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Study: Does Mindfulness Meditation training help adults with ADHD?

MeditationAs aware­ness of ADHD in adults increas­es, so do efforts to devel­op effec­tive treat­ments for adults that can com­ple­ment, or sub­sti­tute for, med­ica­tion. One promis­ing treat­ment is mind­ful­ness med­i­ta­tion train­ing. In mind­ful­ness train­ing, indi­vid­u­als learn to ori­ent their atten­tion pur­pose­ful­ly towards the present moment and to approach their one’s expe­ri­ence with curios­i­ty, open­ness, and accep­tance.

Mind­ful­ness med­i­ta­tion may be par­tic­u­lar­ly well-suit­ed to address ADHD in adults because it focus­es on pro­mot­ing the reg­u­la­tion of atten­tion. Pri­or stud­ies also sug­gest that mind­ful­ness train­ing can enhance aspects of exec­u­tive func­tion­ing and may con­tribute to bet­ter emo­tion reg­u­la­tion, areas where many adults with ADHD strug­gle.

A study recent­ly pub­lished online in the Jour­nal of Atten­tion Dis­or­ders, A pilot tri­al of mind­ful­ness med­i­ta­tion train­ing for ADHD in adult­hood: Impact on core symp­toms, exec­u­tive func­tion­ing and emo­tion dys­reg­u­la­tion, pro­vides the most rig­or­ous inves­ti­ga­tion to date of mind­ful­ness med­i­ta­tion train­ing for adults with ADHD.

Twen­ty-two adults with ADHD (aver­age age 38, 12 females) were ran­dom­ly assigned to an 8-week group-based mind­ful­ness med­i­ta­tion train­ing pro­gram or a wait-list con­trol con­di­tion. This ran­dom assign­ment method­ol­o­gy had not been uti­lized in ear­li­er research on this approach and rep­re­sents an impor­tant strength of the study. Near­ly all par­tic­i­pants were on ADHD med­ica­tion and con­tin­ued with their treat­ment dur­ing the study.

Mind­ful­ness Train­ing

Each ses­sion last 2.5 hours and was sup­ple­ment­ed with dai­ly at-home prac­tice. Week­ly ses­sions began with a brief open­ing med­i­ta­tion, fol­lowed by a dis­cus­sion of in-home prac­tice, intro­duc­tion of new exer­cis­es and prac­tice, a review of at-home prac­tice for the upcom­ing week, and a clos­ing med­i­ta­tion. As not­ed above, the over­all goal of mind­ful­ness train­ing is to help indi­vid­u­als learn to ori­ent their atten­tion pur­pose­ful­ly towards the present moment and to approach their one’s expe­ri­ence with curios­i­ty, open­ness, and accep­tance.

You can learn more about this approach, and read an inter­est­ing inter­view with the psy­chol­o­gist who devel­oped the pro­gram, here.

Mea­sures

To eval­u­ate the impact of mind­ful­ness train­ing, mul­ti­ple mea­sures were col­lect­ed from inter­ven­tion and con­trol par­tic­i­pants before treat­ment began, dur­ing sev­er­al days in the 8-week pro­gram, and imme­di­ate­ly after treat­ment end­ed. These mea­sures are sum­ma­rized below.

Core ADHD symt­poms — Adults com­plet­ed an ADHD symp­tom rat­ing scale in which all 18 core symp­toms of ADHD were rat­ed. They also rat­ed the extent to which ADHD symp­toms were impair­ing their func­tion­ing in dif­fer­ent domains, e.g., work, rela­tion­ships, etc. Rat­ings of core symp­toms were also obtained from trained clin­i­cians who inter­viewed par­tic­i­pants before and after treat­ment.

Exec­u­tive func­tion­ing (EF) — Rat­ings of EF were col­lect­ed using the Deficits in Exec­u­tive Func­tion­ing Scale (DEFS) and the Behav­ior Rat­ing Inven­to­ry of Exec­u­tive Func­tion­ing- Adult Ver­sion (BRIEF-A). Items on the DEFS and the BRIEF-A assess mul­ti­ple aspects of exec­u­tive func­tion­ing includ­ing self-man­age­ment, self-orga­ni­za­tion, self-dis­ci­pline, self-moti­va­tion, self-reg­u­la­tion of emo­tion, work­ing mem­o­ry, behav­ioral inhi­bi­tion, plan­ning skills, etc. As with core ADHD symp­toms, EF rat­ings were also obtained from clin­i­cians.

Emo­tion Dys­reg­u­la­tion — Emo­tion dys­reg­u­la­tion was assessed via the Dif­fi­cul­ties in Emo­tion Reg­u­la­tion Scale (DERS), a 36-item scale that assess­es how often var­i­ous types emo­tion­al­ly dys­reg­u­lat­ed behav­ior occurs. A sec­ond scale — the Dis­tress Tol­er­ance Scale — was also admin­is­tered. These scales were com­plet­ed by par­tic­i­pants only.

Eco­log­i­cal Momen­tary Assess­ment (EMA) — A nov­el fea­ture of this study was the use of an expe­ri­ence sam­pling strat­e­gy in which hand-held com­put­ers were used to obtain adults’ratings of their ADHD symp­toms and EF dur­ing 2 days in the first and last week of the study. The com­put­er was pro­grammed to beep at ran­dom inter­vals dur­ing these days; the beep prompt­ed par­tic­i­pants to indi­cate their cur­rent sit­u­a­tion, affect, and to rate their lev­el of ADHD and EF symp­toms. This tech­nique pro­vides a valu­able addi­tion to the typ­i­cal rat­ing scale data by obtain­ing repeat­ed assess­ments of indi­vid­u­als in their nor­mal dai­ly envi­ron­ment.

Lab­o­ra­to­ry assess­ments of EF — In addi­tion to the self- and clin­i­cian report mea­sures sum­ma­rized above, a num­ber of lab­o­ra­to­ry tasks were includ­ed to mea­sure dif­fer­ent aspects of EF. These includ­ed a com­put­er­ized test of atten­tion, an assess­ment of work­ing mem­o­ry, as well as sev­er­al oth­er objec­tive assess­ments.

Results

Core ADHD symp­toms — Com­pared to con­trol par­tic­i­pants, adults who received mind­ful­ness med­i­ta­tion train­ing report­ed sta­tis­ti­cal­ly sig­nif­i­cant and clin­i­cal­ly mean­ing­ful declines in core ADHD symp­toms, both inat­ten­tive symp­toms and hyper­ac­tive-impul­sive symp­toms. Near­ly 64% of adults receiv­ing treat­ment report­ed at least a 30% decline in inat­ten­tive and hyper­ac­tive-impul­sive symp­toms com­pared to 0% in the con­trol group. Inter­ven­tion par­tic­i­pants also report­ed sig­nif­i­cant reduc­tions in the impair­ment caused by ADHD symp­toms. Rat­ings pro­vid­ed by clin­i­cians were con­sis­tent with adults’ self-reports as were rat­ings obtained via the expe­ri­ence sam­pling method­ol­o­gy described above.

Exec­u­tive Func­tion­ing — Adults receiv­ing mind­ful­ness treat­ment report­ed sig­nif­i­cant gains in mul­ti­ple EF domains rel­a­tive to con­trol par­tic­i­pants. These includ­ed gains in self-man­age­ment, self-orga­ni­za­tion, and self-dis­ci­pline. Clin­i­cians who inter­viewed inter­ven­tion and con­trol par­tic­i­pants report­ed sim­i­lar gains for the for­mer. How­ev­er, no treat­ment group dif­fer­ences were found for lab­o­ra­to­ry mea­sures of EF.

Emo­tion Dys­reg­u­la­tion — Inter­ven­tion par­tic­i­pants report­ed sig­nif­i­cant gains in their abil­i­ty to reg­u­late emo­tions and tol­er­ate dis­tress. The mag­ni­tude of group dif­fer­ences would be con­sid­ered large.

Fea­si­bil­i­ty and Sat­is­fac­tion — The mind­ful­ness treat­ment was fea­si­ble to imple­ment and high­ly accept­able to par­tic­i­pants. Inter­ven­tion adults attend­ed near­ly 90% of sched­uled ses­sions and the aver­age treat­ment sat­is­fac­tion rat­ing was 5.91 on a 7 point scale; this reflects a high degree of sat­is­fac­tion. Near­ly all par­tic­i­pants felt con­fi­dent that they would con­tin­ue to use the tech­niques they had been taught.

Sum­ma­ry and Impli­ca­tions

Results from this study sug­gest that mind­ful­ness med­i­ta­tion train­ing for adults with ADHD holds sig­nif­i­cant promise. Par­tic­i­pants attend­ed near­ly all ses­sions, were quite sat­is­fied with the treat­ment, and report­ed gains rel­a­tive to con­trol sub­jects on a vari­ety of mea­sures. This includ­ed core ADHD symp­toms, mul­ti­ple aspects of EF, and the abil­i­ty to reg­u­late affect and tol­er­ate dis­tress. These gains were echoed in rat­ings pro­vid­ed by clin­i­cian inter­view­ers.

The only mea­sures for which treat­ment relat­ed improve­ments were not evi­dent was lab­o­ra­to­ry assess­ments of exec­u­tive func­tion­ing. This may reflect the fact that lab­o­ra­to­ry assess­ments of EF do not accu­rate­ly cap­ture the dai­ly deficits in EF that adults with ADHD expe­ri­ence. Because most adults were tak­ing med­ica­tion dur­ing the study, there may also have been lim­it­ed room for improve­ment on these mea­sures. On the oth­er hand, because these were the only ‘objec­tive’ mea­sures col­lect­ed in the study, the null find­ings raise ques­tions as to whether the self- and clin­i­cian report data accu­rate­ly reflects changes that actu­al­ly occurred.

Although these are promis­ing results, the study has sev­er­al lim­i­ta­tions that are impor­tant to rec­og­nize. First, the sam­ple is rel­a­tive­ly small and repli­cat­ing the find­ings with a larg­er sam­ple would be impor­tant.

Sec­ond, pos­i­tive find­ings were obtained only for self-report mea­sures and for rat­ings pro­vid­ed by clin­i­cians who were aware of par­tic­i­pants’ sta­tus. This is akin to test­ing a new ADHD med­ica­tion when every­one rat­ing par­tic­i­pants is aware that they took med­ica­tion. The study would have been strength­ened had clin­i­cians been blind to treat­ment vs. con­trol sta­tus and if infor­ma­tion had also been obtained from par­tic­i­pants’ spous­es or oth­er adults who knew them well.

It should also be not­ed that the com­par­i­son group was adults in wait­list con­trol con­di­tion rather than an active con­trol con­di­tion. As a result, whether it was mind­ful­ness train­ing specif­i­cal­ly that con­tributed to the appar­ent treat­ment gains, or sim­ply the extra atten­tion that treat­ment par­tic­i­pants received, can­not be deter­mined with any cer­tain­ty.

While these lim­i­ta­tions will be impor­tant to address in future work, find­ings from this study add to a grow­ing lit­er­a­ture point­ing towards the ben­e­fits of mind­ful­ness train­ing for adults with ADHD. The results cer­tain­ly sup­port the val­ue of con­duct­ing a larg­er, ran­dom­ized-con­trolled tri­al that address­es the lim­i­ta­tions not­ed above. Hope­ful­ly, results from such a study will be avail­able short­ly.

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.

Pre­vi­ous arti­cles by Dr. Rabin­er:

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