Mindfulness for children and
adolescents with ADHD and
their parents
Susan Bögels
University of Amsterdam, Research Institute CDE
UvA-Virenze Academic Center for Treatment of Parent and Child
Mindfulness in adolescents with
externalising disorders, and their
parents (CBCL/YSR)
Bögels et al., 2008
Adolescent
Post
Fu
Int
Ext
Social
Think
Att
.5
1.1
.6
.4
1.0
.5
1.2
.5
.3
.9
Parent
Post
Fu
-.1
.3
.2
.0
.3
.3
.4
.3
.1
.5
Mindfulness for children with ADHD
and their parents
(van der Oord, Bögels & Peijnenburg, 2011)
• Evidence-based treatment for childhood ADHD: medication and
Parent Management training (Van der Oord et al., 2008).
• But: Medication works only short-term, side effects, treatment
fidelity often low (Schachter et al., 2001).
• But: Parent Management training does not work for parents with
ADHD (and ADHD is highly heritable) (Sonuga et al., 2002)
• CBT for children with ADHD is not effective.
Attention systems and ADHD
• Alerting (how attention is readied and sustained)
• Orienting (how attention is placed-dis-reengaged)
• Conflict (inhibiting an automatic response in order to attend to a less
automatic one)
• Formal practice:
1. Bringing attention to “attentional anchors”
2. Noting that distraction occurs and letting go of the distraction
3. Refocusing attention to the “attentional anchor”
Stress and ADHD
• Under stress ADHD symptoms (impulsivity, hyperactivity, lack of
control over attention) become worse –in children as well as
their parents-
• Taking a breath under stress may therefore help regulate
attention, emotion and behaviour, as well as the interaction
between parent and child
Mindfulness for children with ADHD
• Four groups of 4-6 children
(n=22, mean age 9.6, 73%
boys)
• 8 group sessions of 1,5 hour
for children
• Highly structured program
with immediate rewards
Content program
• Focusing on the senses (hearing, seeing,
feeling, tasting, smelling) starting with the
raisin meditation
• Following the breath: from 10 seconds to 5
minutes
• Body-scan: 10 minutes
• Yoga: 5-10 minutes (with pictures)
• Seeing, hearing, and walking meditation
• Breathing space: 1 minute
Increasing awareness
• The breath and body as an alarm clock to
notice impulsivity and attention problems
• (When you feel angry, what is happening in
your body? When you feel bored, what do
you notice in the body? When your
teacher/parent is angry with you, watch your
body!)
Coping
• High way -Walking way (breathing space)
• When your parents are on the high way: suggest them to take a
breathing space!
Child themes
Parent themes
1.
Man from Mars
1.
Being attentive
2.
Home in my body
2.
Home in my body
3.
Breath
3.
Breath
4.
Distractors
4.
Answering
5.
Freeze!
5.
Patterns and habits
6.
High way-Walking way
6.
Rupture and repair
7.
Practice, practice…
7.
Acceptance
8.
On my own
8.
The future
What have we learned..
• Remove meditation pillows (they throw them at
eachother)
• Watch your cookies (they steal them and have sugar
highs)
• Some children meditate better when lying
• Heads facing wall works best for sitting meditations
• Children are excellent meditation and yoga teachers
• Children love using the bell
Parallel mindful parenting
• Mindfulness training for parents, for three reasons:
1 To guide the child
2 For own attention/impulsivity issues
3 Because raising a child with ADHD is a challenge
• Every night parents practice 5-10 minutes with their child in the
child’s bedroom (reward: the child goes to bed 5 or 10 minutes
later!)
• Reward system with points and presents
• Remind the child to apply the mindfulness skills (take a breath)
Mindful parenting is paying
attention to your child and your
parenting in a particular way: on
purpose, in the present moment,
and non-judgmentally (KabatZinn & Kabat-Zinn, 1997)
Children and parents together
• Session 1 first half hour (name game, rewards, raisin exercise)
• Session 5 first half hour (sitting with the breath together, what
have you learned in one word)
• Session 8 most of the session (body scan together, children as
yoga-meditation teachers, video, mindful eating of an
excessively decorated cake made by the children for their
parents, what has your parent/your child learned? What are you
planning to keep doing the next 8 weeks?)
• Follow-up session (8 weeks after the end of training) most of the
session
Results on child ADHD
25
24,5
24
23,5
23
22,5
22
21,5
21
20,5
20
20
19,5
**
19
18,5
pre
post
FU
*
pre
post
FU
18
17,5
17
16,5
16
15,5
Inattention
Hyperactivity
ADHD behavior child (Parent rated DBDRS)
 sign reduction pre-post Inattention & Hyperactivity/Impulsivity
 Large effect size for inattention, medium for hyperactivity
 effects stable from post > FU
Results on parental ADHD
12
*
10
8
pre
post
FU
6
4
2
0
10
9
8
7
6
5
*
4
3
2
1
0
pre
post
FU
Hyperactivity
Inattention
ADHD rating scale Adults (Kooij et al., 2005)
 sign reduction pre-post inattention and hyperactivity
Medium effect size
 effects stable from post >FU
(Children of) parents with ADHD
• Six parents met adult criteria for ADHD
• Parents improved considerably on own ADHD (effect size for
inattention .6, for hyperactivity 1.0)
• Their children improved likewise (effect size for inattention 1.0,
for hyperactivity .5)
Other measures
• Medium effect size improvements on parental overreactivity, on
parental stress, and on parental mindful attention and
awareness, but not on parental permissiveness (effects appear
specific)
• Teachers report medium effect size improvements on children’s
inattentiveness, but not on their hyperactivity
Parents’ process descriptions
•
“First I thought: oh how soft. But now precisely not! You become aware
of your own actions. I learned that I don’t do it as bad as a mother. I am
happy I did it and sometimes I use sentences from the workbook to
explain things to my son!! And the food tastes better hahaha”
•
“Becoming aware of life itself. In the things you do. That Roy used the
exercises and that it helped him. And that he became aware that it
helped”
Mindfulness for adolescents with ADHD
and their parents
Van de Weijer-Bergsma, Formsma, de Bruin & Bögels (in progress)
N=10 (5 boys, 5 girls, two groups, mean age 13.4, 1 medication)
Assessments (pre, post, FU)
Perceived attention problems (YSR/CBCL/TRF, Achenbach, 1991)
Objective attention (SAD/SAA van de ANT, De Sonneville, 2005)
Parenting Stress (NOSIK, de Brock et al., 1991)
Results on adolescents’ perceived attention
problems
9
8
7
*
voor
na
FU
4
3
7
7
6
6
6
5
8
5
5
voor
na
FU
4
3
3
2
2
2
1
1
1
0
0
0
adolescents
voor
na
FU
4
fathers
teachers
YSR (self-report), CBCL (parent report), TRF (teacher report)
Pre-post: adolescents (trend), fathers (sign), teachers (trend),ES=.60
Pre-FU: adolescents (sign, ES=1.0), fathers (sign, ES=1.8)
Mothers: no changes
Results on adolescents’ objective attention
Sustained attention dots (visueel)
• faster reaction times (pre-post, ES=1.8)
• no improvements on misses & false alarms
Sustained attention auditory
• no changes in reaction times
• less false alarms (pre-post, ES=.80) & misses (pre-fu, ES=.10)
Results on parental stress
•
sign. improvement reported by fathers (at
post & FU)
•
Mothers don’t show improvement on any
measures