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RESEARCH
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COMMUNITY PRACTITIONER 9 NOV Volume 20 Issue 11
MANDALA COLORING FOR CHILDREN WITH SYMPTOMS OF
ATTENTION DEFICIT HYPERACTIVITY DISORDER- A CASE SERIES
Chhavi Singh 1*, Surekha C 2 and Prachi Pandey 3
1 Research Scholar, Department of Psychology, School of Humanities and Social Sciences,
Christ (Deemed to be University), Delhi NCR. ORCID ID: 0000-0002-7438-9173
* Corresponding Author Email: singh.chhavi16@gmail.com
2 Associate Professor, Department of Psychology, School of Humanities and Social Sciences,
Christ (Deemed to be University), Delhi NCR. Email: surekha.chukkali@christuniversity.in
3 Textile Designer, National Institute of Designs, Ahmedabad. Email: prachivsp@gmail.com
DOI: 10.5281/zenodo.10065957
Abstract
Attention Deficit Hyperactivity condition (ADHD) is the most common neuropsychiatric condition of
childhood. Inattention, Hyperactivity, and impulsivity are the 3 major signs of ADHD. Various therapies
and techniques are well-established for children with ADHD disorder. However, there is a sizable subset
of some signs of ADHD in children that do not fulfill the diagnostic standards. To adjacent this gap,
psychologists have adopted various forms of art therapy to attain good results. Mandala coloring is a
relatively new art-based intervention that can be used on children at risk of ADHD. However, literature
is lacking on the usefulness of mandala coloring intervention on such at-risk children. Here we present
a series of three children with ADHD symptoms in whom mandala coloring intervention was used. There
were significant improvements in executive functioning after 30 sessions, indicating enhanced cognitive
skills. There was also a moderate improvement in emotional and motivational self-regulation. At follow-
up, parents reported improvement in academic performance and were able to concentrate on one
activity for a longer duration.
Keywords: Art Therapy, Mandala Coloring, ADHD Symptoms, Executive Functioning, Attention Span.
INTRODUCTION
Attention Deficit Hyperactivity Disorder (ADHD) is one of the most frequent behavioral
disorders with an estimated global incidence of 3-5%, in children and
adolescents. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [1]
defines ADHD in children younger than age 17 years as the presence of six or more
symptoms in either the inattentive or hyperactive and impulsive domains, or both. The
major symptoms of ADHD According to the ICD-10 [2] Classification are as follows
Symptoms of ADHD
 Inattention
 Difficulty in perceiving
 Hyperactivity
 Constant fidgeting
 Excessive physical exertion
 Action without thinking
 Unable to sit quiet in calm surroundings
 Unable to concentrate on tasks
 No sense of danger
 Excess talking
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 Anxiety, Carelessness, Restlessness
 Forgetfulness
 Inability to deal with stress
 Impatience
 Less Organizational Skills
 Inability to focus
These manifestations of ADHD symptoms lead to profound effects in adulthood like
academic underachievement, anti-social behaviors, substance abuse, borderline
personality disorder and addiction [3, 4]. Some existing strategies for supporting
children with symptoms of inattention and impulsivity/hyperactivity and preventing the
progress to ADHD are art therapy, cognitive restructuring, behavior modification,
social skills training, self-control training, and parent training. Art therapy is one of the
methods that has been used to channelize aggressive and impulsive behaviors related
to hyperactivity into socially constructive forms of self-regulation [5].
TYPES OF ADHD
Source:(theminiadhdcoach.com)
1. In attentive type: It refers to the challenges with tasks, focus and organization. 6
A) Does not pay attention to tasks
B) Inefficient in focusing on tasks
C) Does not listen while speaking
D) Does not follow the instructions given by the adults
E) Inefficient in organizing tasks and work
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COMMUNITY PRACTITIONER 11 NOV Volume 20 Issue 11
F) Dislikes tasks that requires sustained mental efforts
G) Easily distracted
H) Forgets daily tasks
2. Hyperactive / Impulsive type: It refers to the excessive movements such as
excessive energy, fidgeting and actions taken without thinking 6.
A) Fidgets with hands and feet
B) Does not stay seated
C) Does not play quietly
D) Talkative and blurts the answers before the question
E) Intrudes others conversations
3. Combined type: It is the combination of inattentive and hyper active types
under the umbrella term of art therapy, one of the upcoming approaches is mandala
coloring. Mandala coloring has been used in patients with schizophrenia, bipolar
affective disorder and major depressive disorder with good outcomes8. With the
growing chorus on the efficacy of mandala coloring in various behavioral disorders,
we explored its use in the management of children with inattention and hyperactivity.
Drawing, Painting and Sculpting are the various techniques used in this art therapy. It
employs to deal the interpersonal abilities, behaviour, stress, self-awareness,
emotional issues etc.
METHODOLOGY
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CASE PRESENTATION
Case-1
Ms A is a 9-year-old girl in fifth grade. Her parents brought her to the clinic to
evaluate her inattention and lack of focus at school. She has struggled with academic
tasks in school since the beginning. She has been disorganized, with inattention, easy
distraction, and mood swings. Ms A feels anxious when she arrives at school due to
homework and classroom activities. Further questioning reveals that she dislikes going
to school because “she can never focus,”. She is unable to interact well with individuals
who do not share her interests, and she often becomes frightened when asked to
speak in public or spend time with people she does not know.
Her parents are both university graduates. Her father is a businessman, while her
mother is a teacher. She is the first child of a non-consanguineous marriage and has
no other congenital or developmental issues. She has met all of her developmental
and social milestones a- the right age.
Case-2
Mr B is a 10-year-old child who was brought to the clinic by his parents with concerns
about his disobedient and violent attitude toward siblings and school teachers. He
was not paying attention at home and spoke loudly and excessively. He got less
interested in academic activities after starting school. He typically avoids activities that
require greater mental work.
He began to avoid schoolwork and became disobedient to classmates and teachers.
As a result, his academic performance was deteriorating daily. He had a strained
relationship with his teachers and performed mediocrely in class. He believes he has
been rejected by teachers and parents as a result of his poor academic performance.
He began to dislike school even more after being chastised by teachers and parents
for his bad performance and disrespectful behavior. All of his developmental and social
milestones were on time. The family history suggested his father had symptoms of
inattention and during pregnancy mother was diagnosed with hypertension.
Case-3
Mst C, a 9-year-old boy, was brought to the clinic with concerns of inattention for the
past 1.5 years. He is the youngest child in his family and has one older sister. He does
not have any other congenital or developmental disorders. He achieved all physical,
mental, and social milestones at the appropriate age.
During clinical observation, it was noted that he had difficulty remaining seated in class
and struggled to maintain focus on tasks or play activities. He frequently interrupted
other students and engaged in continuous conversation with them. His speech was
sometimes challenging to comprehend due to word omissions and rapid speech rate.
In group activities he displayed impatience, often demanding immediate attention and
failing to return items to their proper places after the activities. Despite these
challenges, his fine motor skills were developmentally appropriate for his age.
Ravens Color Progressive Matrices and ADHD-SRS were used for screening of
disability and ADHD symptoms. Color Trails 1 & 2 test (attention span), Digit Span
test (working memory), Stroop Color and Word Test (interference control), Animal
Name Test, Controlled Oral Words Association (COWA) Test (cognitive flexibility) and,
Emotion and Motivation Self-Regulation Questionnaire (EMSRQ) were used in the
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study. Clinical history and screening tests for all three children showed that they had
symptoms of ADHD and had an average level of intelligence. Based on these findings,
the case was considered (diagnosed) to be of ADHD symptoms and was planned for
mandala coloring intervention.
A mandala coloring workbook consisting of 30 designs of increasing complexity was
used for the intervention. The designs were created by the authors and validated by
experts from the field of psychology with more than eight years of expertise. The child
was instructed to use only 11 universal basic colors - red, pink, orange, brown, white,
gray, black, yellow, blue, green, and purple. Each day participants were asked to color
one design in the given sequence (Figure 1). A total of thirty sessions were completed
within five weeks. Pre and post-intervention data were recorded using a battery
of above mentioned six tests. After the sessions, a debriefing was done in the
presence of their parents, along with conclusive remarks and suggestions for follow-
up sessions.
Figure 1: (A) Mandala Coloring done by Ms A; (B) Mandala Coloring done by
Mst B; (C) Mandala Coloring done by Mst C
All three children showed significant improvement subjectively as well as objectively.
Ms A & Mst B reported improvement in five parameters meanwhile Mst C shows
improvement in executive functioning. We found maximum improvement in Color trial
Test-2 which represents that there is an improvement in the attention span of the
children. It was observed that compared to other sub-tests, the improvement in the
Animal Name Test was less. The difference between the pre-test and post-test data
shows that there is an improvement in executive functioning after the mandala coloring
intervention.
DISCUSSION
ADHD is the most prominent mental level disorder affecting children. Children with the
symptoms of ADHD have difficulty controlling activity, attention, focus organization,
still sitting, concentration, mood management, etc. [7]. Mandala coloring is being
utilized more commonly for behavioral and emotional issues as it is becoming more
widely recognized as a quick and efficient therapy choice. When made by an
individual, it promotes psychological recovery through the serenity brought on by a
serene state of mind [9]. Mandala is useful in reducing impulsive behavior, improving
RESEARCH
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COMMUNITY PRACTITIONER 14 NOV Volume 20 Issue 11
the ability to accomplish tasks, allowing for improved decision-making, allowing for an
interest in personal aesthetics, and enhancing attention abilities [10-13].
We may conclude that mandala coloring is successful in enhancing attention span
because the results of color trial tests 1 and 2 demonstrate that attention is raised in
all three children at the end of therapy. Both the forward and backward sub-scales of
the digit span test also showed significant improvements in working memory in Ms A
and Mst C However, Mst B’s scores showed no improvement, indicating that his
working memory has not improved, which may be due to anxiousness or aberrant
cognitive processes. We can assume that mandala coloring might be a useful
technique for immediate remembering since this is a test of immediate auditory-verbal
memory.
After the intervention, parents reported that their children's ability to adjust behavior
and thinking has improved as compared to before, which represents an improvement
in verbal fluency, as evidenced by higher ANT and COWA test scores. In the STROOP
test, all three of the children demonstrated an improvement in their capacity to manage
interruptions and conflicting information efficiently, which represents an improvement
in interference control. A study produced remarkably comparable findings. A drawback
of this strategy is that of the three children, EMSRQ showed the least improvement.
An advantage of this intervention was that the children were comfortable during the
process as it was administered in their homes under parental supervision. After the
whole intervention child was more focused on studies and other day-to-day activities,
level of hyperactivity also decreased. The child started taking an interest in academics.
CONCLUSION
Based on observation of the three cases, we found mandala coloring is an effective
therapy for children with ADHD symptoms and may also have a role in other childhood
behavioral disorders. However, further studies with longer follow-ups and larger
sample sizes will be needed to evaluate the same.
References
1) Regier DA, Narrow WE, Kuhl EA, Kupfer DJ. The conceptual development of DSM-V. American
Journal of Psychiatry. 2009 Jun;166(6):645-50. 10.1176/appi.ajp.2009.09020279
2) Tripp G, Luk SL, Schaughency EA, Singh R. DSM-IV and ICD-10: a comparison of the correlates
of ADHD and hyperkinetic disorder. Journal of the American Academy of Child & Adolescent
Psychiatry. 1999 Feb 1;38(2):156-64. 10.1097/00004583-199902000-00014
3) Kooij JJS, Bijlenga D, Salerno L, et al. European Consensus Statement on diagnosis and treatment
of adult ADHD. European Psychiatry. 2019;56:14-34. https://doi.org/10.1186/1471-244X-10-67
4) Langley K, Fowler T, Ford T, et al. Adolescent clinical outcomes for young people with attention-
deficit hyperactivity disorder. The British journal of psychiatry:the journal of mental science.
2010;196, 235-240. doi: https://doi.org/10.1192/bjp.bp.109.066274.
5) Weissenberger S, Ptacek R, Klicperova-Baker M, et al. ADHD, Lifestyles and Comorbidities: A Call
for an Holistic Perspective - from Medical to Societal Intervening Factors. Front Psychol.
2017;8:454. doi: 10.3389/fpsyg.2017.00454
6) Semple RJ, Droutman V and Reid BA. Mindfulness goes to school: Things learned (so far) from
research and real-world experience. Psychology in the Schools. 2017; 54:29-52. doi:
10.1002/pits.21981
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COMMUNITY PRACTITIONER 15 NOV Volume 20 Issue 11
7) Smitheman-Brown V, Church RR. Mandala drawing: Facilitating creative growth in children with
ADD or ADHD. Art Therapy. 1996 Oct 1;13(4):252-60.
https://doi.org/10.1080/07421656.1996.10759233
8) Sayal K, Prasad V, Daley D, Ford T, Coghill D. ADHD in children and young people: prevalence,
care pathways, and service provision. The Lancet Psychiatry. 2018 Feb 1;5(2):175-86.
10.1016/S2215-0366(17)30167-0
9) Henley D. Art therapy in a socialization program for children with attention deficit hyperactivity
disorder. American Journal of Art Therapy. 1998;37:2-11.
10) Kim, H., Kim, S., Choe, K., et al. Effects of Mandala Art Therapy on Subjective Well-being,
Resilience, and Hope in Psychiatric Inpatients. Archives of psychiatric nursing. 2018;32:167-173.
doi https://doi.org/10.1016/j.apnu.2017.08.008.
11) Mahar, D. J., Iwasiw, C. L., & Evans, M. K. The mandala: First-year undergraduate nursing
students' learning experiences. International Journal of Nursing Education Scholarship. 2012;9:1-
16. doi:10.1515/1548-923X.2313.
12) Brown VS and Church RR. Mandala Drawing: Facilitating Creative Growth in 1Children with ADD
or ADHD. Journal of The American Art Therapy Association. 1996;13:252-260. doi:
10.1080/07421656.1996.10759233
13) Zahra Borzabadi Farahani, Abolfazl Rahgoi, Masoud Fallahi-Khoshknab et al. (2023) The Effect
of Art Therapy (Mandala Coloring) on the Attention Level of Children With Attention
Deficit/Hyperactivity Disorder, Art Therapy, 10.1080/07421656.2022.2156238

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MANDALA COLORING FOR CHILDREN WITH SYMPTOMS OF ATTENTION DEFICIT HYPERACTIVITY DISORDER- A CASE SERIES

  • 1. RESEARCH www.commprac.com ISSN 1462 2815 COMMUNITY PRACTITIONER 9 NOV Volume 20 Issue 11 MANDALA COLORING FOR CHILDREN WITH SYMPTOMS OF ATTENTION DEFICIT HYPERACTIVITY DISORDER- A CASE SERIES Chhavi Singh 1*, Surekha C 2 and Prachi Pandey 3 1 Research Scholar, Department of Psychology, School of Humanities and Social Sciences, Christ (Deemed to be University), Delhi NCR. ORCID ID: 0000-0002-7438-9173 * Corresponding Author Email: singh.chhavi16@gmail.com 2 Associate Professor, Department of Psychology, School of Humanities and Social Sciences, Christ (Deemed to be University), Delhi NCR. Email: surekha.chukkali@christuniversity.in 3 Textile Designer, National Institute of Designs, Ahmedabad. Email: prachivsp@gmail.com DOI: 10.5281/zenodo.10065957 Abstract Attention Deficit Hyperactivity condition (ADHD) is the most common neuropsychiatric condition of childhood. Inattention, Hyperactivity, and impulsivity are the 3 major signs of ADHD. Various therapies and techniques are well-established for children with ADHD disorder. However, there is a sizable subset of some signs of ADHD in children that do not fulfill the diagnostic standards. To adjacent this gap, psychologists have adopted various forms of art therapy to attain good results. Mandala coloring is a relatively new art-based intervention that can be used on children at risk of ADHD. However, literature is lacking on the usefulness of mandala coloring intervention on such at-risk children. Here we present a series of three children with ADHD symptoms in whom mandala coloring intervention was used. There were significant improvements in executive functioning after 30 sessions, indicating enhanced cognitive skills. There was also a moderate improvement in emotional and motivational self-regulation. At follow- up, parents reported improvement in academic performance and were able to concentrate on one activity for a longer duration. Keywords: Art Therapy, Mandala Coloring, ADHD Symptoms, Executive Functioning, Attention Span. INTRODUCTION Attention Deficit Hyperactivity Disorder (ADHD) is one of the most frequent behavioral disorders with an estimated global incidence of 3-5%, in children and adolescents. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [1] defines ADHD in children younger than age 17 years as the presence of six or more symptoms in either the inattentive or hyperactive and impulsive domains, or both. The major symptoms of ADHD According to the ICD-10 [2] Classification are as follows Symptoms of ADHD  Inattention  Difficulty in perceiving  Hyperactivity  Constant fidgeting  Excessive physical exertion  Action without thinking  Unable to sit quiet in calm surroundings  Unable to concentrate on tasks  No sense of danger  Excess talking
  • 2. RESEARCH www.commprac.com ISSN 1462 2815 COMMUNITY PRACTITIONER 10 NOV Volume 20 Issue 11  Anxiety, Carelessness, Restlessness  Forgetfulness  Inability to deal with stress  Impatience  Less Organizational Skills  Inability to focus These manifestations of ADHD symptoms lead to profound effects in adulthood like academic underachievement, anti-social behaviors, substance abuse, borderline personality disorder and addiction [3, 4]. Some existing strategies for supporting children with symptoms of inattention and impulsivity/hyperactivity and preventing the progress to ADHD are art therapy, cognitive restructuring, behavior modification, social skills training, self-control training, and parent training. Art therapy is one of the methods that has been used to channelize aggressive and impulsive behaviors related to hyperactivity into socially constructive forms of self-regulation [5]. TYPES OF ADHD Source:(theminiadhdcoach.com) 1. In attentive type: It refers to the challenges with tasks, focus and organization. 6 A) Does not pay attention to tasks B) Inefficient in focusing on tasks C) Does not listen while speaking D) Does not follow the instructions given by the adults E) Inefficient in organizing tasks and work
  • 3. RESEARCH www.commprac.com ISSN 1462 2815 COMMUNITY PRACTITIONER 11 NOV Volume 20 Issue 11 F) Dislikes tasks that requires sustained mental efforts G) Easily distracted H) Forgets daily tasks 2. Hyperactive / Impulsive type: It refers to the excessive movements such as excessive energy, fidgeting and actions taken without thinking 6. A) Fidgets with hands and feet B) Does not stay seated C) Does not play quietly D) Talkative and blurts the answers before the question E) Intrudes others conversations 3. Combined type: It is the combination of inattentive and hyper active types under the umbrella term of art therapy, one of the upcoming approaches is mandala coloring. Mandala coloring has been used in patients with schizophrenia, bipolar affective disorder and major depressive disorder with good outcomes8. With the growing chorus on the efficacy of mandala coloring in various behavioral disorders, we explored its use in the management of children with inattention and hyperactivity. Drawing, Painting and Sculpting are the various techniques used in this art therapy. It employs to deal the interpersonal abilities, behaviour, stress, self-awareness, emotional issues etc. METHODOLOGY
  • 4. RESEARCH www.commprac.com ISSN 1462 2815 COMMUNITY PRACTITIONER 12 NOV Volume 20 Issue 11 CASE PRESENTATION Case-1 Ms A is a 9-year-old girl in fifth grade. Her parents brought her to the clinic to evaluate her inattention and lack of focus at school. She has struggled with academic tasks in school since the beginning. She has been disorganized, with inattention, easy distraction, and mood swings. Ms A feels anxious when she arrives at school due to homework and classroom activities. Further questioning reveals that she dislikes going to school because “she can never focus,”. She is unable to interact well with individuals who do not share her interests, and she often becomes frightened when asked to speak in public or spend time with people she does not know. Her parents are both university graduates. Her father is a businessman, while her mother is a teacher. She is the first child of a non-consanguineous marriage and has no other congenital or developmental issues. She has met all of her developmental and social milestones a- the right age. Case-2 Mr B is a 10-year-old child who was brought to the clinic by his parents with concerns about his disobedient and violent attitude toward siblings and school teachers. He was not paying attention at home and spoke loudly and excessively. He got less interested in academic activities after starting school. He typically avoids activities that require greater mental work. He began to avoid schoolwork and became disobedient to classmates and teachers. As a result, his academic performance was deteriorating daily. He had a strained relationship with his teachers and performed mediocrely in class. He believes he has been rejected by teachers and parents as a result of his poor academic performance. He began to dislike school even more after being chastised by teachers and parents for his bad performance and disrespectful behavior. All of his developmental and social milestones were on time. The family history suggested his father had symptoms of inattention and during pregnancy mother was diagnosed with hypertension. Case-3 Mst C, a 9-year-old boy, was brought to the clinic with concerns of inattention for the past 1.5 years. He is the youngest child in his family and has one older sister. He does not have any other congenital or developmental disorders. He achieved all physical, mental, and social milestones at the appropriate age. During clinical observation, it was noted that he had difficulty remaining seated in class and struggled to maintain focus on tasks or play activities. He frequently interrupted other students and engaged in continuous conversation with them. His speech was sometimes challenging to comprehend due to word omissions and rapid speech rate. In group activities he displayed impatience, often demanding immediate attention and failing to return items to their proper places after the activities. Despite these challenges, his fine motor skills were developmentally appropriate for his age. Ravens Color Progressive Matrices and ADHD-SRS were used for screening of disability and ADHD symptoms. Color Trails 1 & 2 test (attention span), Digit Span test (working memory), Stroop Color and Word Test (interference control), Animal Name Test, Controlled Oral Words Association (COWA) Test (cognitive flexibility) and, Emotion and Motivation Self-Regulation Questionnaire (EMSRQ) were used in the
  • 5. RESEARCH www.commprac.com ISSN 1462 2815 COMMUNITY PRACTITIONER 13 NOV Volume 20 Issue 11 study. Clinical history and screening tests for all three children showed that they had symptoms of ADHD and had an average level of intelligence. Based on these findings, the case was considered (diagnosed) to be of ADHD symptoms and was planned for mandala coloring intervention. A mandala coloring workbook consisting of 30 designs of increasing complexity was used for the intervention. The designs were created by the authors and validated by experts from the field of psychology with more than eight years of expertise. The child was instructed to use only 11 universal basic colors - red, pink, orange, brown, white, gray, black, yellow, blue, green, and purple. Each day participants were asked to color one design in the given sequence (Figure 1). A total of thirty sessions were completed within five weeks. Pre and post-intervention data were recorded using a battery of above mentioned six tests. After the sessions, a debriefing was done in the presence of their parents, along with conclusive remarks and suggestions for follow- up sessions. Figure 1: (A) Mandala Coloring done by Ms A; (B) Mandala Coloring done by Mst B; (C) Mandala Coloring done by Mst C All three children showed significant improvement subjectively as well as objectively. Ms A & Mst B reported improvement in five parameters meanwhile Mst C shows improvement in executive functioning. We found maximum improvement in Color trial Test-2 which represents that there is an improvement in the attention span of the children. It was observed that compared to other sub-tests, the improvement in the Animal Name Test was less. The difference between the pre-test and post-test data shows that there is an improvement in executive functioning after the mandala coloring intervention. DISCUSSION ADHD is the most prominent mental level disorder affecting children. Children with the symptoms of ADHD have difficulty controlling activity, attention, focus organization, still sitting, concentration, mood management, etc. [7]. Mandala coloring is being utilized more commonly for behavioral and emotional issues as it is becoming more widely recognized as a quick and efficient therapy choice. When made by an individual, it promotes psychological recovery through the serenity brought on by a serene state of mind [9]. Mandala is useful in reducing impulsive behavior, improving
  • 6. RESEARCH www.commprac.com ISSN 1462 2815 COMMUNITY PRACTITIONER 14 NOV Volume 20 Issue 11 the ability to accomplish tasks, allowing for improved decision-making, allowing for an interest in personal aesthetics, and enhancing attention abilities [10-13]. We may conclude that mandala coloring is successful in enhancing attention span because the results of color trial tests 1 and 2 demonstrate that attention is raised in all three children at the end of therapy. Both the forward and backward sub-scales of the digit span test also showed significant improvements in working memory in Ms A and Mst C However, Mst B’s scores showed no improvement, indicating that his working memory has not improved, which may be due to anxiousness or aberrant cognitive processes. We can assume that mandala coloring might be a useful technique for immediate remembering since this is a test of immediate auditory-verbal memory. After the intervention, parents reported that their children's ability to adjust behavior and thinking has improved as compared to before, which represents an improvement in verbal fluency, as evidenced by higher ANT and COWA test scores. In the STROOP test, all three of the children demonstrated an improvement in their capacity to manage interruptions and conflicting information efficiently, which represents an improvement in interference control. A study produced remarkably comparable findings. A drawback of this strategy is that of the three children, EMSRQ showed the least improvement. An advantage of this intervention was that the children were comfortable during the process as it was administered in their homes under parental supervision. After the whole intervention child was more focused on studies and other day-to-day activities, level of hyperactivity also decreased. The child started taking an interest in academics. CONCLUSION Based on observation of the three cases, we found mandala coloring is an effective therapy for children with ADHD symptoms and may also have a role in other childhood behavioral disorders. However, further studies with longer follow-ups and larger sample sizes will be needed to evaluate the same. References 1) Regier DA, Narrow WE, Kuhl EA, Kupfer DJ. The conceptual development of DSM-V. American Journal of Psychiatry. 2009 Jun;166(6):645-50. 10.1176/appi.ajp.2009.09020279 2) Tripp G, Luk SL, Schaughency EA, Singh R. DSM-IV and ICD-10: a comparison of the correlates of ADHD and hyperkinetic disorder. Journal of the American Academy of Child & Adolescent Psychiatry. 1999 Feb 1;38(2):156-64. 10.1097/00004583-199902000-00014 3) Kooij JJS, Bijlenga D, Salerno L, et al. European Consensus Statement on diagnosis and treatment of adult ADHD. European Psychiatry. 2019;56:14-34. https://doi.org/10.1186/1471-244X-10-67 4) Langley K, Fowler T, Ford T, et al. Adolescent clinical outcomes for young people with attention- deficit hyperactivity disorder. The British journal of psychiatry:the journal of mental science. 2010;196, 235-240. doi: https://doi.org/10.1192/bjp.bp.109.066274. 5) Weissenberger S, Ptacek R, Klicperova-Baker M, et al. ADHD, Lifestyles and Comorbidities: A Call for an Holistic Perspective - from Medical to Societal Intervening Factors. Front Psychol. 2017;8:454. doi: 10.3389/fpsyg.2017.00454 6) Semple RJ, Droutman V and Reid BA. Mindfulness goes to school: Things learned (so far) from research and real-world experience. Psychology in the Schools. 2017; 54:29-52. doi: 10.1002/pits.21981
  • 7. RESEARCH www.commprac.com ISSN 1462 2815 COMMUNITY PRACTITIONER 15 NOV Volume 20 Issue 11 7) Smitheman-Brown V, Church RR. Mandala drawing: Facilitating creative growth in children with ADD or ADHD. Art Therapy. 1996 Oct 1;13(4):252-60. https://doi.org/10.1080/07421656.1996.10759233 8) Sayal K, Prasad V, Daley D, Ford T, Coghill D. ADHD in children and young people: prevalence, care pathways, and service provision. The Lancet Psychiatry. 2018 Feb 1;5(2):175-86. 10.1016/S2215-0366(17)30167-0 9) Henley D. Art therapy in a socialization program for children with attention deficit hyperactivity disorder. American Journal of Art Therapy. 1998;37:2-11. 10) Kim, H., Kim, S., Choe, K., et al. Effects of Mandala Art Therapy on Subjective Well-being, Resilience, and Hope in Psychiatric Inpatients. Archives of psychiatric nursing. 2018;32:167-173. doi https://doi.org/10.1016/j.apnu.2017.08.008. 11) Mahar, D. J., Iwasiw, C. L., & Evans, M. K. The mandala: First-year undergraduate nursing students' learning experiences. International Journal of Nursing Education Scholarship. 2012;9:1- 16. doi:10.1515/1548-923X.2313. 12) Brown VS and Church RR. Mandala Drawing: Facilitating Creative Growth in 1Children with ADD or ADHD. Journal of The American Art Therapy Association. 1996;13:252-260. doi: 10.1080/07421656.1996.10759233 13) Zahra Borzabadi Farahani, Abolfazl Rahgoi, Masoud Fallahi-Khoshknab et al. (2023) The Effect of Art Therapy (Mandala Coloring) on the Attention Level of Children With Attention Deficit/Hyperactivity Disorder, Art Therapy, 10.1080/07421656.2022.2156238