Running head: SECONDARY PERCEPTIONS OF BRAIN BREAKS

EVALUATING THE EFFECTIVENESS AND SUSTAINABILITY OF CLASSROOM
BREAKS: PERCEPTIONS OF SECONDARY TEACHERS
_________________
A Dissertation
Presented to
The College of Graduate and Professional Studies
Department of Special Education
Slippery Rock University
Slippery Rock, Pennsylvania
_____________________
In Partial Fulfillment
of the Requirements for the Degree
Doctorate of Special Education
_________________
by
Vivian Greene-Snell
August 2025
© Vivian M. Greene-Snell, 2025

Keywords: Brain Breaks, Secondary Teachers, ADHD, Student Focus/Attention, Secondary
Classroom Practices

SECONDARY PERCEPTIONS OF BRAIN BREAKS
COMMITTEE MEMBERS
Committee Chair: Christopher Tarr, Ed.D., LBS
Senior Licensed Professional Care Manager
Slippery Rock University
Committee Member: Jessica Hall-Wirth, Ed.D.
Associate Professor of Special Education
Slippery Rock University
Committee Member: Aimee Workman, Ed.D., PTA
Associate Professor, Director of Clinical Education, PTA program
PennWest California University

SECONDARY PERCEPTIONS OF BR,AIN BREAKS

Signatory Page for Dissertation
Slippery Rock Universir."" of Pennsvh'ania
Department of Special Education

A Dissertation Written By Vivian Greene-Snell
Bachelor of Science in Education, West Chester Universi(v, December 2017
Master of Science in Educational Development and Instructional Strategies, Wilkes
Universit-v, Decem ber 202 I
Doctorate of Education in Special Education, Slippery Rock Universig of Pennsylvania,
August l, 2025

Approved by

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Dr. Christopher Tarr, D
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Dr. Jessica Hall-Wirth, Committee Member
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Dr. Aimee Workman. Committee Member
August l, 2025

Accepted bv

Dr. Keith Dils,

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of Education, Slippery Rock University of Pennsylvania
August l, 2025

SECONDARY PERCEPTIONS OF BRAIN BREAKS
ABSTRACT
Many secondary schools face challenges balancing academic rigor with students’ social,
emotional, and behavioral needs. Although brain breaks are widely used in elementary
classrooms, there is limited knowledge about how secondary teachers perceive and implement
them. The purpose of this mixed-methods study is to explore secondary teachers’ perceptions of
brain breaks, identify factors that support or hinder their use, and understand how teachers
perceive their impact on student focus, behavior, and engagement. Guided by Cognitive Load
Theory, Self-Determination Theory, and the Ecological Model of Physical Activity, this study
addresses three research questions: teachers’ perceptions of brain breaks, factors influencing
acceptance or resistance, and perceived impacts on students. Data were collected from eleven
secondary teachers using an online survey with demographic questions, the Teacher Efficacy
Toward Providing Physical Activity in the Classroom Scale (TETPPACS), and open-ended
questions. Quantitative data were analyzed using descriptive statistics and one-way ANOVAs,
and qualitative responses were coded thematically. Results showed that teachers generally value
brain breaks for improving focus and behavior but face barriers such as time constraints,
classroom management concerns, and limited physical space. Teachers felt more confident when
they had administrative support, peer modeling, and clear routines. The study concludes that
sustaining brain breaks requires more than teacher buy-in; it depends on supportive leadership
and practical training. Recommendations include providing relevant professional development
and creating school cultures that normalize brain breaks as part of effective instruction. These
findings may contribute to positive social change by encouraging schools to adopt simple
practices that help students reset, refocus, and ultimately learn more efficiently.

i

SECONDARY PERCEPTIONS OF BRAIN BREAKS
DEDICATION
This dissertation is dedicated to all my students with ADHD and every neurodivergent student
who has ever felt different in a world that doesn’t always understand how brightly they shine.
Most of all, this work is dedicated to my student I call “Robin Hood,” whose courage and
perseverance in the face of trauma inspired this research and reminded me why every student
deserves a safe chance to pause, reset, and thrive. I am endlessly proud of your strength and your
spirit.

ii

SECONDARY PERCEPTIONS OF BRAIN BREAKS
ACKNOWLEDGMENTS
This dissertation represents not just the culmination of my academic work but also the
result of consistent support, guidance, and encouragement from many people in my life.
First, I want to thank my dissertation chair and committee. Their guidance, feedback, and
insight were invaluable throughout this process. I’m grateful for their time and expertise.
To my colleagues, thank you for your encouragement throughout this journey. Your
support, understanding, and words of motivation made a meaningful difference throughout this
process.
To “Group 4” from SRU (Julie, Andrea, and Emily), I genuinely could not have done this
without you. From our shared laughter to our late-night Zoom sessions, I will be forever grateful
for your friendship and partnership throughout this process.
To my best friend, Cailyn—thank you for always showing up, checking in, and believing
in me no matter what. Your friendship has been one of the greatest constants in my life, and I’m
so grateful to have had you in my corner.
To my in-laws, the Snells—thank you for your kindness, encouragement, and for being
such a steady presence throughout this journey. Your support has meant more than you know.
To my parents, thank you for modeling resilience, hard work, and the importance of
education. Your constant belief in me and your unwavering support over the years have made all
the difference. I am who I am because of you.
And finally, to my husband, Mike—thank you for your patience, understanding, steady
support, and everything in between. You’ve been my greatest source of strength throughout this
entire process. Thank you for your constant encouragement and for reminding me to keep going,
even when the process felt overwhelming.

iii

SECONDARY PERCEPTIONS OF BRAIN BREAKS
TABLE OF CONTENTS
ABSTRACT……………………………………………………………………………………….i
DEDICATION…………………………………………………………………………………….ii
ACKNOWLEDGEMENTS………………………………………………………………………iii
LIST OF TABLES………………………………………………………………………………...x
LIST OF FIGURES………………………………………………………………………………xi
GLOSSARY OF TERMS……………………………………………………………………….xii
CHAPTER ONE: INTRODUCTION……………………………………………………………. 1
Overview of ADHD……………………………………………………………………… 2
Overview of Brain Breaks……………………………………………………………….. 3
Statement of the Problem………………………………………………………………… 7
Organizational Context…………………………………………………………………... 9
Research Questions……………………………………………………………………... 10
Existing Research……………………………………………………………………….. 10
Significance of the Study……………………………………………………………….. 12
Delimitations……………………………………………………………………………. 13
Definition of Terms……………………………………………………………………... 13
Summary………………………………………………………………………………... 15
CHAPTER TWO: LITERATURE REVIEW…………………………………………………... 16
Historical Evolution of Terminology and Diagnostic Criteria ………………………… 16
Lifespan Perspective……………………………………………………………………. 17
Etiology of ADHD……………………………………………………………………… 17
Genetic Factors…………………………………………………………………. 17

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SECONDARY PERCEPTIONS OF BRAIN BREAKS
Environmental Influences………………………………………………………………. 18
Neuroscience/Pathophysiology…………………………………………………………. 19
Developmental and Transdiagnostic Perspectives……………………………………… 21
Genetic and Environmental Interactions………………………………………………... 21
Comorbidities…………………………………………………………………………… 21
Prevalence and Impact of Comorbidities……………………………………….. 23
Diagnosis and Symptomatology………………………………………………………... 24
Diagnosis Criteria………………………………………………………………. 25
Symptom Presentation Over Time…………………………………………….... 27
Incidence and Prevalence……………………………………………………………….. 27
Regional Variations………………………………………………………………28
Ethnic and Socioeconomic Variations………………………………………….. 30
Historical Trends………………………………………………………………... 31
Understanding Neuroscience and Its Role in Special Education……………………….. 33
Key Brain Differences………………………………………………………….. 33
Functional Brain Networks……………………………………………………... 33
Multimodal Approaches………………………………………………………… 34
Neuroplasticity and Educational Strategies…………………………………….. 34
Collaborating Across Disciplines………………………………………………. 34
Treatments for ADHD………………………………………………………………….. 35
Behavioral Therapy and Behavioral Interventions……………………………... 35
Neurophysiological Changes from Physical Exercise………………………….. 36
Specific Exercise Interventions………………………………………………… 36

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SECONDARY PERCEPTIONS OF BRAIN BREAKS
Neurotherapeutics………………………………………………………………. 37
Brain Stimulation……………………………………………………………….. 38
Parent Training………………………………………………………………….. 38
Cognitive Behavioral Therapy………………………………………………….. 38
Organizational Skills Training………………………………………………….. 39
Holistic Approaches…………………………………………………………….. 39
Pharmacological Treatments……………………………………………………. 39
Novel Medications……………………………………………………………… 40
Non-Pharmacological Treatments……………………………………………… 40
Comprehensive Treatment Approach…………………………………………... 40
Multimodal Approach to ADHD Treatment……………………………………. 41
School-Based Interventions for ADHD………………………………………………… 42
Behavioral Classroom Management……………………………………………. 42
Organizational Skills Training………………………………………………….. 43
IEPs and 504 Plans……………………………………………………………… 43
Counseling and Communication………………………………………………... 43
School-Based Intervention Summary…………………………………………... 44
Impact of ADHD on Secondary Students………………………………………………. 44
History of Implementation of Breaks and Their Effectiveness………………………… 46
Perceived Barriers and Enablers of Breaks……………………………………………... 48
Barriers………………………………………………………………………….. 48
Enablers…………………………………………………………………………. 50
Teacher Perceptions and Practices……………………………………………… 50

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SECONDARY PERCEPTIONS OF BRAIN BREAKS
Recommendations from the Literature…………………………………………………. 51
Professional Development……………………………………………………… 51
Resources and Planning………………………………………………………… 52
Further Research………………………………………………………………... 52
Communication…………………………………………………………………. 52
Whole School Policy……………………………………………………………. 52
Focus on Student Outcomes…………………………………………………….. 53
Continued Support and Follow-Up……………………………………………... 53
Management and Practical Strategies…………………………………………... 53
Resources and Training ………………………………………………………… 53
Main Findings…………………………………………………………………………... 54
Purpose of the Study……………………………………………………………………. 54
Research Questions……………………………………………………………………... 55
Need for the Study……………………………………………………………………… 55
Summary………………………………………………………………………………... 57
CHAPTER THREE: METHODOLOGY………………………………………………………. 59
Action Plan: Intervention ……………………………………………………………… 59
Data Collection…………………………………………………………………………. 60
TETPPACS Rationale…………………………………………………………... 61
TETPPACS Validity……………………………………………………………. 62
TETPPACS Reliability…………………………………………………………. 63
Adaptation of TETPPACS……………………………………………………… 63
Data Analysis…………………………………………………………………………… 64

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SECONDARY PERCEPTIONS OF BRAIN BREAKS
Site Permission…………………………………………………………………………. 64
Presentation of Results…………………………………………………………………. 64
Limitations……………………………………………………………………………… 65
Summary………………………………………………………………………………... 65
CHAPTER FOUR: FINDINGS………………………………………………………………… 66
Restatement of the Problem…………………………………………………………….. 66
Demographics…………………………………………………………………………... 67
Data Collection ………………………………………………………………………… 69
Quantitative Findings…………………………………………………………………… 69
TETPPPACS ANOVA Results…………………………………………………………. 73
Gender Differences……………………………………………………………... 73
Experience Level Differences…………………………………………………... 74
Interpretation of ANOVA Findings…………………………………………….. 74
ANOVA Results Summary……………………………………………………... 75
Qualitative Findings…………………………………………………………………….. 76
Teachers’ Perceptions of Brain Breaks (RQ1)...................................................... 76
Factors Influencing Acceptance or Resistance (RQ2).......................................... 78
Perceived Impacts on Student Focus, Behavior, and Engagement (RQ3)............ 80
Summary of Qualitative Findings………………………………………………………. 83
Summary of Quantitative and Qualitative Findings……………………………………. 85
CHAPTER FIVE: CONCLUSIONS AND RECOMMENDATIONS…………………………. 87
Summary of Findings……………………………………………………………………87
Implications…………………………………………………………………………….. 88

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SECONDARY PERCEPTIONS OF BRAIN BREAKS
Conclusions…………………………………………………………………………….. 89
Alignment with Previous Research ……………………………………………………. 89
Recommendations for Further Research……………………………………………….. 92
Recommendations for Practice…………………………………………………………. 93
Recommendations for Teachers………………………………………………… 93
Recommendations for Administrators………………………………………….. 93
Recommendations for Policymakers and Stakeholders………………………… 94
Final Thoughts………………………………………………………………….. 95
REFERENCES…………………………………………………………………………………. 96
APPENDIX A: SIGNATORY PAGE OF DISSERTATION TOPIC APPROVAL…………… 107
APPENDIX B: APPROVAL OF WRITTEN AND ORAL COMPREHENSIVE
EXAMINATION………………………………………………………………………………. 108
APPENDIX C: REQUEST FOR PERMISSION TO CONDUCT RESEARCH WITH
FACULTY……………………………………………………………………………………... 109
APPENDIX D: PARTICIPANT EMAIL……………………………………………………… 110
APPENDIX E: RESEARCH PARTICIPANT INFORMED CONSENT LETTER…………... 111
APPENDIX F: SURVEY PARTICIPATION CONSENT FORM…………………………….. 114
APPENDIX G: PARTICIPANT DEMOGRAPHIC QUESTIONNAIRE…………………….. 115
APPENDIX H: TEACHER SURVEY………………………………………………………… 116

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SECONDARY PERCEPTIONS OF BRAIN BREAKS
LIST OF TABLES
Table 1. Enrollment by Gender…………………………………………………………………. 67
Table 2. Enrollment by Race/Ethnicity…………………………………………………………. 68
Table 3. Participant Codes and Teaching Profiles………………………………………………. 68
Table 4. TETPPACS Descriptive Statistics………………………………………………………70
Table 5. One-Way ANOVA Perceived Efficacy by Gender and Years of Experience…………..73

x

SECONDARY PERCEPTIONS OF BRAIN BREAKS
LIST OF FIGURES
Figure 1. Genetic Variations of Brain Changes in Patients with ADHD……………………….. 18
Figure 2. Brain Mechanisms in ADHD………………………………………………………… 20
Figure 3. Percent of children with ADHD with at least one other disorder……………………. 24
Figure 4. Percent of children (aged 3-17) with ADHD………………………………………… 28
Figure 5. Percent of children who receive ADHD medication………………………………… 29
Figure 6. Percent of children with ADHD who receive behavior treatment…………………… 29
Figure 7. Percent of children with ADHD who receive any treatment………………………… 30

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SECONDARY PERCEPTIONS OF BRAIN BREAKS
GLOSSARY OF TERMS
ABs – Active Breaks
ADHD – Attention-Deficit/Hyperactivity Disorder
AIT – Aerobic Interval Training
ASD – Autism Spectrum Disorder
BB – Brain Breaks
BDNF – Brain-Derived Neurotrophic Factor
CABs – Classroom Activity Breaks
CBPA – Classroom-Based Physical Activity
CBT – Cognitive Behavioral Therapy
CDC – Centers for Disease Control and Prevention
CD – Conduct Disorder
DSM – Diagnostic and Statistical Manual of Mental Disorders
EEG-NF – Electroencephalography-Neurofeedback
EF – Executive Functions
ERD – Emotional Regulation Difficulties
fMRI-NF – Functional Magnetic Resonance Imaging Neurofeedback
GWAS – Genome-Wide Association Studies
ICD-10/11 – International Classification of Diseases, 10th/11th Revision
IEP – Individualized Education Program
MI – Movement Integration
NIMH – National Institute of Mental Health
NIRS-NF – Near-Infrared Spectroscopy Neurofeedback
ODD – Oppositional Defiant Disorder
OHI – Other Health Impairment

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SECONDARY PERCEPTIONS OF BRAIN BREAKS
PA – Physical Activity
PD – Professional Development
PMTM – Perceptual Motor Training and Meditation
rTMS – Repetitive Transcranial Magnetic Stimulation
SCT – Sluggish Cognitive Tempo
SLD – Specific Learning Disabilities
tDCS – Transcranial Direct Current Stimulation

xiii

PERCEPTIONS OF BRAIN BREAKS

1

Chapter 1: Introduction
This research focuses on the implementation and impact of brain breaks in secondary
education, specifically for students with Attention-Deficit/Hyperactivity Disorder (ADHD).
ADHD is a common neurodevelopmental disorder marked by inattention, hyperactivity, and
impulsivity, significantly impacting children's academic performance, social interactions, and
emotional stability. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
(DSM-V), classifies ADHD with specific subcategories based on predominant symptoms
(American Psychiatric Association, 2013).
Given the high prevalence and significant impact of ADHD on school-aged children,
addressing this disorder in educational settings is crucial. Research indicates that ADHD affects
approximately 5-10% of children worldwide, underscoring the need for practical classroom
strategies to manage ADHD symptoms and enhance educational outcomes and overall
well-being (Faraone et al., 2021).
Brain breaks (BB) are short, structured breaks involving physical activity or cognitive
relaxation that have emerged as an intervention for managing ADHD symptoms. These breaks
enhance attention, reduce disruptive behaviors, and improve classroom engagement. Break
integration into daily classroom routines has gained popularity due to its potential to provide
physical and cognitive benefits, helping students with ADHD maintain focus and productivity
(Centers for Disease Control and Prevention [CDC], 2024).
However, there is a lack of comprehensive understanding regarding secondary teachers'
perceptions of brain breaks and the factors that facilitate or hinder their implementation in the
classroom (Stylianou et al., 2015). This knowledge gap necessitates further research to develop
effective strategies and support systems for integrating brain breaks into secondary education.

PERCEPTIONS OF BRAIN BREAKS

2

Understanding these perceptions and factors is essential for creating supportive and inclusive
educational environments that cater to the diverse needs of all students, particularly those with
ADHD in the secondary school setting.
Overview of ADHD
ADHD is the most prevalent neurodevelopmental disorder globally. The disorder is
characterized by symptoms of inattention, hyperactivity, and impulsivity that are
developmentally inappropriate (American Psychiatric Association, 2013). ADHD affects
approximately 5-7% of children worldwide, with boys being more commonly diagnosed than
girls (Polanczyk et al., 2007). Research has shown that ADHD can significantly affect academic
performance, social interactions, and overall quality of life (Barkley, 2015).
Children with ADHD often struggle with sustaining attention, following through on
tasks, and regulating their behavior in a classroom setting (CDC, 2024). These difficulties can
lead to academic underachievement, increased classroom disruptions, discipline issues, and
strained teacher-student relationships (DuPaul & Stoner, 2014). Moreover, children with ADHD
are at a higher risk for comorbid conditions such as anxiety, depression, and learning disabilities,
further complicating their educational experience (Pliszka, 2015).
Interventions for ADHD typically include a combination of behavioral strategies,
psychoeducation, and, in some cases, medication (Evans et al., 2014). Physical activity has also
been recognized as a beneficial intervention for children with ADHD, as it can help improve
attention, reduce hyperactivity, and enhance executive functioning (Pontifex et al., 2013; Verret
et al., 2012). Given the challenges faced by students with ADHD, incorporating brain breaks that
include physical activity can be a valuable strategy for managing symptoms and promoting a
positive learning environment for students of all ages.

PERCEPTIONS OF BRAIN BREAKS

3

Overview of Brain Breaks
The implementation of BB has garnered attention in educational settings due to its
potential to improve student engagement and cognitive functioning. BB helps students
re-energize, refocus, and enhance their learning experience. Research shows that these breaks
particularly benefit students with ADHD, who often struggle with sustained attention and
impulsivity (Centers for Disease Control and Prevention [CDC], 2024).
Over the past decade, research on physical activity levels among children with disabilities
has indicated that these children generally do not meet the recommended daily or weekly
physical activity guidelines (Frey et al., 2008; McCoy et al., 2016). Furthermore, children with
disabilities tend to exhibit higher rates of sedentary behavior compared to their peers without
disabilities (Stanish et al., 2019). The increased sedentary behavior and physical inactivity raise
concerns, as they can lead to higher rates of morbidity and mortality, cardiovascular disease, and
elevated healthcare costs (González et al., 2017). On the other hand, increased physical activity
can help reduce the risk of obesity and Type 2 Diabetes, and it can improve a child's
psychosocial well-being by mitigating stress, anxiety, and depression (Archer, 2014).
While the benefits of physical activity and the risks of inactivity apply to all children,
they are more pronounced for children with disabilities. Inactivity often exacerbates delays in
gross motor development, poor balance and coordination, and reduced cardiovascular fitness in
these children (Shields & Synnot, 2016).
Individuals with disabilities are less likely to meet physical activity guidelines compared
to the general population, highlighting health disparities linked to physical inactivity among
people with disabilities (Carroll et al., 2014).

PERCEPTIONS OF BRAIN BREAKS

4

For example, watching more than two hours of TV per day is associated with a greater
risk of cardiovascular mortality. Youth with disabilities, particularly those who experience
bullying at school, often watch more TV than their peers without disabilities (Foster et al., 2020).
Hsieh et al. (2017) found that among 1,618 adults with intellectual disabilities, a high percentage
of participants were obese and spent significant time watching TV daily.
The CDC defines physical activity as any bodily movement produced by skeletal muscles
that increases energy expenditure (Centers for Disease Control and Prevention, 2017). In
contrast, sedentary behavior involves a metabolic equivalent (MET) of less than 1.5 and minimal
energy expenditure above resting levels (Tremblay et al., 2017). The Centers for Disease Control
and Prevention (1999) categorize physical activity behaviorally into light (<3 METs), moderate
(3.0 to 6 METs), and vigorous (>6 METs) activities. The 2018 Physical Activity Guidelines for
Americans recommend that children aged 6 to 17 engage in at least 60 minutes of moderate to
vigorous physical activity daily (U.S. Department of Health and Human Services, 2018). These
guidelines also acknowledge that while children with disabilities should aim to meet these
recommendations, they should be as active as possible if they cannot comply fully (U.S.
Department of Health and Human Services, 2018).
Research has demonstrated variations in sedentary behavior patterns among children with
disabilities compared to those without, especially as they age (Jung et al., 2018; Ross et al.,
2020). Lobenius-Palmer (2018) found that children with disabilities spent significantly less time
engaging in light physical activity and more time in sedentary behavior than their peers without
disabilities when monitored with accelerometers. Additionally, children with disabilities are
involved in fewer minutes of moderate-to-vigorous physical activity than recommended, which

PERCEPTIONS OF BRAIN BREAKS

5

can increase their risk of secondary health issues (Fox et al., 2019; Okur et al., 2019; Stanish et
al., 2017).
Since children spend nearly 40 hours per week in school, it is imperative for schools to
deliver behavioral interventions, including physical activity programs (Hall & Eric, 2020).
Schools cater to diverse student populations and have been sites for various public health
interventions targeting obesity, physical activity, and nutrition (Greening et al., 2011; Gibson et
al., 2008; Driessen et al., 2014; Micha et al., 2017). Legislation like the Every Student Succeeds
Act (ESSA) of 2015 supports equal opportunities for all students, including those for physical
activity (U.S. Department of Education, 2015).
However, access to physical education classes and recess is only sometimes available,
reducing opportunities for physical activity, especially at the secondary level, where recess and
breaks are virtually nonexistent. Nettlefold et al. (2011) found that only a small percentage of
elementary school children engaged in sufficient physical activity during recess. Research has
shown that students with disabilities and secondary students engage in limited physical activity
during school hours, emphasizing the need for additional interventions (Sit et al., 2007).
Classroom-based physical activity breaks (CBPAs), which involve short intervals of
physical activity in the classroom, can help increase physical activity and reduce sedentary
behavior during the school day (The Foundation for Global and Community Health, 2021). BB,
synonymous with CBPAs, allows students to refocus after extended periods of sitting and can be
incorporated into lessons or as stand-alone activities. Research has shown that CBPAs can
improve behavior management, academic performance, and overall well-being (Cothran et al.,
2010; Stylianou et al., 2016; Watson et al., 2017). Although beneficial, secondary teachers'

PERCEPTIONS OF BRAIN BREAKS

6

perceptions and use of BB and the factors that facilitate or hinder their classroom implementation
remain poorly understood.
Types of Brain Breaks
BB can be categorized into several types based on their activities and intended outcomes.
Each type serves a distinct purpose and can be strategically used to address different needs
within the classroom.
Physical activity (PA) breaks involve exercises and movements that increase students'
physical activity levels. These include stretching, jumping jacks, dance routines, or simple
aerobic exercises. The primary goal of physical activity breaks is to get students moving, which
can help boost their physical fitness, energy levels, and cognitive function. Research has shown
that short bouts of physical activity can lead to improved attention, better behavior, and enhanced
academic performance (Mahar et al., 2006; Watson et al., 2017). For example, integrating brief
periods of exercise into the school day has been linked to improvements in students' on-task
behavior and overall engagement in classroom activities.
Mindfulness and relaxation breaks focus on calming the mind and body through deep
breathing exercises, guided imagery, or progressive muscle relaxation. Designed to help students
manage stress and anxiety, breaks enhance emotional regulation and improve focus. Mindfulness
practices in schools have been associated with reduced symptoms of stress, better emotional
regulation, and increased attention span (Zenner et al., 2014). Engaging in activities like deep
breathing or listening to soothing music can provide students with a sense of tranquility and help
them approach their academic tasks with a clearer mind and improved focus.
Cognitive breaks involve activities that stimulate the brain differently from typical
classroom tasks. These activities include puzzles, brainteasers, or creative thinking exercises.

PERCEPTIONS OF BRAIN BREAKS

7

Cognitive breaks aim to refresh the mind and encourage creative and critical thinking. By
providing a mental refresh, these breaks can enhance problem-solving skills and boost creativity
(Bishop, 2014). For example, a quick game of Sudoku or a short brainstorming session on an
unrelated topic can shift students' cognitive focus and give their brains a break from continuous
academic strain.
Sensory breaks cater to students' sensory needs through activities that provide tactile,
auditory, or visual stimulation. Examples of sensory breaks include using sensory bins filled with
various textured objects, listening to calming music, or engaging in visually stimulating activities
such as watching a video of flowing water or colorful patterns. Sensory breaks can be
particularly beneficial for students with sensory processing issues, helping them to regulate their
sensory input and maintain focus in the classroom (Case-Smith et al., 2015). These activities can
help students who are easily overstimulated or understimulated achieve a sensory balance,
enabling their academic participation.
Understanding and utilizing different BB modalities can help educators create a more
dynamic and responsive learning environment. Each type of break addresses specific needs and
can be incorporated into the school day to support students' physical, emotional, and cognitive
well-being.
Statement of the Problem
The average attention span of secondary students typically ranges from 10 to 20 minutes,
influenced by factors such as age, individual differences, task complexity, and interest levels
(Best & Miller, 2010). Adolescents aged 12 to 18 are still developing executive function skills,
including attention regulation, leading to shorter attention spans in younger adolescents
compared to older ones. Engaging or interactive tasks tend to maintain attention longer than

PERCEPTIONS OF BRAIN BREAKS

8

passive activities like lectures (Bligh, 2000). External factors such as the classroom environment,
teaching methods, and individual student characteristics, including motivation and fatigue, also
impact attention span (Mayer, 2011). Research supports these observations, indicating that high
school students need brief breaks to refocus after 10-20 minutes of focused attention (Sousa,
2017). To sustain engagement, educators should adopt strategies like breaking up lectures and
lessons with interactive activities, incorporating BB, and using varied teaching methods such as
group work and technology integration (Mahar et al., 2006; Prince, 2004). For students with
ADHD, attention spans are even shorter, typically about 3 to 5 minutes, up to around 20 minutes
for older adolescents (DuPaul & Stoner, 2014; Barkley, 2015). ADHD symptoms of inattention,
hyperactivity, and impulsivity exacerbate difficulties in maintaining focus, particularly in
traditional classroom settings (American Psychiatric Association, 2013). Practical strategies for
managing shorter attention spans in ADHD students include breaking tasks into manageable
segments, using visual and auditory cues, incorporating frequent breaks, and providing a
structured classroom environment (Evans et al., 2014; DuPaul et al., 2014). The length of class
periods at the secondary level in the United States varies from 50 to 90 minutes, depending on
the school's scheduling model, which influences how instructional strategies are implemented to
optimize student focus and learning outcomes (Queen, 2000; Veal & Schreiber, 1999).
The implementation of brain breaks in daily lessons among secondary teachers in the
U.S. varies, and specific statistics on the exact number or percentage of secondary teachers who
regularly use brain breaks are not widely documented. Available research and surveys provide
insight into the prevalence and attitudes toward using BB in the classroom. While using brain
breaks is highly encouraged and has gained significant popularity, particularly in elementary
education, its implementation at the secondary level must be more consistent. For instance, a

PERCEPTIONS OF BRAIN BREAKS

9

survey by GoNoodle, a popular platform providing brain break activities, indicated that over
90% of elementary school teachers use brain breaks. However, this adoption rate drops in middle
and high schools, with a study by Webster et al. (2015) showing that about 50% of secondary
teachers use some form of physical activity breaks in their classes. Secondary teachers often
need assistance with challenges such as time constraints, curriculum demands, and lack of
training or resources, which hinder the consistent use of brain breaks (Cothran et al., 2010;
Stylianou et al., 2016). These barriers suggest that while many teachers recognize the benefits of
brain breaks, fewer integrate them regularly into their daily lessons. There is, however, a
growing trend towards incorporating more physical activity and mindfulness practices into
secondary education, supported by organizations like SHAPE America and the CDC. Despite
this positive trend, the shift is gradual, and widespread adoption across all secondary classrooms
is still pending progress.
The study addresses the problem of understanding secondary teachers' perceptions of
brain breaks, including the facilitators and barriers to implementation. While research supports
that brain breaks offer significant benefits for student engagement and focus (Mahar et al., 2006;
Webster et al., 2015), secondary teachers face challenges that may impede their adoption of these
breaks. These challenges include time constraints, loss of control, lack of training, and concerns
about losing instructional time (Cothran et al., 2010; Stylianou et al., 2016). Identifying these
barriers and facilitators is crucial to promoting the effective use of brain breaks in secondary
education settings.
Organizational Context
The study will be conducted in the Central York School District in York County,
Pennsylvania. This district serves diverse student populations in terms of socioeconomic status

PERCEPTIONS OF BRAIN BREAKS

10

(SES), ethnicity, and academic abilities. The selected schools will include middle and high
schools to cover a broad range of secondary education settings. This district's political,
economic, social, and ethical systems play a significant role in shaping the educational
environment and the feasibility of implementing brain breaks. For instance, varying funding
levels and resources across schools and districts can impact the availability of professional
development opportunities for teachers (Evans et al., 2014). Societal views on innovative
teaching methods and the ethical obligation to address every student’s learning needs provide
additional context.
Assumptions about the problem include the belief that teachers' perceptions significantly
influence the implementation of brain breaks and that a supportive organizational culture can
facilitate their adoption. Previous studies have indicated that teacher training and administrative
support are critical factors in successfully integrating new educational practices (Stylianou et al.,
2015).
Research Questions
1. What are secondary teachers' perceptions regarding using brain breaks in the classroom?
2. What factors influence the acceptance or resistance to brain breaks among secondary
teachers?
3. How do secondary teachers perceive the impact of brain breaks on student focus,
behavior, and overall classroom engagement?
Existing Research
The researcher reviews several key concepts and topics to understand the problem better
and design the intervention. Research consistently shows that physical activity significantly
positively affects cognitive function, including improved attention, memory, and executive

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11

function (Hillman et al., 2008). These benefits are significant for students with ADHD, who
often face challenges in maintaining focus and controlling impulses (CDC, 2024). In contrast,
sedentary behavior, characterized by prolonged sitting and minimal physical activity, is
associated with various health risks, including obesity, cardiovascular disease, and metabolic
syndrome (Tremblay et al., 2017). For children with disabilities, these risks are even more
pronounced due to their generally lower levels of physical activity (Stanish et al., 2017).
BB has shown improved classroom behavior, reduced off-task behavior, and increased
student engagement (Mahar et al., 2006; Webster et al., 2015). Understanding teachers'
perceptions of brain breaks and identifying the barriers to implementation is crucial for designing
effective interventions. Common barriers include lack of time, inadequate training, and concerns
about managing classroom time effectively (Stylianou et al.,2016; Cothran et al., 2010).
Several seminal studies and theories inform this study. Cognitive Load Theory (CLT)
suggests that the human brain has a limited capacity for processing information and that
excessive cognitive load can hinder learning (Sweller, 1988). BB helps manage the mental load
by providing rest intervals, thus enhancing learning efficiency and effectiveness.
Self-determination theory (SDT) emphasizes the role of intrinsic motivation in driving human
behavior (Deci & Ryan, 1985). Providing students with enjoyable, short breaks can increase their
intrinsic motivation for learning and participating in class activities. The Ecological Model of
Physical Activity highlights the multiple levels of influence on physical activity behavior,
including individual, interpersonal, organizational, community, and policy factors (Sallis et al.,
2008). Understanding these levels helps design comprehensive interventions that address various
barriers and facilitators to physical activity in schools.

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12

The conceptual framework for this study is grounded in the intersection of educational
psychology, physical activity research, and behavioral health theories. The framework integrates
CLT, SDT, and the Ecological Model of Physical Activity to provide a holistic understanding of
how BB can be effectively implemented in classrooms to improve student outcomes. CLT
informs the study by highlighting the importance of managing students' cognitive load to
enhance learning and retention. BBs are a practical application of this theory by providing
necessary pauses to prevent cognitive overload (Sweller, 1988). SDT provides insight into the
motivational aspects of brain breaks. By incorporating activities that students find enjoyable and
engaging, brain breaks can foster a more motivated and enthusiastic learning environment (Deci
& Ryan, 1985). Finally, the Ecological Model of Physical Activity helps understand the broader
context of brain break implementation, considering factors at multiple levels that influence
teachers' ability to incorporate physical activity into their classrooms (Sallis et al., 2008).
Significance of the Study
This study is significant for several reasons. It addresses a gap in the literature by
focusing on secondary general and special education teachers' perceptions of brain breaks, an
area that has received less attention than primary and general education. The findings will
provide valuable insights for educators, administrators, and policymakers to develop effective
strategies and supportive policies that promote the use of BB in secondary education. Ultimately,
this research aims to enhance secondary students' educational experiences and outcomes,
particularly those with ADHD, by fostering a more supportive and engaging learning
environment.

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Delimitations
The study is limited to secondary regular and special education teachers within the
Central York School District in York County, Pennsylvania. The focus is on teachers' perceptions
of brain breaks, excluding the perspectives of different stakeholders such as students and parents.
Additionally, the study will primarily use surveys and five open-ended questions to gather data,
which may limit the depth of insights compared to qualitative methods like interviews or focus
groups.
Definition of Terms
Attention-Deficit/Hyperactivity Disorder (ADHD): ADHD is a common neurodevelopmental
disorder characterized by developmentally inappropriate symptoms of inattention, hyperactivity,
and impulsivity. It significantly impacts children's academic performance, social interactions,
and emotional stability. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
(DSM-V), classifies ADHD into specific subcategories based on predominant symptoms
(American Psychiatric Association, 2013).
Brain Breaks (BB): Brain breaks are short, structured breaks that involve physical activity or
cognitive relaxation techniques. These breaks help students re-energize, refocus, and enhance
their learning experience. Brain breaks have been shown to improve attention, reduce disruptive
behaviors, and increase classroom engagement, particularly for students with ADHD (Centers
for Disease Control and Prevention [CDC], 2024).
Physical Activity (PA): Physical activity is defined by the Centers for Disease Control and
Prevention (CDC) as any bodily movement produced by skeletal muscles that increases energy
expenditure. Physical activity is categorized behaviorally into light (<3 METs), moderate (3.0 to
6 METs), and vigorous (>6 METs) activities (Centers for Disease Control and Prevention, 1999).

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Sedentary Behavior: Sedentary behavior is characterized by a metabolic equivalent (MET) of
less than 1.5 and minimal energy expenditure above resting levels. It includes activities such as
sitting or lying down while awake and engaging in minimal physical activity (Tremblay et al.,
2017).
Classroom-Based Physical Activity Breaks (CBPAs) are short intervals of physical activity
integrated into the classroom setting. They aim to increase physical activity and reduce sedentary
behavior during the school day. These breaks can be incorporated into lessons or conducted as
stand-alone activities to help students refocus and improve classroom behavior and academic
performance (Mok et al., 2020).
Traditional Schedule: In secondary education, a traditional schedule typically involves students
attending six to eight daily classes, each lasting 45 to 55 minutes. This model is still prevalent
nationwide in many middle and high schools (Queen, 2000).
Block Schedule: In secondary education, a block schedule involves students attending fewer
classes per day, but each class period lasts longer, usually around 80 to 90 minutes. Schools
using a block schedule often rotate classes every other day, meaning students might have four
courses on one day and a different set of four classes the next day (Canady & Rettig, 1995).
Modified Block Schedule: This scheduling model combines traditional and block scheduling
elements. For example, students might have some classes that meet daily for shorter periods
(50-60 minutes) and other classes that meet less frequently but for more extended periods (80-90
minutes) (Queen, 2000).
Self-Determination Theory (SDT): SDT is a theory of motivation that emphasizes the role of
intrinsic motivation in driving human behavior. Providing activities that students find enjoyable

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15

and engaging can increase their intrinsic motivation for learning and participation in class
activities (Deci & Ryan, 1985).
Cognitive Load Theory (CLT): The theory posits that the human brain has a limited capacity
for processing information and that excessive cognitive load can hinder learning. Brain breaks
help manage cognitive load by providing rest intervals, thus enhancing learning efficiency and
effectiveness (Sweller, 1988).
Ecological Model of Physical Activity: This model highlights the multiple levels of influence
on physical activity behavior, including individual, interpersonal, organizational, community, and
policy factors. Understanding these levels helps design comprehensive interventions that address
various barriers and facilitators to physical activity in schools (Sallis et al., 2008 ).
Summary
This chapter underscores the significance of understanding secondary teachers'
perceptions of brain breaks and the factors that facilitate or hinder their implementation. Given
the short attention spans of secondary students, particularly those with ADHD, integrating BB
can significantly enhance student engagement, focus, and overall academic performance. BB
helps manage cognitive load and provides mental rest, fostering a more effective and enjoyable
learning environment. However, challenges such as time constraints, curriculum demands, and
lack of training can impede their consistent use. The chapter also highlights various educational
scheduling models and theoretical frameworks, including Self-Determination Theory and
Cognitive Load Theory, which support the strategic implementation of BB. By addressing these
perceptions and barriers, the study aims to develop effective strategies that create supportive and
inclusive educational settings, ultimately enhancing educational outcomes for all students,
especially those with ADHD.

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Chapter 2: Literature Review
ADHD is a pervasive neurodevelopmental disorder that has a considerable impact on
children. It is characterized by inattention, hyperactivity, and impulsivity. The core symptoms
limit functioning in academic performance, social relationships, and emotional stability in
children, and these limitations may persist into adulthood. Historical data describe ADHD-like
symptoms as reported in the medical literature, dating back to 1775, which outlines the chronic
nature of the condition (Faraone et al., 2021).
The DSM-V, classifies ADHD as a neurodevelopmental disorder. It divides the symptoms
into two significant categories: inattention and hyperactivity/impulsivity. The DSM-V outlines
three presentations of ADHD: Predominantly Inattentive Presentation, Predominantly
Hyperactive/Impulsive Presentation, and Combined Presentation. Similarly, the International
Classification of Diseases, 10th/11th Revision (ICD-10/11) also categorizes ADHD but includes
more subcategories and does not restrict symptom onset with strict age limits.
ADHD influences an estimated 5-10 percent of school-aged children worldwide,
constituting one of the most prevalent conditions in childhood. Concerning the difference
between ADHD and Specific Learning Disabilities (SLDs), which are limited to some facets,
like math or reading, ADHD can affect all areas of cognitive functioning. About 30% of children
with ADHD also have an SLD, with the majority diagnosed with dyslexia (Barkley et al., 2021).
Historical Evolution of Terminology and Diagnostic Criteria
The DSM-II (1968) initially termed ADHD a "hyperkinetic reaction of childhood," which
the American Psychiatric Association (APA) later renamed "Attention Deficit Disorder (ADD)"
in the DSM-III (1980) before incorporating hyperactivity. According to the current DSM-V,
ADHD falls under three presentations requiring symptoms to persist for at least six months, with

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onset before age twelve and causing significant impairment in social, academic, or occupational
functioning (American Psychiatric Association, 2013).
Lifespan Perspective
Both in the DSM-V and ICD-11, ADHD has been identified as a lifespan
neurodevelopmental condition. It is one of the most frequent childhood disorders, with
symptoms persisting into adolescence and adulthood in many cases. ADHD is a persistent
pattern of inattention, hyperactivity, and impulsivity that is more frequent and severe than is
typically observed in individuals at comparable age and developmental levels. Definitions of
ADHD evolved from various editions of the DSM and ICD, with advances in concepts and
understanding of the disorder (About Attention-Deficit / Hyperactivity Disorder (ADHD), 2024).
Understanding ADHD requires considering its historical context, diagnosis, prevalence,
impact, and the evolution of its definitions and classifications.
Etiology
The exact causes of ADHD are still unclear, but research suggests a substantial genetic
influence. Other potential risk factors include brain injuries, exposure to environmental toxins
(e.g., lead) during pregnancy or early childhood, prenatal exposure to alcohol and tobacco,
premature delivery, and low birth weight. Myths such as sugar consumption or excessive
television watching lack empirical support (About Attention-Deficit / Hyperactivity Disorder
(ADHD), 2024).
Genetic Factors
Studies on ADHD have revealed heritability estimates ranging between 70% and 90%,
indicating a strong genetic influence. Family and twin studies consistently demonstrate this
genetic predisposition. Children are more likely to have ADHD if their relatives have been

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18

diagnosed with the disorder. The Genome-Wide Association Studies (GWAS) indicate that
ADHD is influenced by genetic risk factors associated with multiple psychiatric conditions,
suggesting shared biological pathways in their development (Sonuga-Barke et al., 2023).
Sex-dependent genetic effects of ADHD are also evident, contributing to differences in
prevalence and symptom presentation between males and females.
Figure 1
Genetic Variations of Brain Changes in Patients with ADHD

(Genetic variations influence brain changes in patients with attention-deficit hyperactivity disorder, 2021)

Environmental Influences
Environmental factors, along with prenatal and perinatal influences, also contribute to
ADHD. Notable risk factors include maternal smoking, prenatal stress, low birth weight, and
early exposure to environmental toxins (Sonuga-Barke et al., 2023). Fetal exposure to teratogens
such as tobacco and alcohol has been implicated in the development of ADHD. Teratogens can
disrupt normal prenatal development, leading to symptoms characteristic of both fetal alcohol
syndrome (FAS) and ADHD, such as memory problems, poor judgment, and hyperactivity

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19

(Faraone et al., 2005). Complications during pregnancy, such as hypoxia, toxemia, and
eclampsia, have also been linked to an increased risk of ADHD in children (Linnet et al., 2003).
The interaction between genes and the environment demonstrate how complex the
etiology of ADHD is, where environmental factors may elevate genetic risk or vice versa
(Sonuga-Barke et al, 2023). ADHD rarely has a single cause, whether it is genetic or
environmental. Most cases occur due to the combined effects of several genetic and
environmental risks, each having a minimal impact (Faraone et al., 2021). Neuroimaging studies
have shown that the structure and function of the brain in people with ADHD are subtly different
from those without it, especially in the frontal, cingulate, and temporal regions. This provides
further evidence that ADHD has a neurobiological basis (Faraone et al., 2021).
Neuroscience/Pathophysiology
Neurobiologically, ADHD is associated with alterations in brain structure and function,
specifically in the frontal cortex, which plays a crucial role in executive functioning such as
problem-solving, decision-making, and behavioral control (Shaw et al., 2007). Studies have
shown morphological differences in the brains of individuals with ADHD, including smaller
volumes in the Corpus Callosum, which is responsible for communication between the brain’s
hemispheres. Additionally, there is often asymmetry in the brains of children with ADHD, with
the right frontal region being more prominent than the left in most typical brains (Shaw et al.,
2007).
A prevailing theory in understanding the etiology of ADHD is the imbalance of
neurotransmitters, particularly norepinephrine and dopamine. These neurotransmitters are crucial
for stimulating brain activity and supporting the neural circuits that regulate attention and
behavior. Neuroimaging studies have demonstrated abnormalities in brain areas related to these

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20

functions, primarily in the prefrontal cortex and the dopaminergic mesolimbic system (Posner et
al., 2020). The effectiveness of stimulant medication in alleviating ADHD symptoms further
supports this theory, as these medications increase the availability of neurotransmitters in the
brain, thereby improving symptoms related to attention and hyperactivity (Faraone et al., 2015).
Additionally, ADHD psychopathology includes Emotional Regulation Difficulties
(ERD), which indicate symptom severity, continuity, and adverse outcomes such as comorbid
anxiety and depression. ERD involves failing to regulate and react appropriately to emotional
experiences, adding additional complexity to the clinical presentation of ADHD (Sonuga-Barke
et al., 2023).
Figure 2
Brain Mechanisms in ADHD

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21

Developmental and Transdiagnostic Perspectives
ADHD is a lifelong disorder with various developmental trajectories. Therefore, this is
relevant to early intervention and preventive strategies, although it is still somewhat limited by
the restricted knowledge on early predictors of ADHD (Posner et al., 2020). Current studies view
ADHD as a dimensional disorder from a categorical perspective, characterized by symptom
severity and increased variability in symptom presentation (Sonuga-Barke et al., 2023).
Furthermore, there is an overlap in the etiology and pathophysiology of this condition with other
psychiatric conditions. A transdiagnostic framework may help to identify standard vulnerability
processes and improve treatment approaches across disorders (Posner et al., 2020).
Genetic and Environmental Interactions
Neuroimaging research has shown that the combined effects of genetic predispositions
and environmental exposures lead to altered brain development, increasing the risk of ADHD
(Pereira-Sanchez & Castellanos, 2021). Professionals can understand these interactions in the
context of prevention and early intervention. These factors include maternal pre-pregnancy
obesity, antibiotic use, and acetaminophen use during pregnancy, maternal smoking, prenatal
opioid exposure, and perinatal complications such as preeclampsia and low birth weight
(Chaulagain et al., 2023). Additional contributors that may increase an individual's risk for
ADHD include postnatal factors like breastfeeding duration and exposure to secondhand smoke
(Chaulagain et al., 2023).
Comorbidities
ADHD often coexists with many other disorders, such as anxiety, depression, learning
disabilities, and sleep disorders. These comorbidities complicate the diagnosis and treatment of

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22

ADHD, and therefore, its treatment should be multifaceted (About Attention-Deficit /
Hyperactivity Disorder (ADHD), 2024).
Other Common Comorbidities:
Psychiatric Disorders
● Anxiety and Depression: ADHD often co-occurs with anxiety and depression,
exacerbating the conditions of children with ADHD and affecting their academic
performance and social life (Chan et al., 2022).
● Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD): The presence of ODD
and CD is pervasive in children with ADHD, and it adds to behavior management
problems and complexities in the treatment and intervention of ADHD.
● Bipolar Disorder and Tourette Syndrome: Frequently coexisting with ADHD necessitates
detailed diagnostic assessment in these cases (Chaulagain et al., 2023).
Neurodevelopmental Disorders
● Autism Spectrum Disorder (ASD): ADHD often coexists with ASD, so interventions
need to be focused on the comorbidity of the two conditions and approaches directed at
the impairment of each (Chaulagain et al., 2023).
● Learning Disorders: Dyslexia, dyscalculia, and dysgraphia are common types of learning
disorders that children with ADHD usually experience, making the process of learning
increasingly challenging for them (Danielson et al., 2018).
● Sluggish Cognitive Tempo (SCT): SCT is characterized by dreaminess, mental fogginess,
and a slow cognitive process. It is not considered to be ADHD but often presents with
ADHD, which makes diagnosis and treatments even more complex (Sonuga-Barke et al.,
2023).

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Somatic Conditions
● Sleep Problems: Sleep problems are common in ADHD and add to the overall
impairment of ADHD. Poor sleep quality exacerbates attention deficit symptoms, and it
may give rise to other psychiatric comorbidities (Sonuga-Barke et al., 2023).
● Obesity and Eating Disorders: Individuals with ADHD experience increased obesity and
eating disorders that require ADHD healthcare services (Chaulagain et al., 2023).
Genetic studies indicate significant genetic overlaps between ADHD and its various
comorbidities, like major depression, autism, and bipolar disorder. This gene comorbidity
suggests shared biological pathways and challenges the notion of ADHD as a distinct, isolated
condition (Sonuga-Barke et al., 2023). Environmental factors also play a role, and
gene-environment interactions contribute significantly to the complexity of ADHD etiology
(Sonuga-Barke et al., 2023).
Prevalence and Impact of Comorbidities
A 2016 parent survey by the CDC indicated that approximately 64% of children with
ADHD had at least one other disorder. Common comorbidities include behavioral or conduct
problems (52%), anxiety (33%), depression (17%), ASD (14%), and Tourette syndrome (1%).
These coexisting conditions create a need for thorough screening and personalized intervention
strategies, particularly for individuals already diagnosed with ADHD (Danielson et al., 2018).

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Figure 3
Percent of children with ADHD who had at least one other disorder

(Percent of children with ADHD who had at least one other disorder, 2016)

The high degree of comorbidity between ADHD and other psychiatric,
neurodevelopmental, and somatic conditions necessitates an integrated approach to diagnosis and
treatment. This approach should include thorough screening for co-occurring conditions,
individualized interventions, and a strong emphasis on managing challenges in emotional
regulation. Understanding and addressing the complex interactions between ADHD and its
comorbidities can enhance outcomes and improve the quality of life for affected individuals.
Diagnosis and Symptomatology
Diagnosing ADHD involves a comprehensive assessment that includes medical
examinations to rule out other disorders, symptom checklists, and thorough histories from
parents, teachers, and the child.
Licensed clinicians diagnose ADHD based on clinical interviews, behavioral
assessments, and rating scales like the Conners' Rating Scale (About Attention-Deficit /
Hyperactivity Disorder (ADHD), 2024). Explicit criteria document symptoms and make the

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25

diagnosis valid across all ages and cultures, even when comorbid with other psychiatric
disorders.
Diagnosis Criteria
The DSM-V criteria for the diagnosis of ADHD indicate that, in the last six months, there
should exist either symptoms of hyperactivity-impulsivity, inattentiveness, or both in various
settings, with an associated functional impairment (Faraone et al., 2021). The DSM-V identifies
three presentations for classifying ADHD: predominantly inattentive, predominantly
hyperactive-impulsive, and combined (About Attention-Deficit / Hyperactivity Disorder
(ADHD), 2024). The diagnosis is made according to criteria in DSM-V and ICD-11 to ensure
consistency in diagnosis between regions and population studies.
Symptoms of Inattention:
● Difficulty sustaining attention
● Forgetfulness
● Disorganization
Symptoms of Hyperactivity-Impulsivity:
● Fidgeting
● Excessive talking
● Impulsive actions
Subtypes of ADHD Each subtype has distinct diagnostic criteria:
Predominantly Inattentive Presentation (A1):
● Failing to give close attention to details
● Difficulty holding attention on tasks
● Not listening when spoken to directly

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● Poor follow-through on instructions
● Difficulty organizing tasks
● Avoiding tasks requiring mental effort
● Losing things
● Being easily distracted
● Forgetfulness in daily activities (American Psychiatric Association, 2013)
Predominantly Hyperactive-Impulsive Presentation (A2):
● Fidgeting
● Leaving one's seat in inappropriate situations
● Running about or climbing excessively
● Inability to play quietly
● Seems to be "on the go"
● Talking excessively
● Blurting out answers
● Difficulty waiting for turns
● Interrupting others (American Psychiatric Association, 2013)
Combined Presentation:
● A combination of hyperactive and inattentive symptoms
● Associated with higher rates of behavior disorders and other psychiatric conditions
● Lower average intellectual, academic, and social functioning compared to non-ADHD
children (American Psychiatric Association, 2013)

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Symptom Presentation Over Time
ADHD symptoms often persist into adolescence and adulthood, though their expression
may evolve (Sonuga-Barke et al., 2023). Hyperactivity and impulsivity generally initiate in early
childhood, and longitudinal studies ascertain that some will exhibit a remission of symptoms;
however, most individuals have ADHD symptoms continuing into their adult life, indicative of
the intermittent nature of ADHD. Additionally, the symptoms of ADHD can begin in
adolescence or adulthood, as recent data suggests, including cases of late-onset ADHD. This
further complicates the traditional view that ADHD must exist from early childhood
(Sonuga-Barke et al., 2023).
Incidence and Prevalence
ADHD is the most common neurodevelopmental disorder diagnosed in children and
teens, with global prevalence rates ranging from 5.29% to 7.2% (Chan et al., 2022; Drechsler et
al., 2020). This variability can be attributed to differences in diagnostic criteria, methodological
variations, and region-specific factors. Generally, the rate remains constant, around 5% to 7%
between children and adolescents; additionally, boys are diagnosed more frequently than girls.
This gender difference is observed worldwide and may result from boys displaying more overtly
hyperactive and impulsive behaviors, which are more easily recognizable than the inattentive
symptoms that girls typically show (Drechsler et al., 2020).
The prevalence of ADHD in adults is estimated to be around 2.5-2.8% globally (Posner et
al., 2020; Drechsler et al., 2020). Compared to children, the lower prevalence implies either a
decrease in the symptoms with age or underdiagnosis in adulthood. Longitudinal studies indicate
that while some individuals alleviate their symptoms as they age, most continue to exhibit these
characteristics into adulthood, albeit in a different form (Posner et al., 2020).

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Regional Variations
Studies utilizing clinical interviews conducted in North America often report higher rates
of ADHD prevalence, which may vary based on geographic location and the nature of the
research study (Chaulagain et al., 2023). According to the CDC, the prevalence of ADHD among
children aged 3 to 17 years in the United States was approximately 9.8 percent based on data
pooled from 2016 to 2019. This translates to about 6 million children, with diagnosis rates higher
in older children: 2 percent in children aged 3 to 5 years, 10 percent in those aged 6 to 11 years,
and 13 percent in those aged 12 to 17 years (Danielson et al., 2018).
ADHD diagnosis and treatment rates also vary significantly across US states, with
diagnosis rates ranging from 6% to 16%. Treatment rates, including medication and behavioral
treatment, fluctuate between 58% to 92% and 38% to 62%, respectively (Danielson et al., 2018).
Figure 4
Percent of children (aged 3-17) with ADHD

(Prevalence, 2016)

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Figure 5
Percent of children with ADHD who receive ADHD medication

(Treatment: Medication, 2016)

Figure 6
Percent of children with ADHD who receive behavior treatment

(Treatment: Behavior Treatment, 2016)

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Figure 7
Percent of children with ADHD who receive any treatment

(Treatment: Any Treatment, 2016)

Millions of children and adults worldwide are affected by ADHD, leading to its
widespread incidence and prevalence. While prevalence rates vary somewhat, seemingly due to
methodological differences and regional factors, the disorder consistently appears more common
in males. Research indicates an increasing trend in diagnoses over time. Understanding these
patterns will be crucial for developing effective strategies for diagnosis, treatment, and support
for individuals with ADHD across various populations and settings.
Ethnic and Socioeconomic Variations
The prevalence of diagnosis also varies among different ethnic and socioeconomic
groups. Data from a 2016 CDC survey indicate higher diagnosis rates for children identified as

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Black non-Hispanic (12%) and White non-Hispanic (10%) compared to those classified as
Hispanic (8%) or Asian non-Hispanic (3%) (Danielson et al., 2018).
Historical Trends
Over the past few decades, the number of children diagnosed with ADHD has increased
significantly. Specifically, between 2003 and 2011, ADHD diagnoses among children in the U.S.
surged by 42% (Attention-Deficit/Hyperactivity Disorder, n.d.). This surge has occurred partly
due to a better understanding of ADHD and increased awareness among healthcare professionals
and the general public. As more people recognize the symptoms, more children are being
diagnosed. However, the increase may also stem from changes in diagnostic practices and
heightened vigilance by doctors and educators (Morrow et al, 2012).
Furthermore, the increasing ADHD diagnosis trend isn't unique to the United States.
Globally, around 5% of children and adolescents are diagnosed with ADHD, though this rate
varies significantly across different regions. These variations suggest that cultural attitudes and
diagnostic criteria play a crucial role in how ADHD is recognized and reported (Polanczyk et al.,
2007). For instance, Europe has seen a similar rise in ADHD diagnoses, though the rates differ
due to varying healthcare systems and cultural perceptions (Hinshaw & Scheffler, 2014).
As mentioned earlier, boys are diagnosed with ADHD significantly more often than girls.
Studies indicate that 13% of boys are diagnosed with ADHD compared to 6% of girls (Danielson
et al., 2018). This disparity may be because boys often exhibit more pronounced and disruptive
symptoms, such as hyperactivity and impulsivity, making them easier to notice and report. In
contrast, girls typically display inattentive symptoms, like daydreaming, which can be easily
overlooked due to their less disruptive nature (Gaub & Carlson, 1997).

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The criteria for diagnosing ADHD have also evolved. The DSM has undergone several
revisions impacting ADHD diagnosis. The DSM-IV, released in 1994, expanded the diagnostic
criteria to include a broader range of symptoms and subtypes, likely contributing to the rise in
diagnoses during that period (American Psychiatric Association, 1994). The DSM-V, published
in 2013, further refined these criteria, stressing the need for consistent symptoms across different
settings over time (American Psychiatric Association, 2013).
Society itself has influenced the rising rates of ADHD diagnoses. Increased academic
pressures, changes in educational policies, and a greater emphasis on standardized testing may
have heightened awareness and diagnosis of ADHD (Sax & Kautz, 2003). Plus, the rise of
technology and social media has spread information about ADHD, boosting public and
professional awareness.
Finally, it is vital to evaluate how the COVID-19 pandemic has impacted ADHD
diagnoses and management. The transition to remote learning and the disruption of daily routines
exacerbated ADHD symptoms for many children, leading to an increase in the number of
diagnoses during the pandemic (Bobo et al., 2020). The lack of structured environments and the
challenges of virtual classrooms made it difficult for students with ADHD to stay focused and
engaged. Additionally, COVID-19 underscored the need for mental health services and support
systems for kids with ADHD (Lee, 2020).
Ergo, the historical trends in ADHD diagnosis reflect a combination of improved
recognition, evolving diagnostic criteria, and broader societal influences. Understanding these
factors is essential for ensuring accurate diagnosis and effective management of ADHD.

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Understanding Neuroscience and Its Role in Special Education
Investigating the connection between neuroscience and special education reveals
promising opportunities to enhance the teaching methods for students with ADHD. Research
involving brain imaging offers crucial insights into the brain's structure and functioning
associated with ADHD, aiding in the development of more effective Individualized Educational
Plans (IEPs) and targeted interventions.
Key Brain Differences
Studies using neuroimaging have found notable structural differences in the brains of
children with ADHD. These children often have smaller volumes in brain areas crucial for
attention, impulse control, and executive functions, such as the prefrontal cortex, basal ganglia,
and cerebellum (Pereira-Sanchez & Castellanos, 2021). Additionally, researchers have observed
smaller volumes in subcortical structures such as the accumbens, amygdala, caudate,
hippocampus, and putamen, alongside reduced cortical thickness and surface area in the frontal,
cingulate, and temporal cortices (Pereira-Sanchez & Castellanos, 2021). Understanding these
structural differences allows educators to tailor IEPs, 504s, and differentiated instruction to
address specific cognitive deficits, ensuring that educational interventions are customized to each
student's unique brain development.
Functional Brain Networks
Research on brain function highlights impairments in networks like the default mode
network (DMN), frontoparietal network (FPN), and salience network (SN) in children with
ADHD. These networks are crucial for maintaining sustained attention, managing tasks, and
recognizing and responding to important stimuli (Pereira-Sanchez & Castellanos, 2021). Special
education programs can include strategies to strengthen these networks through specific

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34

cognitive and behavioral interventions. Methods like regular breaks, multimodal instruction, and
structured routines can help improve focus and executive functioning in students with ADHD.
Multimodal Approaches
Integrating genetic, neuroimaging, and behavioral data can help identify students who are
at greater risk for severe ADHD symptoms, facilitating early and tailored interventions. This
strategy enables the development of personalized learning environments that meet the specific
needs of students with ADHD, providing a more comprehensive understanding of their
developmental profiles (Pereira-Sanchez & Castellanos, 2021).
Neuroplasticity and Educational Strategies
Research on brain plasticity, the brain's ability to change and adapt, highlights the
potential for developing effective educational interventions for students with ADHD.
Customized learning approaches based on neuroscientific insights can cater to the unique
cognitive profiles of these students (Diamond, 2013). Differentiated instruction methods enhance
attention and executive functions, while technology-based learning tools provide interactive and
engaging experiences (Diamond 2013).
Incorporating physical activity and sensory integration exercises into the curriculum can
enhance neuroplasticity, boost focus, and improve cognitive functions. Techniques addressing
sensory processing issues help students concentrate more effectively and learn more efficiently
(Pascual-Leone et al., 2005). Additionally, mindfulness and relaxation practices can promote
focus and self-regulation by leveraging the brain's adaptive capacity (Diamond 2013).
Collaborating Across Disciplines
Integrating neuroscientific findings into educational strategies requires collaboration
between educators and neuroscientists. This partnership is crucial for translating research into

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35

practical classroom applications, leading to the development of evidence-based teaching
strategies tailored to the needs of students with ADHD (Willis, 2008). Educators must stay
current with the latest research to avoid misconceptions and outdated ideas, such as the debunked
notion of left-brain/right-brain learning styles (Willis, 2008). A solid understanding of brain
function supports the implementation of effective educational practices.
Educators should stay open to incorporating neuroscientific insights into teaching
methods, regularly assessing their impact, and sharing successful practices within the educational
community (Willis, 2008). As neuroscience advances, we expect to see more direct links
between brain research and classroom strategies, promoting inclusive and supportive learning
environments.
To conclude, advancements in neuroscience offer valuable insights into the unique needs
of students with ADHD. By leveraging these insights, educators can develop more effective and
personalized interventions, creating learning environments that significantly improve learning
and behavioral outcomes for these students. The collaboration between educators and
neuroscientists is essential for bridging the gap between research and practical classroom
applications, ensuring that scientific advancements lead to meaningful improvements in special
education.
Treatments for ADHD
Behavioral Therapy and Behavioral Interventions
Behavioral therapy is a vital part of ADHD treatment, especially for younger children. It
focuses on modifying behavior through structured techniques. Traditional ADHD treatments
include medications, psychological counseling, and behavioral therapy. Physical exercise has

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recently been recognized as a practical addition that benefits cognitive function and overall
health (About Attention-Deficit/Hyperactivity Disorder (ADHD), 2024; Chan et al., 2022).
Neurophysiological Changes from Physical Exercise
Physical exercise triggers neurophysiological responses that enhance cognitive functions,
including memory and executive function. Exercise increases neurotransmitters such as serotonin
and dopamine, and promotes the synthesis of brain-derived neurotrophic factor (BDNF), thereby
enhancing neuroplasticity (Chan et al., 2022). Both short-term and long-term exercises benefit
cognitive functions, with moderate to high-intensity aerobic exercises efficiently improving
attention, executive function, and motor skills. Even a single exercise session can have a positive
impact on cognitive functions, such as improved inhibitory control and attention (Chan et al.,
2022).
Specific Exercise Interventions
● Aerobic Interval Training (AIT). AIT involves repeated bouts of high-intensity effort
followed by recovery periods. It suits children with ADHD due to their impulsive and
hyperactive nature, improving cognitive functions and reducing ADHD symptoms (Chan
et al., 2022).
● Perceptual Motor Training and Meditation (PMTM). The intervention involves
rhythmic dancing and mindfulness practices that enhance sensory perception and
coordination of motor control. PMTM has shown potential benefits for improving
attention and self-control in children with ADHD (Chan et al., 2022).
Neurotherapeutics
Further exploring non-pharmacological treatments, biofeedback and neurofeedback are
becoming crucial tools, reflecting the growing trend of using personal data to enhance health.

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Biofeedback assists individuals with ADHD in gaining control over physiological functions like
heart rate variability, which helps manage symptoms related to anxiety and impulsivity.
Neurofeedback, a specific type of biofeedback that concentrates on brain activity, is especially
effective in treating ADHD. It trains individuals to regulate brain functions through protocols
such as theta/beta ratio (TBR), sensorimotor rhythm (SMR), and slow cortical potential (SCP)
training (DuPaul et al., 2013). These methods are effective in meta-analyses and randomized
controlled trials, providing a non-pharmacological alternative to traditional ADHD treatments,
which frequently have limitations regarding long-term symptom remission and potential side
effects. However, the clinical application of neurofeedback is not yet standardized, and further
research is needed to understand and optimize its use (DuPaul et al., 2013). Integrating these
innovative, non-invasive tools with traditional ADHD treatments could enhance overall patient
care, empowering individuals with ADHD to improve their self-regulation skills and, thus, their
quality of life.
Researchers have explored several neurotherapeutic approaches for ADHD treatment:
● EEG-Neurofeedback (EEG-NF). This method trains self-regulation of brain oscillations
linked to ADHD, such as the theta/beta ratio. While it has shown small to medium
improvements in symptoms, its overall effectiveness and self-regulation outcomes are
inconsistent (Rubia et al., 2021).
● Functional Magnetic Resonance Imaging Neurofeedback (fMRI-NF). This targets
specific brain regions with poor activation in ADHD. Although promising, more
extensive trials are needed to confirm its efficacy (Rubia et al., 2021).

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● Near-Infrared Spectroscopy Neurofeedback (NIRS-NF): A pilot study demonstrated
improvements in ADHD symptoms and cognitive functions, although it did not
outperform other neurofeedback methods (Rubia et al., 2021).
Brain Stimulation
● Repetitive Transcranial Magnetic Stimulation (rTMS). rTMS is a non-invasive method
that targets cortical excitability. Studies show mixed results, with some improvements in
ADHD symptoms but limited cognitive benefits (Rubia et al., 2021).
● Transcranial Direct Current Stimulation (tDCS). tDCS applies a weak, continuous,
direct current to the brain, modulating cortical function. Studies show minor cognitive
improvements, but the effects on clinical symptoms are mixed. tDCS is considered safe
and well-tolerated, especially in children (Rubia et al., 2021).
Parent Training
Parents undergo training to employ positive reinforcement and consistent discipline to
manage their child's behavior. Techniques include setting clear expectations, implementing
reward systems, and offering immediate feedback (About Attention-Deficit/Hyperactivity
Disorder (ADHD), 2024).
Cognitive Behavioral Therapy (CBT)
CBT is an effective non-pharmacological treatment for ADHD. CBT focuses on
modifying dysfunctional thoughts and behaviors, improving organizational skills, and
developing coping strategies (About Attention-Deficit / Hyperactivity Disorder (ADHD), 2024).
A meta-analysis by Knouse and Safren (2010) found that CBT significantly improves ADHD
symptoms, particularly in adults. Randomized controlled trials have shown that by teaching
techniques to control core symptoms and cope with related emotional challenges, CBT can

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significantly improve clinician-reported ADHD symptoms and self-reported inattention, as well
as reduce associated depression and anxiety. In some studies, integrating CBT with
pharmacotherapy is more effective than medication alone.
The American Academy of Pediatrics recommends CBT as the primary approach for
children under six, while advising a combination of medication and behavioral therapy for older
children (Wolraich et al., 2019).
Organizational Skills Training
Organizational training teaches children and adolescents time management, planning, and
organizational skills, which are particularly effective for secondary students struggling with
managing assignments and school materials (About Attention-Deficit/Hyperactivity Disorder
(ADHD), 2024).
Holistic Approaches
Recent approaches emphasize holistic, person-centered assessment and intervention,
focusing on reducing impairment and improving overall quality of life rather than solely
targeting symptom reduction (Sonuga-Barke et al., 2023).
Pharmacological Treatments
Several medications are recognized globally as safe and effective for reducing ADHD
symptoms. Stimulant medications are more effective than non-stimulants but have a higher
potential for misuse and abuse. Non-medication treatments, such as behavioral therapy, help
address residual problems after medication optimization (Faraone et al., 2021).
● Stimulants. Methylphenidate and amphetamines are first-line pharmacotherapies,
showing immediate symptom reduction. Side effects include reduced appetite, sleep
disturbances, and potential cardiovascular issues (Drechsler et al., 2020).

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● Non-Stimulants. These include atomoxetine, guanfacine, and clonidine. Atomoxetine is a
norepinephrine reuptake inhibitor with common side effects like nausea, vomiting, and
fatigue. Clonidine and guanfacine enhance noradrenergic neurotransmission in the
prefrontal cortex (Mechler et al., 2022).
Novel Medications
New medications such as Centanafadine, Mazindol, Serdexmethylphenidate, Tipepidine
Hibenzate, and Viloxazine are being developed. They have shown varying degrees of efficacy in
clinical trials (Mechler et al., 2022).
Non-Pharmacological Treatments
Behavioral interventions, cognitive training, neurofeedback, mindfulness, and physical
activity demonstrate modest efficacy, particularly when tailored to individual needs and used in
conjunction with medication (Chaulagain et al., 2023).
Comprehensive Treatment Approach
The most comprehensive method for managing ADHD is a multimodal treatment
approach combining pharmacology, CBT, neurofeedback, and educational support. This
approach addresses various aspects of ADHD, contributing to a comprehensive treatment plan
that caters to the individual's unique needs. Despite controversies and challenges surrounding
pharmacological interventions, this approach remains highly effective, as evidenced by extensive
research and clinical practice (Sibley et al., 2023). Continued research and interdisciplinary
collaboration are essential for refining these treatments and improving outcomes for individuals
with ADHD (About Attention-Deficit / Hyperactivity Disorder (ADHD), 2024; Chan et al.,
2022; Rubia et al., 2021; Faraone et al., 2021; Mechler et al., 2022; Sibley et al., 2023;
Chaulagain et al., 2023).

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Multimodal Approach to ADHD Treatment
Managing ADHD effectively often requires a multimodal approach that combines
behavioral therapy and medication. For preschool-aged children, behavior therapy, especially
parent training, is recommended before considering medication. This early intervention focuses
on teaching parents techniques to manage their child's behavior, providing a foundation for
future treatment. For school-aged children and adolescents, combining behavioral therapy with
medication is typically the most effective approach. Behavioral therapy helps address specific
challenges related to attention, hyperactivity, and impulsivity. At the same time, medication can
significantly reduce core symptoms, allowing for better engagement in therapeutic activities and
daily tasks (About Attention-Deficit / Hyperactivity Disorder (ADHD), 2024).
Close monitoring and regular follow-up are crucial components of any ADHD treatment
plan. This ongoing assessment involves collaboration among healthcare providers, parents,
teachers, and individuals with ADHD to ensure the chosen interventions are effective and make
necessary adjustments. Regular check-ins help track progress, address any side effects from
medications, and adapt strategies to meet the evolving needs of the individual (About
Attention-Deficit / Hyperactivity Disorder (ADHD), 2024).
Lifestyle and environmental changes also play a significant role in managing ADHD
symptoms. Maintaining a healthy lifestyle, including a nutritious diet, regular physical activity,
and adequate sleep, is essential. A balanced diet of fruits, vegetables, whole grains, and lean
proteins supports overall health and cognitive function. Regular physical exercise reduces
hyperactivity and improves focus, while sufficient, quality sleep is crucial for managing
symptoms and enhancing overall well-being (About Attention-Deficit/Hyperactivity Disorder
(ADHD), 2024).

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Creating a structured and predictable environment at home and school can help children
with ADHD manage their symptoms more effectively. Establishing routines, minimizing
distractions, and utilizing organizational tools provide the stability and predictability essential for
enhancing focus and reducing anxiety. These adjustments support individuals in developing
better organizational skills and self-regulation (About Attention-Deficit / Hyperactivity Disorder
(ADHD), 2024).
School-Based Interventions for ADHD
Effective school-based interventions for ADHD are crucial in assisting students in
managing symptoms and attaining academic success. These interventions generally encompass
behavioral classroom management, organizational skills training, and IEPs or 504 Plans, working
together to establish structured environments with clear expectations and consistent feedback
(About Attention-Deficit / Hyperactivity Disorder (ADHD), 2024).
Behavioral Classroom Management
Behavioral classroom management is a cornerstone of these interventions, with teachers
employing structured techniques to foster positive behavior in the classroom. Key methods
include reward systems, clear rules, and consistent consequences. Reward systems encompass
strategies where students earn rewards for exhibiting desired behaviors, promoting consistent
adherence to rules and expectations. Establishing and communicating clear, concise classroom
rules provides a predictable environment, reducing anxiety and impulsivity. Applying consistent
consequences for rule-breaking helps students understand the relationship between actions and
outcomes, which is crucial for behavioral regulation (About Attention-Deficit / Hyperactivity
Disorder (ADHD), 2024).

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Organizational Skills Training
Organizational skills training is particularly beneficial for students with ADHD who have
difficulty with time management, tracking assignments, and organizing school materials. This
training equips students with skills in time management, task organization, and effective study
techniques. Time management training teaches students how to use planners, prioritize tasks, and
allocate time efficiently to complete assignments. Task organization enables students to break
down large tasks into manageable steps while maintaining organized materials and study spaces.
Offering strategies for effective note-taking, summarizing information, and preparing for tests
improves their study skills (About Attention-Deficit / Hyperactivity Disorder (ADHD), 2024).
IEPs and 504 Plans
IEPs and 504 Plans are customized educational frameworks designed to address the
unique needs of students with disabilities, including ADHD, which is classified under the Other
Health Impairment (OHI) category. These plans provide specific, individualized
accommodations, such as extended time on tests, preferential seating, flexible seating, breaks,
and reduced distractions to support students' learning needs. It's essential to set realistic,
measurable academic and behavioral goals based on each student's strengths and needs. These
plans are developed and regularly reviewed in collaboration with parents, teachers, and school
specialists to ensure they remain adequate and relevant. (About Attention-Deficit / Hyperactivity
Disorder (ADHD), 2024).
Counseling and Communication
Counseling and communication between home and school are effective educational
interventions. Counseling, which encompasses family and child therapy, is crucial in managing
ADHD. Together with home-school communication, these interventions foster a supportive

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environment to tackle the emotional and behavioral aspects of ADHD (DuPaul et al., 2013).
Family therapy and communication, in particular, can assist in addressing the challenges that
ADHD presents to family dynamics and daily functioning.
School-Based Intervention Summary
Effectively executing school-based interventions demands robust teamwork and
collaboration among parents, students, and educators. This partnership involves ensuring open
lines of communication between home and school to monitor progress, share observations, and
adjust strategies as needed. Utilizing resources and guidelines provided by organizations such as
the National Institute of Mental Health (NIMH) to inform treatment and management strategies
is essential. Consistent behavioral management techniques and accommodations at home and
school create a cohesive support system for the child (Attention-Deficit/Hyperactivity Disorder,
n.d.).
In conclusion, school-based interventions for ADHD, including behavioral classroom
management, organizational skills training, IEPs or 504 Plans, and counseling, are critical in
creating supportive educational environments for students with ADHD.
Impact of ADHD on Secondary Students
ADHD can significantly impact the academic performance, social relationships, and daily
functioning of secondary students. Effective management of ADHD in this age group often
requires a combination of medication, behavioral therapy, and educational interventions tailored
to the individual's needs (Attention-Deficit/Hyperactivity Disorder, n.d.).
Rubia et al. (2021) link ADHD to deficits in executive functions (EF), which include
motor response inhibition, working memory, sustained attention, cognitive shifting, and temporal
processing. Individuals with ADHD face higher risks of academic underachievement,

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unemployment, substance abuse, and involvement in the criminal justice system (Chaulagain et
al., 2023). These risks underscore the importance of comprehensive management strategies that
address both the symptoms of ADHD and the related challenges for secondary students.
Additionally, ADHD is linked to higher rates of smoking and substance use disorders, an
increased risk of injuries, and a greater likelihood of suicidal ideation (Chaulagain et al., 2023).
ADHD can also lead to various medical conditions, including obesity, asthma, allergies,
diabetes mellitus, and sleep problems, underscoring the need for comprehensive healthcare that
addresses both ADHD and its comorbidities (Faraone et al., 2021). The disorder imposes a
substantial economic impact on society, with costs running into hundreds of billions of dollars
annually worldwide. These costs encompass healthcare expenses, productivity losses, and
expenditures associated with comorbid conditions (Faraone et al., 2021).
The impact of ADHD extends to the quality of life, affecting not only academic
performance but also social relationships and daily functioning. The stigma associated with
ADHD can lead to reduced self-esteem and reluctance to seek help, further complicating the
challenges faced by adolescents with ADHD (Sonuga-Barke et al., 2023).
Secondary students with ADHD experience unique challenges that often differ between
boys and girls. Males with ADHD typically exhibit more overt hyperactivity and impulsivity,
which can lead to frequent disciplinary issues and academic difficulties. Interventions
incorporating physical activity and structured environments are particularly beneficial for these
students (About Attention-Deficit / Hyperactivity Disorder (ADHD), 2024).
In contrast, females with ADHD are more likely to present predominantly inattentive
symptoms, which can result in underdiagnosis and internalized struggles such as anxiety and low

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self-esteem. Thus, secondary girls benefit from interventions that focus on organizational skills
and emotional support (About Attention-Deficit / Hyperactivity Disorder (ADHD), 2024).
ADHD significantly impacts secondary students' academic performance, social
relationships, and emotional well-being. Effective management requires tailored approaches that
address the specific needs of all genders with ADHD, ensuring that both groups receive the
support necessary to succeed academically and socially.
History of Implementation of Breaks and Their Effectiveness
Research indicates that breaks, particularly those involving physical activity, can
significantly improve attention and reduce disruptive behaviors in students with ADHD. Breaks
that allow movement and sensory engagement are especially beneficial (About Attention-Deficit
/ Hyperactivity Disorder (ADHD), 2024). Studies demonstrate that incorporating cognitive
breaks and activities that engage multiple brain functions can enhance learning outcomes,
supporting the effectiveness of brain-based learning strategies. For example, the BRAVE Study
highlights the significance of integrating physical activity into the daily routines of secondary
school students, emphasizing the role of schools in promoting healthy habits during adolescence
(Longo et al., 2022).
Extensive studies have examined the effects of Classroom Activity Breaks (CABs) on the
on-task behavior and physical activity levels of primary school children. CABs, implemented in
formats such as the Tabata routine, have been shown to improve on-task behavior and reduce
off-task behaviors. For instance, a study found that CABs improved on-task behavior regardless
of the time of day, with significant improvements noted in students who initially exhibited higher
levels of off-task behavior. Additionally, these breaks contributed to increased physical activity
levels during the school day (Broad et al., 2023).

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Researchers explored the benefits of daily outdoor walking breaks. A study involving
British Columbia high school students and teachers found that participants welcomed these
breaks, reporting improvements in mental clarity, focus, energy levels, and social interactions.
This study underscored the logistical ease of organizing such breaks and highlighted the benefits
of integrating nature and physical activity into the school routine, particularly during the
COVID-19 pandemic (Robillard, 2021).
Active breaks (ABs) have shown moderate, significant effects on selective attention,
suggesting their utility in educational settings without compromising students' attention
(Infantes-Paniagua et al., 2021). Adequate breaks include structured activities such as short
physical exercises, mindfulness practices, or sensory tasks that help reset attention and improve
focus. These breaks should be short, frequent, and integrated into the daily routine (About
Attention-Deficit / Hyperactivity Disorder (ADHD), 2024).
The BRAVE Study and other research highlight that teachers believe that ABs improve
psycho-physical well-being and classroom behavior. This finding aligns with research suggesting
that PA breaks can enhance cognitive functions and classroom dynamics (Longo et al., 2022).
The importance of PA breaks is well-documented, with benefits including better sleep,
reduced depression, improved cognitive functioning, and social benefits. Breaking up sedentary
periods with PA is recommended to counteract health issues linked to inactivity (Masini et al.,
2024). The TransformUs initiative and similar programs emphasize integrating PA and reducing
sedentary behavior through active breaks and supportive environments (Lander et al., 2024).
Professional development for teachers on integrating movement and classroom
management strategies can help them effectively implement PA breaks. Incorporating PA breaks
into daily lesson plans and routines can simplify the process for teachers to include them

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consistently (Campbell & Lassiter, 2020). The decreasing opportunities for physical activity in
schools due to academic pressures underscore the necessity for empirical research on the effects
of movement in middle and high school environments, particularly in lecture-style classrooms.
Movement fosters cognitive growth, memory retention, and overall academic performance,
reinforcing the importance of incorporating breaks into the educational setting. (Henry, 2023).
Integrating physical activity and breaks within the school day has substantially benefited
students' attention, behavior, and academic performance. Effective implementation requires
structured activities, teacher professional development, and a supportive school environment that
values the importance of movement and breaks.
Perceived Barriers and Enablers of Breaks
Implementing breaks in educational settings for students with and without ADHD
presents both challenges and opportunities. Understanding these barriers and enablers is crucial
for developing effective interventions that enhance student outcomes.
Barriers
Several barriers hinder the implementation of breaks, including misconceptions about lost
instructional time and a lack of teacher training on integrating breaks effectively. A recent study
revealed that teachers often feel inadequate, embarrassed, or lack the knowledge to conduct ABs,
and concerns about maintaining authority and managing class behavior further complicate their
efforts (Masini et al., 2024). Research indicates that teachers frequently struggle with classroom
control during ABs, highlighting the need for effective management strategies to maintain order
and engagement (McMullen et al., 2014). Additionally, social-level barriers such as the potential
for student injury and the perceived lack of pedagogical value among students also play a role.

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Environmental barriers include limited classroom space, time constraints, and the
physical layout of school buildings (Masini et al., 2024). The variability in exercise intensity and
protocols indicates the need for standardized guidelines and comprehensive teacher training.
Teachers often favor activities that align with academic content, making integration more
seamless and increasing their likelihood of adoption (McMullen et al., 2014). However, many
educators still view ABs as separate from learning, which hinders their implementation (Lander
et al., 2024).
Common challenges include time constraints, crowded curricula, lack of teacher
confidence, limited resources, space constraints, and the perception that active breaks disrupt
learning (Lander et al., 2024; Routen et al., 2018). The ease of implementation and student
enjoyment are also critical factors influencing whether teachers regularly incorporate ABs, with
many preferring simple, engaging activities that do not disrupt class flow (McMullen et al.,
2014).
Additional barriers include behavioral management issues, particularly with students who
have poor self-control, making it challenging to manage the class effectively during and after
breaks (Campbell & Lassiter, 2020). External pressures from school observations and parental
perceptions also influence the adoption of movement integration (MI) (Routen et al., 2018).
Teachers must navigate these challenges while considering individual student differences,
including physical fitness and activity preference (Routen et al., 2018). Addressing these barriers
through professional development, practical implementation strategies, and curricular alignment
can enhance the effectiveness of ABs and encourage widespread adoption.

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Enablers
Despite these barriers, several enablers can facilitate the effective implementation of
breaks. A 2024 study illustrated that personal motivation and trying activities before class
implementation can help teachers feel more confident (Masini et al.). Support from school
administration and colleagues is also crucial, as is the use of outdoor spaces and simple exercises
that require minimal space. Compatibility with teaching philosophy, strong administrative
support, and ease of implementation are significant facilitators (Campbell & Lassiter, 2020).
Teachers' observations of student enjoyment and the positive impact on attention and
energy levels encourage the continued use of breaks (Campbell & Lassiter, 2020). Positive
student responses and engagement with MI activities also support their use (Routen et al., 2018).
The BRAVE Study and other research emphasize the importance of ongoing support and
flexibility in physical activity programs to ensure long-term implementation (Longo et al., 2022).
Teacher autonomy and flexibility, allowing them to integrate MI based on their teaching
style and classroom needs, are also essential enablers (Routen et al., 2018). Establishing routines
and consistently delivering MI can help mitigate behavioral issues, making breaks a more
integral part of the classroom environment (Routen et al., 2018). Most teachers favor
classroom-based physical activity, citing benefits such as enhanced student focus, engagement,
and learning readiness (Stylianou et al., 2015).
Teacher Perceptions and Practices
Teacher perceptions of ADHD and the use of breaks are crucial. While many teachers
recognize the benefits of breaks, they often feel constrained by curriculum demands and a lack of
resources. Training and administrative support are essential to overcoming these barriers and
promoting effective practices (About Attention-Deficit/Hyperactivity Disorder (ADHD), 2024).

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A 2023 study revealed that teachers believe CABs benefit students, as evidenced by more
focused behavior post-CAB and a willingness to implement CABs multiple times per week
(Broad et al.).
Teachers' values, confidence, and teaching styles have a significant influence on the
adoption of MI (Routen et al., 2018). Professional development and resources tailored to enhance
teacher confidence and competence in delivering MI are essential. Both teachers and students
preferred 5-10 minute ABs at the beginning or end of lessons, suggesting low-intensity exercises
that could integrate with academic content (Masini et al., 2024).
Addressing the barriers and leveraging the enablers identified can significantly enhance
the implementation of breaks in educational settings for students with ADHD. By fostering an
environment that values physical activity and provides the necessary resources and support,
schools can help students with ADHD improve their academic performance, behavior, and
overall well-being.
Recommendations from the Literature
Professional Development
Continuous training and support for teachers are critical for successfully implementing
MI strategies and classroom management techniques. Professional development (PD) programs
should include practical modeling of these strategies to build teacher confidence and competence
(Routen et al., 2018). For instance, teachers in a PD program increased their daily use of CBPAs
from 0.83 to 3.38 and consistently applied the management strategies they learned (Stylianou et
al., 2015). To address teachers' concerns about feeling inadequate and managing classroom
behavior, PD should emphasize the need for short, simple ABs to integrate with academic
content, leveraging outdoor spaces and multimedia tools for engagement (Masini et al., 2024).

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Resources and Planning
Providing simple, easy-to-implement resources and integrating MI into lesson plans
without increasing teachers' workload is essential (Routen et al., 2018). The BRAVE Study
highlights the importance of flexibility in AB content, timing, and implementation, suggesting
that PA interventions must be adaptable and co-designed with teachers to ensure sustainability
(Longo et al., 2022). This approach aligns with recommendations for creating resources that are
accessible and user-friendly, making it easier for teachers to incorporate ABs into their daily
routines.
Further Research
Further studies are needed to determine the optimal types and durations of active breaks
for different age groups and to investigate their long-term effects on academic performance
(Mazzoli et al., 2021). Future research should encompass a range of educational settings to gain a
deeper understanding of how to tailor these interventions to meet the diverse needs of all
students, particularly those in secondary education.
Communication
Effectively communicating the benefits of MI to teachers, parents, and school leadership
is vital for gaining broader support and ensuring alignment with educational goals (Routen et al.,
2018). Clear communication highlights the positive impacts on student outcomes, encouraging
teacher buy-in and support from the wider school community.
Whole School Policy
Integrating MI into a comprehensive school policy, accompanied by ongoing monitoring
and support from administrators, can help ensure these practices are practical and sustainable
(Routen et al., 2018). Incorporating a 15-minute daily outdoor walking break into the high school

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curriculum benefits both students and teachers by enhancing mental clarity, physical health, and
social interactions (Robillard, 2021).
Focus on Student Outcomes
Interventions should emphasize the positive impact of CBPA on student outcomes,
including improved focus, behavior, and academic performance (Stylianou et al., 2015). Teachers
should be encouraged to reflect on these benefits to maintain their motivation and commitment to
implementing PA breaks.
Continued Support and Follow-up
Ongoing PD and support are crucial for sustaining new practices. School administration
involvement and support can help alleviate barriers and facilitate the integration of CBPA into
daily routines (Stylianou et al., 2015).
Management and Practical Strategies
PD programs should incorporate practical strategies for managing CBPA, including
effective transition back to academic tasks (Stylianou et al., 2015). Teachers prefer short,
easy-to-implement PA activities that are quickly integrated into lessons and should be included in
the training.
Resources and Training
Providing accessible and user-friendly resources is essential for successful
implementation. Training should include demonstrations and opportunities for teachers to
practice these activities and receive feedback, ensuring they feel prepared and confident to use
them in their classrooms (Stylianou et al., 2015).

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Addressing these recommendations can help schools create a supportive environment that
enhances the effectiveness of breaks and improves outcomes for students with ADHD and other
learning challenges.
Main Findings
The literature review highlights several critical areas related to using breaks in secondary
education for students with ADHD. Firstly, teacher perceptions are essential to the successful
implementation of breaks. Teachers' beliefs about the benefits and challenges of breaks
significantly influence their willingness to integrate these strategies into classroom routines.
Secondly, various types of breaks, especially those involving physical activity and mindfulness,
have been shown to improve behavior, attention, and academic performance in students with
ADHD. However, implementing these breaks faces practical challenges, particularly in
secondary education, where academic demands and classroom management issues are more
pronounced. The review also identifies significant gaps in the current literature, including a need
for long-term studies on the impact of breaks, the need for standardized guidelines, and the
necessity of tailored interventions for secondary students.
Purpose
The purpose of this study is to explore and understand secondary teachers' perceptions
regarding the use of brain breaks in the classroom. Specifically, this research investigates how
secondary teachers perceive the effectiveness and practicality of brain breaks for managing
classroom dynamics and enhancing student focus, behavior, and overall engagement. By
examining the factors that influence teachers' acceptance or resistance to incorporating brain
breaks into their teaching routines, the study aims to identify the challenges and barriers they
encounter and the supports that encourage the adoption of brain breaks. Additionally, the study

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seeks to assess teachers' views on how brain breaks affect student outcomes, particularly in
improving attention, reducing disruptive behavior, and fostering a more positive and engaged
classroom environment. Through qualitative methods, including surveys and interviews, the
study will gather detailed and nuanced data that will be analyzed thematically to identify patterns
and key themes. The findings will provide valuable insights for educators, administrators, and
policymakers to develop effective strategies and supportive policies that promote the use of brain
breaks in secondary education, ultimately aiming to enhance the educational experiences and
outcomes for students with ADHD and the broader student population.
Research Questions:
The forthcoming study will focus on the perceptions of secondary teachers regarding
brain breaks to address the gaps in the aforementioned research. The primary research questions
are:
1) What are secondary teachers' perceptions regarding using brain breaks in the
classroom?
2) What factors influence the acceptance or resistance to brain breaks among
secondary teachers?
3) How do secondary teachers perceive the impact of brain breaks on student focus,
behavior, and overall classroom engagement?
Need for the Study
Brain breaks have become increasingly prominent in schools nationwide due to the need
for proactive, restorative approaches to managing inattentive, hyperactive, and impulsive
behaviors in school settings. Critical factors related to managing ADHD among secondary
students underscore the importance of this study. ADHD is highly prevalent among school-aged

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children and adolescents, significantly impacting their academic, behavioral, and social
development (Centers for Disease Control and Prevention, 2020). While extensive research
exists on ADHD interventions in primary education, secondary education presents unique
challenges that require tailored strategies. Secondary students face increased academic pressures,
complex social dynamics, and higher expectations for self-regulation, underscoring the need for
practical, age-appropriate interventions (American Psychiatric Association, 2013; Barkley et al.,
2021).
Teacher perceptions are pivotal in the successful implementation of classroom
interventions. Teachers' beliefs about the practicalities and benefits of breaks for students with
ADHD profoundly influence their adoption and efficacy (Evans et al., 2014). This study aims to
shed light on these perceptions and their effect on implementation. Furthermore, there is an
urgent need for focused professional development to prepare secondary educators with the skills
and confidence necessary to integrate breaks effectively into their teaching practices (DuPaul &
Stoner, 2014).
Adequate breaks have demonstrated the potential to mitigate ADHD symptoms, enhance
attention, and reduce disruptive behaviors, thereby improving academic performance and
classroom dynamics (Raggi & Chronis, 2006; Diamond, 2013). However, there is a notable need
for long-term studies on their sustained impact on secondary education. This study seeks to fill
this gap by identifying teacher perceptions of breaks in the secondary setting, specifically for
students with ADHD.
The implications for policy and practice highlight the urgency of this study. Establishing
standardized guidelines for implementing breaks can ensure consistency and effectiveness across
various educational settings (Rief, 2016). Additionally, customizing breaks to address the diverse

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needs of students with ADHD fosters inclusivity and equity in education. This study aims to
provide evidence-based recommendations that inform educational policies and enhance
classroom practices (Pelham & Fabiano, 2008).
Summary
Chapter 2 focused on the existing literature on the research problem, specifically
examining the use of breaks in secondary education for students with ADHD. The researcher
analyzed, summarized, and presented key findings related to ADHD, including its definition and
history, etiology and pathophysiology, and diagnostic criteria and symptomatology. The literature
review also covered the prevalence and incidence of ADHD, the impact of ADHD on secondary
students, and common comorbidities. Additionally, the chapter explored various treatment
approaches, including behavioral and pharmacological interventions, school-based strategies,
and the implementation of breaks in educational settings.
The literature review highlighted the importance of understanding teacher perceptions of
breaks for students with ADHD. It emphasized that teachers' beliefs about the benefits and
challenges of breaks significantly influence their willingness to integrate these strategies into
classroom routines. The review identified significant gaps in the current literature, particularly
the need for long-term studies on the impact of breaks, the need for standardized guidelines, and
the necessity of tailored interventions for secondary students.
The forthcoming study will focus on secondary teachers' perceptions of brain breaks to
address the research gaps. This study will employ a qualitative methodology to explore these
questions. Data will be collected through surveys and interviews with secondary teachers.
Thematic analysis will identify key themes from the survey and interview transcripts, including

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familiarization, coding, theme development, reviewing themes, defining and naming themes, and
reporting with supporting quotes.
Chapter 3 presents the study's methodology. The content reflects the research design,
approach, instrumentation, participants, setting, validity, and reliability. Later in the chapter, the
researcher elaborates upon the site permission and selection process, data collection and analysis
procedures, ethical considerations, and potential limitations.

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Chapter 3: Methodology
Chapter 3 describes the research design and methods used to explore secondary teachers’
perceptions of classroom brain breaks and the factors that influence their implementation and
sustainability in middle and high school settings. This chapter outlines the study’s
mixed-methods approach, participant selection, data collection procedures, rationale for the use
and adaptation of the TETPPACS, data analysis strategies, site permissions, and study
limitations.
Action Plan: Intervention
This research examines the implementation and sustainability of break programs in
secondary schools, focusing on educators' perspectives on their effectiveness. Classroom breaks,
also known as brain breaks or movement breaks, have been shown to enhance student focus,
engagement, and overall academic performance. Evidence suggests that brief, structured breaks
during instructional time can enhance cognitive function and reduce stress, leading to a more
effective learning environment. Nevertheless, while numerous schools have adopted break
programs, their sustainability and effectiveness over time can differ. This study aims to identify
common traits among sustainable break programs by examining teachers' perceptions of their
efficacy, the obstacles they face, and the elements that contribute to long-term success.
The research question guiding this study is: (1) What are secondary teachers' perceptions
regarding using brain breaks in the classroom? (2) What factors influence the acceptance or
resistance to brain breaks among secondary teachers? (3) How do secondary teachers perceive
the impact of brain breaks on student focus, behavior, and overall classroom engagement?
Participants will include secondary teachers (grades 7-12) from Central York Middle
School and Central York High School. The study will feature a diverse sample of educators from

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various subject areas, with differing years of teaching experience, educational levels, and
familiarity with break programs. Demographics such as age and gender will also be considered
to ensure a comprehensive analysis. The selected schools are located within the Central York
School District in York, Pennsylvania, which serves a diverse student population with varied
socio-economic backgrounds, ethnicities, and academic abilities.
Data Collection
This research employs a mixed-methods approach, integrating quantitative and
qualitative data collection methods. The primary data source comprises teacher surveys to assess
their views on the effectiveness, practicality, and sustainability of break programs. A validated
demographic survey, such as a version of the National Assessment of Educational Progress
(NAEP) questionnaires, will be implemented to gather background information. The researcher
will assess teacher perceptions by applying the Teacher Efficacy Toward Providing Physical
Activity in the Classroom Scale (TETPPACS) (Centeio et al., 2022). Requests for permission to
replicate and modify existing validated tools were obtained.
In addition to utilizing the standardized TETPPACS, the researcher added five
open-ended questions to the survey, which were explicitly designed to capture more in-depth
perceptions and experiences of secondary teachers using brain breaks in their classrooms. The
inclusion of open-ended questions was motivated by the need to delve deeper into the qualitative
aspects of teachers' perceptions and experiences that are not fully captured by the closed-ended
format of TETPPACS. These questions aim to provide richer, contextual insights into the factors
influencing the adoption and implementation of brain breaks, as well as the perceived impacts on
student focus, behavior, and overall classroom engagement.

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The survey will be conducted online via Qualtrics for all participating educators. It will
include questions designed to evaluate perceptions regarding the effectiveness, feasibility,
facilitators, and obstacles associated with break programs. To encourage participation, reminder
emails and gift cards will be sent out. The study consists of three phases: preparation,
implementation, and evaluation. In the preparation phase, the researcher will finalize Chapters
1-3, secure committee approval, submit the Institutional Review Board (IRB) application, obtain
the requisite permissions from the Central York School District and the school board, and recruit
participants through district-wide announcements, emails, and school meetings. The
implementation phase involves pilot testing the survey to ensure clarity and relevance,
distributing the survey, providing instructions for completion, and following up to encourage
participation. The evaluation phase encompasses the collection of survey responses via Qualtrics,
the analysis of data using statistical and thematic methods, and the preparation of a
comprehensive report summarizing the findings.
TETPPACS Rationale
This study focuses on secondary education, where scheduling and curriculum demands
frequently restrict physical activity. Teacher perceptions are essential for effective
implementation, and TETPPACS has been chosen to evaluate these perceptions because of its
comprehensive method for assessing teacher efficacy (Centeio et al., 2022).
Since the original development and validation of TETPPACS involved input from
secondary school teachers and was designed for their context, it is particularly well-suited for
assessing this group. Secondary teachers encounter unique challenges, such as managing
adolescent attitudes and meeting intense curricular requirements, which TETPPACS addresses
by evaluating barriers and supports within the school environment (Centeio et al., 2022).

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TETPPACS stands out as a rigorously validated and reliable instrument for measuring
teacher efficacy in promoting physical activity, making it exceptionally suitable for this study on
secondary teachers’ perceptions of activity breaks (Centeio et al., 2022). Its comprehensive
assessment of the multifaceted nature of teacher efficacy will provide valuable insights that can
inform policy and practice to enhance student health and academic achievement in secondary
schools.
TETPPACS Validity
The TETPPACS was developed through a rigorous process involving subject matter
experts in physical education and pedagogy. This ensured that the scale items reflected a wide
range of behaviors and attitudes relevant to promoting physical activity in the classroom. The
scale was designed to capture nuanced aspects of teacher efficacy, from personal belief in
capability to institutional and student-related barriers (Centeio et al., 2022).
The scale's developers conducted initial exploratory and follow-up confirmatory factor
analyses, which highlighted a robust factor structure and validated its construct. Their research
pinpointed three interconnected constructs (institutional, student, and educational barriers)
crucial for comprehensively understanding teacher efficacy regarding physical activity (Centeio
et al., 2022).
Further validation of the TETPPACS has shown that higher scores on the scale correlate
with greater frequency and quality of physical activity breaks initiated by teachers. This indicates
that the scale measures perceived efficacy and aligns with actual teacher behaviors that promote
student physical activity (Centeio et al., 2022).

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TETPPACS Reliability
The internal consistency of TETPPACS, measured by Cronbach’s alpha, has consistently
exceeded 0.80 across its subscales in various studies, indicating a high level of reliability
(Centeio et al., 2022). This consistency ensures that the scale can accurately measure the
constructs of teacher efficacy across different populations and contexts. Although specific
test-retest reliability data for TETPPACS may be limited, repeated studies in diverse educational
settings have suggested that its constructs are stable, demonstrating consistent patterns of
efficacy perceptions among teachers.
Adaptation of TETPPACS
For this study, the researcher adapted the TETPPACS. The wording of two items was
deliberately modified to better align with the target audience and the administrative structure
standard in secondary education settings. Specifically, the term "principal" in items 14 and 15 of
the original TETPPACS was changed to "administrator."
This change was implemented to broaden the scope of the questions to include a broader
range of educational leaders who may influence physical activity policies and practices within
schools, not just principals. The term "administrator" encompasses various leadership roles,
including assistant principals, special education supervisors, instructional coordinators, and
others involved in decision-making processes that impact the implementation of brain breaks and
physical activity initiatives.
This terminological adjustment is intended to ensure that the survey accurately captures
the influence of all relevant leadership positions within the respondents' educational context. It
acknowledges the diversity in school leadership structures and aims to gather data that more
accurately reflects the dynamics of school management as it relates to teacher efficacy and the

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provision of physical activity. The adjustment also helps avoid any potential confusion or bias
from the specific titles used in different schools or districts, thus enhancing the validity of the
responses regarding administrative support for physical activity.
Data Analysis
Descriptive statistics will summarize demographic data and key survey responses for data
analysis. In contrast, inferential statistics, including a one-way Analysis of Variance (ANOVA),
will examine differences in perceptions based on demographic variables such as years of
experience and gender. Thematic analysis will be applied to open-ended responses to identify
recurring themes related to the break program's sustainability.
Site Permission
Permission to conduct this study was obtained from the Central York School District
administration. As the district does not have an IRB, external approval will be sought through
Slippery Rock University’s IRB. Coordination with school principals and special education
supervisors will be necessary to ensure the smooth implementation of data collection. Additional
approval from school-level administrators and potentially district leadership will be secured to
maintain compliance with ethical standards and encourage participant involvement and
engagement.
Presentation of Results
Findings will be shared with teachers, administrators, and other stakeholders through
formal presentations to school and district leadership teams, written reports summarizing key
findings, and professional development sessions focused on best practices for sustaining break
programs. Furthermore, findings may be submitted for publication in educational research

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journals to contribute to the broader discourse on best practices for implementing and
maintaining break programs in secondary schools.
Limitations
Several limitations should be acknowledged. Variations in teacher engagement may
influence the overall representativeness of the sample. Differences in school environments,
administrative support, and policies may also impact data collection. Self-reported data carries
the risk of social desirability bias, which can affect its accuracy. This study concentrates on a
single school district, so its findings may not be broadly generalizable to other educational
settings. Other limitations include the possible survey fatigue that may affect participants'
responses.
Summary
This chapter offers a comprehensive overview of the methodology used to examine
teacher perceptions of break programs in secondary schools. It outlines participant selection, data
collection, methods of analysis, procedures for obtaining site permissions, and the expected
study timeline. Additionally, the presentation of results and discussion of study limitations are
included to ensure a thorough understanding of the research approach. This study aims to
provide valuable insights for sustaining break programs in educational settings by systematically
analyzing teacher perceptions and identifying key enablers and barriers.

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Chapter 4: Findings
Restatement of the Problem
This mixed-methods study aims to explore secondary teachers’ perceptions of using
classroom brain breaks and to understand how these views influence the practical
implementation and ongoing sustainability of brain breaks in middle and high school settings.
Although brain breaks are often promoted in elementary education as strategies to enhance
student focus, behavior, and engagement, there is limited research on how these practices are
viewed and applied at the secondary level, where challenges such as instructional time
constraints, classroom management issues, and physical space limitations are more prominent.
This study also aimed to identify the key factors that support or hinder teachers’
acceptance and consistent use of brain breaks, including time constraints, curriculum pacing,
administrative expectations, and peer support. By examining teachers’ perspectives on both the
benefits and barriers, this research provides insight into how schools can better support the
integration of brain breaks as a practical and sustainable practice that balances academic rigor
with student well-being. To address these gaps and inform practice, the following research
questions guided this study:
1. What are secondary teachers' perceptions regarding using brain breaks in the classroom?
2. What factors influence the acceptance or resistance to brain breaks among secondary
teachers?
3. How do secondary teachers perceive the impact of brain breaks on student focus,
behavior, and overall classroom engagement?

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Demographics
Eleven secondary teachers currently employed at Central York Middle or High School,
within the Central York School District, a public school district in central Pennsylvania,
participated in this study. All participants were recruited through a district-wide email invitation
that described the study's purpose and included a link to an online Qualtrics survey, once the
consent form was returned. The survey process included three components: a demographic
questionnaire that gathered details such as gender, years of experience, subject area, and
educational background, along with the TETPPACS, which was supplemented with five
open-ended questions. This mixed-methods approach allowed the researcher to collect both
quantitative and qualitative data simultaneously.
The demographic section of the survey collected information on each participant’s
gender, race/ethnicity, years of teaching experience, teaching assignment, grade levels taught,
class size, and highest degree earned. The sample included teachers from a range of subject areas
and experience levels to ensure a variety of perspectives on the use of brain breaks in secondary
classrooms. Tables 1 and 2 present the gender and race/ethnicity distribution of the participants.
Table 3 includes the range of grade levels, content areas, academic degrees, and years of
experience among the participant pool.
Table 1
Enrollment by Gender
Gender

Percentage

Female
Male
Other/Prefer not to say

73%
27%
0%

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Table 2
Enrollment by Race/Ethnicity
Race/Ethnicity

Percentage

Hispanic
White
African American or Black
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander

0%
91%
9%
0%
0%
0%

Table 3
Participant Codes and Teaching Profiles
Years of
Professional
Teaching
Experience

Number of
Years
Teaching in
the District

Current Teaching
Code Position

Current
Teaching
Assignment

Grades
Taught

Academic
Degree

A

Regular Education

Science

7, 8

Master’s

22

22

B

Special Education

ELA

7, 8

Master’s

16

4

C

Regular Education

Culinary Arts

9-12

Master’s

12

10

D

Regular Education

ELA

10-12

Master’s

32

18

E

Regular Education

Science

9,11,12

Master’s

14

14

F

Regular Education

Health

9-12

Master’s

4

2

G

Regular Education

Health

8

Master’s

6

6

H

Regular Education

Science

9

Master’s

15

10

I

Special Education

Science/Math

9-12

Master’s

12

4

J

Special Education

Resource Room

10-12

Master’s

10

8

K

Regular Education

Social Studies

7

Master’s

34

25

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Data Collection
Data for this study were gathered through a mixed-methods online survey designed to
collect both quantitative and qualitative insights into secondary teachers’ perceptions of brain
breaks. The survey, distributed via Qualtrics, included three main parts: a demographic
questionnaire, TETPPACS, and five open-ended questions.
Before distribution, permission to use and adapt the TETPPACS was obtained from the
original authors. Two minor wording changes were made to better align with the secondary
school setting, specifically replacing the term “principal” with “administrator” to cover a wider
range of leadership roles that influence classroom practices.
The demographic section collected background information to help describe the
participants and analyze any differences in perceptions by variables such as gender or years of
teaching experience. The TETPPACS items were presented in Likert-scale format, and responses
were later converted to numeric scores (1 = Not at all confident, 5 = Fully confident) for
analysis. The open-ended questions provided teachers with an opportunity to elaborate on their
experiences, barriers, and perceived impacts of brain breaks in their classrooms.
Participants were given approximately two weeks to complete the survey, and one
reminder email was sent to encourage participation. All responses were collected and maintained
anonymously. Quantitative data were exported directly from Qualtrics for analysis using SPSS.
Meanwhile, qualitative responses were downloaded, organized systematically, and thematically
coded to identify recurring concepts and quotes that support the findings.
Quantitative Findings
To assess secondary teachers’ perceptions of their confidence in implementing
classroom-based physical activity breaks, the study utilized the TETPPAC Scale. The scale

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consisted of 18 items, each rated on a five-point Likert scale. For analysis, all qualitative Likert
responses were translated into numeric values: 1 = Not at all confident, 2 = Slightly confident, 3
= Moderately confident, 4 = Confident, and 5 = Fully confident. This conversion enabled
consistent, quantitative comparison of teachers’ perceived efficacy and barriers.
Table 4 displays the descriptive statistics for each of the 18 items on the TETTPACS. For
each item, the mean (M) and standard deviation (SD) are presented alongside the original
question stem to provide context for how teachers rated their confidence in implementing brain
breaks under various conditions.
Table 4
TETPPACS Descriptive Statistics
Question Item

M

SD

1) My students are not concerned with being
physically active.

3.36

1.21

2) My students are preparing for tests.

3.27

1.42

3) My students are having problems getting along.

2.82

1.08

4) My students have a wide range of academic abilities.

4.55

0.69

5) My students have a wide range of physical abilities.

4.18

0.87

6) I have a crowded classroom of students.

3.82

1.08

7) My school does not have enough room outside/inside
to provide students with adequate physical activity.

2.45

0.93

8) The weather is bad and students can’t go outside.

3.45

1.04

9) I do not have enough time during the day to provide
physical activity breaks.

3.0

1.34

10) I do not have enough time in the period to provide
students recess/any type of break.

3.09

1.38

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Question Item

M

SD

11) I do not have enough time to prepare physical
activity breaks

2.91

1.30

12) Other teachers at my school do not value physical
activity.

3.09

1.30

13) My administration does not provide adequate
support for physical activity.

2.45

1.04

14) My administration puts pressure on getting high
test scores.*

2.82

1.47

15) I do not have enough equipment/resources for all
my students to be physically active.*

2.91

1.51

16) I can attend professional development focused on
implementing physical activity.

3.55

1.21

17) I can learn a variety of strategies to implement
physical activity.

3.55

1.29

18) I can improve my knowledge about how to get my
students active.

3.91

1.04

Note. M = mean; SD = standard deviation.
Descriptive statistics showed notable variation across the 18 items. Overall, mean scores
ranged from 2.45 to 4.55, with standard deviations between 0.69 and 1.51, indicating moderate
variability in responses. Teachers reported the highest levels of confidence for items related to
navigating student diversity and ability differences. Specifically, TETPPACS Item 4 (“I am
confident that I can get my students active when my students have a wide range of academic
abilities,” M = 4.55, SD = 0.69) and Item 5 (“…when my students have a wide range of physical
abilities,” M = 4.18, SD = 0.87) suggest that most teachers feel capable of adapting brain breaks
for diverse classrooms.

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In contrast, the lowest mean scores emerged for items reflecting structural or
environmental barriers and lack of support. For example, Item 7 (“…when my school does not
have enough room outside/inside to provide students with adequate physical activity,” M = 2.45,
SD = 0.93) and Item 13 (“…when my administration does not provide adequate support for
physical activity,” M = 2.45, SD = 1.04) indicate that limited facilities and insufficient
administrative backing may significantly affect teachers’ perceived ability to implement brain
breaks consistently. Similarly, lower confidence was reported for Item 14 (“…when my
administration puts pressure on getting high test scores,” M = 2.82, SD = 1.47) and Item 15
(“…when I do not have enough equipment/resources,” M = 2.91, SD = 1.51), highlighting
barriers related to competing academic demands and lack of materials.
Meanwhile, items related to professional growth received relatively high scores. Items
such as 16 (“I can attend professional development focused on implementing physical activity,”
M = 3.55), 17 (“…I can learn a variety of strategies to implement physical activity,” M = 3.55),
and 18 (“…I can improve my knowledge about how to get my students active,” M = 3.91)
suggest that teachers feel reasonably confident in their potential ability to build capacity through
targeted training.
Overall, these descriptive results highlight both strengths and areas that may require
additional support. While secondary teachers generally feel confident in addressing student
diversity and learning new strategies for physical activity integration, they report lower
confidence in overcoming structural and administrative barriers. These insights emphasize the
importance of addressing time constraints, resource availability, physical space, and
administrative support when designing interventions to sustain brain breaks in secondary
classrooms.

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TETPPACS ANOVA Results
To examine whether there were statistically significant differences in teachers’ perceived
confidence toward implementing brain breaks based on gender and years of teaching experience,
a series of one-way ANOVAs was conducted. The dependent variable was each teacher’s overall
mean TETPPACS score, calculated by averaging their responses across all 18 items after
converting the original Likert responses to numerical values (1 = Not at all confident, 2 =
Slightly confident, 3 = Moderately confident, 4 = Confident, 5 = Fully confident).
Table 5 summarizes the results of the one-way ANOVAs conducted to test for differences
in overall teacher efficacy scores by gender and by years of teaching experience. The table
includes the degrees of freedom (df), F-statistic, and p-value for each test, along with the mean
TETPPACS scores for each group. Although no statistically significant differences were found at
the p < .05 level, the descriptive group suggests some interesting trends that may warrant further
exploration in future studies.
Table 5

One-Way ANOVA for Efficacy by Gender and Years of Experience
Source
Gender

df

F

p

Group Means Source

1, 9

2.08

.183

Male = 3.80; Female = 3.10

Years of Experience 2, 8

1.39

.302

0–5 yrs = 4.39; 6–10 yrs = 2.94; 11+ yrs = 3

Note. df = degrees of freedom; F = F-statistic; p = p-value
Gender Differences
Regarding gender, the mean TETPPACS score for male teachers was 3.80, compared to
3.10 for female teachers. The one-way ANOVA comparing these means yielded F(1, 9) = 2.08, p
= .183, indicating that the difference was not statistically significant at the p < .05 level.
Although the results do not demonstrate a significant difference, the descriptive statistics suggest

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that, in this small sample, male teachers reported slightly higher perceived confidence in
providing physical activity breaks than their female counterparts.
Experience Level Differences
Based on years of teaching experience, teachers were categorized into three groups: 0–5
years, 6–10 years, and 11+ years. The descriptive means showed that teachers with 0–5 years of
experience had the highest average TETPPACS score (M = 4.39), followed by those with 11+
years (M = 3.24) and 6–10 years (M = 2.94). The ANOVA indicated that this difference in means
was not statistically significant, F(2, 8) = 1.39, p = .302.
Interpretation of ANOVA Findings
Although the ANOVA results did not reveal statistically significant differences, the
descriptive trends offer valuable insights. The finding that teachers with 0–5 years of experience
reported the highest average confidence in providing physical activity breaks suggests that newer
teachers may be more comfortable or familiar with incorporating flexible, student-centered
practices into their classroom routines. This could be related to recent trends in teacher
preparation programs that increasingly focus on integrating movement and wellness into daily
instruction.
Conversely, teachers with 6–10 years and 11+ years of experience reported lower average
confidence scores. This might suggest that more experienced teachers feel more restricted by
established classroom management routines, pacing guides, or curricular pressures that limit
their perceived ability to incorporate brain breaks regularly. It may also reflect a need for
ongoing professional development focused on balancing instructional demands with strategies
that boost student engagement and well-being.

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Regarding gender, the difference in mean scores, with male teachers reporting slightly
higher perceived efficacy than female teachers, did not reach statistical significance and should
be interpreted cautiously. The small sample size likely limits the ability to detect significant
effects, but the trend might warrant further exploration. Differences in confidence could be
linked to varying comfort levels with classroom management during physical activities or
different experiences with administrative support.
Overall, these patterns suggest that teachers’ perceptions of their ability to implement
brain breaks are likely influenced by a combination of experience, training, and structural or
contextual factors. The lack of significant differences highlights that barriers and facilitators to
maintaining brain break programs may not vary greatly between these groups, but specific trends
(such as newer teachers feeling more confident) could inform targeted professional development
or mentorship opportunities. School leaders might consider leveraging the relative confidence of
novice teachers by pairing them with more experienced colleagues, sharing practical strategies,
or demonstrating how breaks can be incorporated without disrupting instructional time.
ANOVA Results Summary
In summary, although the ANOVA results did not yield statistically significant
differences by gender or years of experience, the descriptive trends reveal potential patterns that
could inform future support for teachers. Further research with a larger sample size may be
necessary to explore these trends more thoroughly and to better understand how demographic
factors influence teachers’ confidence in maintaining classroom-based physical activity
initiatives.

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Qualitative Findings
The qualitative portion of this study provided deeper insight into secondary teachers’
perceptions of brain breaks, the factors that influence their acceptance or resistance, and the
perceived impacts on student focus, behavior, and overall classroom engagement. Teachers’
responses to the five open-ended survey questions were analyzed using thematic coding to
identify recurring ideas, patterns, and direct participant quotes that illustrate each theme.
Participants’ quotes are labeled Participant A through Participant K to protect confidentiality
while highlighting the diverse perspectives represented in the data. The themes presented in this
section are organized according to the study’s three primary research questions and include
multiple participant voices to show both shared experiences and variations in how teachers
approach brain breaks in the secondary classroom context.
Teachers’ Perceptions of Brain Breaks (RQ1)
Teachers shared a range of perceptions about brain breaks, but overall described them as
an increasingly vital part of maintaining student engagement and managing the classroom
climate. Many admitted they were initially skeptical but shifted their views after observing the
practical benefits.
“At first, I thought it was just another trend - something elementary teachers do, but not
practical for high school,” said Participant A. “Once I actually saw my kids come back more
focused after a short stretch or brain teaser, I realized it’s not wasted time - it gives me time
back.”
Several participants described how brain breaks became routine after seeing positive
results. Participant B explained, “I started using them once a week; now it’s almost daily.

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Students expect it, they know it helps them recharge.” Participant C added, “It’s one of those
things I didn’t know I needed until I saw the results.”
Teachers highlighted that brain breaks are flexible, not “one-size-fits-all.” Participant D
shared, “In science, sometimes the break is just standing and doing a quick movement to review
vocab. It doesn’t have to be a big thing.” Participant E echoed this: “My culinary classes take
natural breaks when we switch tasks, so I see that as a type of brain break too.”
Despite generally positive perceptions, some teachers expressed tension or uncertainty.
Participant F wrote, “I’m still torn. I see the benefit, but I feel guilty about using class time for
something that’s not content.” Similarly, Participant G described an internal conflict, “I know
kids need it, but the pressure to keep going makes it hard to justify sometimes.”
Teachers also noted that their perceptions were shaped by student maturity and class
dynamics. Participant H shared, “Some classes respond really well, they come back ready to
learn. Others see it as a chance to mess around.”
When asked why some colleagues embrace brain breaks and others resist them, teachers
tied perceptions to school culture and trust. Participant I explained, “Some teachers think it’s
‘fluff.’ They don’t believe it works, or they don’t want to give up control.” Participant J added,
“It comes down to trust; trust that it won’t get out of hand and trust that it’s worth the few
minutes.”
Overall, the responses indicate that teachers generally view brain breaks as beneficial and
adaptable, while also being aware of potential trade-offs. Their perceptions are shaped by
firsthand experience, content area, student age and maturity, and whether they feel they have
administrative and peer support to use these strategies consistently.

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Factors Influencing Acceptance or Resistance (RQ2)
Teachers described a wide range of factors that influenced whether they consistently
implemented brain breaks or avoided them altogether. Their comments reveal how time
constraints, classroom management, student behavior, peer modeling, administrative support,
and school culture interact in complex ways to either encourage or discourage use.
Facilitators: Peer Modeling and Administrative Expectations. Several teachers
indicated that clear expectations from leadership and seeing colleagues model brain breaks made
them feel more comfortable using them. Participant A shared, “I was told by my (middle school)
principal that it’s an expectation to build in breaks, so I do it. It helps to know leadership at the
middle school wants this and I’m not doing it alone.”
Participant B noted, “When I see other teachers do it and see it working for them, it
pushes me to try it with my kids too.” This peer influence helped reduce uncertainty about when
or how to use breaks. Participant C explained, “It started because my co-teacher does it. She
showed me how to keep it short and structured.” These examples illustrate how peer support
normalizes the practice and provides concrete ideas.
Facilitators: Student Buy-In. Another factor encouraging acceptance is student response.
Participant D described, “My students remind me if I forget; they know it helps them. That alone
motivates me to keep doing it.” Participant E added, “When kids are asking for it, you know it’s
worth it. They feel like they have some control too, which is good.” This sense of student
ownership reinforces teachers’ commitment to keep brain breaks routine.
Barriers: Lack of Time and Academic Pressure. Almost all teachers mentioned time
constraints as the most significant barrier to consistent use. Participant F mentioned, “There is
never enough time. If I do a five-minute break, that’s five minutes I’m not covering standards.”

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Participant G agreed, “I’d love to do it more, but with our pacing guides and testing pressure, it’s
just not realistic every day.”
Others described trade-offs between short-term and long-term gains: Participant H
explained, “Sometimes it feels like a break will take longer than just pushing through, especially
when we’re behind.”
Barriers: Fear of Losing Control. The fear of losing control or dealing with post-break
chaos was one of the main reasons teachers gave for avoiding brain breaks. Participant I
explained, “I avoid them with certain groups because they see it as free time to act out. Once
they’re off-task, it’s ten times harder to pull them back.” Participant J echoed this concern, “If I
have a tough class, I’d rather not give them a chance to get wild. It’s not worth the struggle to
regain order.” Others described the challenge of transition, “It can get too silly too fast,” said
Participant K. “If you don’t have clear routines, it backfires. I’d rather not risk it with bigger
classes.”
Interestingly, a few teachers noted that when they do feel confident managing behavior,
brain breaks help maintain control in the long run. Participant C reflected, “Once I established
boundaries, my students knew what a break was and wasn’t. It’s about being consistent so it
doesn’t turn into a free-for-all.” This highlights that some teachers overcome their fear of losing
control by establishing clear structures and practicing effective methods.
Barriers: Physical Space, Weather, and Resources. Teachers also described practical
barriers, such as small classrooms, adverse weather conditions, or a lack of equipment.
Participant D said, “In the winter, we can’t go outside. My room is tiny. Where are they supposed
to move?” Participant F added, “I don’t have mats or enough room for them to stretch out. So
sometimes it’s just not worth the hassle.” This frustration ties back to the environmental barriers

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that appeared in your TETPPACS scores, where perceived efficacy dropped when teachers
lacked physical space or resources.
Barrier or Facilitator: Professional Development. Lastly, several teachers described
professional development as both a barrier (when absent) and a potential facilitator. Participant G
said, “I’ve never had real training on this. I know it’s good, but I don’t know enough strategies
that work for high schoolers.” Participant B suggested, “If we had PD that showed realistic
examples, like videos of real teachers doing it in math or ELA, I think more people would buy
in.” This underscores that even supportive teachers may resist using brain breaks if they lack
practical, secondary-specific ideas.
To summarize, these perspectives show that teachers’ willingness to adopt brain breaks is
not simply a matter of attitude; it is shaped by a complex mix of leadership signals, peer culture,
time and curriculum demands, classroom management dynamics, and the physical environment.
The recurring theme of control, whether teachers think they can sustain it before, during, or after
a break, emerges as a central element across all factors.
Perceived Impacts on Student Focus, Behavior, and Engagement (RQ3)
Teachers consistently described brain breaks as a practical tool for improving focus,
maintaining engagement, and supporting positive classroom behavior, especially for students
who struggle with attention or hyperactivity. Many participants emphasized that even small,
structured breaks help students “reset” their minds and bodies.
Improvements in Focus and Attention. Participant A shared, “It helps my students with
ADHD more than anyone, they burn through their attention span fast. A break gives them just
enough pause to come back to the task.”Participant B agreed, writing, “Knowing they will get up

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soon actually makes them more willing to focus during instruction. It’s like a promise that the
lesson isn’t an endurance test.”
Teachers also described how breaks can prevent drifting attention in general. Participant
C explained, “Without a break, by the last 20 minutes, they’re done - fidgeting, staring off. But
when we break it up, they can handle the rest of the block.”
Behavior Management and Preventing Disruptions. Several teachers noted that brain
breaks can be a proactive behavior management tool. Participant D explained, “When I skip
breaks, I get more side conversations and behavior issues. When we do them, they’re less likely
to act out because they’ve had that moment to decompress.” Participant E emphasized the same
point, “It’s like a release valve. If you don’t give them a chance to move, they make their own
break by getting off task.”
However, a few participants made it clear that the positive impact depends on routines
and expectations. Participant F warned, “If the break isn’t structured, it can do the opposite. Kids
can get too rowdy and lose focus for the rest of the period.” This underscores why some teachers
still worry about giving up control, even when they see the potential benefits.
Impact on Students With and Without ADHD. Many teachers specifically highlighted
the importance of brain breaks for students with ADHD or other executive functioning
challenges. Participant G wrote, “My co-taught kids need it more than anyone. They can’t sit and
be quiet for 80 minutes straight, I don’t blame them.”
At the same time, they noted that all students benefit. Participant H shared, “It’s not just
the kids with diagnoses. Honors students, athletes - they all need a second to breathe, especially
after lunch or testing.” This demonstrates teachers’ nuanced understanding that while breaks may
have outsized benefits for students with attention difficulties, they’re a universal support.

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Improved Classroom Climate and Student-Teacher Relationships. Several teachers
reflected on the relational benefit of showing students that their well-being matters. Participant I
said, “It helps the vibe of the room. They know you care about them as people, not just test
scores.”
Participant J added, “They feel like they have permission to be human. It builds trust
because they know they won’t get in trouble for needing to move or talk for a minute.”
One teacher also highlighted how brain breaks help teachers manage their own energy.
Participant K shared, “Honestly, it helps me too. I get a breather, they get a breather, and we’re
all better for it.”
Limits and Contextual Caveats. Not every teacher described universal success.
Participant B noted, “Some classes handle it perfectly. Others, I pick and choose my moments
because it can backfire.” Participant D agreed, “It’s not a magic fix. You have to know your kids
and your timing.” This indicates that teachers generally perceive the impact of brain breaks as
positive, but it is context-dependent, influenced by class dynamics, student maturity, and the
teacher's ability to manage transitions effectively.
Overall, these quotes demonstrate that secondary teachers view brain breaks as an
effective and practical strategy for enhancing focus, preventing disruptive behavior, and fostering
a more supportive classroom climate. While the most significant benefits were noted for students
with ADHD and other attention challenges, teachers emphasized that all students gain from the
mental reset. However, the perceived impact hinges on clear expectations, routines, and an
underlying sense of trust between teacher and students.

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Summary of Qualitative Findings
This mixed-methods study explored secondary teachers’ perceptions of brain breaks and
the factors that influence their implementation and sustainability. Overall, the findings
demonstrate that while secondary teachers generally perceive brain breaks as beneficial for
sustaining student focus and improving classroom behavior, they face persistent barriers that
affect their consistent use.
Quantitative results from the TETPPACS revealed that teachers’ confidence levels varied
according to the situation. Items related to adapting brain breaks for student diversity, such as
working with students who have a wide range of academic and physical abilities, received the
highest mean scores (Item 4, M = 4.55; Item 5, M = 4.18), suggesting that teachers feel relatively
capable of modifying breaks to meet students’ needs. However, confidence dropped in items
related to structural or institutional barriers, such as a lack of time, administrative pressure for
test scores, or limited space and equipment (Items 7 and 13, both M = 2.45). This pattern shows
that teachers recognize the value of brain breaks but feel constrained by external factors. The
ANOVA results did not reveal statistically significant differences by gender or years of
experience. Still, descriptive trends suggested that newer teachers (0–5 years) reported slightly
higher confidence overall than their more experienced colleagues, highlighting a potential
generational shift in training or attitudes.
The qualitative analysis added depth and nuance, showing that teachers’ perceptions
often evolve over time. Many initially described skepticism, seeing brain breaks as “fluff” or
only suitable for younger students, but shifted their views once they witnessed improvements in
student focus and classroom climate. Participant A reflected, “At first, I thought it was a waste of
time, but it really does help them reset. I actually get more teaching time back.” Others shared

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that brain breaks have become part of their routine because students themselves ask for them.
Participant D noted, “My students remind me if I forget. That tells you it works.”
At the same time, the qualitative themes highlighted significant barriers. Teachers
consistently described time constraints as the biggest obstacle: tight pacing guides, curriculum
demands, and high-stakes testing pressure make it difficult to “justify” giving up precious
minutes. Participant F explained, “There’s never enough time; it always feels like something has
to give.”
The fear of losing control was another powerful theme, woven through responses about
both avoidance and hesitancy. Teachers shared that certain classes handle breaks well, but others
use them as an excuse to get off task. Participant I said, “I avoid them with some groups. If they
get silly, I lose them for the rest of the period.” Others described how practice and clear
expectations helped build trust and reduce this fear: Participant C said, “It’s about setting the
tone. They know it’s not free time, it’s a quick reset. That helps keep it from getting out of
control.”
Teachers also pointed to physical and environmental constraints, such as small
classrooms, large class sizes, and adverse weather conditions, as limiting factors, echoing the
lower confidence scores on related TETPPACS items. Participant D shared, “In winter, we can’t
go outside, and the room’s too cramped. So you end up skipping it.”
Despite these barriers, teachers identified several facilitators that increase the likelihood
of acceptance and sustainability: clear expectations from administrators, a supportive peer
culture, and students’ visible buy-in. Participant A shared, “I was told it’s an expectation by the
middle school admin, that makes it easier to keep it up.” Peer modeling also played a role, with

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some teachers crediting co-teachers for showing how to make breaks short, structured, and
effective.
Teachers extensively discussed the positive effects of brain breaks, especially for students
with ADHD or anxiety, but also for all students. They described brain breaks as a “reset button”
that enhances attention and decreases off-task behavior. Participant B explained, “It’s
preventative. If I don’t give them a break, they make their own by acting out.” Teachers also
highlighted a relational benefit: brain breaks show students that their well-being matters, which
builds trust and creates a more positive classroom environment.
Finally, many teachers emphasized the need for relevant, practical professional
development, especially for secondary grades. While they believe in the benefits, they want clear
strategies that work for older students and large classes. Participant G said, “We need real
examples for secondary students, not just the theory.”
Summary of Quantitative and Qualitative Findings
Together, the quantitative and qualitative findings offer a comprehensive understanding
of how secondary teachers view brain breaks and the complex factors influencing their use in
real classrooms. Although most teachers recognize the benefit of brain breaks in supporting
student focus, behavior, and classroom environment, they also face competing demands on time,
classroom management issues, and structural limitations like limited physical space. These
barriers can impact how confidently and consistently brain breaks are used, even when teachers
see their advantages.
The results of this study indicate that teachers are more likely to maintain brain break
practices when they have consistent administrative support, see colleagues modeling effective
strategies, and trust that students will follow clear expectations and routines. These insights

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reinforce the idea that sustaining brain breaks in secondary settings is not just about individual
teacher commitment; it requires systemic support, realistic scheduling, flexible physical
environments, and professional development that boosts teachers’ confidence in managing
transitions without sacrificing instructional momentum or classroom control. Together, these
findings lay the groundwork for the broader interpretation, practical implications, and actionable
recommendations presented in Chapter 5.

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Chapter 5: Conclusions and Recommendations
Summary of Findings
The findings of this study indicate that secondary teachers generally perceive brain
breaks as valuable tools for enhancing student attention, mitigating disruptive behavior, and
promoting a positive classroom climate. Many teachers described an evolution in their thinking,
moving from skepticism to firm support, once they observed the practical benefits. Participant A
reflected, “At first, I thought it was fluff, but it really does help them reset. I actually get more
teaching time back.” Teachers noted that brain breaks help students, especially those with ADHD
and anxiety, manage long periods of instruction by providing a structured opportunity to move,
refocus, and return to task.
Quantitatively, the TETPPACS results revealed that teachers felt most confident
implementing brain breaks when addressing student-level factors, such as varying academic or
physical abilities (Item 4, mean = 4.55; Item 5, mean = 4.18). However, confidence dropped
notably when institutional or environmental barriers were present, such as lack of time, pressure
for high test scores, or insufficient physical space (Items 7 and 13 means = 2.45). Although the
ANOVA did not reveal statistically significant differences by gender or years of experience, the
descriptive trends suggested that newer teachers (0–5 years) reported slightly higher confidence
overall, highlighting a possible generational shift in attitudes or preparation.
The qualitative data added depth, identifying both key facilitators and barriers. Teachers
emphasized that clear administrative expectations, supportive peer culture, and visible student
buy-in all increased their willingness to use brain breaks. Participant B noted, “When students
remind me, that tells me they need it and value it.” Conversely, the fear of losing control was a
recurring theme. Participant I described, “I avoid them with some groups because once they’re

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off-task, it’s hard to pull them back.” This underscores how classroom management concerns,
alongside curriculum demands and scheduling limitations, complicate even the most supportive
perceptions.
Teachers described clear positive impacts on student behavior and classroom
engagement, describing brain breaks as a “reset button” that reduces side conversations and helps
maintain a calm, focused environment. This aligns with CLT and SDT, as short breaks help
students manage cognitive fatigue and sustain intrinsic motivation. However, teachers
emphasized that the benefits depend heavily on structure, consistency, and clear expectations.
Implications
These findings have important implications for teachers, service providers,
administrators, and policymakers. For teachers, the study emphasizes that implementing brain
breaks effectively requires clear routines, consistent expectations, and an understanding of
student dynamics. Classroom management concerns are valid, but many teachers explained how
consistent practice helped ease these worries. Peer modeling can play a crucial role in
demonstrating how to use breaks without losing instructional time or control.
For administrators, the results underscore that brain breaks are not just an individual
teacher strategy but a systems-level practice that thrives when there is clear guidance, visible
support, and alignment with school culture. Policies that normalize short, structured breaks,
especially within block schedules, help overcome the perceived trade-off between instructional
time and student well-being. Administrative support should extend beyond policy language;
walkthroughs, Professional Learning Community (PLC) conversations, and targeted PD can help
reinforce that brain breaks are valued and encouraged.

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For policymakers and district leaders, these findings align with broader calls for
whole-child frameworks that strike a balance between academic rigor and student mental health
and engagement. Secondary-level implementation needs to be realistic about structural barriers,
such as tight pacing guides, large class sizes, and limited space. Equitable access to flexible
spaces and appropriate equipment can make a difference in how confident teachers feel about
using breaks consistently.
Conclusions
This study concludes that secondary teachers recognize the clear value of brain breaks,
not just as an “extra,” but as a practical, student-centered strategy that supports focus, reduces
disruptive behaviors, and fosters trust within the classroom. However, acceptance and
sustainability are heavily shaped by time constraints, classroom management dynamics, and
physical or institutional limitations. While teachers are generally confident in adapting breaks to
meet diverse student needs, their confidence declines when faced with structural barriers or
unclear expectations.
The data suggest that sustaining brain breaks at the secondary level requires more than
individual teacher buy-in; it depends on a shared culture that balances accountability for
academic outcomes with flexibility for student well-being. Teachers need ongoing opportunities
to see successful examples, share strategies, and establish routines that maintain classroom
control while providing students with the mental reset they need.
Alignment with Previous Research
The findings of this study reinforce and extend the existing literature on the benefits and
challenges of implementing brain breaks in school settings. Consistent with research by Longo et
al. (2022), Broad et al. (2023), and Infantes-Paniagua et al. (2021), participants described brain

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breaks as effective tools for enhancing student focus, reducing behavioral disruptions, and
supporting student engagement, particularly for students with ADHD and executive functioning
difficulties. Several teachers noted that breaks allowed students to “reset,” with visible
improvements in attention and on-task behavior following even short, structured pauses. These
insights support previous findings emphasizing the value of CABs in promoting psycho-physical
well-being and improving the classroom climate.
Similarly, the barriers identified by teachers in this study reflect those reported in earlier
research. Participants frequently cited time constraints, curriculum pacing demands, limited
space, and classroom management concerns as persistent obstacles, echoing findings from
Masini et al. (2024), McMullen et al. (2014), and Lander et al. (2024). The fear of losing control
emerged as a theme, with several teachers expressing reluctance to use brain breaks due to
concerns about maintaining student behavior post-break. These concerns are well-documented in
the literature. McMullen et al. (2014) found that many teachers feared active breaks would lead
to a loss of classroom order, while Masini et al. (2024) reported that teachers often felt
unprepared or lacked the authority to effectively manage transitions. Routen et al. (2018)
similarly noted that behavioral challenges and inconsistent student self-regulation deterred some
teachers from incorporating movement. These findings affirm that concerns over control and
post-break management continue to be major deterrents to consistent implementation, even when
teachers recognize the potential benefits.
The role of enablers in promoting the adoption and sustainability of brain breaks was also
evident. Teachers who received administrative support, observed peer modeling, or had access to
relevant professional development reported greater confidence in incorporating breaks into their
routines. These findings reflect the work of Campbell and Lassiter (2020) and Stylianou et al.

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(2015), which emphasize the importance of leadership backing, school-wide culture, and
practical training. In addition, many participants noted that student enthusiasm for brain breaks
served as an internal motivator to sustain the practice, reinforcing earlier studies that highlighted
student engagement and enjoyment as critical influences (Routen et al., 2018).
However, this study also identified several nuanced findings that diverge from prior
research. While many studies promote structured or standardized movement programs, such as
TransformUs or Tabata-style routines, as models for effective integration, participants in this
study emphasized the importance of autonomy and professional discretion. Rather than adhering
to rigid, system-wide protocols, teachers expressed a strong preference for adapting brain breaks
based on classroom dynamics, instructional pacing, and student needs. Several participants
voiced concern that overly formalized structures might undermine their classroom management
or instructional flow, pointing to a need for more flexible, teacher-driven implementation models,
an issue not widely explored in earlier intervention-based studies.
Additionally, although some prior literature encourages integrating brain breaks with
academic content (e.g., movement-based math or vocabulary review), most teachers in this study
viewed brain breaks as separate from instruction - a pause rather than a pedagogical strategy.
While participants acknowledged cognitive benefits and improved behavior, few described using
breaks to reinforce learning objectives. This disconnect suggests a missed opportunity and
underscores the need for professional development that helps secondary teachers see brain breaks
not only as tools for regulation and engagement but also as vehicles for reinforcing academic
content in creative and meaningful ways.
Another noteworthy contribution of this study is the nuanced distinction in how special
education and general education teachers perceive the value of brain breaks. Special education

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teachers often described breaks as essential tools for regulation, engagement, and student
success, particularly for neurodivergent learners. In contrast, general education teachers more
frequently position brain breaks as helpful but secondary to academic instruction. This contrast
suggests that professional training and classroom context influence how brain breaks are
conceptualized and prioritized, an area not widely explored in the existing literature.
In sum, the study affirms the well-documented benefits of brain breaks while highlighting
enduring barriers to their implementation in secondary classrooms. The alignment with prior
research is clear, yet this study extends the conversation by offering deeper insight into how role,
setting, professional autonomy, and systemic support shape teacher confidence and consistency
towards BB.
Recommendations for Further Research
Given the study’s small sample size and single-district context, future research should
expand on these findings with larger, multi-site studies that include diverse secondary school
environments. Research could also examine student perspectives on brain breaks to compare
teacher perceptions with student-reported effects on focus and engagement. Experimental or
longitudinal studies measuring academic outcomes alongside behavior and attention would
strengthen the evidence for how brain breaks influence learning over time.
Additionally, there is a clear need for research into effective professional development
models that help secondary teachers integrate brain breaks confidently. Future studies might
examine how PD, peer coaching, or PLCs influence teacher buy-in and classroom management
strategies. Research could also investigate how structural elements, such as flexible seating,
outdoor access, or dedicated movement spaces, impact teacher confidence and student outcomes.

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By addressing these areas, future studies can help schools design practical, sustainable
approaches that make brain breaks a natural part of daily learning, supporting the whole student
without sacrificing academic rigor.
Recommendations for Practice
Based on the findings of this study, several practical recommendations emerge to support
teachers, administrators, and policymakers in sustaining brain breaks as an effective classroom
strategy at the secondary level.
Recommendations for Teachers
It is essential to establish consistent, clear routines for implementing brain breaks so
students understand when they will occur, how they will look, and what is expected afterward.
Many teachers in this study emphasized that setting the tone early reduces the likelihood of
losing control. Starting small, with short, simple activities such as quick stretches, walking,
mindfulness moments, or brief partner discussions, can help build student buy-in and make
breaks feel manageable within tight class periods. Teachers are encouraged to observe colleagues
who have successfully integrated brain breaks and to share practical strategies through
professional learning communities or informal conversations. As one teacher noted, seeing a
co-teacher model breaks in action was what finally made it feel realistic. Teachers should also
reflect on what works best for different classes and note any patterns; this informal data can
guide adjustments and support conversations with administration when barriers arise.
Recommendations for Administrators
The findings highlight the importance of setting clear, positive expectations that brain
breaks are valued and supported. Administrators can reinforce this by including breaks in lesson
planning templates or pacing guides, sharing best practices during staff meetings, and

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recognizing teachers who model effective, structured breaks. It is equally important to address
structural barriers where possible. Building in flex time within block scheduling, identifying
shared spaces that can be used for short movement breaks, or adjusting classroom layouts can
make a big difference, especially when weather or room size limits options. Providing relevant,
practical professional development is critical; teachers repeatedly expressed the need for training
that is secondary-specific and realistic, rather than generic examples geared toward elementary
settings. Above all, administrators should foster a culture that balances accountability for
academic rigor with an understanding of the whole child. Teachers are more likely to use brain
breaks when they do not feel that every minute must be rigidly devoted to direct instruction.
Recommendations for Policymakers and Stakeholders
This study reinforces the value of supporting whole-child approaches that recognize the
connection between physical activity, cognitive functioning, and student well-being.
Policymakers can help by promoting policies that normalize short, structured breaks and by
funding flexible learning spaces and appropriate equipment for movement in older grades. At the
secondary level, where large class sizes and traditional room layouts can make breaks more
challenging, physical infrastructure can play a key role in teacher confidence. Ultimately,
ongoing investment in research and innovation is necessary to strengthen the evidence base on
how brain breaks impact academic outcomes, particularly for students with ADHD and other
attention-related challenges, and to identify the most effective professional development models
for sustaining these practices over time.
Ultimately, these recommendations emphasize that brain breaks are not a distraction from
instruction, but rather a simple and cost-effective strategy to help students and teachers manage
the demands of longer class periods and more rigorous content. When teachers are supported by

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clear expectations, practical training, peer collaboration, and administrative encouragement, they
are more likely to consistently implement brain breaks, creating classrooms where students can
reset, refocus, and fully engage in learning.
Final Thoughts
In conclusion, this study emphasizes that maintaining brain breaks in secondary schools
is not merely an instructional tactic but a reflection of a school’s dedication to balancing
academic rigor with student well-being. While teachers recognize the benefits of brain breaks for
enhancing focus, behavior, and classroom climate, they cannot implement these practices
consistently without meaningful support from administrators, colleagues, and the wider
educational system. By listening to teachers’ experiences and valuing their practical insights, this
research shows that small, intentional breaks, when planned with structure, trust, and shared
expectations, can help students and teachers alike reset, refocus, and thrive. As schools continue
to adapt to the evolving needs of diverse learners, I hope that these findings serve as a reminder
that sometimes, making time to pause is one of the most powerful ways we help students move
forward.

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107

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APPENDIX B – APPROVAL OF WRITTEN AND ORAL COMPREHENSIVE
EXAMINATION

108

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APPENDIX C – REQUEST FOR PERMISSION TO CONDUCT RESEARCH WITH
FACULTY
Dr. Peter J. Aiken
Superintendent
Central York School District
775 Marion Road
York, PA 17406
Dear Dr. Aiken,
I hope this letter finds you well. My name is Vivian Snell, and I am currently a doctoral student
at Slippery Rock University under the supervision of Dr. Christopher Tarr, Senior Licensed
Professional Care Manager, Ed.D., LBS. I am requesting your permission to conduct a research
study within Central York Middle School and Central York High School as part of my doctoral
dissertation. This dissertation focuses on the effectiveness and sustainability of classroom break
programs, commonly known as brain breaks.
My dissertation research aims to explore secondary teachers' perceptions of brain breaks, the
factors influencing their acceptance or resistance, and the impact these breaks have on student
focus, behavior, and overall engagement. I plan to include a diverse group of teachers from
various subjects and experience levels to ensure comprehensive insights.
As the district does not have its own Institutional Review Board (IRB), approval will be sought
from Slippery Rock University’s IRB. I will coordinate closely with school administrators to
uphold all ethical standards. Upon completion of the study, the findings will be shared with
district leaders and Slippery Rock University.
I am enthusiastic about the potential impact of this research and sincerely hope for the
opportunity to contribute to our shared goal of enhancing educational outcomes. Should you
require further information or wish to discuss this proposal in more detail, please do not hesitate
to contact me.
Thank you very much for considering this request. I look forward to the possibility of working
together to support our students' learning experiences.
Sincerely,
Vivian Snell
Special Education Doctoral Student
Slippery Rock University
vmg1005@sru.edu
717-855-0227

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APPENDIX D – PARTICIPANT EMAIL
Dear ______________ ,
I hope this message finds you well. My name is Vivian Snell, and I am a doctoral student in the Special
Education program at Slippery Rock University in Slippery Rock, PA, working on my dissertation
focused on the implementation and effectiveness of classroom break programs, often referred to as brain
breaks.
I invite you to participate in a research study titled "Evaluating the Enablers and Barriers of Classroom
Break Programs in Secondary Schools." This study seeks to understand secondary teachers' perceptions of
brain breaks, the factors influencing their acceptance or resistance, and their impact on student focus,
behavior, and engagement.
Your participation would involve completing a survey that will take approximately 15-20 minutes.
Participation is voluntary, and all responses will be kept confidential in a password-protected file.
Participation is entirely your choice. Because your colleague is conducting this study, we recognize the
potential for feeling obliged to participate. Please know that choosing not to participate will carry no
negative consequences or impact on your professional relationships. Please be assured that neither the
principal nor the co-investigators hold any evaluative or supervisory authority over participants.
Participation in this study will not affect your assignments, evaluations, or standing within the district.
This study will enroll a maximum of 20 teachers. If more than 20 teachers express interest, we will notify
the additional respondents that they have been placed on a waitlist and will be invited to participate if a
spot opens up.
As a token of appreciation, all participants who complete the survey will be entered into a raffle. Twelve
randomly selected participants will each receive a $25 Amazon gift card. Please review and complete the
attached consent form if you are willing to participate. Upon receipt of your consent, a link to the
demographic questionnaire and the survey will be provided. A summary of the study's findings will be
shared with you to contribute to our understanding and implementation of effective educational practices.
If you have any questions or require further information, please do not hesitate to contact me at
717-855-0227 or vsnell@cysd.k12.pa.us.
Thank you for considering this opportunity to contribute to our research aimed at enhancing teaching
practices and student outcomes.
Sincerely,

Vivian Snell
Special Education Doctoral Student
Slippery Rock University

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111

APPENDIX E – RESEARCH PARTICIPANT INFORMED CONSENT LETTER

CONSENT TO PARTICIPATE IN RESEARCH
EVALUATING THE EFFECTIVENESS AND SUSTAINABILITY OF CLASSROOM
BREAK PROGRAMS: PERCEPTIONS OF SECONDARY TEACHERS
Vivian Snell, vmg1005@sru.edu, 717-855-0227
Invitation to be Part of a Research Study
You are invited to participate in a research study. In order to participate, you must be a secondary
teacher. Taking part in this research project is voluntary.
Important Information about the Research Study
Things you should know:
● The study's purpose is to explore secondary teachers' perceptions of brain breaks, the
factors influencing their acceptance or resistance, and their impact on student focus,
behavior, and classroom engagement.
● If you choose to participate, you will be asked to complete a demographic and
18-question survey using a scale rating to assess your perceptions. Additionally, you will
answer five open-ended questions to provide deeper insights into your experiences.
● Risks or discomforts from this research are minimal, primarily involving the time
commitment required to complete the surveys and potential emotional discomfort from
reflecting on professional practices and experiences.
● There are no direct personal benefits to you for participating in this study. However, the
information gathered may help improve the implementation and effectiveness of brain
breaks in schools, which could contribute to enhanced educational practices and better
student outcomes.
● Taking part in this research project is voluntary. You do not have to participate, and you
can stop at any time.
● Participation is entirely your choice and will have no impact on your professional
evaluations, assignments, or relationships with the investigators or any colleagues. Please
be assured that neither the lead nor the co-investigator holds any evaluative or
supervisory authority over participants.
● This study will enroll a maximum of 20 participants. Enrollment will be on a first-come,
first-served basis among those who provide consent. If more than 20 secondary teachers
consent, you will be notified of your status (selected or wait-listed) within five business
days of the consent deadline.
● Please take time to read this entire form and ask questions before deciding whether to
take part in this research project.

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What is the Study About and Why are We Doing it?
The purpose of this study is to evaluate the effectiveness and sustainability of "brain breaks" in
secondary schools. These programs, which integrate short periods of physical activity or mental
breaks during academic instruction, are designed to enhance student engagement and focus.
Despite their increasing popularity in educational settings, there remains a significant gap in
research regarding how these breaks are implemented, their sustainability, and their outcomes
regarding student behavior and academic performance. The research will focus on three main
objectives: assessing secondary teachers' perceptions of brain breaks, including the benefits and
challenges; identifying the factors that influence teachers' willingness to implement these breaks
in their classrooms; and measuring the impact of brain breaks on student focus, behavior, and
overall classroom engagement. By fulfilling these aims, the study will provide critical insights
into the practical application of brain breaks and offer evidence-based recommendations for their
effective use in educational practices, potentially influencing curriculum development, teacher
training, and policy decisions.
What Will Happen if You Take Part in This Study?
If you agree to participate, you will be asked to (1) complete the demographic survey to provide
background information and (2) answer the 18-question scale-rated survey and respond to 5
open-ended questions online. We expect this entire process will take approximately 20 minutes.
How Could You Benefit From This Study?
Although you will not directly benefit from being in this study, others might benefit because your
involvement enhances the overall understanding of the effectiveness and sustainability of
classroom break programs. The findings could lead to more effective and tailored
implementation strategies that improve educational outcomes for students across various
settings.
What Risks Might Result From Being in This Study?
You might experience some risks from being in this study. The survey consists of 18 scaled
questions and five open-ended questions designed to be non-intrusive. The survey questions
focus on your views and experiences regarding classroom break programs while safeguarding
your employability and comfort. Engaging in this study presents minimal privacy concerns, and
breaches of confidentiality are not anticipated.
How Will We Protect Your Information?
I/We plan to publish the results of this study. To protect your privacy, I/we will/will not include
information that could directly identify you. Your information will be securely stored in a

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password-protected electronic format (Google Drive) and accessible only to the research team.
Identifiable information will be separated from the survey responses to ensure confidentiality.
What Will Happen to the Information We Collect About You After the Study is Over?
I/We will not keep your research data to use for future research or other purposes. Your name and
other information that can directly identify you will be kept secure and stored separately from the
research data collected as part of the project.
How Will We Compensate You for Being Part of the Study?
You will be entered into a raffle for one of twelve $25 Amazon gift cards for your participation
in this study.
What Other Choices do I Have if I Don’t Take Part in This Study?
If you choose not to participate, there are no alternatives.
Your Participation in this Research is Voluntary
It is totally up to you to decide to be in this research study. Participating in this study is
voluntary. Even if you decide to be part of the study now, you may change your mind and stop at
any time. You do not have to answer any questions you do not want to answer. If you decide to
withdraw before this study is completed, your information will be removed from the data
collection.
Contact Information for the Study Team and Questions about the Research
If you have questions about this research, you may contact Dr. Christopher Tarr (lead
investigator) at christopher.tarr@sru.edu or Vivian Snell (co-investigator) at vmg1005@sru.edu
or 717-8550227.
Contact Information for Questions about Your Rights as a Research Participant
If you have questions about your rights as a research participant, or wish to obtain information,
ask questions, or discuss any concerns about this study with someone other than the
researcher(s), please contact the following:
Institutional Review Board
Slippery Rock University
104 Maltby, Suite 302
Slippery Rock, PA 16057
Phone: (724)738-4846
Email: irb@sru.edu

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APPENDIX F – SURVEY PARTICIPATION CONSENT FORM
Interview Consent Form
By signing this document, you are agreeing to be included in this study. Make sure you
understand what the study is about before you sign. I/We will give you a copy of this document
for your records. I/We will keep a copy with the study records. If you have any questions about
the study after you sign this document, you can contact the study team using the information
provided above.
I understand what the study is about and my questions so far have been answered.
I agree to take part in this study. I understand that I can withdraw at any time. A copy of this
signed Consent Form has been given to me.
____________________________
Printed Participant Name

______________________________
Signature of Participant

_________
Date

By signing below, I indicate that the participant has read and to the best of my knowledge
understands the details contained in this document and have been given a copy.
____________________________

_______________________________

____________

Printed Name of Investigator

Signature of Investigator

Date

PERCEPTIONS OF BRAIN BREAKS
APPENDIX G – PARTICIPANT DEMOGRAPHIC QUESTIONNAIRE
1) Gender
a) Male
b) Female
c) Other: ________________
d) Prefer not to say
2) What racial/ethnic group do you identify with?
a) Hispanic
b) White
c) African American or Black
d) Asian
e) American Indian or Alaska Native
f) Native Hawaiian or Other Pacific Islander
g) Other: _____________
3) What is your Professional Title
a) Regular Education Teacher
b) Special Education Teacher
c) Other: ________________

4) What is your primary teaching assignment (i.e. classes or subjects taught)

5) What grades do you teach?

6) What is your typical class size?

7) What is the highest degree you have earned?

8) How many years have you been an educator?

9) How many years have you been a teacher in the Central York School District?

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APPENDIX H - TEACHER SURVEY
Response Scale: Rate on a scale from 1 to 5; “Not at all confident” (1) and “Fully confident”
(5).
Question Stem: I am confident that I can get my students active when…
1) My students are not concerned with being physically active.
2) My students are preparing for tests.
3) My students are having problems getting along.
4) My students have a wide range of academic abilities.
5) My students have a wide range of physical abilities.
6) I have a crowded classroom of students.
7) My school does not have enough room outside/inside to provide students with adequate
physical activity.
8) The weather is bad and students can’t go outside.
9) I do not have enough time during the day to provide physical activity breaks.
10) I do not have enough time in the period to provide students recess/any type of break.
11) I do not have enough time to prepare physical activity breaks
12) Other teachers at my school do not value physical activity.
13) My administration does not provide adequate support for physical activity.
14) My administration puts pressure on getting high test scores.*
15) I do not have enough equipment/resources for all my students to be physically active.*
16) I can attend professional development focused on implementing physical activity.
17) I can learn a variety of strategies to implement physical activity.
18) I can improve my knowledge about how to get my students active.

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Open-Ended Questions:
1) Describe your initial thoughts or feelings about integrating brain breaks into your
classroom routine.
2) What factors or considerations influence your decision to implement brain breaks in your
classroom? Feel free to mention experiences, school policies, perceived outcomes, or any
other influencing elements.
3) What factors or considerations influence your decision to avoid brain breaks in your
classroom? Feel free to mention experiences, school policies, perceived outcomes, or any
other influencing elements.
4) Based on your experience, how do brain breaks affect your students' focus, behavior, and
engagement in the classroom? Specifically consider your students with and without
ADHD.
5) Based on your observations and discussions with colleagues, why do you think some
teachers choose to incorporate brain breaks, while others might avoid them? Please
provide any examples or insights that have shaped your understanding.