Intervention Summary
HeartMath: Coherence Training in Children With ADHD
HeartMath: Coherence Training in Children With ADHD (attention-deficit/hyperactivity disorder) is designed for use with youth ages 8-14 who have a diagnosis of ADHD. The intervention aims to help these youth reduce stress, control impulses, and improve academic focus (e.g., word recognition, memory, attention, problem solving) by gaining and maintaining self-control over their emotional responses to stressful events. HeartMath, which can be implemented by educators, clinicians, or parents, usually consists of 6-12 sessions, although more sessions can be conducted as needed. Sessions are brief to help participating youth sustain attention. Participants learn coherence-building techniques for emotional self-regulation, which teach them to focus on the physical area of the heart through deep, rhythmic breathing while thinking of positive feelings. This process is supported by emWave technology, and using an ear or finger sensor connected to a USB port on a computer running the emWave Desktop software, participants can view, on the computer screen, the different coherence levels and wave patterns produced by their heart rhythms (an indicator of physiological activity) in response to stressful and nonstressful thoughts. This visualization allows participants to monitor their pulse rates during different activities and learn how to self-regulate their emotions and maintain the breathing and heart rhythm pattern that is associated with nonstressful thoughts. The software also includes three age-appropriate games, of varying length, which help participants to practice coherence-building techniques. Throughout the sessions, implementers have opportunities to assess the progress of the youth.
The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted. Lloyd, A. Investigating the impact of HeartMath techniques for children with ADHD (Unpublished doctoral dissertation). Liverpool John Moores University, Liverpool, UK. Goodman, R. Psychometric properties of the Strengths and Difficulties Questionnaire. Journal of the American Academy of Child and Adolescent Psychiatry, 40(11), 1337-1345.
The following populations were identified in the studies reviewed for Quality of
Research.
External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
Evidence of test-retest reliability and face validity was presented for both the SDQ and the CDR test battery, and evidence of internal consistency, interrater reliability, and criterion validity was presented for the SDQ. No missing data were reported, and the small amount of attrition that was reported was adequately addressed. Some strategies were put in place to minimize confounding variables, including double-blind randomization and use of an active control group. The statistical analysis was appropriate. A number of variables may have presented confounds, including varying levels of teacher familiarity with the students they rated with the SDQ, varying time for daily intervention sessions, and effects of the administration of ADHD medication. The sample size was small, and there was no evidence that a power analysis was conducted.
The materials below were reviewed for Readiness for Dissemination. The implementation
point of contact can provide information regarding implementation of the intervention
and the availability of additional, updated, or new materials. Institute of HeartMath. emWave Desktop personal stress reliever [Hardware]. Boulder Creek, CA: Quantum Intech. Institute of HeartMath. emWave Desktop software kit with Coherence Coach tutorial. Boulder Creek, CA: Quantum Intech. Institute of HeartMath. Using emWave technology with young adolescent children diagnosed with ADHD: A guide for implementation and application. Boulder Creek, CA: Author.
External reviewers independently evaluate the intervention's Readiness for Dissemination
using three criteria: For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.
The implementation guide is well organized and appropriate for a variety of users, with clear, step-by-step instructions on how to incorporate the emWave technology into practice and implement the program. The program Web site provides a wealth of information and resources to support implementation. Coaching and consultation are available through weekly bridge calls, and topics of discussion are based on the callers' needs. The technology itself, along with simple provider checklists, can be used to contribute to overall quality assurance. Limited information is provided to support organization-level implementation readiness. Although the program Web site contains a number of resources, it is challenging to find all of the implementation, training, and evaluation support materials, including those for interpreting data to improve program delivery or client outcomes.
The cost information below was provided by the developer. Although this cost information
may have been updated by the developer since the time of review, it may not reflect
the current costs or availability of items (including newly developed or discontinued
items). The implementation point of contact can provide current information and
discuss implementation requirements. Descriptive Information
Areas of Interest
Mental health treatment
Outcomes
1: Internalizing and externalizing problems
2: Accuracy of new word recognition
Outcome Categories
Education
Social functioning
Ages
6-12 (Childhood)
Genders
Male
Female
Races/Ethnicities
Non-U.S. population
Settings
School
Geographic Locations
Urban
Implementation History
HeartMath: Coherence Training in Children With ADHD was first implemented during the school year in Liverpool, England. Since then, it has been implemented in all 50 States and in Australia, Austria, Canada, China, France, Germany, Indonesia, Italy, Mexico, the Netherlands, Saudi Arabia, South Africa, South Korea, Spain, and the United Kingdom. The intervention has been implemented in approximately 2,000 school sites and in numerous private agencies and homes. It is estimated that more than 5,000 educators and clinicians have used the emWave technology with children with ADHD or related conditions.
NIH Funding/CER Studies
Partially/fully funded by National Institutes of Health: No
Evaluated in comparative effectiveness research studies: No
Adaptations
The emWave technology is available in Chinese, Dutch, French, Japanese, and Spanish.
Adverse Effects
No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories
IOM prevention categories are not applicable.
Documents Reviewed
Study 1
Lloyd, A., Brett, D., & Wesnes, K. Coherence training in children with attention-deficit hyperactivity disorder: Cognitive functions and behavioral changes. Alternative Therapies in Health and Medicine, 16(4), 34-42. Supplementary Materials
Wesnes, K. Psychometric documentation for the Cognitive Drug Research test battery.
Wesnes, K. A., Pincock, C., Richardson, D., Helm, G., & Hails, S. Breakfast reduces declines in attention and memory over the morning in schoolchildren. Appetite, 41(3), 329-331.
Wesnes, K. A., Ward, T., McGinty, A., & Petrini, O. The memory enhancing effects of a Ginkgo biloba/Panax ginseng combination in healthy middle-aged volunteers. Psychopharmacology, 152(4), 353-361. Outcomes
Outcome 1: Internalizing and externalizing problems
Description of Measures
Internalizing and externalizing problems were assessed with the Strengths and Difficulties Questionnaire (SDQ). The SDQ is composed of five scales that yield scores for strengths (positive attributes) and difficulties (negative attributes) in a student's psychological development. Internalizing and externalizing problems were determined from the difficulties score, which was produced from items in four of the five scales: the emotional symptoms scale (e.g., "I worry a lot"), the conduct problems scale (e.g., "I usually do as I am told"), the hyperactivity/inattention scale (e.g., "I am easily distracted"), and the peer relationship problems scale (e.g., "I have one good friend or more"). Using a 3-point Likert scale ranging from "not true" to "certainly true," students and their teachers rated each item.
Key Findings
Students were recruited from three secondary and two primary schools in England, and those who met the DSM-IV criteria for an ADHD diagnosis were randomly assigned to the intervention group or the wait-list control group. Students in the intervention group received instruction in emotional self-regulation techniques through HeartMath, and those in the control group used LEGO bricks to build models of the student's choice during each session. All students received a baseline assessment and a 6-week assessment (after the 6-week intervention and LEGO sessions). Students in the wait-list control group subsequently were offered HeartMath. From baseline to the 6-week assessment, students in the intervention group had a greater improvement in self-reported (p = .044) and teacher-reported (p = .001) internalizing and externalizing problems compared with students in the control group.
Studies Measuring Outcome
Study 1
Study Designs
Experimental
Quality of Research Rating
3.0
(0.0-4.0 scale)
Outcome 2: Accuracy of new word recognition
Description of Measures
Accuracy of new word recognition was assessed with the word recognition task of the Cognitive Drug Research (CDR) test battery. The CDR test battery is composed of 10 tasks that assess an aspect of cognition: immediate word recall, picture presentation, simple reaction time, digit vigilance, choice reaction time, spatial working memory, numeric working memory, delayed word recall, word recognition, and picture recognition. Using a notebook computer, school staff trained by the developer administered the measure to participants, who recorded their response to each item by clicking one of two buttons corresponding to "no" or "yes."
Key Findings
Students were recruited from three secondary and two primary schools in England, and those who met the DSM-IV criteria for an ADHD diagnosis were randomly assigned to the intervention group or the wait-list control group. Students in the intervention group received instruction in emotional self-regulation techniques through HeartMath, and those in the control group used LEGO bricks to build models of the student's choice during each session. All students received a baseline assessment and a 6-week assessment (after the 6-week intervention and LEGO sessions). Students in the wait-list control group subsequently were offered HeartMath. From baseline to the 6-week assessment, students in the intervention group had a greater improvement in new word recognition accuracy (p < .01) compared with students in the control group.
Studies Measuring Outcome
Study 1
Study Designs
Experimental
Quality of Research Rating
2.8
(0.0-4.0 scale)
Study Populations
Study
Age
Gender
Race/Ethnicity
Study 1
6-12 (Childhood)
89.7% Male
10.3% Female
100% Non-U.S. population
Quality of Research Ratings by Criteria (0.0-4.0 scale)
Outcome
Reliability
of Measures
Validity
of Measures
Fidelity
Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Internalizing and externalizing problems
3.5
3.5
2.0
3.8
2.8
2.5
3.0
2: Accuracy of new word recognition
3.0
3.0
2.0
3.8
2.8
2.5
2.8
Study Strengths
Study Weaknesses
Materials Reviewed
Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)
Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
3.3
3.3
3.0
3.2
Dissemination Strengths
Dissemination Weaknesses
Item Description
Cost
Required by Developer
emWave Desktop (includes hardware, software, and manual)
$249
Yes
Using emWave Technology With Young Adolescent Children Diagnosed With ADHD: A Guide for Implementation and Application (includes emWave Desktop Proficiency Checklist and emWave Learning Checklist)
Free
No
2-day, off-site Institute of HeartMath Training
$1,500
No
Training programs targeting specific audiences, including educators, clinicians, parents, nonprofit agencies, and government agencies
Contact developer for detailed information
No
Weekly conference calls to support implementation of emWave technology
Free
No
Phone-, email-, or Webinar-based coaching and consultation
Free
No