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Mindfulness Interventions and Attention Deficit-Hyperactivity Disorder

Introduction

Mindfulness is defined by Kabat-Zinn (2003) as the awareness that emerges through paying attention, on purpose, in the present moment, and non-judgmentally to the unfolding of experience moment by moment. There are many benefits of mindfulness, such as emotion regulation, decreased reactivity, and increased response flexibility. There are interpersonal and intrapersonal benefits of mindfulness as well. Some of the interpersonal benefits are that mindfulness protects against the emotionally stressful effects of relationship conflict, is positively associated with the ability to express oneself in various social situations, and predicts relationship satisfaction (Davis & Hayes, 2011). While some of the intrapersonal benefits are enhanced well-being, reduced psychological distress, as well as having fewer thoughts that are unrelated to the current task.

Two of the most commonly used evidence-based treatments for patients with ADHD are medicine and cognitive behavioral therapy (CBT). Out of all of the prescribed medications for individuals with ADHD; the majority of these medications fall into one of two groups, Amphetamine-based and Methylphenidate-based and would be considered stimulants. Stimulants are available in both short-acting and long-acting preparations, with the longest acting medications wearing off after about 10-12 hours. This wear off causes an individual with ADHD who is taking the medication to need multiple doses just to maintain consistent effects throughout the day. There are also nonstimulant medications available for individuals who do not respond to stimulants or have intolerable side effects (Ramsay & Rostain, 2016). Additionally, the nonstimulant medication options provide 24-hr symptom coverage if medications are taken daily as prescribed. These medications have consistently been shown to reduce the core symptoms of ADHD, including inattention, hyperactivity, and impulsivity as well as causing an improvement of emotional regulation, as well as other executive functions.

CBT can be separated into two different types of approached; group approach and individual approach. The group approach allows for individuals to possess a feeling of belongingness and have the tendency to target specific impairments and symptoms than individuals with ADHD face. While the individualized approach provides the patient and therapist with the opportunity to invest more time into tailoring interventions and coping strategies specific to the patient’s individualized situation. Individuals with ADHD have the tendency to develop other comorbid disorders, such as anxiety and depression, these disorders can be treated through the implementation of CBT, being as though some of the main principles surrounding this therapy is mood management.

Mindfulness is a growing practice that had been implemented as a treatment in various therapy sessions to treat patients who have different types of disorders; one of these being attention deficit hyperactivity disorder (ADHD). Children with ADHD can show ADHD symptoms as early as preschool age, these symptoms will continue to be present throughout adolescence and eventually into adulthood (Singh, Soamya, & Ramnath, 2016). There are 18 diagnostic items in the DSM-V criteria that would be needed to qualify a patient to have ADHD. Some of these criteria are forgetfulness, difficulty maintaining attention, restlessness, noisy, leaves their seat in class, often blurts out, often interrupts, and often fidgets (Garcia Rosales, Vitoratou, Banaschewski, Asherson, Buitelaar, Oades, Rothenberger, Steinhausen, Faraone, & Chen, 2015). Children with ADHD had the tendency to develop behavior problems such as aggression and defiance. Along with behavioral problems, adolescents with ADHD had the likelihood of increased symptoms of depression and anxiety, as well as substance abuse and delinquency. The very functional difficulties experienced by adults with ADHD in their daily lives, such as disorganization, poor time management, procrastination, and poor follow-through on tasks, also interfere with their efforts to develop and consistently use effective coping skills with which to manage their ADHD (Ramsay & Rostain, 2016).

ADHD not only affects the individual with the diagnosis but also the people that makeup with individuals’ microsystem, including parents and peers. Parents of children and adolescents with ADHD tend to experience a higher level of parenting stress in comparison with the general population. Parenting stress occurs when the perceived demands of parenting are greater than the resources for coping. These high levels of parenting stress are also associated with high levels of conflict in the home.

When trying to find some beneficial treatments for ADHD, mindfulness was seen to be a well-accepted intervention for ADHD (Mitchell, Zylowska, & Kollins, 2015). Individuals with ADHD often exhibit deficits in one or more areas of executive functioning, including; emotion regulation, behavioral inhibition, strategy generation and implementation, and self-monitoring (Haydicky, Shecter, Wiener, & Ducharme, 2015). Mindfulness training would thusly focus on attention regulation, executive functioning, and emotion regulation. Some of the underlying neural mechanisms that are involved with the previously mentioned functions are the anterior cingulate cortex is activated when an individual focused on enhancing attention regulation. For emotion regulation involved with reappraisal, the neural mechanism involved in the dorsal prefrontal cortex, which helps increase positive reappraisal. For the exposure, extinction, and

Reconsolidation aspects of emotion regulation, the underlying neural mechanisms that are used are the ventromedial prefrontal cortex, hippocampus, and amygdala, all of which are involved in the increase of nonreactivity to inner experiences (Hözel, Lazar, Gard, Schuman-Olivier, Vago, & Ott, 2011).

When looking at both adolescents and adults with ADHD it is seen that aggressive behavior and conduct problems have been associated with ADHD (Singh et al., 2016), and emotion regulation would be very beneficial to their overall development. Emotion regulation refers to our efforts to influence emotions in ways that we think will increase the chance that they will be helpful rather than harmful (Gross, 2015). It is important to note that emotion regulation changes for individuals across a lifespan, in which children learn social rules for managing negative and positive emotions, allowing them to start to appreciate the power that their changing of thinking has on shaping their own emotions. Then when these adolescents react adulthood, they are able to sophisticate their emotion regulation through the many experiences that they have had, allowing them to have high levels of socioemotional functioning.

There are also individual differences because, for instance, when comparing an individual with ADHD and an individual without ADHD, they are going to learn and implement emotion regulation in many different ways to best benefit their affective functioning, social interactions, and overall well-being, Furthermore, when looking at attention regulation for individuals with ADHD it is important to note that selective attention and executive attention enable self-regulated action that is goal-directed and controlled rather than reactive and automatic (Lymeus, Lundgren, & Hartig, 2016). Simply meaning that mindfulness will assist an individual to focus on the present moment through attention regulation. The benefits that mindfulness-based treatments have on individuals with ADHD are going to be further examined.

Moreover, attention training is also important in the regulation of emotion. Attention regulation can be successfully trained through repeated practices. Wadlinger & Isaacowitz, (2010) show that selective attention to positive information is a very critical element for emotion regulation. In this study that uses a strategy called attentional deployment, in which different attentional processes are recruited to shape an affective experience for the individual. The three strategies that were implemented were distraction, concentration, and rumination. The pairing of emotion regulation training strategies with particular attentional networks allows for psychologists to investigate what mechanisms create attentional flexibility, stability, broadening, and narrowing as well as the neurobiological correlates of these mechanisms (Wadlinger & Isaacowitz, 2010).

It is important to look into mindfulness treatment effects on individuals with ADHD is because ADHD is one of the most frequently diagnosed disorders. In fact, 7 % of children aged

4–17 years old in the United States have been diagnosed with attention deficit hyperactivity disorder (Murrell, Steinberg, Connally, Hulsey, & Hogan, 2015).  It is important to find out the impacts that ADHD have on different individuals, such as the diagnosed individual’s parent, the diagnosed individual as a child, then as an adult, and how the family was impacted. Additionally, there are not many empirically supported mindfulness-based treatments for ADHD and it is important to see if different mindfulness mechanisms could help with the treatment of ADHD.

Literature Review

Mindfulness is a type of meditative technique that emphasizes an observant and nonreactive standpoint toward one’s thoughts, emotions, and body states (Zylowska, Ackerman, Yang, Futrell, Horton, Hale, Pataki, & Smalley, 2008). Zylowska et al. (2008) focused on a pilot mindfulness training or adolescents and adults in group settings. In order to have a successful group mindfulness treatment, there are two important aspects that need to be incorporated are flexibility and accessibility. Given the fact that everyone is entitled to their own schedule and the fact that everyone’s schedule and timing are different, it is important to ensure that the mindfulness-based treatment is easily accessible to both the children groups and the adult groups and that the schedule for this treatment is flexible. Mindfulness training is a feasible intervention for adolescents and adults with ADHD and has been shown to improve both behavioral and neurocognitive impairments.

Furthermore, in a study conducted by Smalley, Loo, Hale, Shrestha, McGough, Flook, & Reise, (2009) tested whether individuals with ADHD have lower mindfulness scores than their coequals without an ADHD diagnosis and, if true, whether personality contributed to these different mindfulness scores. In the study, individuals with ADHD self-reported themselves as being less mindful in comparison to their non-ADHD controls and more novelty-seeking, less self-directed, and more self-transcendent. The findings of the study show that mindfulness was found to be negatively associated with ADHD and positively associated with self-directedness and self-transcendence (Smalley et al., 2009). Showing that interventions that increased mindfulness benefit some symptoms of ADHD, as well as benefiting the individual’s anxiety, depression, and inhibition.

Kids with ADHD

When looking at the effects that mindfulness-based interventions have on kids diagnosed with ADHD, it is interesting to see that acceptance and commitment therapy (ACT) was a very beneficial intervention. ACT is a behavior treatment that targets experiential avoidance directly by utilizing acceptance and mindfulness strategies to increase both the psychological and behavioral flexibility of an individual. Furthermore, The ACT model consists of six core processes: acceptance, defusion, self-as-context, contact with the present moment, valuing, and committed action, however, not all six of these core processes will be implemented for individuals with ADHD. A study conducted by Murrell et al. (2015) showed that individuals with ADHD had experiential avoidance, defined as the tendency to change the form or frequency of thoughts, feelings, bodily sensations, or related events. Experiential avoidance had been seen to be related to many emotional and behavioral difficulties. Some of the participants that were given the ACT treatment experienced a positive effect on it after a fairly short amount of time.

Moreover, when discussing mindfulness-based treatments for adolescents, it is important to compare and contrast non-pharmaceutical treatments and medicine in terms of cost-effectiveness. According to Meppelink, de Bruin, & Bögels (2016), treatments were shown to have varying benefits, for instance, “medication and psychosocial interventions are the most commonly used treatments for reducing ADHD symptoms in children and adolescents”. This study examined the effects that mindfulness training, more specifically the MYmind protocol to compare and contrast the effects of mindfulness on the effects of medication. In the MYmind protocol, adolescents were taught to focus and enhance their attention, self-control, and awareness through mindfulness exercises (Haydicky et al., 2015). Parents were also given mindful parenting training, where they were taught to be completely present in the current moment with their child non-judgmentally, self-care, as well as reactivity to behavior difficulties presented from their child.

The medication that was used and examined in the study was methylphenidate, and this is because methylphenidate is globally the most prescribed drug to individuals with ADHD and its global usage has been gradually increasing since 1990. Methylphenidate is short-acting, is administered individually, and monitored by a child psychiatrist, following the guidelines of “Multidisciplinary guidelines ADHD” (Meppelink et al., 2006). However, there are many limitations that go along with the use of methylphenidate, including severe side effects, low treatment adherence, short-term effects, non-effectiveness, contraindications, and that its long-term effectiveness and safety are not very known. Overall, medical health professionals and health insurance companies should discuss the cost-effectiveness of mindfulness training versus the effectiveness of the medication, methylphenidate.

Parents and Parent Stress

However, it is important to reiterate that the disorder ADHD impacts for than the diagnosed individual, but also the people that are in this individual’s life as well, that make up their microsystem. One of these individuals that are impacted by the diagnosis of ADHD is parents. Children with ADHD and behavioral problems typically are in need of parental support to help them manage their excessive activity, however being a parent of a child with ADHD can be draining, mentally, physically, and emotionally (Gershy, Meehan, Omer, Papouchis, & Schorr Sapir, 2017). Parents of children with developmental delays, such as ADHD typically have reported elevated levels of parental stress in comparison to their counterparts, parents of typically developing children (Neece, 2013). Also, while children with developmental delays are seen to be at high-risk for developing behavioral problems, it is also important to note that parental stress has been shown to impact the overall development of these behavioral problems in children. This being said it is important to use mindfulness to implement parent-focused coping mechanisms.

The main goal of mindfulness in terms of parental stress is focused on how parents can manage their negative emotion and reactivity that arises while raising a child with ADHD. A parents’ own emotion regulation impacts their ability to respond to the child’s behaviors in a more controlled way and helps reduce their overall hostile reactions. Gershy et al. (2017) discussed the importance of mindful parenting, which can be defined as listening with full attention and nonjudgmental acceptance, the ability to be emotionally aware of self and child, and exercising self-regulation in the parenting relationship. Parent training will be able to assist parents in achieving mindful parenting, through the use of behavioral conditioning to reduce child behavior problems by teaching parenting skills such as positive parenting, planned responses to a child’s wrongdoings, consistent usage of reinforcements and a more structured home routine (Gershy et al., 2017). Mindfulness-based stress reduction (MBSR) for parents has been used in past studies to enhance the parent’s response to their child with ADHD.

MBSR is an evidence-based stress-reduction intervention program supported by extensive research to show its effectiveness in reducing stress, anxiety, and depression and promoting overall well-being (Neece, 2014). Mindfulness may help parents to notice the impulses of their child before they act, thoroughly listen to their children, and come to a more at peace state of mind, which in turn may have a positive impact on their children with developmental delays. According to Neece (2014), MBSR seemed to be an effective intervention for dealing with parental stress and overall mental health problems found in children with ADHD. Parents who received MBSR intervention reported significant reductions in parental stress, decreases in depression, improved coping mechanisms and increases in their general life satisfaction compared with parents who did not receive MBSR treatment. Additionally, when it came to how MBSR for parental stress related to children with ADHD, it was seen that parents that went through the intervention reported a reduction of child ADHD symptoms, reduced attentional difficulties, and improvement of behavioral problems.

Family-focused

Poor management of child behavior and family relationships further increase the risks of

other comorbid psychopathologic conditions, such as conduct disorders in children that already have been diagnosed with ADHD and major depressive disorders in their caregivers. A study by Lo, Wong, Wong, Wong, & Yeung (2016), that took place in Hong Kong, was a controlled study with family-based mindfulness interventions. This study was created to examine effects of medication and evidence-based behavior training in adolescents and to see if mindfulness in the family context is beneficial when dealing with an individual with ADHD.

Medication and behavior training, although most commonly used, have many limitations. Medical treatment is not suitable for young children in the preschool age due to the fact that it promotes growth suppression and parents that undergo much stress due to their adolescent with ADHD, may lack the capability to be able to consistently apply the skills needed for behavioral management. This lack of capability from the parents’ standpoint can be seen in more ways than one, for example, some parents of children with ADHD have reported having shown more negative parenting behaviors. A family-based mindfulness intervention was developed in the study specifically to promote both the attention and mental health of a child with ADHD symptoms as well as assisting in the reduction of stress that their parents experience.

Lo et al. (2016) had three different hypotheses; (1) family-based mindfulness interventions were expected to reduce the inattention and hyperactivity of children with ADHD compared to the control group, (2) family-based mindfulness interventions were expected to reduce the various internalizing and externalizing symptoms for children with ADHD in comparison with the control group, and (3) family-based mindfulness interventions were expected to reduce parental stress, which would in turn improve their mindful parenting and overall well-being in comparison to the control group. This was the first randomization study conducted in China that focused specifically on family-based mindfulness interventions, however, all of the hypotheses were supported. Meaning that family-cased mindfulness intervention is another option that should be taken into consideration when trying to implement mindfulness mechanisms to enhance the overall quality of life for both the child with ADHD and their caregivers.

Parent and Child

ADHD is seen to be highly heritable, meaning that parents of the children with ADHD will also show similar ADHD symptoms. Some of these symptoms include difficulty maintaining attention over a longer amount of time, impulsivity, a difficulty mentally holding goals or plans, as well as inattentiveness and hyperactivity. When focusing on the effects that ADHD in children have on parent-child relationship, it is seen that there are many factors that cause a disturbance in this relationship. Due to the ADHD symptoms of the child, parents have the tendency to experience parental over-reactivity, in which parents can become less patient, pay more attention to disruptive behavior of the child and react more impulsively towards this child. Furthermore, this parental over-reactivity is a major predictor of externalizing behavior of the child (van der Oord, Bögels, & Peijnenburg, 2012). Another cause for the disturbance in the parent-child relationship is the high heritability mentioned earlier in the paragraph. The third cause for a relational disturbance is the fact that parents possess the tendency to automatically respond to their child’s disruptive behavior. This automatic behavior is typically based on the parent’s personal upbringing experienced as well as using judgment towards their child’s particular misbehavior. Lastly, due to the presence of parenting stress for individuals who have children diagnosed with ADHD, it is possible that parents may become more rejecting, controlling and reactive to their children.

Van der Oord et al. (2012) conducted a study in which both the parent of the child diagnosed with ADHD as well as the child themselves were provided with mindfulness-based training to see if mindfulness if effective. In the mindful parenting aspect, parents were taught coping mechanisms and meditations that would allow them to practice acceptance, non-judgment, and nonreactivity, along with how to encourage their child to do their meditation exercises, and how to practice together. In the mindful child training aspect, children learn how to apply mindfulness in difficult daily situations, attention regulation, self-control, and awareness. This study showed the many benefits that mindfulness has on the parent-child relationship, such as reduced reactivity in both the parent and the child, a decrease in ADHD symptoms in the parent as well as in the child, and a reduction of over-reactive parenting and parental stress.

Haydicky et al. (2015) discuss the use of a mindfulness-based cognitive therapy (MBCT) called MYmind in finding benefits for both the child with ADHD as well as their caregiver. In the present study, there were three preliminary evaluations of MYmind in different populations; (1) a non-controlled pre-post evaluation of MYmind for adolescents with externalizing disorders, (2) a non-controlled pre-post evaluation with 8–12-year-old children with ADHD, and (3) a small sample that consisted only of adolescents with ADHD. The results of the first evaluation showed significant improvements in attention, sustained attention and internalizing/externalizing behaviors. The result of the second evaluation portrayed improvements in parent inattention and hyperactivity, as well as parenting stress, parent levels of mindfulness, and parental

over-reactivity (Haydicky et al., 2015). The results of the third and final evaluation showed no significant changes between pre-post data for children or parents.

The overall purpose of MYmind is to implement mindfulness through the training in formal meditation practices, as well as integrating awareness and attitude into the real world daily life of individuals, allowing individuals with ADHD to cope with stress, family, ADHD symptoms, and complex emotions. The core mindfulness concepts emphasized

throughout the MYmind program were awareness, non-judgment, acceptance, letting go, beginner’s mind, and presence in the moment. Some of the mindfulness exercises included in the MYmind program are the body scan, 3 min breathing space, sitting meditation, and mindfulness in everyday activities such as eating and walking (Haydicky et al., 2015). It is crucial to note that these exercises varied from patient to patient depending on their individual needs. MYmind consisted of mindfulness components as well as CBT components; the cognitive behavioral component of the program consisted of having the patient identify various thoughts, feelings, and sensations. The patient would later be able to explore how these thoughts and feelings influenced their reactivity and actions. The patient would also be able to notice when they are going through the world with automatic thoughts and behaviors.

The results of the Haydicky et al. (2015) study showed that MYmind would be a promising mindfulness treatment to be utilized in the future for patients with ADHD, as well as their parents. MYmind was seen to be associated with reductions in adolescent inattentiveness and conduct problems, improvements in adolescent peer relations, reductions in parenting stress, and increases in parental mindfulness. Furthermore, parents of individuals with ADHD reported significant increases in mindful parenting during the intervention time, improved present-centered awareness and non-judgmental acceptance of their children, as well as less reactivity to their child’s behavior.

ADHD in adults

When looking at ADHD in adults, it is important to note that there is a high need for additional or alternative evidence-based interventions for existing treatments and this is due to the economic and personal impacts (Janssen, Kan, Carpentier, Sizoo, Hepark, Grutters, Donders, Buitelaar, & Speckens, 2015). Some of these impacts are; adult ADHD is related to greater levels of unemployment and those who are employed often experience impairment in the workplace along with reduced productivity, medicinal stimulants are usually the first type of treatment provided to adults with ADHD, as well as adults with ADHD have significantly more functional impairments and an increased health care use than persons without ADHD.

The type of treatment that was offered in the Janssen et al. (2015) study was a mindfulness-based cognitive therapy (MBCT). This type of treatment is usually offered in a group configuration, which is usually more cost-effective than an individual treatment, and one is likely to produce the same results. Time and time again MBCT has been proven to reduce depression, anxiety, and stress in many psychiatric disorders. There is also evidence that mindfulness meditation helps to enhance attention regulation as well as other executive functions. Results of the study show that MBCT reduces the ADHD symptoms in adults and it found to be more cost efficient than medication.

Critique

When looking at the overall quality of each of these studies, it is important to understand that not all of these studies are equal in quality. Some of these studies were methodologically rigorous, especially the studies that focus on trying to implement new pilot programs. Some of the methodologically rigorous studies were Haydicky et al. (2015), that went into detail about the significance of the implementation of the MYmind program along with explaining the core mindfulness mechanisms that were focused on and improved with the use of this program. Meppelink et al. (2016) focused on the advantages and disadvantages that non-pharmaceutical treatments had as well as the benefits and setbacks of medication. Gershy et al. (2017) and Neece et al. (2014) discussed the specific causes of parental stress that comes with having a child with ADHD, as well as the best ways to combat this stress in a healthy and mindful way. Van der Oord et al. (2012) was very meticulous in how to incorporate a mindfulness-based treatment for the child diagnosed with ADHD and a different mindfulness-based treatment for the parent, that would both focus of the individual needs of these family members, as well as the needs of the family system as a whole. Garcia Rosales et al. (2015) was very useful in identifying the 18 criteria that would be needed to diagnose an individual with ADHD and the critiques about the changes from the DSM-IV to the DSM-V. Of all the studies, there was only one correlational study that looked at the relationship between individuals with ADHD and MBCT, Smalley et al. (2009) results show a negative associated with ADHD, meaning that the more an individual with ADHD practices mindfulness their ADHD symptoms begin to reduce.

The major drawback of Lo et al. (2016) was, even though it was an experimental study examining family-based mindfulness interventions, it lacked generalizability due to the fact that the only participants were from Hong Kong, China. Additionally, a drawback of Lymeus et al. (2016) was the generalizability as well, with the location being Sweden. An implication of Janssen et al. (2015) was that the location, the Netherlands, is not able to be generalized to individuals in the United States. A strength of Singh et al. (2016), was that the study clearly explained the relationship between ADHD and aggression, and discussed how mindfulness should be implemented to help individuals with ADHD improve their quality of life. A strength of Kabat-Zinn (2012/2016) was the definition of mindfulness, that was also used throughout many of the other studies.

Furthermore, Hözel et al. (2011) was very useful when explaining the underlying neural mechanisms of mindfulness, which was a great benefit of the study. Ramsay & Rostain (2016), clearly explained the varying benefits and drawbacks of CBT, allowing for a clear comparison between MBCT and CBT a strength of the study. This comparison between mindfulness-based interventions and ADHD was made in Mitchell et al. (2015), which allowed for research-based support, which is a great strength of the study. Davis & Hayes (2011) study’s strength was to be able to go more in-depth with the varying benefits of mindfulness, including the interpersonal and intrapersonal benefits. Gross (2015), was beneficial in providing a conceptualized definition of emotion regulation. Murrell et al. (2015) was a weakness with the very small sample size of nine children in the grades fifth through eighth. Wadlinger & Isaacowitz (2010) had limitations due to the fact that only small effects were observed because in the study there was only a small sample size. A strength of Zylowska et al. (2008) was that the study clarified what aspects were important in the making of a successful treatment, as well as, showing a clear relationship between ADHD and mindfulness-based intervention.

Interestingly enough many of the studies that were used in the paper, measured their data using self-report surveys. The studies that used self-reported statistics were, Davis & Hayes (2011), Gershy et al. (2017), Haydicky et al. (2015), Hözel et al. (2011), Janssen et al. (2015), Lo et al. (2016), Lymeus et al. (2016), Meppelink et al (2016), Mitchell et al. (2015), Murrell et al. (2015), Neece et al. (2014), Ramsay & Rostain (2016), Singh et al. (2016), Smalley et al. (2009), van der Oord et al. (2012), Wadlinger & Isaacowitz (2010), and Zylowska et al. (2008). While the other studies varied, Garcia Rosales et al. (2015) used the DSM-IV and the DSM-V to investigate the criteria that would allow someone to properly diagnose an individual with ADHD. Gross (2015), was not an experimental or correlation study, it looked at studies over time to understand how far research has come when looking the development of emotion regulation. Kabat-Zinn (2012/2016) is the only book that was used in the study, this book analyzed the different features of mindfulness and ways that it can benefit people with different psychological disorders.

Summarize the Research

Mindfulness has been seen to have many benefits on not only individuals with ADHD, but for individuals with comorbid disorders such as conduct disorder. Mindfulness is a well-accepted intervention for ADHD, but it is still fairly new. The many mindfulness-based practices that were implemented throughout the study were seen to have similar results for individuals with ADHD. More importantly, mindfulness-based interventions can be used for all members of the family, as well as the individual with ADHD and the same benefits will be seen. Family-based mindfulness intervention would be most beneficial if one is dealing with an adolescent that has ADHD. There are many struggles that go along with dealing with an individual with ADHD, due to the diagnosed individual having typically one or more deficit in their executive functioning, including verbal working memory, behavioral inhibition, motivation, planning, emotion regulation, and self-monitoring. Coping mechanisms need to be taught to both the child with the ADHD diagnosis and the parents because it was seen throughout the studies that when a parent does not know how to properly cope with their child who has ADHD, the result with be that the child will develop behavioral issues.

Adolescents need to be taught to focus and enhance their attention, self-control and awareness through mindfulness exercises. While, parents need to be given mindful parenting training, where they would be taught to be completely present in the current moment with their child non-judgmentally, self-care, as well as reactivity to behavior difficulties presented from their child. This would allow for a better relationship between parents and their children. Studies show that the two most commonly used treatments for patients with ADHD are medication and CBT. However, when it comes to what is most beneficial to the individuals with ADHD, medical health professionals and health insurance companies should discuss the cost-effectiveness of mindfulness training versus the effectiveness of the medication, methylphenidate.

Synthesis & General Conclusions

Mindfulness mechanisms have been shown to have a direct and positive impact on the negative behaviors and other symptoms that a child or adult diagnosed with ADHD possesses. Out all of the articles that were reviewed, 10 of them found a positive impact mindfulness had on individuals and there were no studies found on adverse impact of mindfulness. The other studies were used to find conceptualized definitions of ADHD, mindfulness, and the various connections between the two concepts. Given that the majority of the studies were showing that the implementation of mindfulness is very beneficial to individuals with ADHD, as well as their parents. It would be safe to say that mindfulness-based treatments could possibly become an alternative to medications being as though it is more cost efficient.

The positive impacts that mindfulness has on an individual have been proven time and time again and are undeniable. These impacts are what cause mindfulness-based meditations to be a practical upcoming form of treatment.

Future Research

Future studies would have to address issues such as sample size, gender inclusion, and generalizability. When looking into sample size, it is important to have studied with a larger sample size, which will, in turn, provide the studies with results containing a larger effect size.  Future studies need to examine different emotion regulation strategies and see if some type of strategy will benefit an individual with ADHD more than another. More studies should compare and contrast mindfulness-based group therapies and mindfulness-based individual therapies. Not solely the cost efficiency but to analyze and understand if one type of therapy has more of a beneficial impact on the individual diagnosed with ADHD as well as their family. Future studies could benefit from finding different type of scales to measure various states of mindfulness.

When it comes to looking at parents and their impacts on children, it is important to understand that when parents are impacted by parental stress, the children are impacted as well. This parental stress will eventually cause the formation of behavioral problems within children. The underlying mechanisms of parental stress need to be examined and then how they affect individuals with ADHD. Future studies should compare the effectiveness of both mindful parenting, and mindfulness for the child, as well as a combination of both, this would allow professionals to understand the specific effects that each treatment has. If a study aims to conduct a systematic review on the effects that mindfulness has on patients with ADHD, these reviews should include some longitudinal studies as well as the underlying mechanisms that were of great significance to the psychiatric symptoms involved with ADHD.

When looking specifically at the MYmind program, more fathers and other immediate family members should be included in the study to help with generalizability of the results. Furthermore, mindfulness-based interventions for parent training need to be further investigated so that more beneficial changes can be made to programs like MYmind. Future research should examine the connections between therapists’ regular mindfulness meditation practice and how this effects a successful mindfulness-based treatment outcome in patients diagnosed with ADHD. Future studies need to look deeper into protocols, in terms of the length of time of the therapy and training costs compared with regular ADHD therapies. Looking into other treatments for patients with ADHD on top of the two most commonly used ones, CBT and medication, will be beneficial alternatives to allow patients to find the option that best suited their individualized needs.

There is a great need for therapist, especially in the trauma department, and this is because therapists endure a lot of work-related stress. This work-related stress causes therapists to burnout and quit their job. Future research should look at therapist burnout rates and how the therapist’s own mindfulness practice could help combat these rates. Future research should use more causal studies to understand the relationships between mindfulness-based protocols and ADHD. Future research needs to look into how socioeconomic status impacts the possible mindfulness treatments that an individual with ADHD can access. More at home mindfulness-based interventions should be looked into for those individuals that live with a low socioeconomic status.

Practice Implications

There needs to be more empirically supported evidence on relationships between family members, as well as family members and their therapist. The ways in which therapists implement mindfulness into their daily practice needs to be further investigated. This would ensure that the mindfulness-based therapies that are being suggested follow more of a protocol, allowing therapists and other professionals to know what protocols are more beneficial. Furthermore, the neuropsychological process that is being used, can be further investigated to see what exact neural mechanisms are impacted my medication, versus the neural mechanisms that are impacted by mindfulness-based treatment.

Mindfulness-based meditations are known to be helpful for individuals with a range of psychological disorders. However, it would be important to figure out if there is a way to enhance the benefits that mindfulness already had been shown to have on individuals with ADHD. There also needs to be a deeper look into establishing one uniform program, such as MYmind, where the protocol can be critiqued overtime to ensure the best type of mindfulness-based treatment can be utilized for both adults and children.

Due to the fact that parent’s mental health and well-being are seen to impact the ways in which a child develops, it is important to produce an intervention that focuses specifically on parents. When the parent is able to develop proper coping mechanisms specific to dealing with their child, the ADHD symptoms and behavioral problems of the child will be seen to reduced. Furthermore, a family-based intervention should be generated and implemented to allow both the child and their immediate family to work together in a group-like setting to figure out a mindfulness plan that would be beneficial to all members impacted directly by individuals diagnosed with ADHD. Hereditability was of major significance to the child’s later development of ADHD, parent-child mindfulness-based treatments should be further investigated to find similarities in the way to treat a child with ADHD as well as their diagnosed caregiver.

Work Cited

Davis, D. M. & Hayes, J. A. (2011). What are the benefits of mindfulness?: A wealth of new research has explored this age-old practice. Here is a look at its benefits for both clients and psychologists. PsycEXTRA Dataset48(2), 198-208. doi:10.1037/e584442012-022.

 

Garcia Rosales, A., Vitoratou, S., Banaschewski, T., Asherson, P., Buitelaar, J., Oades, R., Rothenberger, A., Steinhausen, H., Faraone, S., & Chen, W. (2015). Are all the 18 DSM-IV and DSM-5 criteria equally useful for diagnosing ADHD and predicting comorbid conduct problems? European Child & Adolescent Psychiatry24(11), 1325-1337. doi:10.1007/s00787-015-0683-7.

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