercises to
increase nonjudgmental
awareness, and
group interactions
through games and
movement
- Train graduate
research assistants
administered and
scored the
assessment
- 12 week program
for 90 minutes a
week with brief

behavior
problems were
predictive of
attention
change
- Using a
multiple
regression
analysis with
attention as the
mediator
variable,
researchers
wanted to see if
the effective
pre-test
(independent
variable) would
reduce at
predicting posttest outcomes
when using
attention as
mediator. It was
not statistically
significant, p= .
053. - Meaning,
attention was a
good predictor

engaged in social
interaction
Societal needs:
- MBCT-C would be
beneficial to
implement in inner
city schools where
children with and
without mental
illnesses may not be
afforded the
opportunity to
receive mindfulnessbased and
cognitively oriented
intervention to help
regulate emotions,
behavior problems,
and attention
deficits.
Health care delivery
and health policy:
- Results from this
study can be shared
with school boards
and policy makers to
ensure children with
mental illnesses are
being treated within
schools to help
alleviate symptoms
associated with
mental health issues.
Education and
training of OT

Tells, Singh,
Bhardwaj,
Kumar, &
Balkrishna.
(2013).

- The effects of
yoga or physical
exercise on
physical fitness,
cognitive
performance,
self-esteem, and
teacher-rated

Latino
English speaking
- Same size was
representative of
inner-city children
struggling with
academics
- Groups A and C
consisted of
children who were
9 or 10 years old.
- Groups B and D
consisted of
children who were
1113 years old.
- There were six or
seven children in
each of the four
groups.

homework
- Took place at a
reading tutoring
program at the
University of
Southern California

- Level I
- Parallel group
design with
allocation ratio of
1:1
- 98 participants
were randomized
- Each participant

- The participants
were recruited in
August, 2010, and
post data
assessment was
completed in
December, 2010.
List measures used:

- There was one

significant
difference
between
groups. This
was in social
self-esteem
which was

- Study included
two
independent
groups
- Participants
were
geographically
localized to the

students:
- MBCT-C requires
training and
certification to utilize
the techniques in
practice. OT students
should be familiar
with what techniques
can be used in
practice and the
training required to
implement the
program.
Refinement, revision,
and advancement of
factual knowledge or
theory:
- Further research
needs to be done on
the effects of MBCT-C
on children in a
variety of settings, at
different ages, and a
larger population to
be able to generalize
the results of the
program.
The clinical and
community-based
practice of OT:
- In school aged
children, this study
looked at yoga and
physical exercise and
how it has an effect

behavior and
performance, in
school children

was given a serial

number from 1-98
- A computer
program was used
to generate 98
random numbers
- The random
numbers were
written on
identical slips of
paper and folded
identically
- A person who had
nothing to do with
the trial place the
sheets alternately
between two
boxes, labeled A
and other was B
A allocated to yoga
B allocated to
physical exercise
Demographics:
- 98 school
children between
8-13 years were
randomized as
yoga and physical
exercise groups
(49 in each)
- Yoga: 15 girls and
34 boys
- Physical exercise:
23 girls and 26
boys

- Eurofit physical
fitness test battery
- Stroop color-word
naming task
- Indian adaptation
of Battles selfesteem
- Analog scales
Outcome areas:
- Eurofit physical
fitness test battery:
measures trunk
strength, hand grip,
standing jump,
height, balance, etc.
- Stroop color-word
naming task:
measures cognitive
function, volitional
control over
neuropsychological
functions, word and
color naming
responses.
- Indian adaptation
of Battles selfesteem
questionnaire:
measures general,
social, academic,
and parental selfesteem
- Analog scales:
teacher ratings
assessed childs

higher after
physical
exercise
compared to
yoga (p < 0.05)
- Both groups
showed an
increase in BMI,
and number of
sit-ups (p <
0.001)
- Balance
worsened in the
physical
exercise group,
while plate
tapping
improved in the
yoga group (p <
0.001)
- In the Stroop
task both
groups showed
improved color,
word- and colorword naming (p
< 0.01), while
the physical
exercise group
showed higher
interference
scores
- Total, general
and parental
self-esteem

north of India

on physical fitness,
cognitive
performance, selfesteem, etc. OTs can
utilize these
techniques and
findings to help
facilitate
engagement in
activities.
Program
development:
- The yoga and
physical exercise
program was
developed to
promote healthy
behaviors and
cognitive and
psychosocial
wellbeing, and should
be used as an
adjunct to addressing
the self-confidence
and social interaction
needs of children
with mental illnesses.
Societal needs:
- Implementing these
two programs in
schools can have
positive effects on
depression, anxiety,
mood, self-esteem,
and even higher

- Both groups were

blind

obedience,
academic
performance,
attention,
punctuality,
behavior with
friends, and
behavior with
teachers
Intervention:
- 45 min each day, 5
days a week for 3
months
- Yoga focused on
breathing
techniques,
loosening exercises,
and physical
postures
- Physical exercise
group involved
jogging in place,
rapid bending
forward and
backward, bending
sideways, spinal
twisting, and relay
races or games
- The instructors
were trained who
had completed 17
years of education
and were not school
teachers

improved in the
yoga group (p <
0.05)

academic
performance, which
can relieve academic
pressure from
educators and
students
Health care delivery
and health policy:
- Due to the
increasing amount of
school aged children
with low physical
fitness, a yoga and
physical exercise
program can help
promote healthy
behaviors.
Education and
training of OT
students:
- Specific training is
not required to teach
yoga and physical
exercise although the
future practicing OT
needs to be familiar
with the positions
and techniques
involved with them to
be able to use them
effectively.
Refinement, revision,
and advancement of
factual knowledge or
theory:

van de
WeijerBergsma,
Formsma, de
Bruin, &
Bogels.
(2011).

- The study
examined the
effectiveness of
a novel
treatment
approach,
mindfulness
training, for
adolescents
with ADHD and
their parents.

- Level III
- Pre-test and two
post-tests
appropriate for the
study because it
tested the effects
of mindfulness on
the effects of
adolescents of
ADHD
Demographics:
- Age (11-15
years), gender (5
boys and 5 girls),
tutors, and the
parents that
participated (5
moms, 4 dads, and
1 kid had both
their mom and dad
participate).
- They referred to
an academic
treatment center
and had to have a

- The pre-test was

administered one
week prior to the
start of the study. 8
weeks after
completion of the
treatment and 8
weeks following the
originally posttest,
then 16 weeks later.
List measures used:
- Youth Self Reportcompleted by
adolescents
- Child Behavior
Checklist
- Teacher Report
Form for parents
and tutors
Outcome areas:
The scales were
used from these
assessments:
Attention,
Internalizing, and

- The study was

not large
enough to show
statistical
significance due
to the sample
size only
involving 10
adolescents
- The difference
in observation
and perceived
outcome among
fathers and
mothers proved
unreliable
outcome
- Using a 95%
confidence
interval: p< .10
- Attention:
reduction in
attention
problems was
-5.35 to .46 t 8

- Small sample
size
- Nonrandomized
control
- The effects of
mindfulness
training on
attention were
only
subjectively
investigated
- Trainers met
before
intervention to
discuss the
effects of
mindfulness and
the benefits it
has as well as
problems they
face

- Further research on
this topic needs to
involve a control
group as well as
more geographically
balance to be able to
generalize and the
results of yoga and
physical exercise on
school aged children.
The clinical and
community-based
practice of OT:
- Mindfulness training
can be utilized in all
settings working with
children suffering
from ADHD to
address the negative
behaviors associated
with the diagnosis
along with attention
deficits.
Program
development:
- Mindfulness training
was developed for
children with ADHD
to help with being
mindful of their
negative behaviors
and be able to
emotionally regulate
their emotions,
therefore it should be

DSM IV
classification of
ADHD.

Externalizing
Intervention:
Intervention:
- Treatment
consisted of 1.5
hours for 8 weeks
consisting of
mindfulness training
specific to ADHD
- The participants
were taught both
distraction and
fixation exercises
during training
- The distraction
training involved
other participants
purposefully
distracting their
peers, and the
fixation involved
asking participants
to focus on
environmental
distractors like
bubbles and paper
- Additionally
participants were
taught role-playing
during conflict
situations

week follow up.

At 16 weeks no
further
reduction was
reported
- Externalizing:
reduction was
-7.09 to .34 at 8
week follow up.
At 16 weeks no
further
reduction was
reported.
- Internalizing:
Fathers reported
a reduction at
-8.09 to .09.
Mothers and
adolescents did
not report a
significant
reduction

the core of therapy

with this population.
Societal needs:
- Bringing more
awareness of ADHD
in the schools and
other contexts can
help others
understand the
behaviors associated
with the diagnosis.
This study shows that
mindfulness training
can help with these
negative symptoms
Health care delivery
and health policy:
- ADHD is becoming
more and more
prevalent in
adolescents which
have an effect on
behavior and
attention.
Mindfulness training
can help alleviate
many of these
negative symptoms.
Education and
training of OT
students:
- Mindfulness training
requires practice,
certification, and
additional training to

be able to implement
in treatment. OT
students need to be
familiar of this prior
to entering the field.
However, techniques
of mindfulness can
be used.
Refinement, revision,
and advancement of
factual knowledge or
theory:
- Future research of
this study needs to
include a larger
sample size along
with a randomized
control trial to be
able to generalize
the results.