Section 2 Children and Yoga

## **Chapter 3** Benefits of Yoga on Children

*Mei-Ling Lin*

## **Abstract**

This chapter begins with an introduction of yoga and available yoga programs or curriculum for children of all ages and all abilities. Next, it summarizes the theoretical frameworks that support the investigation of the benefits of yoga, with an emphasis on the sensory integration theory. Third, this chapter draws on empirical studies from multiple disciplines to pinpoint the physical, mental, and social benefits of yoga on children with and without special needs. To conclude this chapter, case examples are utilized to showcase the implementation of yoga activities in school and group settings. Suggestions for researchers and practitioners who work with children are discussed as well.

**Keywords:** yoga, sensory integration, children, health benefits, well-being

## **1. Introduction**

Yoga is a mind-body practice that originated in ancient India and has been gaining popularity worldwide due to its numerous physical, mental, cognitive, and spiritual health benefits [1]. While practicing yoga, individuals are instructed to focus their attention on their body posture, breathing, emotional awareness, and meditation [2]. In recent years, yoga has become increasingly popular in children and youth populations. Yoga programs designed for young learners often incorporate storytelling, games, music, and imagination to make the yoga practice fun and engaging. See **Table 1** for a listing of children's yoga programs that are available in the United States.

## **2. Conceptualizing the benefits of yoga from sensory integration theory perspectives**

The sensory integration (SI) theory and the definition of sensory integration (SI) were formulated by Dr. Jean Ayres as "the neurological process that organizes sensations from one's own body and from the environment" (p. 11) [4]. Individuals learn knowledge and skills by reading, listening, speaking, and writing or manipulating [5]. The SI theory postulates that learning, or adaptive behaviors, is dependent on the ability to process and integrate sensation and use it to regulate emotions and plan movements. Practicing yoga, from the perspectives of the SI theory, is a learning process; competently and safely performing yoga is viewed as an adaptive behavior. See **Figure 1** for a schematic representation of practicing yoga based on the SI theory.


#### **Table 1.**

*Children's yoga program and curriculum in the United States.*

#### **Figure 1.**

*A schematic representation of practicing yoga based on the SI theory. Adapted from Figure 1-1 A schematic representation of the learning component of SI theory [6].*

#### *Benefits of Yoga on Children DOI: http://dx.doi.org/10.5772/intechopen.112105*

While practicing yoga, a child is presented with visual information about certain yoga poses from cards/pictures or from yoga instructor's demonstration. The instructor may supplement their demonstration with verbal explanations or guided imagination (auditory information). To follow and successfully perform the yoga poses, the child then integrates the visual and auditory inputs with their ability to plan and use two aides of their body in a coordinated way, their ability to form the spatial relationship of different body parts in their mind (i.e., body scheme), and their ability to sense the internal signal from their body to breath. According to the SI theory, the bilateral coordination skills, body scheme, and breathing are hypothesized to be rooted in individual's vestibular, proprioception, tactile, and interoception processing abilities [6].

Notably, when a child is trying to imitate and perform yoga poses, he/she is obtaining sensory feedback from their body and their surrounding environment, specifically, the feedback from their body about their head position and balance (vestibular), the spatial relationship of different body parts (proprioception), and their breath (interoception). The feedback from their surrounding environment may include, but not limited to visual, auditory and tactile inputs (e.g., touching a yoga ball). The SI theory also postulates that the sensory feedback generated in the context of a just right postural or movement challenge contributes to improved sensory integration/processing, thereby enhancing learning and adaptive behavior [6].

So, upheld by the SI theory, the benefits of yoga may be contributed directly by the sensory feedback the child's body obtains during the practice of yoga and improved sensory processing following the practice of yoga. Proprioception is defined as perception or awareness of the position and movement of the body [7]. In the neuroscience literature, proprioceptive feedback, obtained from proprioceptive receptors located in muscle spindles and joints, have been clinically observed to have a calming effect [8–10]. This may explain the emotional or psychological benefits associated with practicing yoga. The vestibular system enables the perception of balance and provides information about body position, facilitating quick compensatory movements in response to both internally initiated and externally applied forces [11]. Together, vestibular and proprioceptive processing contribute to the coordination of head and body movement in space, the development of bilateral coordination, and the development of postural control (e.g., equilibrium). This may explain the physical health benefits of practicing yoga. Also, both proprioceptive and vestibular inputs have been linked to increased arousal levels [12]. This may explain the cognitive benefits (i.e., attention and learning readiness) of practicing yoga. The mental, physical, and cognitive benefits of yoga practices jointly contribute to an individual's self-awareness and social interaction with other people at different developmental stages.

## **3. Understanding the benefits of yoga for children from scientific evidence**

Since yoga is considered a mind-body practice and often embedded in mindfulness practices and mindfulness-based interventions, and the deep breathing technique is an integral part of yoga practices, the findings from empirical studies that investigate the effects derived from deep breathing techniques as well as mindfulness and yoga practices are summarized in the following.

The previous research findings have revealed that instructing third- and fifthgrade students to engage in deep breathing techniques prior to tests led to reduced test anxiety and enhanced test performance [13, 14].

Mindfulness practice involves cultivating a state of heightened awareness attained through nonjudgmental attention to the present moment [15]. Across adolescent, adult, and geriatric populations, mindfulness practice has demonstrated associations with a range of benefits encompassing interpersonal aspects (such as fostering healthy relationships), emotional well-being (including decreased loneliness, stress, and anxiety), as well as intrapersonal advantages (such as the development of empathy, compassion, self-efficacy, attention, and executive functioning) [16–21]. Systematic reviews and meta-analyses conducted on mindfulness-based interventions implemented in school settings have established a positive correlation between mindfulness practices and enhanced mental health outcomes. These outcomes include reductions in stress, anxiety, and depression, as well as improvements in attention [22, 23].

Yoga offers numerous benefits for children with all abilities. Research has indicated that engaging in yoga serves as an effective intervention in mitigating anxiety, depression, and associated symptoms or behaviors among children and adolescents [24–26]. For typically developing children, yoga can also promote physical and mental health [27], as well as improve emotional regulation and self-awareness [28–30]. The study conducted by Morena-Gomez and Cejudo on kindergarten students revealed further advantages of mindfulness-based programs, which encompassed practices such as meditation, mandalas, and body awareness activities. These programs were found to contribute positively to overall child development, nonverbal development, and visual perception, while concurrently reducing maladaptive behaviors [31]. The above evidence support the use of mindfulness-based programs and yoga to enhance children's confidence, self-esteem, and social skills, while also providing an outlet for creativity and self-expression.

For children with special needs, yoga practices can help improve motor coordination, increase strength and flexibility, reduce anxiety and stress, and enhance overall well-being. For example, children and adolescents diagnosed with attention-deficit hyperactivity disorder (ADHD) have demonstrated improved attention and social behaviors following the participation in the mindfulness-based interventions (including yoga) [32]. Additionally, yoga has shown promise as a potential strategy for reducing stress and anxiety, enhancing quality of life, and improving lung function in children and adolescents diagnosed with asthma [33]. Moreover, a multicomponent program that involves yoga, dance, and modified relaxation response program has showed promising outcomes in improving behavioral and some core features of autism spectrum disorders for children aged 3–16 years [34]. Overall, there is gaining evidence to support the incorporation of yoga in treating children and adolescents with depression, sleep disorders, and as an augmentation therapy for pediatric populations with schizophrenia and ADHD [35].

## **4. Methods**

Given the health benefits associated with yoga and mindfulness practices, the author conducted a needs assessment and developed a school-based mental health promotion program to address children's mental health needs in a US-Mexico border community. In this section, the community's mental health needs are presented first. Then, the group-based program activities are described in greater detail. Third, the lessons learned from program implementations are discussed; future directions for yoga research and practices are presented.

## **4.1 Mental health needs in schools at the US-Mexico border community**

School-age children living in an US-Mexico border city are facing multiple stressors in their school and home lives. In the state of Texas, third-grade to twelfthgrade students need to take the State of Texas Assessments of Academic Readiness (STAAR) test every spring semester. The increasing level of academic stress derived from numerous practice tests, quizzes, and exams in preparation for the STAAR test is noticeable and sensible. At the time of the needs assessment, no social emotional learning (SEL) curriculum was formally taught to students to recognize their own and others' emotions and to use stress management techniques to positively face and deal with stress and anxiety.

Notably, the elementary school served 535 students in kindergarten through sixth grade, predominantly children living in Hispanic families (92%) with low socioeconomic conditions (78%). Stressors associated with disadvantaged living conditions, along with stressors unique to the Hispanic population, such as language barriers, perceived discrimination, mental health stigma, and higher risks of having inconsistent health insurance coverage and unmet mental and behavioral needs, all indicate a need to improve mental health awareness, literacy, and access in this population [36].

To respond to the school's mental health needs, occupational therapy faculty and students from the University of Texas at El Paso collaborated with the school team to develop and pilot-test a "Tools for stress" workshop to lay the foundation for developing a school-wide mental health promotion program for the elementary school. The author's intention is multi-faced, including equipping elementary school students with evidence-supported coping strategies to address stress and anxiety, documenting scientific evidence to support the implementation of school-based mental health promotion programs, and establishing long-term university-school collaborative relationships.

## **4.2 Case 1: "Tools for Stress" workshop**

"Tools for Stress," a 45-minute workshop for kindergarten through fourth-grade students (N = 382), was designed to fit into the school's career day schedule in which the speakers from the community come to speak their job or profession and answer students' questions. There were four classes per grade level, and each class had around 20 students [37].1 On the date the workshop is held, each grade level would come into the school gymnasium that was set up to accommodate all the program activities. The workshop opened with questions such as, "what is stress?" and "how do you feel and what do you do when you are stressed?" to survey and further students' understanding of physical, emotional, and behavioral signs of stress. Onsite translation support was provided for non-English learners. The sequence of program activities all in a group format is presented in **Table 2**.

This workshop concluded with an anonymous survey to gain student's feedback (e.g., "how much did you like the activities?" and "how confident would you be to use the activities the next time you feel stress?"). Overall, this program obtained an overwhelming positive response from students. Of 364 valid surveys collected from participating students, 85% liked the yoga and deep breathing exercises, 95% liked the sensory bottle they made, and 82% indicated they were confident and competent about using the calming strategies in the future when feeling stressed. The school

<sup>1</sup> The fifth and sixth graders had schedule conflicts that precluded their inclusion.


*The "Tools for Stress" workshop overview.*

#### *Benefits of Yoga on Children DOI: http://dx.doi.org/10.5772/intechopen.112105*

counselor has continued to reinforce the strategies introduced in the workshop with students in 1:1 counseling session. However, the counselor also mentioned challenges to incorporate yoga and other mindfulness-based strategies into each classroom and an already-packed school daily schedule. The school administration requested that this program be continued and expanded for both students and teachers and broadened to include workshops for families.

### **4.3 Case 2: The school-wide mental health promotion program**

In the fall of 2019, based on the feedback collected from the "Tools for Stress" workshop and the synthesis of scientific literature, occupational therapy faculty and students from UT-El Paso design a mental health promotion program and conduct an empirical study to explore its outcome on fifth and sixth graders' perceived ability to handle negative emotions (i.e., emotional self-efficacy, ESE) and their perceived levels of satisfaction with the program. This program consists of four in-person instructional sessions that integrate the existing evidence and incorporate specific lessons from the Zones of Regulation curriculum [39]. Every session was carefully planned to have a duration of 45 minutes and took place once a month within the school's indoor gymnasium during the physical education (PE) class time. The sessions were facilitated by second-year OT students, closely supervised by three OT faculty members, along with the participation of the school counselor and the school nurse. See **Table 3** for the program overview.

Results obtained from a sample of 100 students (39 boys and 60 girls, with 1 case of missing data; 57 fifth graders and 43 sixth graders) indicate that, for the entire group, there are no statistically significant differences in emotional self-efficacy (ESE) ratings before and immediately after the implementation of the mental health promotion program (t(84) = −1.08, *p* = .29). However, noteworthy findings emerge when examining the pretest and posttest scores. Students with lower ESE ratings before the program demonstrated improved ESE ratings after program participation (t(46) = −3.258, *p* = .00), while those with higher initial ESE ratings experienced a decline in ESE ratings (t(37) = 1.98, *p* = .06). No significant differences were observed between boys and girls or between fifth and sixth graders regarding ESE ratings before and after program implementation. Overall, more than 60% of the program participants expressed a neutral to positive attitude toward the program activities. Among all the program activities, students favored mandala coloring the most, followed by slime making, deep breathing, and yoga, respectively. Approximately 70% of the program participants expressed feeling both competent and confident in utilizing one of the calming tools they had learned during the program when facing future stress.

### **4.4 Discussion**

Suggestions are made based on the two case examples for researchers and practitioners who consider implementing yoga programs or curriculum to address the social emotional needs of school-age children.

First, the collaboration among parents, teachers, and mental health providers (e.g., counselors, psychologists, and occupational therapists) is the key to the successful program implementation and the most optimal children outcome. Outside of the "Tools for Stress" workshop, the OT faculty set a booth at the school health fair to provide educational materials to increase parental awareness of family


#### **Table 3.**

*Mental health promotion program overview [40].*

mental health and to facilitate healthy ways to manage stress using the tools and strategies their child learned from the workshop. For teachers and paraprofessionals, two 1-hour workshops introduced evidence-informed stress management techniques (i.e., breathing exercises, yoga stretches, using a sensory board that included various textures) that could be implemented in the classroom to support students' self-regulation and address students' emotional and behavioral challenges. Under the circumstance that all the stakeholders are aware of the importance and benefits of yoga, children can be given provided numerous opportunities to practice yoga. And the benefits of yoga can be maximized and carried over to different environments.

Second, the timing of yoga instruction should allow students to immediately apply their learning to real-life situations. A comparison of the workshop satisfaction survey results and the research study's program satisfaction survey results showed that 85% of kindergarten to fourth-grade students like yoga and deep breathing. Yet only 27% of and 40% of fifth and sixth graders like yoga and deep breathing correspondingly. Additionally, the satisfaction ratings of the workshop activities were higher among younger elementary school students compared to the satisfaction levels of fifth and sixth graders in the implemented program. One possible reason for this

### *Benefits of Yoga on Children DOI: http://dx.doi.org/10.5772/intechopen.112105*

disparity in the satisfaction survey outcomes is that younger students could immediately perceive the benefits of the calming tools they learned when they took the STAAR test. In contrast, older students completed the survey during the fall semester when no STAAR testing was conducted, which could explain their relatively lower satisfaction levels.

Third, early introduction of yoga and cultivation of child's interest in yoga are recommended. It is observed that younger students demonstrated better response and acceptance toward yoga and other program activities compared to older students. The developmental stage of middle childhood is characterized by the emergence of self-autonomy and a significant influence of peers within social networks. That is, older elementary school-age children may be more susceptible to peer pressure compared to their younger counterparts. As a result, they may be more inclined to mimic their peers' responses to stress and anxiety rather than adopting the strategies and techniques taught by adults. Since the motivation and the interest to learn yoga is the foundation for the continuation of practicing yoga, the future design of yoga programs or curriculum should shed more emphasis on early childhood populations.

Last but not the least, the integration of technology into yoga instruction and learning holds great potential for both practitioners and researchers. Utilizing webor mobile-based applications, such as *Adventures in Emotional Literacy* developed for elementary school students (3C Institute, n.d.), offers the advantage of flexibility in terms of time and location to students to acquire emotional literacy and coping skills. This approach allows instructors to maximize in-person teaching time and to enable students to put into practice the knowledge and skills acquired through the e-curriculum. Gathering information such as program satisfaction, frequency of application use, and knowledge gained before and after program implementation can be easily achieved through web-based platforms and learning management systems.

## **5. Conclusion**

To conclude this chapter, key information is highlighted as follows.


## **Acknowledgements**

I want to express my sincere gratitude to the UTEP College of Health Science, Occupational Therapy Program, faculty, and Classes of 2019 and 2020 students for the participation and ongoing support to this research project. I also want to acknowledge the REL Washington Elementary in El Paso, Texas, for their enthusiasm and dedication to this collaborative project and school mental health.

## **Conflict of interest**

The author declares no conflict of interest.

## **Appendices and nomenclature**

See sample yoga script.

## **A. Sample yoga script**

Stand tall like a mountain (mountain will be the resetting posture/resting pose) feet firmly planted down on the ground, arms out, palms out, strong finger reaching to the ground.

Breathing in and out of your nose—as your belly goes in and out. Mindful breathing as you breathe in for 1, 2, 3 and out 1-5.

Relax your arms out to the side—shrug your shoulders toward your ears as you breathe in and away from your ears as you breathe out of your mouth (loud audible) release and relax your shoulders (3×'s)

Roll your head in circles to the R

Roll your head in circles to the L

Now move around however feels good, stretching out your neck and relaxing your shoulders-freestyle while feet are firmly planted on the ground (if you feel silly, you can wiggle it out, if you feel tired, you can move nice and slow)

Come back to mountain, come back to a calm, slow breath. (Sometimes if you have a bad day, it's good to plant your feet firmly on the ground and take a few deep breaths)

Slowly bring your hands to your heart, bring your elbows out to your side, palms facing each other. Press your hands as hard as you can for 1, 2, 3 and relax (3x's)

Relax your arms down at your side, shake it out

Come back to mountain, stand tall and strong like a mountain, and take 3 deep breaths (guided), see how still you can be…

Now bring your arms out to your side, lift them up overhead like you're reaching for the sun/sky.

When your arms and hands are up in the sky, interlace your fingers and make a 'steeple', 'water gin' …etc. Relax the shoulders down and reach your steeple up.

Because you are explorers, bend your knees a little bit and shoot up (jump) like a rocket ship.

Stand tall, take a deep breath in and reach to the L

**50**

*Benefits of Yoga on Children DOI: http://dx.doi.org/10.5772/intechopen.112105*

Come back to center, bend your knees a little bit and shoot up(jump) like a rocket ship (blast off into space one last time).

Release your arms, shake them out.

Widen your stance a little more, reach your arms out to the side and be a starshine bright like the brilliant stars you are! Twist to the right and left, shooting your star around while keeping your legs firmly planted on the ground.

Relax your arms, bring your legs back together.

Stand firm on your L leg and lift your R leg up and back.

Now we are going to pretend we are trees, plant your L foot (leg) down and lift your R leg up to the inside of your L leg (above or below your knee)

Grow your tree, blow in the wind, etc.

Plant your R root (leg) down and lift your L leg up to the inside of your R leg (above or below your knee).

Grow your tree, blow in the wind, etc.

Release and shake it out.

Dancer- bring your R foot into your R hand behind you. Kick your R foot back into your R hand and reach forward with your L hand.

Come back to mountain and prepare to do the other side.

Bring your L foot into your L hand behind you. Kick your L foot back into your L hand and reach forward with your R hand.

Release, and shake it out.

Come back to mountain and take a deep breath in and exhale loudly.

Bring your hands to your waist, stand tall like a superhero. Bring your elbows back like you are trying to touch them together. Lift your chest, lift your heart, lift your

head and be the strong, confident, unique superhero you know you are.

While in superhero—take three deep breaths in and out your nose.

Relax arms down at your side.

Bring your hands back to your heart and say, "I AM AWESOME."

Then turn to your friends and say, "YOU ARE AWESOME!"

Then we end our practice with, "The awesome in me recognizes the awesome in you! Namaste"

## **Author details**

Mei-Ling Lin The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

\*Address all correspondence to: linm2@uthscsa.edu

© 2023 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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