Improving Self-regulation in Individuals With ADHD Through Adapted Karate Training

Methods: Following baseline assessment (T1), participants will be randomly allocated to one of the two sequences. After an eight-week period, all participants will complete a second assessment (T2). The groups will then switch conditions: children who initially received the AKT will receive no intervention, while those in the control group will receive the AKT. A third assessment (T3) will be conducted for all participants eight weeks post T2. All assessments will be administered by an assessor blinded to group allocation.

Participants: Sample size calculation was performed with G\*Power 3.1.9.7 to detect between group differences (F test, ANOVA: Repeated measures, within-between interaction) with a medium effect size (f=0.2), significance level=0.05 and power=0.8. The total sample size needed is 50, and considering \~ 10% dropout, a total of 55 children, ages 6-12 will be recruited.

Intervention: Adapted Karate Training (AKT) is a structured, group-based intervention derived from traditional karate practice and modified to accommodate the attentional, sensory, emotional, and self-regulatory characteristics of children with ADHD. The protocol emphasizes continuity of participation, positive experiences, and the development of individualized self-regulation strategies through adapted movement sequences, structured routines, and supportive instructional method. All participants in the study will engage in AKT sessions twice weekly, each session lasting 60 minutes, over a period of two months.

Data Analysis: Descriptive statistics will be used to describe the participants in terms of their demographic information, primary and secondary outcome measures. Data will be analyzed using repeated-measures models appropriate for a randomized controlled crossover design, examining within-subject changes over time and between-condition effects, while accounting for intervention order. Effect sizes will be reported. Statistical significance will be set at p \< 0.05.

• Dual Tasking gait analysis [Time frame: changes in scores between pre (T1-week 0) to T2 (8 weeks later), to T3 (8 weeks post T2).]
• Behavioral Assessment of the Dysexecutive Syndrome for Children (BADS-zoo map) [Time frame: Changes in scores between pre (T1-week 0) to T2 (8 weeks later), to T3 (8 weeks post T2).]
• The Birthday Task Assessment [Time frame: Changes in scores between pre (T1-week 0) to T2 (8 weeks later), to T3 (8 weeks post T2).]
• The The Preschool Executive Task Assessment (PETA) [Time frame: Changes in scores between pre (T1-week 0) to T2 (8 weeks later), to T3 (8 weeks post T2).]
• Behavior Rating Inventory of Executive function (BRIEF) [Time frame: Changes in scores between pre (T1-week 0) to T2 (8 weeks later), to T3 (8 weeks post T2).]
• Short Sensory Profile (SSP 2) [Time frame: Changes in scores between pre (T1-week 0) to T2 (8 weeks later), to T3 (8 weeks post T2).]
• Difficulties in Emotion Regulation Scale- Parent Report (DERS-P) [Time frame: Changes in scores between pre (T1-week 0) to T2 (8 weeks later), to T3 (8 weeks post T2).]
• Participation In Childhood Occupation (PICO) [Time frame: Changes in scores between pre (T1-week 0) to T2 (8 weeks later), to T3 (8 weeks post T2).]
• Quality of life in school (QoLS) questionnaire [Time frame: Changes in scores between pre (T1-week 0) to T2 (8 weeks later), to T3 (8 weeks post T2).]
• Participation in Physical Activity and Sedentary Behavior Questionnaire (PQ) [Time frame: Changes in scores between pre (T1-week 0) to T2 (8 weeks later), to T3 (8 weeks post T2).]
• In-depth semi-structured interview [Time frame: T3 (8 weeks post T2(8 weeks from baseline)).]