Sharp Brains: Brain Fitness and Cognitive Health News

Neuroplasticity, Brain Fitness and Cognitive Health News


Mindfulness Meditation for Adults & Teens with ADHD

We have talked about the val­ue of med­i­ta­tion before (see Mind­ful­ness and Med­i­ta­tion in meditationSchools), as a form of well-direct­ed men­tal exer­cise than can help train atten­tion and emo­tion­al self-reg­u­la­tion.  Which oth­er stud­ies have shown how it strength­ens spe­cif­ic parts of the brain, main­ly in the frontal lobe.

Dr. Rabin­er shares with us, below, an excel­lent review of a new study that ana­lyzes the ben­e­fits of mind­ful­ness for ado­les­cents and adults with atten­tion deficits. He writes that “although this is clear­ly a pre­lim­i­nary study, the results are both inter­est­ing and encour­ag­ing.”

- Alvaro

Does Mind­ful­ness Med­i­ta­tion Help Adults & Teens with ADHD

– By Dr. David Rabin­er

Although med­ica­tion treat­ment is effec­tive for many indi­vid­u­als with ADHD, includ­ing ado­les­cents adults, there remains an under­stand­able need to explore and devel­op inter­ven­tions that can com­ple­ment or even sub­sti­tute for med­ica­tion. This is true for a vari­ety of rea­sons includ­ing:
1) Not all adults with ADHD ben­e­fit from med­ica­tion.
2) Among those who ben­e­fit, many have resid­ual dif­fi­cul­ties that need to be addressed via oth­er means.
3) Some adults with ADHD expe­ri­ence adverse effects that pre­vent them from remain­ing on med­ica­tion.

Because of the wide­spread inter­est in new ADHD inter­ven­tions — par­tic­u­lar­ly non-phar­ma­ceu­ti­cal approach­es — I try to cov­er cred­i­ble research in this area when­ev­er I come across it. I was thus pleased to learn about a very inter­est­ing study of mind­ful­ness med­i­ta­tion as a treat­ment for adults and ado­les­cents with ADHD that was pub­lished in the Jour­nal of Atten­tion Dis­or­ders [Zylowka, et al. (2008). Mind­ful­ness med­i­ta­tion train­ing in adults and ado­les­cents with ADHD. Jour­nal of Atten­tion Dis­or­ders, 11, 737–746.]

Accord­ing to the authors, “…mind­ful­ness med­i­ta­tion involves expe­ri­en­tial learn­ing via silent peri­ods of sit­ting med­i­ta­tion or slow walk­ing and pur­pose­ful atten­tion to dai­ly activ­i­ties. Relax­ation, although often induced dur­ing the train­ing, is not the sole goal of the activ­i­ty; rather, the main activ­i­ty is a cog­ni­tive and inten­tion-based process char­ac­ter­ized by self-reg­u­la­tion and atten­tion to the present moment with an open and accept­ing ori­en­ta­tion towards one’s expe­ri­ences.”

In recent years, mind­ful­ness med­i­ta­tion has a new approach for stress reduc­tion and has been incor­po­rat­ed into the treat­ment for a vari­ety of psy­chi­atric dis­or­ders, includ­ing depres­sion, anx­i­ety, and sub­stance abuse. Of spe­cial rel­e­vance to the treat­ment of ADHD are find­ings that med­i­ta­tion has the poten­tial to reg­u­late brain func­tion­ing and atten­tion. For exam­ple, research has demon­strat­ed that mind­ful­ness med­i­ta­tion can mod­i­fy atten­tion­al net­works, mod­u­late EEG pat­terns, alter dopamine lev­els, and change neur­al activ­i­ty.

As con­cep­tu­al­iza­tions of ADHD now increas­ing­ly rec­og­nize the impor­tance of exec­u­tive func­tion­ing and self-reg­u­la­tion in the dis­or­der, mind­ful­ness med­i­ta­tion — which can be thought of as a type of attention/cognitive exer­cise pro­gram that is focused in improv­ing self-reg­u­la­tion — is a com­ple­men­tary treat­ment that is well worth inves­ti­gat­ing. How­ev­er, although a few small stud­ies of med­i­ta­tion train­ing in chil­dren with ADHD have yield­ed promis­ing results, no research on the use of mind­ful­ness train­ing in ado­les­cents and adults with ADHD has been pub­lished.

- Par­tic­i­pants —

Par­tic­i­pants were 24 adults and 8 ado­les­cents (62% female) diag­nosed with ADHD fol­low­ing a com­pre­hen­sive eval­u­a­tion. Eight par­tic­i­pants fell 1 symp­tom short of meet­ing full diag­nos­tic cri­te­ria and were con­sid­ered to have “prob­a­ble ADHD.” The aver­age age was 48.5 for adults and 15.6 for ado­les­cents. About two-thirds were being treat­ed with stim­u­lant med­ica­tion and con­tin­ued on med­ica­tion dur­ing the study. As with many adults and ado­les­cents diag­nosed with ADHD, the major­i­ty had strug­gled with oth­er psy­chi­atric dis­or­ders in their life­time, with mood dis­or­ders being par­tic­u­lar­ly com­mon.

- Mind­ful­ness Train­ing -

Mind­ful­ness med­i­ta­tion is described as involv­ing 3 basic steps: 1) bring­ing atten­tion to an “atten­tion­al anchor” such as breath­ing; 2) not­ing that dis­trac­tion occurs and let­ting go of the dis­trac­tion; and, 3) refo­cus­ing back to the “atten­tion­al anchor”.

This sequence is repeat­ed many times dur­ing the course of each med­i­ta­tive ses­sion. As the indi­vid­ual becomes bet­ter able to main­tain focus on the atten­tion­al anchor, the notion of “pay­ing atten­tion to atten­tion” is intro­duced and indi­vid­u­als are encour­aged to bring their atten­tion to the present moment fre­quent­ly dur­ing the course of the day.

By direct­ing one’s atten­tion to the process of pay­ing atten­tion, to notic­ing notice when one becomes dis­tract­ed, and to refo­cus­ing atten­tion when dis­trac­tion occurs, mind­ful­ness med­i­ta­tion train­ing can be thought of as an “atten­tion train­ing” pro­gram. As such, exam­in­ing the impact of such train­ing on indi­vid­u­als with ADHD becomes a very inter­est­ing ques­tion to pur­sue.

- Mind­ful­ness Train­ing Pro­gram —

The mind­ful­ness train­ing pro­gram last­ed for 8 weeks; each week includ­ed one 2.5 hour train­ing ses­sion and dai­ly at-home prac­tice ses­sions.

Week­ly train­ing ses­sions fol­lowed a con­sis­tent for­mat. The ses­sions began with a short med­i­ta­tion, fol­lowed by a dis­cus­sion of at-home prac­tice, the intro­duc­tion and prac­tic­ing of new exer­cis­es, plan­ning for at-home prac­tice ses­sions for the fol­low­ing week, and a clos­ing sit­ting med­i­ta­tion. The at-home prac­tice ses­sions con­sist­ed of “…grad­u­al­ly increas­ing for­mal med­i­ta­tion and var­i­ous mind­ful aware­ness in dai­ly liv­ing exer­cis­es.” For the at-home prac­tice ses­sions, par­tic­i­pants received 3 CDs con­tain­ing guid­ed sit­ting med­i­ta­tions that began at 5 min­utes and increased to 15 min­utes.

To adapt tra­di­tion­al mind­ful­ness med­i­ta­tion prac­tice to the unique needs of ado­les­cents and adults with ADHD, sev­er­al mod­i­fi­ca­tions to tra­di­tion­al prac­tice were made. First, the 8-week pro­gram includ­ed edu­ca­tion­al infor­ma­tion on the symp­toms, eti­ol­o­gy, and biol­o­gy of ADHD. Sec­ond, sit­ting med­i­ta­tions were short­er than required in sim­i­lar pro­grams (45 min­utes of at-home prac­tice is typ­i­cal­ly rec­om­mend­ed) and walk­ing med­i­ta­tion could be sub­sti­tut­ed for sit­ting med­i­ta­tion. Third, visu­al aids were incor­po­rat­ed to help explain mind­ful aware­ness con­cepts. And, fourth, a lov­ing-kind­ness medi­a­tion, i.e., an exer­cise of wish­ing well to self and oth­ers) was incor­po­rat­ed at the end of each ses­sion to address the low self-esteem often asso­ci­at­ed with ADHD.

- Mea­sures -

Pre- and posttest assess­ments includ­ed indi­vid­ual self-report scales of ADHD, depres­sion, and anx­i­ety as well as sev­er­al cog­ni­tive tests that were admin­is­tered when par­tic­i­pants were off med­ica­tion. Atten­tion was assessed using a com­put­er­ized assess­ment called the Atten­tion Net­work Test that mea­sures 3 aspects of atten­tion: alert­ing (main­tain­ing a vig­i­lant state of pre­pared­ness), ori­ent­ing (select­ing a stim­u­lus among mul­ti­ple inputs), and con­flict (pri­or­i­tiz­ing among com­pet­ing tasks). Neu­ropsy­cho­log­i­cal tests that assessed work­ing mem­o­ry and the abil­i­ty to shift atten­tion sets (Trails A and B) were also includ­ed. At the end of the train­ing, par­tic­i­pants were also asked to rate their over­all sat­is­fac­tion with the train­ing.

- Results -

Sev­en­ty-eight per­cent of par­tic­i­pants (25 of 33) com­plet­ed the study. On aver­age, par­tic­i­pants attend­ed 7 of the 8 week­ly train­ing ses­sions. Adults report­ed an aver­age of 90 min­utes and 4.6 ses­sions per week of at-home med­i­ta­tion prac­tice; ado­les­cents aver­aged 43 min­utes and 4 ses­sions of week­ly at-home prac­tice. Both ado­les­cents and adults who com­plet­ed the pro­gram report­ed high lev­els of sat­is­fac­tion with it — aver­age scores above 9 on a 1 to 10 sat­is­fac­tion scale.

Sev­en­ty-eight per­cent of par­tic­i­pants report­ed a reduc­tion in total ADHD symp­toms, with 30% report­ing at least a 30% symp­tom reduc­tion (a 30% reduc­tion in symp­toms is often used to iden­ti­fy clin­i­cal­ly sig­nif­i­cant improve­ment in ADHD med­ica­tion tri­als). Because the major­i­ty of par­tic­i­pants were receiv­ing med­ica­tion treat­ment, for many these declines rep­re­sent improve­ment above and beyond what ben­e­fits were already being pro­vid­ed by med­ica­tion.

On neu­rocog­ni­tive test per­for­mance, sig­nif­i­cant improve­ments were found on the mea­sure of atten­tion­al con­flict and on sev­er­al oth­er neu­ropsy­cho­log­i­cal tests (i.e., Stroop col­or-word test and Trails A and B) but not for mea­sures of work­ing mem­o­ry.

For adults, sig­nif­i­cant reduc­tions in depres­sive and anx­i­ety symp­toms were report­ed. Com­pa­ra­ble reduc­tions in these symp­toms were not evi­dent in ado­les­cents.

- Sum­ma­ry and Impli­ca­tions -

Results from this study indi­cate that mind­ful­ness med­i­ta­tion train­ing may be a ben­e­fi­cial com­ple­men­tary treat­ment approach for ado­les­cents and adults with ADHD. Pos­i­tive find­ings include: 1) the absence of any report­ed adverse events; 2) high­ly favor­able rat­ings of the treat­ment by par­tic­i­pants; 3) reduc­tions in self-report­ed ADHD symp­toms report­ed by over three quar­ters of par­tic­i­pants, even though the major­i­ty were already being treat­ed with med­ica­tion; 4) sig­nif­i­cant improve­ment on sev­er­al of the neu­ropsy­cho­log­i­cal mea­sures; and, 5) reduc­tions in depres­sive and anx­i­ety symp­toms for the adults.

The authors are appro­pri­ate­ly cau­tious in dis­cussing their find­ings and sug­gest that the study sup­ports the “…fea­si­bil­i­ty and poten­tial util­i­ty of mind­ful­ness med­i­ta­tion in at least a sub­set of adults and ado­les­cents with ADHD.” They are care­ful to note, how­ev­er, that this was a pilot study with a small sam­ple, and that the report­ed pre-post changes in behav­ioral and neu­rocog­ni­tive mea­sures should be “…con­sid­ered explorato­ry giv­en the absence of a con­trol group and reliance on self-report mea­sures of psy­chi­atric symp­toms.”

Giv­en the promis­ing results obtained in this pilot study, there is a clear need for a more exten­sive research on mind­ful­ness med­i­ta­tion train­ing as an inter­ven­tion for ADHD. In the mean­time, although mind­ful­ness med­i­ta­tion could not be con­sid­ered a sci­en­tif­i­cal­ly sup­port­ed treat­ment for ADHD, it may have ben­e­fits as a com­ple­men­tary treat­ment and is high­ly unlike­ly to have any adverse effects.

I find it both encour­ag­ing and excit­ing that there seems to be grow­ing inter­est among ADHD researchers to explore the sci­en­tif­ic sup­port for com­ple­men­tary approach­es such as mind­ful­ness med­i­ta­tion train­ing and to sub­ject a wider range of treat­ments sub­ject­ed to rig­or­ous sci­en­tif­ic research. This has not always been the case and it would be won­der­ful if this trend were to con­tin­ue. I hope that the authors of this study are already in the midst of the con­trolled tri­al that they call for and will cer­tain­ly con­tin­ue to cov­er these kinds of inter­est­ing inves­ti­ga­tions in Atten­tion Research Update as they appear in the lit­er­a­ture.

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.

For relat­ed and mind­ful read­ing, you will enjoy:

- Mind­ful­ness and Med­i­ta­tion in Schools for Stress Man­age­ment

- From Med­i­ta­tion to Mind­ful­ness Based Stress Reduc­tion (MBSR)

- On being pos­i­tive

Leave a Reply...

Loading Facebook Comments ...

11 Responses

  1. Thanks for this sum­ma­ry and review — I ref­er­enced your post on my pri­vate prac­tice site, where I pro­vide links to help­ful infor­ma­tion for fam­i­lies and the gen­er­al pub­lic.

  2. FYI — I also post­ed this on my home­page site, Kmare­ka, and there were some good read­er com­ments:

  3. Nina says:

    My younger broth­er who is 25 yrs is suf­fer­ing from ADHD he was diag­nosed of the same at the age of 15 years and was treat­ed on rital­in for 7 months. After which he was suf­fer­ing from severe blink­ing of the eye after con­sum­ing the med­i­cine. Which was the only side effect. Now he has a job but his con­cen­tra­tion to the job (work­ing as a front office exec­u­tive in a 5 star hotel) is min­i­mal. Is there any way I can get any help in get­ting him treat­ed com­plete­ly of this dis­or­der?


  4. I have also been work­ing with teens and adults who have var­i­ous chal­lenges, one off them being ADHD. As a Mind­ful­ness Teacher and Psy­chol­o­gist in West Los Ange­les, I use these prac­tices to help sup­port them with a more non­judg­men­tal form of atten­tion con­trol. They usu­al­ly come out with more than just the relief of ADHD symp­toms, but also with an expand­ed sense of com­pas­sion for them­selves and deep­er con­nec­tion with life. The rea­son is this goes beyond train­ing the mind but can be con­sid­ered a train­ing for advanced live­ing :). Thank you for this arti­cle.

    Elisha Gold­stein, Ph.D.

  5. Alvaro says:

    Kier­sten, thank you for your vis­it. Nice to “meet” you.

    Nina: your broth­er may ben­e­fit from vis­it­ing a good doc­tor, and prob­a­bly a neu­ropsy­chol­o­gist. No gen­er­al advice is enough to help one very spe­cif­ic case.

    Elisha: thank you for shar­ing your expe­ri­ence. Have you found spe­cif­ic chal­lenges work­ing with peo­ple with atten­tion deficits, or have you had a smooth expe­ri­ence engag­ing them with mind­ful­ness?

  6. Hi Alvaro,
    It’s impor­tant to first pref­ace that mind­ful­ness is not a panacea, but is a skill­ful way to approach many of our chal­lenges in dai­ly life. With that said, it’s not for every­one at the time they come in for sup­port. So, it hasn’t been smooth all the time, how­ev­er, more and more I am see­ing a greater accep­tance to actu­al­ly prac­tice. Fol­low through can be an issue, but then that is gris for the mill as we dis­cuss what got in the way of prac­tice which cre­ates a grow­ing aware­ness for the fol­low­ing expe­ri­ences. A big part of this is notic­ing when you’re becom­ing judg­men­tal and being harsh on your­self for not being able to attend. This only serves to cre­ate more chaos in the brain and get in the way. With cul­ti­vat­ing a non-judg­men­tal aware­ness to our aware­ness :), we become more skill­ful at pay­ing atten­tion to the things we want to and liv­ing the lives we want.

    Elisha Gold­stein, Ph.D.

  7. Alvaro says:

    Elisha: I agree, noth­ing is a panacea. But it is very goodd news that we have tools at our dis­pos­al.

    Thank you for shar­ing your expe­ri­ence.

  8. Thank you for this. Quite cor­rect­ly this is not a panacea .
    How­ev­er I’ve found that teach­ing and coach­ing chil­dren, youth and adults Mind­ful­ness, Relax­ation Response skills and med­i­ta­tion ( I know where does one start and the oth­ers end) helps them gain a sense of con­trol over their inner world. A very valu­able com­mod­i­ty these days.

  9. Michael, I agree. Learn­ing how to man­age atten­tion and reg­u­late emo­tions would help many kids (and adults) be more pro­duc­tive and hap­py.

  10. Tom says:

    Thank you for this arti­cle shed­ing light on the pos­si­bil­i­ties for med­i­ta­tion to help with ADHD.

    I’m just curi­ous, why is the ADHD research on Neu­ro­feed­back crit­i­cized by Dr. Rabin­er for
    1. not hav­ing large enough par­tic­i­pants
    2. not using ade­quate con­trols
    3. not offer­ing ran­dom­ized con­trolled tri­als?

    …when this mind­ful­ness study was like­wise small, sug­gest­ed no sig­nif­i­cant con­trols, and appear­ent­ly was not ran­dom­ized? But there’s no men­tion of the need for bet­ter con­trols and big­ger stud­ies here.

    Here is his arti­cle on Neu­ro­feed­back:

    I’m not a sup­port­er of Neu­ro­feed­back and actu­al­ly do not believe that it’s the solu­tion to ADHD. I feel that effec­tive med­i­ta­tion (though not nec­es­sar­i­ly mind­ful­ness) is a much bet­ter route.

    I’m just inter­est­ed in the dif­fer­ent treat­ment of this study, com­pared to Dr. Rabiner’s access­ment of Neu­ro­feed­back, for which there are actu­al­ly more peer-reviewed con­trolled stud­ies than mind­ful­ness for ADHD. It seems Dr. Rabin­er was much more scru­ti­niz­ing of the NF research than he is of research on mind­ful­ness. I’m sure he has a good rea­son but am very curi­ous. Is he a Bud­dhist? Is he into mind­ful­ness him­self and there­fore more favor­able to it?

  11. Dag A. Solberg says:

    Thank you for giv­ing me a review of this inter­est­ing top­ic. I work as a spe­cial­ist in Fam­i­ly med­i­cine i Nor­way. Unfor­tu­nate­ly this method is not dis­cussed very much among experts in my coun­try. I attend­ed a course on mind­full­ness 3 weeks ago, which opened my eyes of the pos­si­bil­i­ties of this approach.
    I have a ques­tion for you;

    Mind­full­ness is known for open­ing up for strong emo­tions and at the same time mak­ing it pos­si­ble to tol­er­ate an emo­tion, a mem­o­ry, with­out flee­ing, with­out shut­ting it out. This , I think , may be an effe­cient way of accept­ing dif­fi­cult emo­tiona. How­ev­er; many patients have a his­to­ry of abuse and hard loss­es in their lives. What cri­te­ri­aes do you use in order to avoid Too strong reac­tions, and what do you think is the best way to find the “right” patients?

Leave a Reply

Categories: Attention and ADD/ADHD, Health & Wellness

Tags: , , , , , , , , , , , , , , , , , , , , , ,

All Slidedecks & Recordings Available — click image below

Search for anything brain-related in our article archives

About SharpBrains

As seen in The New York Times, The Wall Street Journal, BBC News, CNN, Reuters, and more, SharpBrains is an independent market research firm and think tank tracking health and performance applications of brain science.