Dance/Movement Therapy as an
Alternative Treatment for Young
Boys Diagnosed as ADHD:
A Pilot Study
This article is based on a pilot study concerning a short-term dance/
movement therapy (DMT) for two young boys with symptoms related
to Attention Deﬁcit Hyperactivity Disorder (ADHD). The aim was to
investigate the effect and value of DMT as an alternative treatment
and to describe the process. The DMT lasted ten sessions and took
place once a week during three months. In a case study multiple data
sources were used to triangulate the data and describe the DMT
process. The DMT has promoted a positive change to a certain extent.
Two hypotheses, which will be tested in a forthcoming study, are
generated from this study. DMT provided in paired groups for a
minimum of ten weeks will (1) improve the motor function and (2)
reduce the behavioural and emotional symptoms of boys aged 5–7
diagnosed with ADHD.
KEY WORDS: dance/movement therapy; ADHD; young boys; triangulation;
effect and process study.
American Journal of Dance Therapy
Vol. 27, No. 2, Fall/Winter 2005
2006 American Dance
Epidemiological studies show that about 20% of all children and youth
under the age of twenty suffer from mental handicaps such as
emotional or behavioural disturbances (Costello, 1989; Kazdin, 1993; Zill &
Schoenborn, 1990). Neuropsychiatric problems are so common and the risks
for abnormal mental health development and social maladjustment so
great that we may speak of a public health problem (Ofﬁcial Reports of
the Swedish Government, 1997:8). About 5% of the children in a normal
population have been diagnosed as suffering from Attention Deﬁcit
Hyperactivity Disorder (ADHD) (Target & Fonagy, 1996).
ADHD, according to The Diagnostic and Statistical Manual of
Mental Disorders, DSM-IV (American Psychiatric Association, 1994) is
a disruptive behavioural disorder with early childhood onset, charac-
terized by symptoms of inattention, hyperactivity and impulsivity. In a
review article, Barkley (2003) found that research in ADHD is begin-
ning to focus more on poor inhibition and deﬁcient executive func-
tioning (self-regulation) as being central to this disorder. ADHD is
associated with a variety of cognitive, psychiatric, educational, emo-
tional, and social impairments. Some of these are a consequence of
ADHD, while others may be associated conditions, arising from other
primary disorders that overlap with ADHD. There is a strong rela-
tionship, for example, between ADHD and motor-perception dysfunc-
¨& Gillberg, 1998). It has been estimated that 50% of all
children with ADHD have some type of motor dysfunction (Barkley,
1990) related to Developmental Co-ordination Disorder (DCD), (Amer-
ican Psychiatric Association, 1994).
Boys are overrepresented in almost all child neuropsychiatric disor-
ders and those with aggressive and destructive behavioural problems do
not receive adequate treatment (Swedish National Board of Health and
Welfare, 1997). There is strong evidence that genetic factors have a great
inﬂuence on the genesis of ADHD, but environmental factors are also
central (Swedish National Board of Health and Welfare, 2002). Land-
gren, Kjellman, and Gillberg (1998) found that lower socio-economic class
was associated with ADHD. The causal connections will best be ex-
plained by some kind of stress/vulnerability model, in which psychosocial
and biological factors interact (Assarsson & Hoffsten, 1997).
Psychodynamic treatment models with long-term therapy have been
applied to children for nearly a century. However, the circumstances
have changed. Resources today are primarily restricted to short-term
therapy yet children seem to have more complicated problems. To meet
these challenges, treatment models must adapt to individual needs and
the conditions in which children live (Eresund, 2002).
64 Erna Gro
¨nlund et al.
Child and adolescent psychiatry uses an eclectic approach, combining
medical treatment and a variety of psychotherapy methods in combina-
tion or in succession. Art therapies such as art, dance, drama, and music
therapy offer parents more treatment alternatives. For children with
ADHD, dance therapy may be the creative arts therapy of choice for
ADHD manifests somatically. Besides having the characteristic symp-
toms of inattention, hyperactivity and impulsivity, children with ADHD
usually have problems with body tensions, disturbed body image and
fragmented movement patterns. It seems logical, therefore, to attack the
problems through the body by working with breathing, rhythm and
movement. Also from a neurological point of view it is relevant to choose
dance and movement since:
Children with ADHD beneﬁt the most—more than any other disor-
der—from regular exercise, because movement exercises increase
dopamine in the human brain, just like the stimulus does (Barkley,
According to Dulicai (1999) the information discussed at a Consensus
Development Conference focused on the diagnosis and treatment of
ADHD has implications for research and clinical practice in dance/
movement therapy (DMT). In addition, to following the developments in
diagnosis and treatment of ADHD, Dulicai states that the control of
motor responses and the multiple biological bases for this disorder have
particular implications for dance therapy research. Dulicai emphasizes
that such research studies by dance therapists could greatly contribute to
the understanding of ADHD.
In a longitudinal study Gro
¨nlund (1994) described and evaluated
ﬁve years of DMT work with emotionally disturbed school children in
two special classes. DMT proved successful since, by simultaneously
processing both body and emotion, it had a two-pronged effect. The
study focused on the turning points that led to a positive change in
the treatment and the identiﬁcation of the curative factors. Another
¨nlund, Alm, & Hammarlund, 1999) demonstrated different
ways of using DMT with destructive children who could not modulate
Although qualitative studies report improvements related to DMT for a
variety of childhood disorders, Ritter and Graff Low (1996) note that the
effects of DMT for neuropsychiatric disorders in children remain unex-
plored. In that connection, we decided to start a program, consisting of both
the clinical and the evaluative. The purpose of the clinical work was to
examine and develop DMT as a treatment of support for boys diagnosed as
ADHD, thereby attempting to break a negative trend with risk for crimi-
nality (Barkley, 2003; Eresund, 2002; Teeter, 1998). As part of a larger
65Dance/Movement Therapy for ADHD
study, we started with a pilot, designed to identify and control possible
methodological problems and to generate hypotheses for the coming study.
Children with ADHD have problems relating both to adults and children.
Since they need help forming relationships, object relations theory pro-
vides a logical theoretical base for working with them. Concepts of special
importance include Winnicott’s (1971) ideas about the ‘‘transitional
space’’, the place where the psyche of the therapist and child can play
together, and ‘‘holding environment,’’ or the mother’s ability to provide a
secure place for the child. Additional concepts include Bowlby’s (1988)
‘‘attachment theory’’, where touch is of vital importance, Fonagy’s (1994)
ideas about the connection between disturbed attachment and low ability
of reﬂection, and Stern’s (1985) ‘‘affect attunement.’’
For Siegel (1984), it is obvious that children with early disturbances
have strong urges to move. Since most of these children have motor
problems, Schilder’s (1950) theories about body image and Reich’s (1972)
proposal about a link between personality and posture are also useful.
Reich shows that loosening up the body’s armouring and letting go of
muscular tensions releases emotions.
To understand the connection between motion and emotion Tomkin’s
(1991) affect theory is of great help. In dance therapy the connection
between motion and emotion is stressed (Berger, 1972). Chodorow (1991)
argues that dance therapy is involved with both the expression and
transformation of emotion. Nathanson’s (1987) theory of shame helps to
explain the destructive impulsivity that characterizes the behaviour of
children struggling with ADHD. The importance of focusing on the
healthy parts of the individual is maintained by Antonovsky (1987). He
points out that the ability to resist stress of life depends on our sense of
coherence. Since children with ADHD often suffer from low self-esteem,
dance therapy can provide the very avenue they need to (1) express their
strengths and personal resources and (2) transform underlying emotions
such as shame which lead to the destructive impulsivity that charac-
terizes their behaviour and coping methods.
Aims of the Pilot Study
The overarching objective of the pilot study
is to investigate the effect
and value of dance therapy as an alternative treatment for aggressive
The Committee of Ethics at Karlstad University approved the study.
66 Erna Gro
¨nlund et al.
and destructive young boys that show symptoms related to the DSM-IV’s
ADHD criteria. The speciﬁc aims are to
•evaluate movement and socio-emotional changes;
•measure changes in mental health with focus on strengths as well
•evaluate motor development/problems before and after dance
movement treatment and describe the DMT process.
The pilot study will also
•identify and control the methodological problems;
•generate hypotheses for the future study.
DMT: The Clinical Component
DMT for children build on the joy of movement and lust for life. Gro
(1994) found that when children are inspired to have fun together in a
group they can more easily share problems and even show compassion.
Sherborne’s model of creative dance for the special child speaks to the
premises and clinical approach of the study.
Creative dance and movement can enable the children to rebuild a
healthier connection with the body, senses and cognitive skills,
improving body awareness and body image. It can help to give chil-
dren a ‘sense of wholeness’ by connecting body, mind and emotions
(Sherborne, 1990, p. 23).
Siegel’s (1984) emphasis on insight and verbalization to make it easier to
integrate the nonverbal expression were also vital elements of the clinical
component. Thus, ‘‘small talks’’ about important topics aimed during every
session to help the children better understand their problems.
Subjects for the whole project were 5–7 year-old boys of average intelli-
gence who met the diagnostic criteria for ADHD according to DSM-IV.
Although recruited by medical doctors and psychologists from one clini-
cal department of child and adolescent psychiatry, the boys were not
psychotic. The pilot group, consisted of two six-year-old boys who both
fully met the criteria for participation. They started school and DMT at
67Dance/Movement Therapy for ADHD
the same time. They were not on medication and did not attend any other
form of intervention during the treatment period. Both boys were present
at all sessions.
Characteristics of the DMT in the Pilot Study
The DMT consisted of ten 40 minute sessions, which took place once a
week across a period of three months. The sessions took place in the clinic
in a room especially arranged for dance therapy. It had a thick carpet, and
enough space for running and jumping. In one of the corners there was a
pile of cushions. A video camera was installed in the ceiling in one corner of
the room. A mirror on one of the walls was covered by a curtain. On another
wall there were lots of props in beautiful colours. The tape-recorder and
tapes were in the back of the room. No interruptions from outside were
allowed. Two dance therapists together led the DMT in the pair group.
Why ‘‘pair groups’’ and why two therapists? That is indeed an unusual
way to work in psychotherapy. Most boys with ADHD who attend the
child and adolescent psychiatry, receive individual treatment because
they are extremely hard to handle. However, they are also unable to play
or work in groups with other children. We thought that the boys needed
group-training to be prepared for school. To have a better chance of suc-
cess we decided to try DMT in pair groups, a modiﬁed form of group
therapy to learn social skills such as cooperation. Because early treatment
is important in trying to obstruct later maladjustment and criminality
(Barkley, 2003; Eresund, 2002; Teeter, 1998), we decided to concentrate
on young boys who have not yet started or who have just started school.
We thought that working with DMT, even with just two boys in a
group, might sometimes be too hard for only one therapist. For example,
it might be necessary to physically hold a boy who panicked. Therefore,
we decided to engage two dance therapists as leaders. Although expen-
sive this pair group model gave the researchers two perspectives.
The dance therapists met their supervisor once a week to discuss
process, plans for coming sessions, and countertransference. They also
danced together. Siegel accentuates that
It is particularly important for dance therapists to deal with their
countertransferences, because the bodily and affective moving with
another person resonates much more strongly in dance therapy than
in verbal therapies (Siegel, 1995, p. 125).
The DMT, short term, supportive, and goal directed, had distinct rules
and strict boundaries such as not hurting anyone or anything and not
leaving the room during sessions. After setting goals, both for the
68 Erna Gro
¨nlund et al.
group and for each child, a program was planned. The program was
well structured but the dance therapists were free to leave the struc-
ture and just follow the children. To establish trust and create a safe
‘‘transitional space’’ (Winnicott, 1971) the session started and ended
each time with the same rhythmic exercise. Sitting in a ring on the
ﬂoor they clapped hands and sang greetings of welcome or good-bye.
The therapists made eye contact and addressed each boy by name.
Then there was a quick warm up, in a fast tempo, to tire the hyper-
active boys, followed by a relaxation pause to calm the boys down. The
dance therapists massaged the boys’ tense necks and shoulders to help
them loosen their muscular tensions (Reich, 1972) and relax enough to
speak about their personal problems. Sometimes there was also room
for teaching small dances. To help the two boys ﬁnd a balance between
internal and external reality (Winnicott, 1971), the dance/movement
therapists grounded the boys by focusing on the concrete at the end of
Design of the Pilot Study
The study employed an emergent design that entails simultaneous data
collection and analysis. It is both an effect and process study which uses
multiple methods. The use of multiple methods to collect and interpret
data about a phenomenon is one type of triangulation. To use different
theoretical perspectives is another. We used both types of triangulation
in this study. Denzin (1971) concludes that triangulation, though difﬁ-
cult, is deﬁnitely worth doing, because it makes the data and ﬁndings
credible and the uncertainty of the interpretations is greatly reduced.
The data presented as case study illustrate the use of DMT and
evaluate changes in hyperactive boys. The case study’s greatest strength
is the simultaneous consideration of multiple factors. Chaiklin (2000)
maintains that case studies which do not create experimental conditions
or use probability statistics, but adhere, nevertheless, to scientiﬁc
methods are major tools for DMT researchers.
No other form of research allows you to simultaneously see the whole
and the parts or to move the parts around to create different combi-
nations (Chaiklin, 2000, p. 48).
Berrol (2000) notes that experimental designs involving statistical pro-
cedures are sometimes viewed as inappropriate to a process-oriented
form such as DMT. The subjective may be an asset in research, a way of
capturing the unique in man. Berrol claims that
69Dance/Movement Therapy for ADHD
both scientiﬁc quantitative and phenomenological qualitative inquiry
are needed for a comprehensive view of DMT in terms of what it is,
what it does or can do, and of special import, how it works (Berrol,
2000, p. 33).
Both quantitative and qualitative methods are used. Thus the study has
a quasi-experimental approach and a repeated-measures design. The
effectiveness of the treatment is expected to show the differences be-
tween each participant’s pre-test and post-test measurements (Cruz &
Measures included: an original self-designed socio-demographic ques-
tionnaire, the Strengths and Difﬁculties Questionnaire (SDQ), a self-
administered behavioural scale (parent version) and the Movement
ABC Motor Test. Data included the dance therapists’ participant
observations, videotapes of the DMT sessions, and interviews with the
Strengths and Difﬁculties Questionnaire (SDQ) is a behavioural
screening questionnaire developed by Goodman (1997). The SDQ is
available in over 30 languages and is widely used in epidemiological,
developmental, and clinical research. Goodman and Scott (1999) showed
that the SDQ provides a useful measure of inattention and hyperactivity.
Either the parents or the teachers of children and teenagers (by them-
selves) aged between 4 and 16 can complete the informant-rated version
of the SDQ (Goodman, Meltzer, & Bailey, 1998). We used the parent
version. It is a twenty-ﬁve-item ordinal scale with ﬁve subscales of ﬁve
items each: Hyperactivity scale, Emotional Symptoms scale, Conduct
Problems scale, Peer Problems scale and Prosocial scale. The scoring of
SDQ is in a 0,1,2 format for ‘‘Not true’’, ‘‘Somewhat true’’ and ‘‘Certainly
true’’ responses. Five items are reverse scored. The scores for hyperac-
tivity, emotional symptoms, conduct problems and peer problems can be
aggregated to generate a total difﬁculty score ranging from 0 to 40. In the
parent version a score of 0–13 deﬁnes normal, 14–16 borderline and 17–
40 abnormal (Goodman, 1997). The prosocial score is not incorporated
since the absence of prosocial behaviour is conceptually different from
the presence of psychological difﬁculties. The prosocial subscale, range
0–10, measures an aspect of social competence and the higher the score
The SDQ has ﬁve items that examine the need for psychiatric help,
the impact rating. The most straightforward system for scoring impact
adds the scores for the distress plus social incapacity items, using a ‘‘0, 1,
70 Erna Gro
¨nlund et al.
2, 3’’ scale for each item (0 = not at all, 1 = only a little, 2 = quite a lot,
3 = a great deal). The impact rating ranges between 0 and 15 with a cut-
off point of 5. The burden rating is calculated from the response to the
burden question rated on a 4-point scale with a range of 0 to 3. The cut-off
point is 1 (Goodman, 1999).
The Movement ABC motor test, published in 1992 (Henderson &
Sugden, 1992), is a screening test that assesses motor function in chil-
dren 4–12 years old. The test can be used (a) as a normative test, (b) for
clinical exploration, and (c) as a measure of the capacity for improve-
ment. The reason for choosing the Movement ABC motor test was to use
it for measuring the capacity for improvement after DMT. The test has
four age bands: 4–6, 7–8, 9–10, and 11–12 years, each with eight items.
The difﬁculty level of the tasks varies with age, but each child performs
(a) three activities requiring manual dexterity, (b) two tasks requiring
ball skill and (c) three balance tasks. Each item is scored 0–5. The
maximum total score is 40 with the higher scores indicating lower motor
competence (Pless, 2001).
In addition to the quantitative data, there is also a qualitative ele-
ment. For every item in the test, the assessor is encouraged to record how
the child performs by using a series of descriptors (Barnett & Henderson,
1998). There is also a guide to behavioural factors (13 factors) that may
inﬂuence motor performance e.g. timidity, fear of failure.
Both Movement ABC and the earlier version Test of Motor Impair-
ment (TOMI) have been tested for reliability and validity in several
studies with acceptable results (Henderson & Sugden, 1996).
The parents completed a socio-demographic questionnaire with questions
about family situation, age, education and occupational status before
DMT started and the SDQ before and after the full course of treatment. A
trained physiotherapist, the third author, administered the Movement
ABC Test before and after DMT.
The parents were interviewed before and after DMT and also two
years later in a follow-up interview. The researcher in health care did
the initial interview. The researcher in DMT joined her colleague for the
second interview after the DMT was completed. The origins of the
questions and the questions themselves varied. Some came from an
interview guide. Others asked the respondent to reﬂect on dance therapy
and on comments the respondent had made in previous interviews. The
qualitative interview, as described by Starrin and Renck (1996) and
Kvale (1997), was used.
71Dance/Movement Therapy for ADHD
The dance therapy process was documented on videotape. Each ses-
sion was ﬁlmed. That was of great help in the supervision. That also
made repeated detailed analysis of the therapeutic process possible. The
dance therapists’ observations supplemented the video documentation.
The audio-taped interviews were transcribed verbatim. Since the pur-
pose of the videotaping each session in its entirety was for supervision,
the 400 minutes, were edited down to a workable size of approximately
two hours. The researcher in dance therapy and the chief technician at
the University College of Dance cut the unclear and inaudible sections
and any unnecessary repetitions. The purpose was to get a fair picture of
the whole process capturing the speciﬁc traits of the development for
each boy. The abbreviated videotape was repeatedly analysed in relation
to attention, activity, impulsivity, movement changes, socio-emotional
changes, interactions and motor development. Self-esteem was also
As a strategy for qualitative data analysis we used content analysis, to
test theoretical issues to enhance understanding of the data (Cavanagh,
1997). The data from the interviews were also used for interpretations,
discussions and conclusions.
Results presented as case studies describe the two boys’ development in
the DMT process.
Tom, aged 6, an only child diagnosed with ADHD/DCD, lives with his
thirty-nine year old mother. Diagnosed as an adult as having ADHD,
Tom’s mother has some postsecondary education, unemployed, and lives
on a temporary disability pension. Tom’s father is a drug addict. The
parents separated when Tom was two years old. Tom seldom meets his
Tom’s mother brought Tom to child psychiatry because she was con-
cerned about his hyperactivity and aggressive behaviour. Early on, Tom’s
mother knew that something was wrong. The boy could not sit still and
72 Erna Gro
¨nlund et al.
often burst into ﬁts of rage. He was strong willed, had to control everything,
especially his mother and could not tolerate change. Tom’s mother said
There were no problems during his ﬁrst year but when he was one
year old all the problems started. He never slept a whole night, he
could wake up at two o’clock and scream hysterically. He stopped
sleeping in the middle of the day when he was one year old.
When Tom was four years old, he had his ﬁrst contact with child psy-
chiatry and was diagnosed as ADHD/DCD. Tom’s hyperactivity is de-
scribed in terms of lack of patience and an extremely quick tempo. His
motor difﬁculties were apparent in the playground. Tom did not have
friends because other children were afraid of his aggressive outbursts.
His impulsivity had escalated. The psychologist who had tested him re-
ferred Tom to DMT when he was six years old.
Movement and language
Although Tom is in constant motion, he is a clumsy child with low tonus
who often stumbles over his own feet. Gross motor ability, balance, and
coordination are all poor. Very tense, particularly in his neck and
shoulders, he primarily uses stiff and controlled movements that can be
stopped at any moment, according to Laban’s concept of ‘‘bound ﬂow’’
(Laban & Lawrence, 1947). His movements are not directed and some-
times give a fragmented impression. He also has language difﬁculties
and childish intonation that makes him sound younger than his chro-
nological age. Despite his immature movement and language, he has a
good sense of rhythm. He is also fond of music.
Tom is shy, does not make eye contact, or express feelings other than fear
and aggression. He acts out but does not direct his anger. Afraid of
failure, he refuses to try new activities and is a bad loser. However, he
can also be friendly and affectionate. He developed a good relationship
with the dance therapist who focused her attention on him.
Table 1 shows no difference between SDQ Total Difﬁculties pre- and
post-test and the scores after dance therapy are still at an abnormal level
with the impact rating of 10 suggesting that Tom’s problems continue to
affect his daily life. Not surprisingly, Tom’s mother’s burden rate
remains at the highest level. The prosocial behaviour subscale score has
73Dance/Movement Therapy for ADHD
not been changed. The score 5 (borderline-score) suggests that despite his
high impact score, Tom has some degree of social competence.
The quantitative data/total score of Movement ABC shows a positive
change after DMT. Tom’s improvements in motor skills include manual
skills, ball skills and dynamic balance. See Table 2. The qualitative
Behavioural and Emotional Symptoms in Two Cases Measured with
the Strengths and Difﬁculties Questionnaire (SDQ) before and after
Case 1 Case 2
Pre-test Post-test Pre-test Post-test
SDQ Total Difﬁculties* 24 24 23 16
Hyperactivity 9 9 10 7
Emotional symptoms 7 6 5 3
Conduct problems 6 6 5 2
Peer problems 2 3 3 4
Prosocial behaviour** 5 5 7 7
Impact rating*** - 10 10 4
Burden rating**** 3 3 3 3
Note: The Informant-rated parent version of SDQ was used.
*SDQ Total Difﬁculties score range 0–40 (normal 0–13, borderline 14–16, abnormal 17–40).
**Prosocial behaviour range 0–10 (normal 6–10, borderline 5, abnormal 0–4).
***Impact rating range 0–15.
****Burden rating range 0–3.
Motor Function in the Two Cases Measured with the Movement ABC
Motor Test before and after Dance/Movement Therapy
Movement ABC motor test
Case 1 Case 2
Pre-test Post-test Pre-test Post-test
4–6 years 4–6 years 4–6 years 4–6 years
Total score 18.5 7.0 3.5 0
Manual skills 7.5 3.0 2.5 0
Ball skills 8.0 4.0 0 0
Static and dynamic balance 3.0 0 1.0 0
Note: Movement ABC Motor test, total score range 0–40 (Manual skills 0–15, ball skills 0–10,
static and dynamic balance 0–15).
Higher scores indicate lower motor competence.
74 Erna Gro
¨nlund et al.
elements, how Tom performs the tasks, show that the remaining difﬁ-
culties are not as obvious—an improvement in relation to the number of
observations. Regarding the thirteen behavioural factors, there has been
an improvement. Tom is not as timid as before and he can better organise
his ability. He has more staying power and higher spirits. His concen-
tration has improved and he is less impulsive.
Interview with Tom’s Mother after DMT
Tom’s mother reports that Tom is still rather clumsy even if he has better
balance. But Tom has learned
to be more patience and listen ... he has learned to wait. I think that
dance therapy has been very good to him. He is not quite as angry as
before. He has become friendly.
His mother says that Tom now sleeps better at night and has fewer
nightmares. However, he still has aggressive outbursts, but they occur
less frequently. He has learned to play with other children without get-
ting in conﬂict all the time and relates better to adults. Tom’s mother was
astonished that Tom never hesitated to follow the dance therapists in
spite of the fact that mother was not there with him. Tom’s mother
noticed that after the dance therapy sessions Tom was relaxed in a way
that was not possible before. Tom was so exhausted that he sometimes
fell asleep in the car. That had never happened before. His mother told us
that dance therapy obviously was important to Tom, because when she
asked him to tell her what they were doing in the dance therapy Tom
said: ‘‘I won’t tell you, that’s private’’.
I think that Tom needed dance therapy for a longer period...but even
if Tom had dance therapy just for a short period, I still think that
dance therapy has helped.
Tom’s mother was pleased that the DMT was in a pair group, which
allowed Tom to play with another boy in a secure situation. She could see
that Tom had developed socially. Both Tom and his mother were sad
when the dance therapy ended.
In a follow-up interview, two years after DMT, Tom’s mother told us
that Tom still has problems in school, but he has an understanding
teacher, who helps him. The teacher says that Tom concentrates better
and his relationships are acceptable. However, Tom still has outbursts at
home. Not surprisingly, Tom’s mother wanted him to receive more DMT.
75Dance/Movement Therapy for ADHD
Peter, aged 6½, diagnosed with ADHD, not DCD, lives with his mother,
age 32, father, age 37, and a sister two years older than he. Both parents
had postsecondary education and were regularly employed.
Peter’s parents brought him to child psychiatry when he was nearly
six years old. He was hyperactive, aggressive and lacked concentration.
At the day nursery Peter often came into conﬂict with other children,
who were afraid of his sudden temper tantrums and therefore, avoided
him. However, Peter’s mother tells us that she had noticed that Peter
had certain problems during infancy:
He was just a baby when I understood that something was wrong ...
he didn’t sleep and he was never satisﬁed. I could handle Peter during
the early years but the situation got worse. As long as we had to ﬁght
with his hyperactivity I thought it was okay, then we just had to set
limits for him. But when he became so tremendously aggressive and I
felt that he completely lost control then I felt that we could not handle
him on our own. We needed help—professional experts to talk to.
Peter appears tough, but according to his mother, he is a scared little boy,
afraid of many things such as crowds. He has panic anxiety, is afraid of
change, and needs to control everything, especially his mother. He
cannot play with other children if he is not the leader who decides
everything. He is strong and quick to use his ﬁsts. The psychologist who
had tested him referred him to DMT when he started school.
Movement and language
Peter has ﬁne gross motor ability, good balance, and he can climb high
and do several summersaults in a row. Hyperactive and in constant
motion, he runs and jumps at high speed, babbling at the same time.
His language is rather good. Peter cannot sit still at all. When running
he attacks the room furiously; when jumping, climbing high, or
throwing himself on to the ﬂoor, he has no fear. Although well coor-
dinated, he is seldom relaxed and has tensions in his neck and
shoulders. Yet he can engage both spontaneous, free ﬂowing movement
and more controlled, bound movement (Laban & Lawrence, 1947).
Peter’s basic motor skills are ﬁne. His problems are related to modu-
lating time and intensity.
Peter shifts between acting omnipotent and complaining that he is a
complete failure. He is afraid of trying new activities and cannot stand to
76 Erna Gro
¨nlund et al.
lose. He has a good imagination and responds well to attention, positive
feedback, and physical play.
For Peter there has been a progress of change. SDQ Total Difﬁculties de-
clined from 23 to 16 after the DMT. The hyperactivity score, emotional score
and conduct problems scores have dropped, which is a progress. The pro-
social behaviour subscale remained normal. That the impact rating declined
from 10 to 4 suggests that Peter’s problems do not appear to be affecting his
daily life, yet his mother still feels the burden of parentinghim. See Table 1.
For Peter the total score on Movement ABC indicates a change after
DMT, however his original scores did not suggest poor motor competence.
See Table 2. The qualitative elements, how Peter performs the tasks in
the test show, nevertheless, that though there are still problems, there
has been an improvement over time. Analysis of the thirteen behavioural
factors show improvement in hyperactivity, organization and the ability
to estimate one’s own capacity. Impulsiveness to a certain degree and
undesired movement are still present.
Interview with Peter’s mother after DMT
Peter’s mother tells us that before DMT, when playing Peter wanted to
be the leader all the time. Now he can play more constructively on equal
terms with other children. Peter is not as tense and stressed as before.
However, his need for control is still there as are his problems with
change. She notes that
last autumn he was very angry and he furiously hit everybody in the
family and his friends. Today he doesn’t hit us at all but he can still
threaten us. However, he has learnt to stop his anger before an out-
burst ... I have also noticed that Peter is more concerned about other
That the two boys have not been competing is astonishing because Peter
always wants to be number one. He is rather good at running, jumping
and climbing and he has good balance. Peter is also older than Tom so it
is surprising that he has not been competing with Tom.
As I see it ... that depends on the fact that Peter cares for Tom and
doesn’t want Tom to be a sad loser. A kind of friendship has developed
between the two boys.
77Dance/Movement Therapy for ADHD
She also tells us that Peter has been very fond of going to dance therapy,
although he has not said anything about the sessions. When driving
home after the session he remained silent in the car.
According to Peter’s schoolteacher, Peter is not as hyperactive in
school. A couple of months before DMT started Peter could not sit still for
more than ten minutes before he rushed out of the classroom. Today he
can sit still and listen with concentration for the whole hour. He can also
wait for his turn, and does not have to get his needs fulﬁlled immediately.
In the follow-up interview, Peter’s mother told us that Peter really
missed the DMT. However, she also told us that there had been many
ups and downs for Peter. During the ﬁrst year after DMT, she noticed a
remarkable positive change. Peter’s everyday life and school situation
were under control. His relationship to other children was fairly good.
But gradually the situation got worse, both at school and at home. He
appeared confused and neither parents, teachers nor his peers, could
understand him. Peter became depressed and self-destructive with sui-
cidal thoughts. He had to take an antidepressant. Since DMT had helped
Peter, the parents turned to the clinic with their request for more DMT,
but their request was rejected. The project had ended and the clinic did
not have any resources. A year later, at the time of the interview, Peter
had recovered. He was not on medication and the parents did not feel as
The results of this pilot study have generated the following hypothe-
ses for a coming study:
1. Dance/movement therapy provided in paired groups for a minimum
of ten weeks will improve the motor function of young boys aged
5–7 diagnosed with ADHD.
2. Dance/movement therapy provided in paired groups for a minimum
of ten weeks will reduce the behavioural and emotional symptoms
of young boys aged 5–7 diagnosed with ADHD.
Analysis of the DMT process
The Phases of the Dance Therapy
The DMT process divided into three phases: the initial phase (sessions
1– 3), the middle phase (sessions 4–8) and the ﬁnal phase (sessions 9–10).
The initial phase, designed to create a ‘‘conﬂict-free sphere,’’ (Hart-
mann, 1958), emphasized the boys’ strengths, countering the potential
for revealing weaknesses and shame, feelings which can lead to either
aggression or depression (Nathanson, 1987). When the boys eventually
dared to try something new, the dance therapists gave them positive
78 Erna Gro
¨nlund et al.
feedback. That enabled the boys to become aware of their own resources,
increasing their self-esteem. During this phase the dance therapists were
directive, followed the program to maintain boundaries, and engaged
mirroring and movement empathy to build trust and the therapeutic
relationship. The contact was rapid. Each boy had their ‘‘own’’ therapist.
During this initial phase the boys played primarily with their therapists,
rather than with one another.
The middle phase, characterized by the children’s feelings of increased
security and familiarity, allowed the dance therapists to be non-directive,
following the boys’ creative ideas and improvisations, thereby helping the
children to explore their movement potential and develop their fantasy in
playing. Focus was on improving the boys’ body awareness and body
image to give the boys a sense of wholeness (Sherborne, 1990). Now the
boys were not especially dependent on having the same therapist. They
seemed comfortable with both therapists. In the middle phase the boys
started to play more together. Verbal sharing was more frequent (Siegel,
1984). By encouraging the boys to support one another, the therapists
created a friendly atmosphere. Each boy seemed happiest when getting
positive feedback from his peer.
The ﬁnal phase—separation—highlighted the boys’ growth and
development. The boys turned again at times to their ‘‘own’’ therapist, but
now they connected in a more self-dependent contact. Cooperation
between the boys continued to develop and it was now obvious that they
had learned to share their conﬂicts and fears. By the end, they could even
show compassion for one another, both by helping one another and by
sharing problems and sorrows. This was a major step towards de-centring,
and becoming more interpersonally aware.
Structure of the Dance Therapy
The Dance/Movement Therapists
The dance therapists were physically active in playing and dancing. By
doing so, they reduced the chaos triggered by these highly anxious young
boys who could not control their impulses. Sometimes it was necessary to
hold a boy physically when he was frantic. Later on, it was possible for
the therapists to be more passive in the dance, to sit beside and just
comment on how the boys were playing and dancing together. Then the
therapists were active in listening and giving feedback.
Having two leaders was an advantage. The boys could choose the
therapist whose personality best suited them at a particular time. This was
especially important because each boy had strong needs to be seen all the
79Dance/Movement Therapy for ADHD
time. With two therapists present, they could have the attention they
required, avoiding competition and jealousy, as well. Further, it also
showed that a group with two boys and two therapists can deftly play
Music of all kinds provided structure, overriding occasional expressions
of resistance. The dance/movement therapists created challenging, non-
competitive movement exercises with varying tempos that called for turn
taking, turn yielding, and problem solving. At times, the therapists
removed music from the process to give the boys opportunities to expe-
rience stillness in contrast to motion.
The creative use of props such as pillows, balloons and a large gymnastic
ball gave the boys concrete opportunities to develop visual perception,
accurate body image, and balance. Sitting on assigned pillows provided
concrete, opportunities to learn about personal space. When playing with
balloons the boys used different parts of their bodies to toss the balloons.
Standing on top of the gymnastic ball required good balance. Props also
DMT Objectives and Related Methods
Objectives for the boys Methods
Build trust, structure and security Provide structure, e.g. begin
and end in the same way with
a rhythmic exercise, music of
all kinds (classical, folk, pop,
compositions for children
Respect for personal space Assign special spaces on
cushion selected by the child
Cooperate and help one another,
non- aggressive problem, solving
Impulse control, increase patience Introduce exercises that involve
turn-taking and turn yielding
Relaxation to foster physical release
and verbal expression
Massage (necks, shoulders,
and backs); breathing exercises
Develop visual perception,
accurate body image, and balance
Props such as balloons,
large gymnastic ball
Creative and appropriate expression
of frustration and aggression
Large gymnastic ball
80 Erna Gro
¨nlund et al.
helped the boys grow emotionally. Being permitted to handle the ball as
hard as they could, provided an outlet for aggression and frustration.
Yet, they also understood that physical violence against themselves or
others was not allowed. The boys ridded themselves of aggression with-
out hurting anyone.
The sessions also included periods of relaxation that incorporated
massaging the boys’ tense necks, shoulders and backs and breathing
exercises. Conversation emerged during these quieter times, covering
themes important to the boys, such as longing for a friend, how to handle
pet-animals without being destructive, shame of not being as clever as
other boys and fear of being abandoned.
The study suggests that a dance movement therapy program for
young boys with ADHD should address fundamental movement skills
before attempting to address the concomitant behavioural and emotional
symptoms. Coherence at the body level appears to set the stage for
Although Kazdin’s (2000) review of the literature suggests that cognitive
behavioural therapy is the only successful approach to working with
aggressive boys who have behavioural problems, Eresund (2002) found
that boys with severe conduct disorders beneﬁted from psychodynami-
cally oriented supportive play therapy. This pilot study supports Eres-
und’s perspective, however, this study focused on the use of dance
therapy rather than play therapy.
The study’s primary purpose, investigating the effect and value of
dance therapy as an alternative treatment for young boys with symptoms
related to ADHD, also generated hypotheses for a coming larger study.
Although dance therapy only partly reduced the behavioural and emo-
tional symptoms of the boys, it had, however, a positive effect on the
motor function of both boys. Therefore one can suggest that attention to
kinaesthetic coherence or motor coordination may be the stepping stone
to the successful treatment of young boys diagnosed with ADHD.
ADHD presents life-long challenges. DMT can only reduce and relieve
symptoms. According to Pelham (1993) when children with ADHD have
completed treatment, independent of treatment model, the problems
often recur. The parents could see differences in their sons before, during
and after DMT. Since they had noted the positive changes DMT had on
their sons, it was natural that, when the boys had relapses, they ex-
pressed their request of repeated DMT. Another important positive point
is that DMT gives boys with ADHD a possibility, like other children, to
have an activity outside school, which increases a child’s quality of life.
81Dance/Movement Therapy for ADHD
This study only allowed for ten dance therapy sessions, but it did so in
a unique approach which we call the paired group in a one-to-one ratio
between therapist and child. The results suggest that short-term dance
therapy treatment in a paired group setting produces positive results,
but with two subjects, the study can only be viewed as hypothesis
generating. Questions for the larger study to consider include the length
of dance therapy, and the efﬁcacy, feasibility and cost effectiveness of
paired group therapy.
As in all research on human beings the concept of having control groups
raises a spectrum of questions ranging from the ethical to the practical.
Studying children in child and adolescent psychiatry magniﬁes them.
Besides having to attend to the fundamental conundrum of whom to
deprive of treatment, researchers must deal with limited numbers,
families who lack motivation, and the uncontrollable variables associated
with child development. A quasi-experimental study design where there
is a lack of control groups that employed triangulation was the alterna-
tive. Triangulation countered the variables that might have confounded
the study and ensured that the data could be interpreted from different
angles, thereby improving validity.
Treatment or management of ADHD also develop the parents’ and the
teachers’ ability to handle the problems (Teeter, 1998). One obvious
limitation of the study was that we had no contact with the boys’
teachers. We had to rely on the answers we got from interviewing the
parents to get information about how the boys managed at school. The
forthcoming study will include the teachers’ perspectives on the children.
Although the study cannot specify what role DMT played in the boys’
progress, it is reasonable to suggest that DMT has been of importance,
and that motor coordination may be a vital building block in the
treatment of ADHD.
Knowing where to start from, e.g., building motor coordination in
children struggling with ADHD, is especially important in Swedish
schools today. Special needs pupils, who have only limited resources for
individual support (The National Agency for Education, 2004), must
take more responsibility for their own studies, sit in fairly noisy classes
where different grades are integrated, and work in groups and with
projects that challenge their problems with concentration and
By stimulating the joy of movement and creative playing, the study
showed that DMT could give the two boys, perhaps for the ﬁrst time, the
pleasure of playing and dancing together with a peer. By focusing on the
82 Erna Gro
¨nlund et al.
boys’ strengths and inner resources their self esteem and quality of life
improved (Antonowsky, 1987). However, the positive results are vul-
nerable as the problems with ADHD recur without continued interven-
tion (Barkley, 2004; Pelham, 1993). Therefore, children with ADHD
should be offered DMT for extended periods of time and repeatedly if
This work was supported by grants from Sunnerdahl Foundation, the
´n Foundation, the Swedish Inheritance Fond, the County Council of
¨rmland and the University College of Dance, Stockholm. The authors
gratefully acknowledge the grants. Thanks are also due to the Swedish
National Association for Social and Mental Health for support and
American Psychiatric Association (APA) (1994). Diagnostic and statistical manual of mental
disorders (4th ed.). Author, Washington, DC.
Antonovsky, A. (1987). Unraveling the mystery of health. How people manage stress and
stay well. San Francisco, CV: Jossey-Bass Publishers.
Assarsson, N., & Hofsten, G. (1997). Familjeterapi fo¨r barn med neuropsykiatriska
handikapp. En utva¨rdering. [Family therapy in children with neuropsychiatric handicap.
An evaluation], Omsorgsna
¨mndens rapport 97:08, Stockholm.
Barkley, R. A. (1990). Attention deﬁcit hyperactivity disorder: A handbook for diagnosis and
treatment. New York: Guilford Press.
Barkley, R. A. (2003). Issues in the diagnosis of attention-deﬁcit/hyperactivity disorder in
children. Brain & Development,25, 77–83.
Barkley, R. A. (2004). Video documentation of a lecture with the title: ADHD in Children
and Adolescents: Nature, Diagnosis and Management, Sinus AB. Polstja
May 5, 2004.
Barnett, A. L., & Henderson, S. E. (1998). An annotated bibliography of studies using the
Tomi/movement ABC: 1984–1996. London: The Psychological Corporation.
Berger, M. R. (1972). Bodily experience and expression of emotion. Monographs of the
American Dance Therapy Association, 191–230.
Berrol, C. F. (2000). The spectrum of research options in dance/movement therapy.
American Journal of Dance Therapy,22(1), 29–46.
Bowlby, J. (1988). A secure base: parent–child attachment and healthy human development.
New York: Basic Books.
Cavanagh, S. (1997). Content analysis: concepts, methods and applications. Nurse
Chaiklin, H. (2000). Doing case study research. American Journal of Dance Therapy,22(1),
Chodorow, J. (1991). Dance therapy and depth psychology. London: Routledge.
Costello, E. J. (1989). Developments in child psychiatric epidemiology. Journal of the
American Academy of Child and Adolescent Psychiatry,28, 836–841.
83Dance/Movement Therapy for ADHD
Cruz, R. F., & Sabers, D. L. (1998). Dance/movement therapy is more effective than
previously reported. The Arts in Psychotherapy,25(2), 101–104.
Denzin, N. K. (1971). The logic of naturalistic inquiry. Social Forces,50, 166–182.
Dulicai, D. (1999). Special report: The National Institutes of Health Consensus Develop-
ment Conference on Diagnosis and Treatment of Attention Deﬁcit Hyperactivity
Disorder, November 16–18, 1998. American Journal of Dance Therapy,21(1), 35–45.
Eresund, P. (2002). Att behandla sto¨rande beteende. Metodutveckling i barnpsykoterapi
[Treating Disruptive Behaviour. Development of technique in child psychotherapy].
Dissertation. Department of Education, Stockholm University.
Fonagy, P., & Target, M. (1994). The efﬁcacy of psychoanalysis for children with disruptive
disorders. Journal of American Academy Child Adolescent Psychiatry,33(19), 45–55.
Goodman, R. (1997). The strengths and difﬁculties questionnaire: A research note. Journal
of Child Psychology and Psychiatry,38(5), 581–586.
Goodman, R., Meltzer, H., & Bailey, V. (1998). The strengths and difﬁculties questionnaire:
A pilot study on the validity of the self-report version. European Child & Adolescent
Goodman, R. (1999). The extended version of the strengths and difﬁculties questionnaire as
a guide to child psychiatric caseness and consequent burden. Journal of Child Psychology
and Psychiatry,40(5), 791–799.
Goodman, R., & Scott, S. (1999). Comparing the strengths and difﬁculties questionnaire and
the child behavior checklist: Is small beautiful? Journal of Abnormal Child Psychology,
¨nlund, E. (1994). Barns ka¨nslor bearbetade i dans. Dansterapi fo¨r barn med tidiga
sto¨rningar [Children’s Emotions Processed in Dance. Dance Therapy for Children with
Early Emotional Disturbances]. Dissertation. Department of Education, Stockholm
¨nlund, E., Alm, A., & Hammarlund, I. (Eds.). (1999). Konstna¨rliga terapier. Bild, dans
och musik i den la¨kande processen [Art Therapies: Art, dance and music in the healing
process]. Stockholm: Natur och Kultur.
Hartmann, H. (1958). Ego psychology and the problem of adaptation. New York:
International Universities Press.
Henderson, S. E., & Sugden, D. A. (1992). The movement assessment battery for children.
London: The Psychological Corporation.
Henderson, S. E., & Sugden, D. A. (1996). Movement ABC. Manual. Ro¨relsetest fo¨r barn.
[Movement ABC. Manual Movement test for children]. Stockholm: Psykologifo
¨, B., & Gillberg, C. (1998). Attention deﬁcits and clumsiness in Swedish 7-year-old
children. Developmental Medicine & Child Neurology,40, 796–804.
Kazdin, A. E. (1993). Psychotherapy for children and adolescents: Current progress and
future research directions. American Psychologist,48(6), 644–657.
Kazdin, A. E. (2000). Psychotherapy for children and adolescents. Directions for research
and practice. New York: Oxford University Press.
Kvale, S. (1997). Den kvalitativa forskningsintervjun. [The qualitative research interview].
Laban, R., & Lawrence, F. C. (1947). Efforts. London: Mc. Donald & Evans.
Landgren, M., Kjellman, B., & Gillberg, C. (1998). Attention deﬁcit disorder with
developmental coordination disorders. Archives of a Disabled Child,79, 207–212.
Nathanson, D. L. (1987). The many faces of shame. New York: Guilford.
Ofﬁcial Reports of the Swedish Government (1997). Ro¨ster om barns och ungdomars
psykiska ha¨lsa. [Voices about children’s and adolescents’ mental health]. Delbeta
Pelham, W. E. (1993). Pharmaco therapy for children with attention-deﬁcit hyperactivity
disorder. School Psychology Review,22, 199–227.
Pless, M. (2001). Development co-ordination disorder in pre-school children. Effects of motor
skill intervention, parents’ descriptions and short-term follow-up of motor status.
Dissertation. Department of Women’s and Children’s Health, Paediatrics, Uppsala
Reich, W. (1972). Character analysis. New York: Noonday Press.
84 Erna Gro
¨nlund et al.
Ritter, M., & Graff Low, K. (1996). Effects of dance/movement therapy: A meta-analysis.
The Arts in Psychotherapy,23(3), 249–260.
Schilder, P. (1950). The image and appearance of the human body. New York: International
Sherborne, V. (1990). Developmental movement for children. Cambridge: University Press.
Siegel, E. V. (1984). The mirror of ourselves: Dance movement therapy and the psychoan-
alytical approach. Dissertation New York: Human Sciences Press.
Siegel, E. V. (1995). Psychoanalytic dance therapy: The bridge between psyche and soma.
American Journal of Dance Therapy,17(2), 115–128.
Starrin, B., & Renck, B. (1996). Den kvalitativa intervjun. In P.-G. Svensson & B. Starrin
(Eds.), Kvalitativa studier i teori och praktik. [Qualitative studies in theory and practice].
Stern, D. (1985). The interpersonal world of the infant: A view from psychoanalysis and
developmental psychology. New York: Basic Books.
Swedish National Board of Health and Welfare – Socialstyrelsen (1997). Inneha
kvalitet i den barn- och ungdomspsykiatriska va
˚rden. [Contents and quality in child and
adolescent psychiatry care]. Stockholm: Socialstyrelsen.
Swedish National Board of Health and Welfare – Socialstyrelsen (2002). ADHD hos barn
och vuxna. [ADHD in children and adults]. Stockholm: Socialstyrelsen.
Target, M., & Fonagy, P. (1996). The psychological treatment of child and adolescent
psychiatric disorders. In A. Roth & P. Fonagy (Eds.), What works for whom? A critical
review of psychotherapy research. New York: The Guilford Press.
Teeter, P. A. (1998). Interventions for ADHD. Treatment in developmental context. New
York: The Guilford Press.
The National Agency for Education, The National Swedish Board of Health and Welfare.
The National Institute of Public Health (2004). Ta¨nk la
˚ngsiktigt! [Think long-range!].
Stockholm: The National Institute of Public Health.
Tomkins, S. (1991). Affect, imagery, consciousness. Vol. 3. The negative affects, anger and
fear. New York: Springer Publication.
Winnicott, D. W. (1971). Playing and reality. London: Penguin Books.
Zill, N., & Schoenborn, C. A. (1990). Developmental, learning, and emotional problems:
Health of our nation’s children, United States 1988. Advanced Data: National Center for
Health Statistics, 190.
85Dance/Movement Therapy for ADHD