HAPKIDO FOR ADHD: AN EVIDENCE BASED ALTERNATIVE

Attention Deficit and Hyperactivity Disorder (ADHD) is a neurobehavioral developmental disorder characterized by core features such as inattention, distractibility, hyperactivity, and impulsivity (American Psychological Association [APA], 2000). The prevalence and diagnosis of ADHD in children have reached record levels, with a notable gender difference, as boys are diagnosed at significantly higher rates than girls, who represent only 5% of the diagnosed population (Brown, 2009). Furthermore, it has been estimated that a substantial portion of children diagnosed with ADHD continue to experience symptoms well into adolescence and adulthood, with prevalence rates ranging from 30% to 70% (Barkley, Murphy, O’Connell, Anderson, & Connor, 2006).

Despite the widespread use of stimulant medication as a primary treatment for ADHD, research suggests that medication alone may not be sufficient to effectively manage the disorder. Additionally, ethical concerns have been raised regarding the administration of powerful drugs to nonconsenting minors and the potential risks associated with this treatment approach. Given the high incidence of ADHD in the United States, the challenges it poses, and the ethical controversies surrounding its treatment, there is a pressing need to explore nonpharmaceutical interventions for this disorder (Barkley, 2001).

Behavioral health experts have proposed that martial arts could serve as an effective behavior modification technique for children with ADHD (Lakes & Hoyt, 2004). Suggestions have been made that martial arts may be a valuable component of a multimodal treatment strategy aimed at helping children develop the skills necessary to manage and cope with the symptoms of ADHD (Graham, 2007; Lakes & Hoyt, 2004). However, this hypothesis has not yet been subjected to systematic investigation. Thus, the primary objective of my study was to assess the effectiveness of martial arts training as a form of behavior modification, with the specific goal of teaching self-management skills to children diagnosed with ADHD.

Barkley (2001) posited that the behavioral manifestations of ADHD arise from an inability to self-regulate, stemming from deficits in executive function. These deficits frequently result in an individual's inability to effectively manage their time or anticipate the consequences of their actions and impulses. To address these issues, Barkley and Shelton (2000) proposed the use of behavior modification strategies that focus on teaching children self-control as a means of enhancing their ability to manage their behavior effectively.

One method of behavior modification that has garnered attention is martial arts training, which has been recognized for its potential to offer both physical and psychological advantages to children diagnosed with ADHD (Lakes & Hoyt, 2004; Richmand & Rehberg, 1986). Among the various advantages attributed to martial arts training are increased discipline, enhanced focus, improved attention span, heightened concentration, and the acquisition of physical skills (Hiter, 2008). According to Graham (2007), martial arts training places a significant emphasis on the holistic development of both mind and body, a characteristic that sets it apart from many other sports and physical activities. The incorporation of Eastern philosophies into martial arts promotes the cultivation of good character traits and the adoption of nonviolent conflict resolution methods (Back & Kim, 1978). As Becker (1992) posited, the underlying philosophical principles of martial arts provide practitioners with valuable guidance for their daily lives.

Weiser, Kutz, Kutz, and Weiser (1995) conducted a study exploring the psychotherapeutic dimensions of martial arts and uncovered a range of psychological benefits. These benefits included enhanced relaxation, heightened concentration, increased assertiveness, and improved honest communication. Such positive outcomes were associated with elevated self-esteem, a more positive self-perception, and enhanced self-control. Egan (1993) further expanded on these psychological advantages, highlighting the development of greater self-confidence and self-acceptance among martial arts practitioners. McDiarmid (2007) delved into the impact of martial arts training on school performance and reported significant improvements in self-control, accompanied by a notable reduction in the need for disciplinary actions.

Research findings by Duthie, Hope, and Baker (1978) indicated that participation in martial arts training contributed to a reduction in aggression among practitioners. This discovery was corroborated by Cooper (2005), whose study also identified reduced impulsivity, inattention, and hyperactivity in participants. Felmet (1998) focused on the effects of martial arts training on concentration and impulsivity in children aged 7-12, revealing significant behavioral improvements in these areas. Trulson (1986) added that martial arts training could be beneficial for managing comorbid disorders of ADHD, such as depression and anxiety.

Researchers have made a distinction between traditional and modern forms of martial arts, each differing in terms of training modalities, training environments, and instructional styles. Traditional martial arts incorporate meditation and place a strong emphasis on stylized movements, aspects that are typically de-emphasized in most modern martial arts instruction (Nosanchuk & MacNeil, 1989; Trulson, 1986). Several studies have concluded that traditional martial arts instruction tends to be more effective in achieving psychological and behavioral benefits when compared to the modern approach (Egan, 1993; Regets, 1990; Trulson, 1986; Twemlow & Sacco, 1998).

Hapkido training is distinguished by its emphasis on the comprehensive development of both the mind and body, as noted by Walters (1997). Ripley (2003) contended that this holistic approach sets martial arts disciplines apart from other conventional sports and physical activities. In the perspective of Strayhorn and Strayhorn (2009), martial arts training is integrated into an eclectic model of clinical intervention. This model combines various elements, including motivational enhancement, goal-oriented guidelines, positive reinforcement, prompting, and redirection, to create a comprehensive and effective strategy.

Winkle and Ozmun (2003) posited that, especially for children grappling with ADHD, martial arts, such as Hapkido, can serve as a dynamic, enjoyable, healthy, challenging, and rewarding extracurricular pursuit. Success in Hapkido is predicated upon a youth's physical aptitude, information processing abilities, unwavering dedication, and hard work (Winkle & Ozmun, 2003). Lakes and Hoyt (2004) observed that, distinct from many team sports, Hapkido training allows participants to progress at their own pace, thus reducing the competitive stress that may be particularly taxing for children with disabilities.

Engagement in Hapkido practice can instill a profound sense of purpose, commitment, and accomplishment, attributes not always readily found in other recreational endeavors (Reynes & Loran, 2002). Additionally, Hapkido training shares noteworthy commonalities with established strategies used in behavior modification and other modalities for addressing ADHD. For instance, Hapkido instructors often utilize external cues, prompts, and reminders to elicit positive behavioral responses, which can play a pivotal role in helping children with ADHD acquire the self-regulation skills they need (Cooper, 2005).

Graham (2007) proposed that Hapkido's strength-based training imparts critical life and social skills to youth, fostering self-esteem through diverse physical activities, group engagements, relaxation techniques, concentration exercises, and assertiveness training. Ripley (2003) highlighted the prevalence of behavior modeling and positive reinforcement within Hapkido training programs. These techniques are instrumental in shaping the anticipated behavior and mindset of practitioners. Moreover, Walters (1997) underscored that Hapkido's challenging physical techniques are seamlessly integrated with philosophical, meditative, and spiritual components, collectively constituting the essence of this martial art.

An essential facet of Hapkido training is its emphasis on conflict resolution skills as a means to sidestep physical confrontations (Daniels & Thornton, 1990). Meditation practices, breathing exercises, and mind-body focus exercises play a crucial role in helping youth develop emotional regulation, self-control, and anger management (Reynes & Loran, 2002). By providing structured repetition and a highly organized learning environment, Hapkido equips students with the tools to harness their inner resources and effectively manage hyperactive and impulsive behaviors. The study by Hoyt and Lakes (2004) demonstrated that Hapkido training can significantly impact behaviors linked to academic success, self-esteem, and self-respect. Furthermore, Boding and Martinsen (2004) found that Hapkido training can assist individuals in managing clinical depression and anxiety, which are commonly comorbid disorders among individuals coping with ADHD.

 Youth diagnosed with ADHD often grapple with challenges encompassing emotional, behavioral, social, and psychological functions. This multifaceted struggle can manifest in difficulties within the school environment, hindered developmental milestones, and impaired pursuit of life goals, all of which can disrupt the establishment and maintenance of meaningful relationships (Fischer & Barkley, 2006). The findings of Master Marquez's study underscore that consistent and sustained Hapkido training holds promise in helping youth with ADHD navigate the complexities associated with the disorder. Consequently, Hapkido training emerges as a viable alternative to the use of aggressive and potentially deleterious psychostimulant interventions (Ripley, 2003).

To investigate the first research question—namely, whether Hapkido training engenders improvements in the self-regulation skills of children with ADHD—we analyzed data from 11 distinct studies. These analyses encompassed assessments of self-regulation in children and youth with ADHD, with five of them involving treatment and control groups, and the remaining six measuring data at both pretest and posttest stages, with improvement denoted by a decrease from pretest to posttest. The cumulative average effect size amounted to 0.73, indicative of a medium effect size. It is worth noting that meditation practices, breathing exercises, and mind-body focus exercises, as elucidated by Brown (2004), Lakes and Hoyt (2004), and Reynes and Loran (2002), play a pivotal role in teaching emotional modulation, self-control, and anger management within Hapkido. Given the results derived from the current study, it is reasonable to conclude that Hapkido's practice exerts a positive influence on the self-regulation skills of children with ADHD.

Hapkido places a consistent emphasis on values such as courtesy, respect, and self-discipline, which are integral to its training curriculum (Daniels & Thornton, 1990; Strayhorn & Strayhorn, 2009). Furthermore, it imparts conflict-resolution skills as an essential component of its teaching methodology (Daniels & Thornton, 1990; Hiter, 2008). To delve into the second research question—namely, the impact of martial arts training on aggression among children with ADHD—we collated data from four separate analyses. Among these, three studies involved treatment and control groups, while one assessed data at both pretest and posttest junctures, with improvement again marked by a decrease from pretest to posttest. The collective average effect size yielded a value of 0.61, signifying a medium effect size. These results provide substantial support for the proposition that Hapkido training contributes to a reduction in aggression levels among children with ADHD.

It is an established fact that children diagnosed with ADHD often grapple with severe scholastic challenges. Many of them contend with comorbid learning disabilities that impede their ability to concentrate on academic tasks effectively. Consequently, numerous ADHD-afflicted children find themselves falling behind in school, with some necessitating grade repetition. Furthermore, as they progress in age, these individuals become more susceptible to truancy and, in some cases, even school desertion.

To address the third research question—pertaining to the influence of Hapkido training on the academic performance of children with ADHD—we drew upon data from two distinct analyses, both of which featured treatment and control groups. These analyses resulted in an average effect size of 4.55, surpassing expectations with its substantial magnitude. Consequently, it is plausible to contend that Hapkido training, when integrated with special education, functional behavior assessments, and behavior intervention plans (McDiarmid, 2007), could offer tangible benefits to ADHD-affected children within the educational context. School-based educational and mental health professionals are likely to find these findings compelling, as they offer support for the incorporation of Hapkido as an alternative intervention strategy for individuals contending with ADHD.

The analysis delineated above highlights a significant disparity between the treatment and control groups in terms of homework completion. Specifically, the treatment group boasted an 85.7% completion rate, while the control group lagged significantly behind at 37.1%, representing a substantial 48.6% differential. For academic performance, the treatment group attained an impressive mean score of 81.6%, in stark contrast to the control group's 39.6%, which constituted a notable 32% discrepancy. This analysis merits attention for its reliance on tangible measurements of academic achievement, distinguishing it from studies reliant on self-reports or teacher observations and lending it enhanced reliability as a gauge of effect size.

Regrettably, the extant literature did not provide the requisite information to address the fourth research question and its associated hypothesis. Nosanchuk (1981) had postulated that martial arts training might not yield benefits for youth grappling with anger and violence issues, surmising that combat skills imparted through martial arts might exacerbate their aggressive tendencies. Paradoxically, Nosanchuk's study instead revealed that martial arts training does not exacerbate aggression and can provide a safe outlet for individuals with a proclivity for aggression to channel their impulses. Numerous researchers have consequently posited that traditional martial arts instruction surpasses its modern counterpart in achieving psychological and behavioral benefits (Egan, 1993; Regets, 1990; Trulson, 1986; Twemlow & Sacco, 1998).

Popular portrayals of the Mixed Martial Arts (MMA) and Ultimate Fighting Championship (UFC) arena tend to reduce martial arts to a singular criterion: winning fights (Telander, 2006). This portrayal sidelines the canonical components of traditional martial arts, which encompass philosophy, spirituality, and meditative practices, replacing them with intensive cross-training and full-contact sparring. The quintessential MMA competitor is often depicted as a brawler characterized by limited impulse control (McNamara, 2007). While it is crucial to acknowledge that this characterization is predominantly a media-driven construct intended to boost television ratings, it has undeniably influenced the younger generation of martial arts enthusiasts. The advent of MMA has generated a burgeoning martial arts market, with traditional martial arts schools witnessing a decline in student enrollment (Jackson and Andrews, 2005).

Consequently, the contemporary MMA culture appears to be eclipsing the longstanding heritage of traditional martial arts schools (McNamara, 2007). However, despite MMA's growing prominence, it has not been subjected to a sufficiently comprehensive examination to establish a comparative research foundation against traditional martial arts. In light of the current study's affirmation of the benefits of traditional martial arts instruction for children with ADHD (Cooper, 2005; McDiarmid, 2007; Ripley, 2003), the question emerges regarding whether MMA could offer analogous advantages and warrants further exploration.

In summation, the results stemming from this meta-analysis corroborate the study's hypotheses, underscoring that Hapkido training can effectively mitigate aggression, hyperactivity, in

Throughout history, martial arts have played a pivotal role in the cultural and societal development of numerous nations, with particularly strong associations in the Asiatic regions of China, Korea, and Japan. What sets Asian martial arts apart from other forms of martial disciplines is the profound integration of philosophical and spiritual components. Heavily influenced by philosophies such as Taoism, Zen Buddhism, and Confucianism, Asian martial arts have evolved with a steadfast emphasis on self-discipline, personal growth, and the cultivation of spiritual and mental faculties.

Drawing upon 25 years of experience as a Hapkido instructor, I have had the privilege of firsthand observation of the transformative impact that Hapkido training can have on children and youth facing emotional and behavioral challenges. This impact extends to many who have received diagnoses of ADHD and are undergoing medication regimens. My deep-seated interest in this field arises from over three decades of dedicated study and instruction in martial arts (Marquez, 2007), coupled with personal encounters with the profound effects of ADHD on the lives of children, adolescents, and adults.

In my capacity as a Hapkido trainer, I have borne witness to remarkable transformations in children's interpersonal dynamics, not only with their peers but also with parents and adults. Hapkido fosters within them an enhanced sense of belonging, achievement, and pride in their newfound capabilities. Notably, I have observed substantial behavioral shifts, characterized by improved self-control, personal discipline, and the manifestation of socially appropriate conduct, particularly among those who have attained the coveted status of a black belt—the pinnacle of martial arts achievement.

Children and adolescents who ascend to the esteemed rank of black belt set a compelling example for those aspiring to reach such heights. Their demeanor undergoes a discernible transformation, marked by heightened awareness of their interactions with others, the perception they project, and their relationships within their social milieu. They evolve into paragons of restraint, exemplifying commendable behavior and kindness. It is truly remarkable to witness a child who was once disruptive and fidgety in a classroom environment assume the roles of mentor and teacher to those of lower rank. Equally impressive is the newfound sense of pride and self-assuredness these individuals exude as they impart guidance to others on proper conduct within the dojang, the martial arts training hall. Their ability to approach seniors and peers with genuine kindness and respect is a testament to the profound impact of martial arts practice.

Moreover, it is inspiring to witness how they effortlessly translate their verbal exhortations into concrete actions, consistently embodying the values they espouse. Engaging in martial arts instills a profound sense of purpose and provides a sturdy foundation for personal commitment and accomplishment. Notably, Hapkido practice distinguishes itself from team sports by allowing participants to progress at an individualized pace, contingent upon their unique aptitude and dedication. This personalized approach fosters an environment conducive to holistic growth and self-improvement.