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Mindfulness training for children with ADHD and their parents

MeditationMindfulness training is an approach for enhancing mental health and alleviating mental health difficulties that is based on eastern meditation techniques. The focus of mindfulness training is to increase one’s awareness of the present moment, enhance the non-judgmental observation of one’s surroundings, and decrease impulsive and automatic responding to events. Research on mindfulness training with adults has shown benefits for depression, anxiety, chronic pain, and eating difficulties. Preliminary research on mindfulness training with children and adolescents has also yielded positive findings, including several non-controlled pilot studies of youth with ADHD.

A study published recently in the Journal of Child and Family Studies provides a more extensive examination of the possible benefits of mindfulness training for children with ADHD and their parents [S. van der Ord & S. M. Bodgel (2012). The effectiveness of mindfulness training for children with ADHD and mindful parenting for their parents. Journal of Child and Family Studies, 21, 139-147]. Participants were 22 8-12 year old children diagnosed with ADHD and their parents. The study was conducted at an outpatient mental health clinic in the Netherlands.

Children and parents were randomly assigned to receive mindfulness training or to a wait-list control condition; the majority of children were already receiving treatment with stimulant medication and remained on medication during the study. Mindfulness training consisted of 8 weekly 90 minute group sessions – the child group included 4-6 children and the parent group included the parents of these children. Children and parents were given structured assignments to complete between the sessions that focused on practicing the skills they had learning in each group meeting.

Mindful Child Training

In mindful child training children are taught to “…focus and enhance their attention, awareness and self-control by doing mindfulness exercises during the training and as homework assignments.” The exercises include sensory awareness exercises, body awareness exercises, breath awareness exercises along with breathing meditation, yoga, and exercises that promote awareness of automatic responding.

You can find a nice web site on mindfulness for children developed by the Greater Good Science Center at UC-Berkeley clicking Here.

Mindful Parenting

Mindful parenting is “…a framework whereby parents intentionally bring moment-to-moment awareness to the parent-child relationship.” The goals of the Mindful Parenting program used in this study were to help parents learn to …

1. “be deliberately and fully present in the here and now with their child in a non-judgmental way”;
2. “take care of themselves”;
3. “accept difficulties in their child”; and,
4. “answer rather than react to difficult behavior of their child.”

Because parenting stress can contribute to over-reactivity on the part of parents, dealing effectively with stress was an important focus. Parents were also taught how to encourage their child to do meditation exercises at home and how to meditate with their child.

You can find a very informative article on ‘mindful parenting’ clicking Here.

Measures

Parent and teacher ratings of children’s ADHD symptoms and oppositional behavior were collected using a the Disruptive Behavior Disorders Rating pre- and post-treatment and a final time 8 weeks after treatment ended. Parents also reported on their parenting stress at each time point, their disciplinary style, their own level of ADHD symptoms, and their level of mindful attention and awareness.

Results

From pre- to post test, children who received mindfulness training were rated by their parents as showing significant declines in inattentive and hyperactive impulsive symptoms; the magnitude of the decline was large for attention problems and moderate for hyperactivity. These declines remained evident and of similar magnitude at the 8-week follow-up. In contrast, no such declines were evident for children in the wait-list control condition. Reductions in parents’ ratings of oppositional behavior were not evident for either group.

Teachers’ ratings of ADHD symptoms did not show similar declines for treated children; however, the reduction in ratings of attention problems approached significance.

Parents who participated in the mindful parenting program reported significant reductions in their own ADHD symptoms; these declines were smaller than what was reported for children but remained evident at the 8-week follow-up. Relative to parents in the wait-list control condition, parents in the mindful parenting intervention reported reductions in their level of parenting stress and in their tendency to overreact with their child. They also reported an increase in mindful awareness.

Summary and Implications

Results from this study suggest that the combination of mindfulness training for children and parents may be a helpful intervention for ADHD. Parents clearly observed reductions in their child’s ADHD symptoms following training; in addition, they reported declines in their own ADHD symptoms, their parenting stress, and their tendency to overreact to their child’s misbehavior. These are all encouraging findings.

Unfortunately, teachers did not observe similar benefits of mindfulness training on children’s behavior at school, although the reduction of attention problems that were evident in teachers’ reports approached significance. However, the sample size used in this study was relatively small, which makes the acquisition of statistically significant findings more difficult. Thus, the fact that teachers’ ratings are suggestive of positive results is encouraging.

The study has several limitations. As the authors note, an important limitation is that parents were obviously not blind to the treatment that they and their child received, which may have biased their ratings. This is not a limitation that can be easily surmounted, however, and relying on parents’ reports to evaluate treatment effects on children is common practice in many treatment studies.

It is also the case that because the control condition was a wait-list control, the benefits that parents reported may have resulted from non-specific effects of the training, i.e., time with an empathic clinician, rather than from the specific training in mindfulness practices. More conclusive evidence for the specific benefits of mindfulness training would require a control condition where parents and children spent equivalent time with a clinician, but were not instructed in mindfulness practices.

All studies, of course, have limitations and results from this study are encouraging nonetheless. The authors report that families appeared to genuinely enjoy the mindfulness training and that many asked for additional training after the follow-up meeting. It is possible, although evidence on this point does not currently exist, that ongoing mindfulness training would lead to further reductions in children’s ADHD symptoms and that the benefits of mindfulness training would perhaps become more evident in the school setting as well. Certainly, there are no known adverse effects of practicing mindfulness and it may have benefits for children with ADHD in addition to possibly reducing core ADHD symptoms. Thus, additional research on this interesting intervention approach is warranted and I will include such work in Attention Research Update as I become aware of it.

Note – This study is available in full form online for readers who want more detailed information on it. You can find the study clicking Here.

Rabiner_David– Dr. David Rabiner is a child clin­i­cal psy­chol­o­gist and Direc­tor of Under­grad­u­ate Stud­ies in the Depart­ment of Psy­chol­ogy and Neu­ro­science at Duke Uni­ver­sity. He pub­lishes Atten­tion Research Update, an online newslet­ter that helps par­ents, pro­fes­sion­als, and edu­ca­tors keep up with the lat­est research on ADHD, and teaches the online course  How to Navigate Conventional and Complementary ADHD Treatments for Healthy Brain Development.

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