Mindfulness training for children with ADHD and their parents

Mind­ful­ness 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.

– 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.

Relat­ed articles:

• Is ADHD over­diag­nosed? Find­ings from a new study in Germany
• Sur­vey: 40% who dis­con­tin­ue ADHD med­ica­tion treat­ment con­cerned about loss of self
• New Study shows Teens with ADHD helped by Cog­ni­tive Behav­ioral Therapy
• Study: Adap­tive Work­ing Mem­o­ry Train­ing Can Reduce ADHD-relat­ed Off-Task Behavior
• New Review of Neu­ro­feed­back Treat­ment for ADHD — Cur­rent State of the Science