Yoga and Mindfulness Interventions for Preschool-Aged Children in Educational Settings: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Information Sources and Search Strategy
2.2. Eligibility Criteria
2.3. Study Selection
2.4. Data Abstraction
2.5. Quality Appraisal
2.6. Data Synthesis
3. Results
3.1. Search Results
3.2. Characteristics of Included Studies
3.3. Participants
3.4. Mindfulness and Yoga Interventions
3.5. Outcome Measurement
3.6. Quality Appraisal
3.7. Research Question 1: What Available Evidence Suggests that Yoga and Mindfulness Interventions Improve Social Emotional Outcomes and Cognitive or Executive Function for Preschool-Aged Children?
3.7.1. Behavioral Self-Regulation
3.7.2. Emotion Regulation
3.7.3. Executive Function
3.7.4. Attentional Capacities
3.7.5. ADHD Symptoms
3.7.6. Peer and Prosocial Behavior
3.7.7. General Indicators of Social-Emotional Functioning
3.8. Research Question 2: How Does the Effectiveness of Yoga and Mindfulness Programs Differ by Population, Duration of Intervention, and Program Content?
3.8.1. Population
3.8.2. Duration of Intervention
3.8.3. Frequency of Intervention
3.8.4. Other Moderators
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
RoB 2 for RCT Studies (n = 10) | ||||||
---|---|---|---|---|---|---|
1. Risk of Bias Arising from the Randomization Process | 2. Risk of Bias Due to Deviations from the Intended Interventions | 3. Missing Outcome Data | 4. Risk of Bias in Measurement of the Outcome | 5. Risk of Bias in Selection of the Reported Result | Overall Risk of Bias | |
Lim and Qu, 2017 [46] | Some concerns | High | High | Low | Some concerns | High |
Kim et al., 2020 [36] | High | Some concerns | Low | High | Some concerns | High |
Zelazo et al., 2018 [45] | Low | Some concerns | Low | Some concerns | Some concerns | Some concerns |
Jarraya et al., 2019 [15] | Low | Some concerns | Low | Low | Some concerns | Some concerns |
Cohen et al., 2018 [33] | Some concerns | High | Low | High | Some concerns | High |
Lemberger-Truelove et al., 2018 [37] | Some concerns | High | Low | Low | Some concerns | High |
Viglas and Perlman, 2018 [44] | High | Low | Low | High | Some concerns | High |
Razza et al., 2020 [40] | Some concerns | Low | Low | Low | Some concerns | Some concerns |
Jackman et al., 2019 [35] | Low | Some concerns | Low | High | Some concerns | High |
Flook et al., 2015 [34] | Some concerns | Some concerns | Low | Low | Some concerns | Some concerns |
Robins-I for Non-RCT Studies (n = 6) | ||||||||
---|---|---|---|---|---|---|---|---|
1. Bias Due to Confounding | 2. Bias in Selection of Participants into the Study | 3. Bias in Classification of Interventions | 4. Bias Due to Deviations from Intended Interventions | 5. Bias Due to Missing Data | 6. Bias in Measurement of Outcomes | 7. Bias in Selection of the Reported Result | Overall Risk of Bias | |
Thierry et al., 2018 [43] | Low | Low | Low | Low | Moderate | Low | Low | Moderate |
Razza et al., 2015 [39] | Low | Low | Low | Low | Moderate | Low | Low | Moderate |
Thierry et al., 2016 [42] | Moderate | Moderate | Low | Low | Low | Serious | Moderate | Serious |
Carrozza 2019 [32] | Low | Low | Low | Low | Serious | Serious | NI | Serious |
Rich 2010 [41] | Moderate | Low | Low | Critical | Serious | Serious | NI | Critical |
Moreno-Gómez and Cejudo, 2019 [38] | Moderate | Low | Low | Low | Low | Moderate | Moderate | Moderate |
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Study | Design | Country | Setting | Mean Age (±SD) | Sample Size | Gender | Race/Ethnicity | Other Relevant Sample Characteristics |
---|---|---|---|---|---|---|---|---|
Thierry et al., 2018 [43] | QED | USA | Public preschools in a large-sized city in the Southwestern U.S. | 4.5 years (±0.32) | 325 | 51% Female 49% Male | 57% African American, 40% Latina/o, 1% White, 2% Other | Spanish as first language = 27% Free/reduced lunch = 98% |
Lim and Qu, 2017 [46] | RCT, parallel | Singapore | Childcare centers in urban city | 65.1 months (±0.32) | 122 | 48% Female 52% Male | 100% Singaporean | Parents with a high school or above a high school education = 90.7% of mothers and 88.8% of fathers Families with monthly household income below the national median monthly household income = 70.4% |
Kim et al., 2020 [36] | RCT, cluster | Korea | Four Korean preschools | 3 years (SD missing) | 83 | 54% Male 46% Female | 100% Korean | None reported |
Zelazo et al., 2018 [45] | RCT, parallel | USA | Two preschools serving low- income families in urban cities (Houston, TX and Washington, DC) | 57 months (±0.32) | 218 | 46% Female 54% Male | Houston, TX Cohort: 55% White; 32% More than one, 9% African American, 3% Native American, 97.4% Hispanic Washington, DC Cohort: 100% African American | None reported |
Jarraya et al., 2019 [15] | RCT, parallel | Tunisia | Private Tunisian Kindergarten in urban setting | 5.2 years (±0.4) | 45 | 62% Female 39% Male | None reported | Participants were from middle class families with a corresponding average to high socio-economic status. Children with a lack of any frequent participation in yoga exercise programs for at least 6 months prior to the study and no daily intake of medication |
Cohen et al., 2018 [33] | RCT, parallel | USA | A local urban, community-based preschool | 49 months (±9) | 23 | 35% Female 65% Male | 43% White, 4% Asian, 39% Black/African American, 9% Mixed, 4% Unknown | Children had four or more ADHD symptoms as rated by teachers or parents on the ADHD Rating Scale-IV Preschool Version; One child had autism spectrum disorder; Two children had an ADHD diagnosis; One child took ADHD medication |
Lemberger-Truelove et al., 2018 [37] | RCT, parallel | USA | A childcare facility serving low-income children enrolled in a summer session at a childcare center in the southwestern United States | 3.9 years (±0.79) | 23 | 52% Female 48% Male | 52% Hispanic, 26% mixed race, 22% white | The sample consisted of children from low- income households, with 35% under the poverty line (i.e., under $24,000 for a four-person household) and another 43% under twice the poverty line (i.e., under $16,000 for a four-person household). |
Viglas and Perlman, 2018 [44] | RCT, cluster | Canada | Three public preschools in in the ethnically diverse city of Toronto, Ontario in Canada | 62.32 months (±7.5) | 127 | 42% Female 58% Male | None reported | All three schools in this study experienced somewhat higher levels of external challenges (e.g., parents’ education and income, poverty and proportion of lone-parent families as measured by the Toronto District School Board Learning Opportunities Index (LOI). |
Razza et al., 2020 [40] | RCT, cluster | USA | An urban Head Start center in a mid-sized city | 4.1 years (±0.37) | 89 | 50% Female 50% Male | 74% African American 14.3% mixed-race | City residents living below the federal poverty level = 33.33% for all residents, 43% among families with children under age 18; female headed households = 54%; city had highest per capita murder rate in all of New York state in 2013; Rate of post-traumatic stress in community = 51%. |
Razza et al., 2015 [39] | QED | USA | Two full-day universal pre-kindergarten classrooms within the same urban public elementary school | 51.1 months (±3.8) | 34 | 62% Female 38% Male | 52% White, 7% Hispanic, 34% Black or African American, 7% Other | Parents with a master’s or professional degree = 60% married families = 66% cohabiting = 7% average child: adult ratio of 1.6 (SD = 1.1; range 0.3–6.0) |
Jackman et al., 2019 [35] | RCT, cluster | USA | Head Start classrooms in Jefferson and Franklin counties | 3 years, 8 months (+6 months) | 262 | 51.5% Female 48.5% Male | None reported | None reported |
Thierry et al., 2016 [42] | QED | USA | An urban elementary school located in a large-size city | 4.55 years (±0.30) | 47 | 49% Female 51% Male | 85% Hispanic, 9% African American, 6% White | Students qualified for free or reduced-price lunch = 72% Average family income: Intervention Group = $34,416 Control Group = $31,320 |
Flook et al., 2015 [34] | RCT, cluster | USA | Six different elementary schools within a public school district in a medium-sized city Seven classrooms from the study schools | 4.67 years (±0.27) | 68 | 50% Female 49% Male | 58.8% Caucasian, 11.8% Hispanic, 5.9% African American, 10.3% Asian/Pacific Islander, 11.8% Other/mixed ethnicity | Parents with four-year college degree = 72.1% Children considered socioeconomically disadvantaged = 37.9% |
Carrozza 2019 [32] | QED | USA | Private Preschool in urban city | IG: 3 years, 5 months old (± 0.294, 3 months) CG: 3 years, 7 months old (±0.487, 5 months) | 27 | 57% Male 43% Female | 52% White 5% Asian 10% Hispanic 33% Multi-racial | Autism: 10% (n = 2); Typical Development: 81% (n = 17) Speech Delay: 10% (n = 2); Motor Delay: 10% (n = 2) |
Rich 2010 [41] | Pre-Post design trial | USA | Public Preschool in two suburban communities | Mean age: 4.63 years (SD missing) | 49 | 59% Female 41% Male | District A: 3.0% African American, 2.8% Asian, 1.7% Hispanic, 0.7% Native Hawaiian/Pacific Islander, 0.2% Native American, 91% White, 0.2% Multiracial/Non-Hispanic; District B: 14% African American, 3.7% Asian, 4.6% Hispanic, 0.2% Native Hawaiian/Pacific Islander, 0.1% Native American, 75% White, 1.2% Multiracial/Non-Hispanic. | Approximately 40% of the students in the study received services for students with developmental delays from the special education department. |
Moreno-Gómez and Cejudo, 2019 [38] | QED | Spain | Kindergarten children obtained through an incidental non-probability sampling method or by accessibility | 5.08 years (±0.37) | 74 | 47% Male 53% Female | Unknown | None provided |
Study | Intervention Classification and Description | Comparator | Instructor and Location | Duration (# Sessions if Provided) | Frequency | SEL Outcome Measures | Summary of Conclusions | Overall Risk of Bias |
---|---|---|---|---|---|---|---|---|
Thierry 2018 [43] | Mindfulness: Five learning units, each unit contained 2–4 lessons (18 lessons total), with extension activities and strategies to enhance students’ self-regulation and self-awareness | Wait-list | Teacher in classroom | One school year | 2 weeks per unit incorporated into the school day at teacher’s discretion | Executive function: Flanker Task, Hearts and Flowers Task Prosocial Skills: Social Skills Improvement System-Rating Scales (SSIS-RS) | Students in the mindfulness schools showed greater improvement in executive functions than students in the business-as-usual schools. There were no differences between groups on measures of prosocial behavior. | Moderate * |
Lim and Qu 2017 [46] | Mindfulness: Three 5-min activities: 5-min stretching with balance and focusing on the body posture, 5-min listening to the tapping and focusing on the sound, 5-min counting the breath and focusing on the breath | Active control included simple dance, sing and counting guided by researcher | Researcher in quiet unused classroom | 15 min | One 15-min session | Attention: Shortened Child Attention Network Task (ANT), Global—Local Test (GLT) | There was no effect of mindfulness training on children’s performance on the ANT. | High |
Viglas 2018 [44] | Mindfulness: Lessons on “external” and “internal” experiential mindful awareness practices and lessons on heartfulness (i.e., kindness and caring). Following each lesson, children were asked to write or draw in their mindfulness journals. | Wait-list | Researcher in classroom | 6 weeks (18 sessions) | 3 times a week, 20 min per session | Behavioral Self-Regulation: Head-Toes-Knees-Shoulders (HTKS) General Social-Emotional Functioning: Strengths and Difficulties Questionnaire (SDQ) | Children in the mindfulness group showed greater improvement in self-regulation, were more prosocial and less hyperactive compared to children in the control group at Time 2. | High |
Thierry 2016 [42] | Mindfulness: MindUP program lessons taught over the course of the school year and three times each day, students engaged in core mindfulness practice, deep breathing with a focus on a single resonant sound | Business-as-usual | Teacher in classroom | One school year | Daily | Executive Function: Behavior Rating Inventory of Executive Function-Preschool (BRIEF-P) | At the end of the prekindergarten year, students in the mindfulness program showed improvements in teacher-reported executive function skills, specific ally related to working memory and planning and organizing, whereas children in the business-as-usual group showed a decline in these areas. | Serious * |
Moreno-Gomez 2019 [38] | Mindfulness: The program was organized into four content blocks: (1) mindfulness meditation techniques, (2) work with mandalas, (3) visualization techniques, and (4) body awareness | Wait-list | Teacher and Researcher in classroom | 6 months (144 total sessions) | Six times a week, 15 min per session | Attention: Children Neuropsychological Maturity Questionnaire (CUMANIN) General Social-Emotional Functioning: Behavioral Assessment System for Children (BASC-2) | There was a significant reduction in the scores of global maladaptive dimensions, behavioral symptoms index and externalized and academic problems, among the experimental group. There was a significant increase in scores for the experimental group in the dimensions of global development, non-verbal development, visual perception, and attention. | Moderate |
Jarraya 2019 [15] | Yoga: Adapted Hatha yoga including a 5 min warm up period of jogging and jumping followed by yoga specific stretching and breathing, 15 min yoga postures (Asana), 5 min breathing techniques, ending with yogic games. Throughout different phases, a story was told to motivate the children to actively participate. | Post-test with active (physical education) and passive (no physical activity) control groups | Certified yoga teacher in Kindergarten gym | 12 weeks (24 sessions) | Twice per week, 30 min per session | ADHD Symptoms: ADHD Rating Scale-IV Attention: Developmental Neuropsychological Assessment (NEPSY) | In comparison to the active and passive control groups, yoga had a significant positive impact on ADHD symptoms. Yoga had significant positive impact on completion times in two visuomotor precision tasks in comparison to the active control group and on visual attention scores in comparison to the passive control group. | Some concerns |
Cohen 2018 [33] | Yoga: Manualized curriculum from If I Was a Bird Yoga, sequence of breathing exercises and poses consistent over the intervention period | Wait-list | Trained children’s yoga instructors in separate room from classroom | 6 weeks (12 sessions) | Twice per week, 30 min per session | ADHD symptoms: ADHD Rating Scale-IV, Preschool Version Attention: KiTAP Test of Attentional Performance for Children General Social-Emotional Functioning: Strengths and Difficulties Questionnaire (SDQ) | Children in the yoga group had faster reaction times on the KiTAP Go/No go task, fewer distractibility errors of omission, but more commission errors than children in the control group. | High |
Rich 2010 [41] | Yoga: The yoga teacher utilized an instrumental compact disc that was incorporated into the activities in the lesson | Post-test | Certified yoga teacher in classroom | 4 weeks (8 total sessions) | Twice a week, 20 min per session | ADHD symptoms: Conners Teacher Rating Scale‚ Revised: Short Form (CTRS-R:S) | The overall findings of the study did not support the hypothesis that preschool students who participate in yoga therapy will demonstrate increased attention to tasks in the classroom. | Critical * |
Razza 2020 [40] | Combined Yoga and Mindfulness: Each session began with a centering activity, progressed through a set of child-centered yoga poses, and concluded with a brief relaxation activity | Wait-list | Certified yoga teacher in gym | 8 weeks | twice a week, 25 min each 16 sessions | Attention: Attention Sustained task (AST) Behavioral self-regulation: Head-Toes-Knees-Shoulders (HTKS) | Mindfulness and yoga produced significant increases in children’s behavioral and attention regulation. | Some concerns |
Razza 2015 [39] | Combined Yoga and Mindfulness: Daily practice included breathing and sun salutations during morning circle, yoga postures linked to literacy activities I the afternoon, and breathing exercises during transition periods. | Post-test | Certified yoga teacher in classroom | 25 weeks | Daily, average length of time increased gradually across the school year from 10 min per day to 30 min per day | Attention: AST Behavioral self-regulation: HTKS, Toy Wrap Task, Toy Wait Task Executive function: Pencil Tapping General Social-Emotional Functioning: Children Behavior Questionnaire (CBQ) | Mindful yoga produced significant benefits for young children’s self-regulation. | Moderate * |
Zelazo 2018 [45] | Complex: A variety of brief (e.g., 2 min) mindfulness and relaxation practices adapted for children and three EF-challenging games | Business-as-usual | Local teacher recruited from city and trained by researchers in unknown school location | 6 weeks (30 small-group sessions) | Daily, 24 min per session | Behavioral self-regulation: HTKS Executive function: Peg tapping, Minnesota Executive Function Scale (MEFS) Prosocial skills: Theory of Mind Scale General social-emotional functioning: Child Behavior Questionnaire (CBQ), Child Behavior Rating Scale (CBRS) | A brief small-group school-based mindfulness and reflection intervention produced significant improvements in executive function at follow-up (4 weeks post-test) compared to business-as-usual. | Some concerns |
Kim 2020 [36] | Complex: Key daily practices: 8-min guided Samatha meditation at 10 a.m. and nine daily mindfulness activities: Samatha meditation, loving kindness, yoga, gratitude and interconnection activities, kindness and compassion reported, feelings finder, Super Me, Are You Present for Me?, and Sole of the Little Feet | Business-as-usual | Teacher in classroom | ~2 years (with four waves of data collection) | Meditation and mindfulness-based activities incorporated into the school day at teacher’s discretion | Emotion regulation: Emotion Regulation Checklist (ERC) Prosocial skills: Modified Professional Behavioral Questionnaire (Mod-PBQ) General social-emotional functioning: Korean Personality Rating Scale for Children (KPRC) | Guided meditation + mindfulness-based activities resulted in significantly higher scores on lability/negativity, resilience, and prosocial behaviors at the second and third post-intervention assessments. There was no statistically significant difference between groups on adaptive regulation. | High |
Lemberger-Truelove 2018 [37] | Complex: 10 min SEL group kindness song and MBI breathing and movement activity, 20 min didactic instruction on SEL/MBI skill or practice, 10 min counselor encouraging participants to vocalize how they might apply the lesson, finally MBI breathing and movement activity | Business-as-usual | Trained counselor in classroom | 8 weeks (48 sessions) | 4 times a week, 40 min per session | Prosocial skills: inCLASS (Individualized Classroom Assessment Scoring System) Behavioral self-regulation: Child Observation Mindfulness Measure (C-OMM) | Mindfulness has a significant impact on self-regulatory outcomes such as task orientation and orientation to experience. There were no statistically significant results for measures of peer interaction, self-regulated attention, or teacher interaction. | High |
Jackman 2019 [35] | Complex: Seven daily practices: focused meditation, loving-kindness meditation, bell exercises, yoga, gratitude practice, kindness and compassion reporting, and feelings finder practices + supplemental learning activities for promoting prosocial behavior | Post-test | Teacher in classroom | 1 school year | Daily | Behavioral self-regulation: Head-Toes-Knees-Shoulders (HTKS) Executive Function: Behavior Rating Inventory of Executive Function–Preschool (BREIF-P), Go/No-Go | Children in both groups showed improved scores over time on the HTKS, go/no-go tasks, and meta-cognition. There were no changes in inhibitory self-control summary scale or the total GEC scale. Compared to the control group, children in the OM group performed better on the HTKS and showed decreased cognitive flexibility. There were no differences between the groups on the go/no-go task. | High |
Flook 2015 [34] | Complex: Mindfulness-based prosocial skills training aimed at cultivating attention and emotion regulation, with a shared emphasis on kindness practices (e.g., empathy, gratitude, sharing) | Wait-list | Experienced mindfulness instructors in classroom | 12 weeks (10 h of training total) | Twice a week, 20–30 min per session | Behavioral self-regulation: Delay of Gratification Task Executive Function: Dimensional Change Card Sort Task (DCCS), Sharing Task Prosocial skills: Teacher-Rated Social Competence (TSC) | The KC intervention group showed greater improvements in social competence and earned higher report card grades in domains of learning, health, and social emotional development, whereas the control group exhibited more selfish behavior over time. Effect sizes favored the KC group on measures of cognitive flexibility and delay of gratification. | Some concerns |
Carrozza 2019 [32] | Complex: As part of a mindfulness bibliotherapy intervention, teachers read books like “Visiting Feelings” “Peaceful Piggy Meditation” and used accompanying activities when provided. Teachers utilized lesson plans related to emotions as well as mindfulness. | Bibliotherapy | Teacher in classroom | 3 weeks (9 days total) | 3 days a week | Emotion regulation: Emotion Regulation Checklist (ERC) General Social-Emotional Functioning: Devereux Early Childhood Assessment for Preschoolers (DECA) | Mindfulness and bibliotherapy used in combination did not produces any effect on child outcomes | Serious * |
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Sun, Y.; Lamoreau, R.; O’Connell, S.; Horlick, R.; Bazzano, A.N. Yoga and Mindfulness Interventions for Preschool-Aged Children in Educational Settings: A Systematic Review. Int. J. Environ. Res. Public Health 2021, 18, 6091. https://doi.org/10.3390/ijerph18116091
Sun Y, Lamoreau R, O’Connell S, Horlick R, Bazzano AN. Yoga and Mindfulness Interventions for Preschool-Aged Children in Educational Settings: A Systematic Review. International Journal of Environmental Research and Public Health. 2021; 18(11):6091. https://doi.org/10.3390/ijerph18116091
Chicago/Turabian StyleSun, Yaoyao, Renee Lamoreau, Samantha O’Connell, Raquel Horlick, and Alessandra N. Bazzano. 2021. "Yoga and Mindfulness Interventions for Preschool-Aged Children in Educational Settings: A Systematic Review" International Journal of Environmental Research and Public Health 18, no. 11: 6091. https://doi.org/10.3390/ijerph18116091