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Friday, March 1, 2013

Mindfulness Training for Children with ADHD and Their Parents

From SharpBrains.com

By Dr. David Rabiner
February 21, 2013

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 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.

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Note: You can find the full study HERE.

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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.

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You can find a nice site on mind­ful­ness for chil­dren devel­oped by the Greater Good Sci­ence Cen­ter at U.C. Berkeley HERE.

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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 med­i­ta­te at home and how to med­i­tate with their child.

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

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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.

About Dr. David Rabiner

 Dr. David Rabiner is a child clin­i­cal psy­chol­o­gist and Direc­tor of Under­grad­u­ate Stud­ies in the Depart­ment of Psy­chol­ogy and Neu­ro­science at Duke Uni­ver­sity. His research focuses on var­i­ous issues related to ADHD, the impact of atten­tion prob­lems on aca­d­e­mic achieve­ment, and atten­tion train­ing.

He also pub­lishes Atten­tion Research Update, a com­pli­men­tary online newslet­ter that helps par­ents, pro­fes­sion­als, and edu­ca­tors keep up with the lat­est research on ADHD.

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