'Space for Acupuncture' at Stanchester Community School

Abstract
Stanchester Community School is a secondary comprehensive school with 900 pupils in the English county of Somerset. Since the Autumn of 2005 a small project has been offering acupuncture treatment on a voluntary basis to young people in the school identified with anxiety and stress, ADHD and problems controlling anger. This article describes the project, the treatment offered and the results of the treatment, including feedback from the pupils themselves.

Keywords
Acupuncture, Special Educational Needs, school, ADHD, anxiety, stress, anger management.

“I have had acupuncture because I can get angry and I hate that feeling, you know, when you get really hot and out of control with your temper. I find it easier now to stay in control. I would tell anyone to have acupuncture if they have the chance.”
Hannah, aged 16 years.

“Before I had acupuncture for the first time I was a bit scared that the needles would hurt and that made me a bit jumpy! When they actually went in I relaxed and realised that it wasn’t going to hurt. It was really nice to relax and now I look forward to my sessions.”
Adam, aged 12 years.

“I am really pleased with the way it is going and it will improve the academic performance of some pupils but more importantly it improves how well an individual feels about themselves.”
Glyn Ottery, Head teacher.

“I feel like a parent who is coming into school to support my child in a positive way, rather than a parent called in because of bad behaviour”
Parent

The background
Acupuncture is a wonderful complementary therapy for young people and, as the long term effects are to balance and strengthen them both physically and emotionally, it creates the opportunity for some young people to engage in school life in a much more positive way than they might otherwise do so. ‘Space for Acupuncture’ at Stanchester Community School in Somerset is an exciting and innovative new project that brings acupuncture into the curriculum as part of the wider specialist support for Special Educational Needs within the school. Having been a teacher of Special Educational Needs for over twenty years (working at this school for ten years), I found myself in the unique position of being both a teacher and qualified acupuncturist with postgraduate experience of treating young people. Throughout my career as a teacher I have always engaged with young people in a holistic way so it seemed a natural progression to treat them with acupuncture. Being a member of a school community meant that it was possible to offer a service for young people in the place where they spend the majority of their time - at school. The wonderful simplicity of the project comes from the fact that I am able to practise acupuncture during my teaching time so the families invited to take part in the project do not need to pay for the service - it is offered as part of the support for students with individual needs. This embeds the service as part of the school's special educational needs provision rather than it being an 'add on' facility.

Identification and assessment
Students and families who are identified with difficulties such as anger management, anxiety and stress and ADHD (Attention Deficit Hyperactivity Disorder) are invited to join the project. Students are offered a course of acupuncture sessions during the school day. Each treatment session lasts about an hour, the length of one lesson, and it is hoped that a member of the family is able to attend. The full permission of the parent(s) and the positive permission of the young person are always sought and if at any point it is felt that the young person does not want to be treated or does not understand what is happening, then the treatment does not proceed. A course of treatment consists of up to ten sessions, with flexibility for further courses as desirable. Many positive changes are in fact seen within four to six sessions.

The project needed to have some kind of objective assessment before and after a course of treatment and, in talking to the educational psychologist working alongside many of the students and families involved, a ‘Rating Scale of Behaviour at Home and School’ was devised based on an ADHD Rating Scale used by Educational Psychology Services. The questionnaire was written in such a way so that it could be completed by both a parent/guardian at home and by a teacher or other adult working with the young person at school. This way a comparable assessment could be made as to how the treatment was helping the child both in and out of school. Examples of the kinds of questions are as follows:

The number is circled which best describes the child:
0 = not at all, 1 = occasionally, 2 = quite often, 3 = most of the time
Is easily distracted: 0 1 2 3
Often shifts from one uncompleted activity to another: 0 1 2 3
Often talks excessively: 0 1 2 3
Often gets frustrated: 0 1 2 3
Has difficulty moving on from a confrontational situation: 0 1 2 3

As a young person embarks on a course of treatment it usual to find a marked improvement in general well being. Sleep, energy, immunity, happiness and self-esteem can all improve, and so on a regular basis students and their families are also asked about changes they feel are taking place as the acupuncture treatment progresses. A 0-10 assessment scale is used for this and the questioning is much more individualised and informal in style. For example, if a pupil finds it difficult to sleep I may ask how he or she perceives the problem on a scale of 1-10 with 1 being able to sleep well and 10 being never able to sleep. I may ask this same question at the start of each acupuncture treatment and this way I can measure, in an informal, subjective way, any changes that are taking place. A future development will be the use of a self-esteem questionnaire alongside the ‘Behaviour Rating Scale’. As this is such an important aspect of the work, I would like it to be measured in a more objective way.

The students themselves are also given a ‘Tell Me What You Think’ questionnaire to complete on a regular basis throughout their course of acupuncture. They are given a choice of words and phrases and asked to circle three that best describe how they felt during a particular treatment. Choices include: loved it, hated it, comfortable, bored, listened to, OK, happy, nervous, scared, interested, enjoyed it, great! They are also asked to identify one thing they have really enjoyed about the session that day, one difference in how they might feel and one thing they may have learned. They do seem to love learning the names of the points and all of them could tell you where the extra point ‘Yintang’ is and why Zusanli ST-36 is called ‘Leg Three Miles’. We now call it ‘Stanchester’s Marching Needle’.


BOX*:
They do seem to love learning the names of the points and all of them could tell you where the extra point ‘Yintang’ is and why Zusanli ST-36 is called ‘Leg Three Miles’.

The acupuncture
Much research was undertaken before the start of the project to decide the kind of acupuncture treatment method that would be used. Dr. Michael Smith of Lincoln Hospital, New York, USA describes a protocol for treating ADHD using a type of auricular magnetic pellet which is applied to the surface of the ear by adhesive tape. The treatment location is on the posterior surface of the external ear, just opposite to ‘Shenmen’ on its anterior surface. The Reed Academy, a widely acclaimed residential school for boys with serious behavioural health problems, describes its experience following this protocol and reports significant sustained improvement for most of the boys as a result of the bead use. (For the Lincoln Hospital ADHD research and the Reed Academy ADHD research please follow the link at www.snhac.com)

After consideration I decided, however, to use body points because of their versatility, especially for young people presenting with mixed energy patterns. I also decided that treatment plans for each student would be individualised according to the information given at the initial consultation with the young person and the parent/guardian attending and also, of course, according the presentation of their tongues and pulses. Each young person is offered treatment by acupuncture needles or by the stimulation of acupuncture points by an electro-magnetic pen. After discussions with other acupuncturists who have employed alternatives to acupuncture needles, and my own experience of the marvellous results that can be obtained by the employment of non-penetrating methods, it was felt that the electro-magnetic pen would be a good alternative for those students who were genuinely frightened of needles and would otherwise not take part in the project. In fact almost all students prefer to use needles. I change the make of needles every so often which keeps their interest, some liking the purple-handled needles and some enjoying the iridescent quality of other needles. It is explained how acupuncture needles will be placed at selected points and then manipulated to obtain ‘deqi’, producing a warm or tickly sensation. They like trying to describe these feelings and are fascinated by how they can change from point to point and session to session. It was decided to only use acupuncture points on the head, the lower arms and hands and the lower legs and feet, which means of course that they do not have to undress, but just roll up trousers or skirts and sleeves. It was also decided not to use moxibustion as I was worried about the risk of pupils suddenly changing position during a treatment.

Attention Deficit Hyperactivity Disorder (ADHD)
“Professor Lai Xin-sheng from Guangzhou Chinese Medical University has many years of experience in the treatment of ADHD with acupuncture. It is his belief that the treatment effect of western drugs is limited to the time period the child is actively taking them and that the recurrence rates after discontinuing the medications are high. He has found acupuncture to be the most stable and effective treatment for children with ADHD … and it deserves to be popularised.”1

“The term ‘hyperactive’ is used to describe a whole spectrum of behavior in children ranging from very energetic to disruptive and rude and to positively violent. From a Chinese point of view the categories are very clear, and although there may be slight overlaps, the main problem is usually easily identified. This is one of the great strengths of Chinese medicine and is part of the reason that hyperactivity can be treated so well with acupuncture. To be able to identify the cause, and to treat the condition, we can cure the child. This is in stark contrast to conventional medicine, where the cause is unknown, and there are few tools with which to help these children other than drugs.”2

In my experience young people diagnosed with ADHD present with underlying Spleen qi deficiency and/or Kidney qi deficiency. Interestingly the basis of the patterns is deficiency even though they appear to have lots of energy. Those with ‘hyperactive’ Spleen qi deficiency tend to have poor appetites and other signs of Spleen deficiency. Those with Kidney deficiency tend to become hyperactive when they are tired or excited; the Kidneys cannot hold down the energy so it rises up to the head. With careful questioning, some young people I have worked with who have ADHD say that they become extremely tired during their lessons and the hyperactivity comes as an attempt to keep awake. It is interesting to note that the drugs that are commonly prescribed for ADHD are in fact stimulants. Points that I use regularly are Sanyinjiao SP-6 to tonify the Spleen, Zusanli ST-36 to tonify the Spleen and Stomach, Taichong LIV-3 to calm the spirit and regulate the circulation of energy and Taixi KID-3 to tonify the Kidney. One young person has been taught to massage Yongquan KID-1 at home to help calm him before bed-time and he seems to enjoy the fact that he can take some responsibility for his treatment himself.

Anxiety and stress: anger management with acupuncture
Writing for The Journal of Chinese Medicine in the article “Treating Young Adults with Acupuncture” Lynne Grant discusses the use of acupuncture with ‘problem’ teenagers and young people. She explains how the young people using the service offered by RPS Rainer in one project in SE London were happy with the treatment and could easily define its benefits, namely improvements in mood, sleep, appetite, energy levels and overall well being.3

From a Chinese medicine point of view, anger and frustration come when the circulation of qi is blocked and cannot flow smoothly throughout the body. Young people with anger management difficulties will benefit from acupuncture to help smooth their flow of energy and in particular to calm the Liver and move Liver qi stagnation. One seemingly simple yet extraordinarily sophisticated combination of points used for this is Taichong LIV-3 and Hegu L.I.-4: the Four Gates. This combination is renowned for activating the free passage of qi and blood through the body. Some young people have responded incredibly well to this prescription with sustained results being noted within three to four treatments. One reports how he can play football now without losing his temper every time he is tackled.

It is possible, however, that by using this combination, the unblocking of energy can cause a sudden outburst of anger and this is exactly what happened for one young person after an acupuncture session. This kind of release is a pattern that he does often display – however its occurrence immediately after treatment needed explaining to several adults who had become involved. I explained that acupuncture would not cause a loss of temper by itself, that the anger and ‘blockage’ of energy had to be there in the first place, and that the acupuncture had more than likely acted as a safety valve. The pupil has had further treatments and his mother reports that his anger is becoming easier to manage at home. He is not arguing as readily and accepts that he must stay within the boundaries of the home rules, for example the time he was expected to come home one evening was accepted without an argument.

Almost all of the young people treated have a red tongue tip, often in the absence of any other Heart signs and symptoms. As the Heart is the centre of the emotional self and is ‘attacked’ by negative emotions, I almost always include a point to treat the Heart in my prescriptions. This is mostly Shenmen HE-7 which is primarily used to calm the spirit. Another very important point is Yintang (M-HN-3), used for its calming properties. The young people are always amazed at how relaxed it makes them feel and they are encouraged to simply hold or massage the point at home before sleep, or in stressful situations. One young person, who noticeably held his anger and tension in his arms and hands by clenching his fists, became quite bemused after his first treatment because he felt he could no longer move his hands to clench his fists and he thought there was something wrong. I think he genuinely had no experience of how it felt to have relaxed arms and hands.

The politics of acupuncture in school
To set the project up needed thorough consultation with the County Council (local authority), and receiving positive support from the Head teacher was crucial in this process. The County Council Insurance Department covered the practice of acupuncture subject to a detailed and favourable Somerset County Council Health and Safety Risk Assessment. The comprehensive nature of this was essential and needed to deal with hygiene, premises, cross-infection, safety of equipment and storage, and consent. Under section 15 of the Local Government (Miscellaneous Provisions) Act 1982 the practice of acupuncture can only take place if it is registered with the Local Authority and so both the school and myself have been licensed.

It became apparent that there was one potentially worrying political issue: that acupuncture could be portrayed by others, including the media, as a return to corporal punishment, that is, an invasive treatment applied as a result of bad behaviour. In fact the media coverage we have attracted has been enormously positive and has prompted referrals from parents and some young people themselves. Another concern involved the communication links between myself and other professionals involved with the young people, the worry being that the effects of acupuncture might be perceived as interfering with other treatment the child was receiving. Meetings were set up with other professionals such as the Educational Psychologist and Consultant Child and Adolescent Psychiatrist, and the project has enjoyed a great deal of support from them. Some of the students are on medication and it has always been stressed to the families and doctors involved that the acupuncture is seen as a complementary therapy alongside such treatment. It is never suggested that medication be changed or stopped and it is made clear to parents that this would only be done by the primary prescribing doctor on the basis of clear changes in the clinical picture.

The school staff themselves have supported the project with enthusiasm and this has been a rock for the success of the project. One thing that has surprised me a great deal is the improved sleep the young people are now enjoying after acupuncture treatment and I think this demonstrates how fundamentally tired young people do get with the stresses of their everyday lives. One student overslept after his first few sessions and was late for school the next day. It was important, of course, that this was not met with criticism at school. Students can be tired immediately after treatment and if they then need to go onto a lesson without a break this needs managing in a supportive way. The managers of the Social Inclusion Room, (essentially a time-out facility), and the Special Educational Needs Co-ordinator are marvellous with their help.

The politics of kids
Young people in school love encouragement, support and ‘positive strokes’. It is incredibly important for their self-esteem and confidence, and much research documents how important this is for their learning. The students are ‘rewarded’ for their involvement in the project since school staff have been enormously positive about changes they have seen in behaviour in and out of the classroom and have passed their praise on to the young people themselves. Certificates are awarded after a course of treatment and mugs and pens with the project title have been enthusiastically received. We are lucky to have the use of a physiotherapy room where the acupuncture takes place. The young people have been encouraged to take ownership of the room and help with its decoration. One young person purchased a beautiful Chinese calligraphy poster, two small Buddhas and some chopsticks.

BOX*: This project is still in its early days and already I have been amazed at how young people involved have taken acupuncture to their hearts, enthusing about its benefits to family and friends.

Conclusion
As a practitioner of acupuncture I am passionate about the use of Chinese medicine as part of our everyday lives. It is a safe natural treatment for all the family. This project is still in its early days and already I have been amazed at how young people involved have taken acupuncture to their hearts, enthusing about its benefits to family and friends. Many of them easily identify a marked improvement in well-being, happiness, sleep and energy. They feel more relaxed and more able to cope. My hope is that as they become adults and have families of their own they will feel empowered to take a greater responsibility for their health and happiness and use Chinese medicine because they know this will have a profound effect on their well being. Additionally my hope is that as they choose acupuncture within their own families and communities, the culture of Chinese medicine will become comfortably and systemically embedded in Somerset.

Notes
1 Becker S. A (2001). “A Ritalin Alternative: Acupuncture in the Treatment of ADHD” in Chinese Medical Psychiatry: A Text Book and Clinical Manual. Blue Poppy Press: Boulder.
2. Scott J & Barlow T. (1999). Acupuncture in the Treatment of Children. Eastland Press, Seattle. p377.
3 Grant L (2003). “Treating Young Adults With Acupuncture”, The Journal of Chinese Medicine, 73: 5.


Heather Rabone has been a teacher of Special Educational needs for over twenty years and been involved in complementary health care for over ten years. She is a practitioner of Acupuncture and Aromatherapy and has taught natural health to both young people and adults. In September 2004 she was a postgraduate student at Zeijing University, China, specialising in the practice of acupuncture with children. Heather is passionate about the use of Chinese Medicine and Acupuncture as part of our everyday lives.