Virco is committed to keeping abreast of research and evidence that will help us to provide the best possible options for students and teachers. The following literature review and reference list provide a summary of some of the research and concepts that are guiding our efforts in providing options for healthy movement in the classroom.


The confluence of several factors supports the need to consider how best to support positive behavior and engaged attention in school-aged children.  First is the trend toward increasing numbers of children who have identified special learning needs. Specifically, the increasing number of children diagnosed with autism has resulted in many more children needing services than in past times.  In California, the incidence of autism nearly doubled between 1998 and 2002 (Byrd, Sage, Keyzer, et al, 2002), and the CDC released a report in 2012 citing that 1 in 88 boys will received this diagnosis (CDC, 2012).  At the same time, the trend toward full inclusion of children with special needs has moved forward (Hiatt-Michael, 2004).  With increased numbers of children requiring special education services, and more children with special learning needs integrated into regular classrooms, the ways in which the environment both supports or hinders attention and behavior has become more salient.

In the last decade, there also has been an increase in demands on students' academic performance.  Standards associated with No Child Left Behind and other societal influences have resulted in decreased time for recess and other extracurricular activities that previously allowed for physical outlets during the school day (Jarrett & Maxwell, 2000).  In regard to increased emphasis on academic standards, Pellegrini and Bohn (2005) state, "The orientation toward accountability has a number of implications. Perhaps most broadly, schools are organizing schedules so that instructional time is maximized and non-instructional time, such as recess, is minimized." (p.1).  Since attention to tasks and motivation to be engaged in classroom activities have been associated with breaks, such as recess (Jarrett, et al, 1998; Ridgway, Northup, Pellegrin, & Hightshoe, 2003; Toppinio, Kasserman & Mracek, 1991) and researchers such as Barros, Silver and Stein (2009) have also demonstrated that access to daily recess has a positive effect on classroom behavior, the reduction in these activities produces another factor in the consideration of children's engaged attention and positive behavior at school. 

Although advances in technology bring many advantages and opportunities for enhanced learning for children, increased time spent with technological devices can also bring challenges.  Subrahmanyam, Kraut, Greenfield, and Gross (2000) examined the use of home computers on children's activities and development and stated that, "As the combined amount of time children spend across these various media increases, the likelihood of displacing time spent on organized sports and other social activities also increases, thus exacerbating the impact on children's physical and social well-being" (p.125). They note the potential for increased risk of obesity, hand injuries and decreased play skills with increased time in front of computer screens.  Decreased opportunities for physical activity and an increased tendency toward sedentary activities have occurred for all people in the US (Brownson, Boehmer & Luke, 2005) and for developing children in particular, with the US Center for Disease Control naming increased physical activity as a major objective (CDC, 2010). The fact that both attention and behavior have been associated with academic performance (Georges, Brooks-Gunn & Malone, 2011) suggested that these are important aspects of consideration for supporting children's learning.

The physical environment of the classroom, along with school day routines, teacher perspectives and parent involvement, are several aspects of consideration for supporting all children's ability to have positive behavior and engaged attention throughout the school day.  Ritchie, Clifford, and Crawford (2009) make the case for considering how the design of the classroom and school campus affects the development and maintenance of social relationships and partnerships. According to Cheng (1994) student performance is impacted by the social and physical environments of a classroom, as well as classroom management techniques used by the teacher. Most classroom management techniques focus on the use of behavioral strategies, such as positive reinforcement (Austin & Soeda, 2007; Pollistrok & Gottlieb, 2006;). While many articles address classroom management techniques used by teachers, few articles focus on the physical environment and how it can impact student learning.

Lackney (1999) realized the importance of assessing the physical environment of the school and its impact on student learning. In assessing the quality of an environment, he found that the top two concerns in school settings were physical comfort/health and classroom adaptability. In turn, Lackey found that these two areas had strong links between student academic performance and teacher instructional performance. This research suggests that the classroom environment can both improve a teacher's ability to teach and a student's ability to learn.

In current classroom design, the most common methods of arranging a classroom include rows or group clusters (Woolner et al., 2007). Richie et al. (2009) suggested that group clusters are important for developing student relationships. However, some research suggested that students who are easily distracted are less attentive when seated in group clusters (Woolner et al., 2007). According to Emmer et al. (2005), the classroom layout is dependent on the teaching style. If a teacher is using mainly cooperative learning strategies, the classroom should be arranged to accommodate group activities (clusters) rather than rows (Emmer, et al 2005). Thus, a classroom that is easily physically adaptable may contribute to greater student learning and ease of teaching.

Besides adaptability, Lackey's research (1999) also indicated the importance of physical comfort and health. Woolner et al. (2007) expressed concern for physical comfort and health in their work noting an ongoing problem with matching the size and structure of furniture to children's body dimensions. In support of considering size and structure in relation to the size of the child, Knight and Noyes (1999) found that children had improved on-task behavior when sitting in ergonomically designed furniture. Guidelines for teaching children with ADHD also suggest that furniture be sized appropriately, as children may have a more difficult time remaining seated if the furniture is too big or too small for them (U.S. Department of Education, Office of Special Education and Rehabilitative Services, 2006).

Occupational therapists have long been interested in environmental adaptations to enhance occupational performance (Barris, 1982). Given that the effect of any environment is perceived through one's senses, sensory integration theory (Ayres, 2005) has been a guiding force for occupational therapists who have been interested in environmental adaptations for children.  In 1996, Williams and Shellenberger published How Does your Engine Run® A Leader's Guide to the Alert Program® for Self-Regulation. The Alert program is based on sensory integration theory, which recognizes that an individual's arousal level can fluctuate throughout the day, and is largely influenced by sensory experiences. Williams and Shellenberger (1996) proposed that engaging in a variety of individually tailored sensory activities, including movement such as rocking, may help a child regulate his or her arousal level and improve focus and attention to classroom activities. Another occupational therapist, Mulligan (2001) found that the use of movement breaks was one of the most effective strategies utilized by teachers in teaching students with ADHD.

Schilling et al. (2003) and Fedewa and Erwin (2011) focused on the use of alternative seating to help children with ADHD remain focused on activities. In their studies, they compared the use of child-sized therapy balls and stability balls in lieu of regular classroom chairs for children with attention concerns. Both studies reported positive results in functions such as in-seat and on-task behavior and levels of attention when the children were sitting on the balls in comparison to stable chairs. In addition, in both studies, a majority of the children preferred to sit on the therapy balls, commenting that they felt they were more focused, had better posture, and were more comfortable than when they were in their regular classroom chairs. The teachers in both studies also reported increased focus and less noise from the students when they were sitting on the balls (Schilling, et al 2003; Fedewa & Erwin, 2011).  Subsequent studies found varied results of introducing alternative seating options, suggesting that such efforts require an individualized approach (Schilling & Schwartz, 2004; Bagatelle, et al., 2010).

Other factors in a student's classroom environment that can impact attention and behavior include visual elements, such as color. For example, Daggett, et al. (2008) suggested that young children are attracted by warm and bright colors, elementary age children prefer tints and pastels, middle school children prefer greens and blues, and high school children prefer darker colors. In addition to color preference, Engelbrecht (2003) noted that end walls painted a medium hue help reduce eyestrain when the student looks up from his or her desk. Other suggestions included painting surrounding walls neutral with a more contrasting color behind the chalkboard to help provide a focus point and increase contrast between the board and the wall. Engelbrecht (2003) also suggested that the classroom ceiling should have a 90% reflectance and the desk finish be lower (around 30%).

In summary, several trends have led to children having reduced access to physical activity that creates the potential for decreased attention and less positive classroom behavior.  Since attention and behavior are associated with learning and academic performance, efforts to support these functions have important implications for education. Consideration of classroom design, including furniture and its arrangement is one avenue for addressing these considerations. Classroom consultation and environmental modification are a natural fit for the application of occupational science concepts in the educational setting. The literature suggested that an ideal classroom design should be adaptable to match the teacher's style of teaching and promote both group and individual learning as needed. Classroom furniture should be comfortable for the student and fit to the student's size. In addition, furniture that offers dynamic movement may also be helpful in increasing on-task behavior and the student's ability to remain actively engaged. Lastly, colors in a classroom should be used to minimize eye strain, provide focus points, and enhance visual processing.


Ayres, A.J. (2005). Sensory Integration and the Child, 25th Anniversary Ed.  Los Angeles: Western Psychological Services.

Austin, J.L. & Soeda, J.M. (2008). Fixed-time teacher attention to decrease off-task behaviors of typically developing third graders. Journal of Applied Behavioral Analysis, 41 (2), 279-283.

Bagatell, N., Mirigliani, G., Patterson, C., Reyes, Y., & Test, L. (2010). Effectiveness of Therapy Ball Chairs on Classroom Participation in Children with Autism Spectrum Disorders. American Journal of Occupational Therapy, 64, 895–903.

Barris, R. (1982) Environmental interactions: an extension of the model of occupation. American Journal of Occupational Therapy, 36, 637-644.

Barros, R.M., Silver, E.J., & Stein, R.E. (2009). School recess and group classroom behavior. Pediatrics, 123 (2), 431–436

Brownson R.C., Boehmer T.K., & Luke, D.A. (2005). "Declining rates of physical activity in the United States: what are the contributors?" Annual  Review of  Public Health, 26 (1), 421–443. doi: 10.1146/annurev.publhealth.26.021304.144437.

Byrd R.S., Sage A.C., Keyzer J. et al. (2002). Report to the Legislature on the Principal Findings of The Epidemiology of Autism in California: A Comprehensive Pilot Study. Davis CA: M.I.N.D. Institute.

Centers for Disease Control and Prevention. State Indicator Report on Physical Activity, 2010. Atlanta, GA: U.S. Department of Health and Human Services.

Cheng, Yin Cheong (1994). Classroom Environment and Student Affective Performance: An Effective Profile. Journal of Experimental Education, 62(3), 221-239.

Daggett, W.R., Cobble, J.E., & Gertel, S.J. (2008). Color in an Optimum Learning Environment.  International Center for Leadership in Education. Online:

Emmer, E.T., & Gerwels, M.C. (2005). Establishing classroom management for cooperative learning: three cases. Paper presented at the Annual Meeting of the American Educational Research Association; Montreal, Canada. Retrieved from

Engelbrecht, K. (2003). The Impact of Color on Learning. Paper presented at the NeoCon Design Exposition and Conference, Chicago, IL.

Fedewa, A.L., & Erwin, H.E. (2011). Stability Balls and Students With Attention and Hyperactivity Concerns: Implications for On-Task and In-Seat Behavior.  American Journal of Occupational Therapy, 65, 393–399. doi: 10.5014/ajot.2011.000554

Georges, A., Brooks-Gunn, J. & Malone, L.M. (2011). Links Between Young Children's Behavior and Achievement: The Role of Social Class and Classroom Composition. doi: 10.1177/0002764211409196

Hiatt-Michael, D.B. (2004) Connecting Schools to Families of Children with Special Needs. In D.B. Hiatt-Michael (Ed.) Promising Practices Connecting Schools to Families of Children with Special Needs (pp. 1-14). Malibu, CA: Pepperdine University.

Knight, G., & Noyes, J. (1999). Children's behavior and the design of school furniture. Ergonomics, 42 (5), 747-760.

Jarrett, O.S., & Maxwell, D.M. (2000). What Research Says about the Need for Recess. In R.L. Clements (Ed.), Elementary School Recess: Selected Readings, Games, and Activities for Teachers and Parents (pp. 12-23). Lake Charles, LA: American Press.

Jarrett, O.S., Maxwell, D.M., Dickerson, C., Hoge, P., Davies, G., & Yetley, A. (1998). Impact of recess on classroom behavior: Group effects and individual differences. Journal of Educational Research, 92 (2), 121–126.

Lackney, J.A. (1999). Assessing school facilities for learning/assessing the impact of the physical environment on the educational process: Integrating theoretical issues with practical concerns. Paper presented at the NJIT Conference, Newark, NJ.

Pellegrini, A.D., & Bohn, C.M. (2005). The Role of Recess in Children's Cognitive Performance and School Adjustment. Educ Res, 34,13–19.

Pollirstok, S. & Gottlieb, J. (2006). The Impact of Positive Behavior Intervention Training for Teachers – On Referral Rates for Misbehavior, Special Education Evaluation and Student Reading Achievement in the Elementary Grades. International Journal of Behavioral Consultation and Therapy, 2 (3), 354-361.

Ridgway, A., Northup, J., Pellegrin, A., LaRue, R., & Hightshoe, A. (2003). Effects of Recess on the Classroom Behavior of Children With and Without Attention-Deficit Hyperactivity Disorder. School Psychology Quarterly, 18, 253–268.

Ritchie, S., Clifford, R.M., & Crawford, G.M. (2009). FirstSchool Learning Environments: Supporting Relationships. Issues in PreK-3rd Education (#3). Chapel Hill: The University of North Carolina, FPG Child Development Institute, First School.

Schilling, D.L., & Schwartz, I.S. (2004). Alternative Seating for Young Children with Autism Spectrum Disorder: Effects on Classroom Behavior. Journal of Autism and Developmental Disorders, 34, 423–432. doi:10.1023/B:JADD.0000037418.48587.f4

Schilling, D.L., Washington, K., Billingsley, F.F., & Dietz, J. (2003). Classroom Seating for Children with Attention Deficit Hyperactivity Disorder: Therapy Balls Versus Chairs. American Journal of Occupational Therapy, 57 (5), 534-541.

Shapiro, E.S. (2010). Academic Skills Problems: Direct Assessment and Intervention (4th ed.). New York: Guilford.

Subrahmanyam, K., Kraut, R.E., Greenfield, P.M., & Gross, E.F. (2000). The impact of home computer use on children's activities and development. The Future of Children: Children and Computer Technology, 10 (2), 123-142.

Toppino, T.C., Kasserman, J.E., & Mracek, W.A. (1991). The effect of spacing repetitions on the recognition memory of young children and adults. Journal of Experimental Child Psychology, 51 (1), 123–138.

U.S. Department of Education (2006), Office of Special Education and Rehabilitative Services, Office of Special Education Programs, Teaching Children with Attention Deficit Hyperactivity Disorder: Instructional Strategies and Practices. Washington D.C. Retrieved from

Volpe, R.J., DiPerna, J.C., Hintze, J.M., & Shapiro, E.S. (2005). Observing students in classroom settings: A review of seven coding schemes. School Psychology Review, 34, 454 – 473.

Williams, M. & Shellenberger, S. (1996) How Does Your Engine Run?® A Leader's Guide to the Alert Program® for Self-Regulation. Albuquerque, NM: Therapy Works.

Woolner, P., Hall, E., Higgins, S., McCaughey, C., & Wall, K. (2007). A sound foundation?  What we know about the impact of environments on learning and the implications for Building Schools for the Future. Oxford Review of Education, 33 (1), 47-70.


Information from other sources has also been useful in understanding the benefits of classroom furniture that provides "healthy movement." We invite you to check out these additional sources:

ADHD Chair - A New Look at Rocking Chair Therapy

CDC: About 5% of Kids Have ADHD

Many Kids With ADHD Aren't Diagnosed

What Are the Health Benefits of a Rocking Chair?

Rocking Chair: Providing Therapy for ADHD

Statistical Prevalence

Information in this section of Virco's Healthy Movement website is derived, with permission, from: Mailloux, Zoe. Classroom Redesign: Building Partnerships to Support Positive Behavior and Engaged Attention for all Children. Occupational Therapy Doctorate Portfolio, University of Southern California, 2012.