MINDFULNESS AND CHILDREN WITH ADHD
Mindfulness-Based Intervention and Cognitive Function of Children with Attention DeficitHyperactivity Disorder
Melissa K. Craft
Towson, University
Research Methods in Psychology
PSYC.314, Spring 2013
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MINDFULNESS AND CHILDREN WITH ADHD
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Abstract
The research community has increasingly been investigating the impact of mindfulness
on overall physical and mental health. Much of the research has demonstrated an association
between mindfulness and cognitive processes of attention and mood regulation. With Attention
Deficit Hyperactivity Disorder being characterized by problems of cognition, particularly related
to attention and learning, the effectiveness of Mindfulness-based interventions on improving
cognition in this population is in question. The current study assessed the impact of a 16-week
Mindfulness-based intervention program on the spatial learning in the Virtual Morris Water
Maze task of 25 children with diagnosed ADHD and 25 children with no ADHD, ranging from
ages 8-9 years. Relative to age-matched no treatment control groups, the children with ADHD
and the children with no ADHD responded differently to the program. There was a crossover
interaction between the mindfulness treatment and the children’s level of cognitive function, as
the children with ADHD demonstrated significantly improved learning performance and the
children with no ADHD demonstrated significantly impaired learning performance following the
16-week intervention. The findings provide evidence that mindfulness-based interventions are
associated with improvements in spatial-cognitive learning in children with ADHD, but with
learning impairments in children with no ADHD.
Keywords: mindfulness, adhd, learning
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Mindfulness-Based Intervention and Cognitive Function of Children with Attention DeficitHyperactivity Disorder
Attention Deficit/Hyperactivity Disorder (ADHD) is a condition primarily diagnosed in
childhood and marked by cognitive deficits associated with difficulty in sustained attention and
self-regulation (Baron, 2007; Rutledge, Bos, McClure, & Schweitzer, 2012). These deficits often
manifest from symptoms such as over-activity, difficulty following directions, poor academic
performance, difficulty finishing tasks, difficulty holding memories, difficulty avoiding
distraction, difficulty organizing or planning, and difficulty controlling impulses (Baron, 2007;
Daley & Birchwood, 2010; Ek, Westerlund, Holmberg, & Fernell, 2011). Primary brain
structures associated with dysfunction in the case of ADHD have been noted in areas of the brain
including the prefrontal and cingulate cortices (Castellanos & Proal, 2012). In addition,
significant widespread thinning across parts of cortices, including the frontal, medial and left
lateral parietal, occipital and temporal cortices, have been observed in direct relation to
individuals with ADHD (Narr, 2009). This cortical thinning has been associated with the
cognitive dysfunctions related to this condition. Currently, many children with ADHD are often
treated pharmacologically and/or with cognitive behavioral interventions in order to improve
cognitive and behavioral deficits (DuPaul, Eckert, Vilardo, & Brigid, 2012; Rutledge et al.,
2012). However, upcoming research has shed light on an alternative method of treatment that has
been associated with cognitive and behavioral improvements among both cognitively normal and
impaired populations.
Within recent years, a growing body of research has surfaced exploring the impact of
mindfulness on cognition and its implications in regards to potential treatment programs in some
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cases of cognitive dysfunction (Chiesa, Calati, & Serretti, 2011). Mindfulness practice has been
linked to improvements in emotional regulation, mood, cognitive functioning, and even immune
functioning (Davidson et al., 2003; Josefsson & Broberg, 2011; Kozhevnikov, Louchakova,
Josipovic, & Motes, 2009; Lykins & Bear, 2009; Miller, Fletcher, & Kabat-Zinn, 1995;
Witkiewitz, Bowen, Douglas, & Hsu, 2013). Mindfulness can be defined as a meditative process
of purposefully and fully attending to the present moment, allowing for awareness of all
components of the immediate experience while remaining free of judgment (Bishop et al., 2004;
Kabat-Zinn, 1994). Historically, mindfulness has been used as part of a daily religious practice
(Bishop et al., 2004). It was used frequently among Buddhist monks who practiced mindfulness
as part of a daily spiritual regimen. However, modern practices of mindfulness meditation have
been applied clinically and into everyday life without the connection between practice and any
religious affiliation (Brown, Marquis, & Guiffrida, 2013).
In regards to the ways in which mindfulness practice has been used for intervention
purposes, most research has focused on its implications for improving symptoms associated with
anxiety, depression, chronic pain and emotional regulation (Biegel, Shapiro, Brown, & Schubert,
2009; Brown et al., 2013; Miller et al., 1995; Wiltkiewitz et al., 2013). Many of these
improvements seem to be associated with the nature of the overall goal of mindfulness, which is
to shift from a generally negative to positive thinking style and to adopt a positive and nonjudgmental approach toward experiences that occur during the present moment (Bishop et al.,
2004; Kabat-Zinn, 1994).
Specific evidence of emotional and mood improvements following a mindfulness-based
intervention have been noted in studies observing a variety of different conditions. One study
found that a mindfulness intervention program was efficient in reducing substance abuse relapse
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in individuals who were going through alcohol dependency recovery (Wiltkiewitz et al., 2013).
Another study noted the long-term outcome of a mindfulness meditation intervention on a group
of people with various anxiety disorders (Miller et al., 1995). In this population, a significant
decrease in trait anxiety was observed as a result of a mindfulness program even after a threeyear follow up. Furthermore, one other study observed significant decreases in self- ratings of
depression and somatic distress accompanied by improvements in self-esteem in adolescent
psychiatric outpatients who had completed a mindfulness-based intervention program (Biegel et
al., 2009). With these results in mind, the potential efficacy of a mindfulness approach
potentially treating a wide variety of mental health disorders seems widely supported.
Although the most widespread uses for mindfulness-based intervention approaches have
been used with a focus on mood dysfunction and emotional regulation, particularly noteworthy
evidence has been emerging in more recent research demonstrating its association with improved
cognitive functioning (Chan & Woollacott, 2007; Kozhevnikov et al., 2009; Lykins & Baer,
2009). Using both brain imaging techniques and behavioral methods of measurement,
researchers continue to discover additional ways in which mindfulness practice may benefit
cognition. These experiments have involved the observation of Buddhist monks, experienced
mindfulness practitioners and those with only short-term mindfulness experienced by way of
treatment program (Chan & Woollacott, 2007; Kozhevnikov et al., 2009; Lykins & Baer, 2009;
Zeidan, Johnson, Diamond, David, & Goolkasian, 2010). Regardless of the length of experience,
significant cognitive and behavioral improvements have been noted in response to mindfulness
practice (Zeidan et al., 2010).
In regard to cognition, mindfulness has been linked to improvements in sustained
attention, executive attention, self-regulation, and spatial memory (Chambers, Lo, & Allen,
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2008; Chan & Woollacott, 2007; Kozhevnikov et al., 2009; Zeidan et al., 2010). One study
observed the impact of deity yoga meditation, which involves sustaining one’s attention towards
a specific personal object of deity, on spatial processing (Kozhevnikov et al., 2009). This study
found that when tested after meditation, those participants involved in deity yoga meditation
demonstrated significant improvements on tasks of mental rotation and spatial memory when
compared to control groups of both non-meditators and experienced meditators who did not
meditate prior to the test. Another study found that daily mindfulness meditation was
significantly associated with less interference on the Stroop task, which is a measure of executive
attention (Chan & Woollacott, 2007). Similarly, one other study found that when compared to a
control group of no mindfulness meditation, participants who took part in a brief mindfulness
meditation program demonstrated significant improvements on cognitive tasks of working
memory and verbal fluency (Zeidan et al., 2010). These mindfulness participants also
demonstrated improved self-ratings of fatigue and anxiety. These results have been only part of
the recent movement to discover how these cognitive improvements come about and what
specific parts of the brain are impacted by mindfulness meditation.
For this reason, an abundance of studies have risen to the forefront demonstrating the
measurable impact of mindfulness meditation on the brain. Various brain imaging techniques
have been used to measure cortical thickness as a result of mindfulness training and also measure
activation of particular cortical areas during the mindfulness meditation (Cahn & Polich, 2009;
Engstrom, Pihlsgard, Lundberg, & Soderfeldt, 2010; Grant et al., 2013; Holzel et al., 2011;
Moore, Gruber, Derose, & Malinowski, 2012). One study, in particular, evaluated the cortical
thickness of the entire brain of experienced mindfulness meditators and a control group of nonmeditators (Grant et al., 2013). Their results showed that the experienced meditators reported a
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tendency to became more absorbed in mindfulness practice and scored higher on levels of
mindfulness in general. These results were also positively correlated with significant increases in
grey matter thickness measured in the cingulo-frontal-parietal network of attention of the
experienced meditators. Similarly, one other study also noted significant increases in grey matter
concentration in the left hippocampus, cerebellum, posterior cingulated cortex, and the temporoparietal junction (Holzel, 2011). These increases were observed in participants of an 8-week
mindfulness intervention program when compared to a no mindfulness control group.
Furthermore, another study used an EEG recording to measure Evoked-Related Potentials
in different cortical areas of individuals who participated in a 16-week mindfulness program
when compared to a no mindfulness control group (Moore et al., 2012). They measured ERPs of
these individuals during a computerized Stroop task of attention and compared the data to the
pattern of cortical activation related to the task. These researchers found, when compared to
controls, those who participated in the mindfulness program allocated more efficient attentional
resources to cortical areas specifically associated with the assigned task. This was demonstrated
by an increase of activation in task relevant cortical areas in the presence of congruent stimuli
and less activation in the presence of incongruent stimuli. The no meditation control group
demonstrated the opposite effect. Likewise, a similar study found that experienced mindfulness
practitioners demonstrated a decrease in ERP activation in response to distracting stimuli and an
increase in such activation in response to the target stimuli during active mindfulness meditation
(Cahn & Polich, 2009). These results were found to be significantly different from participants in
a control group who engaged in neutral thinking rather than mindfulness meditation.
Comparatively, the control group demonstrated an increased ERP response to the distracter
stimuli and responded with weaker activation to the target response. These studies provide
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support for the potential benefits of mindfulness practice in regard to improving allocation of
attentional resources.
The present study will focus on the potential implications for a mindfulness based
intervention program for improving cognitive function in children diagnosed with ADHD. As
noted previously, ADHD is largely characterized by significant decreases in cortical gray matter
in the prefrontal cortex (Narr et al., 2009). Subsequently, it has been associated with diminished
ability to execute resources of attention properly and in turn individuals with ADHD will often
display weakened learning performance (Baron, 2007; Daley & Birchwood, 2010; Ek et al.,
2011). With Mindfulness-based meditation seeming to directly impact these areas of cognitive
function in the brain and based on its noted success in improving conditions in cases of other
types of cognitive dysfunction, whether or not it could successfully improve cognition in
children with ADHD is currently an intriguing question worthy of further investigation.
Previous studies and reviews have evaluated the potential connections between
mindfulness and ADHD and how mindfulness-based interventions may improve cognitive
function and performance in children diagnosed with ADHD. One study investigated the
mindfulness skills of adults with ADHD compared to those without ADHD (Smalley, Loo, Hale,
Shrestha, & McGough, 2009). They found through self-report measures that adults with ADHD
reported lower trait mindfulness, particularly in regard to attention measures, than individuals
without ADHD. These results suggest a negative correlation between ADHD and trait
mindfulness. Additionally, noteworthy literature has highlighted the associations between
mindfulness and ADHD (Grant et al., 2013; Burke, 2010). They have emphasized the importance
of future research to explore if these associations are true indicators of any measurable outcomes
of improvement in individuals with the disorder as a result of mindfulness-based interventions.
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Few studies have actually explored the measurable cognitive impact of a mindfulnessbased intervention on children with ADHD. One study did measure parent ratings of their child’s
behavior following a mindfulness-based intervention program for both the parents and the child
(Oord, Bogels, & Peijnenburg, 2012). Results indicated that parents noted significant
improvement in ADHD behaviors following the treatment. However, this study did not
investigate specific cognitive functions as a result of the treatment and therefore true
improvements in cognitive performance could not be examined. Another study investigated the
efficacy of a 16-week mindfulness-based intervention program for adolescents with ADHD
(Weijer-Bergsma, Formsma, Bruin, & Bogels, 2012). In this study, the self-reports and parent
and tutor reports revealed significantly improved executive functioning and behavior in the
adolescents following the intervention. Significant improvements in attention were also
demonstrated on measurable tests of attention performance. This study, however, only
investigated the impact of such a treatment on adolescents ranging from ages 11-15 years. There
is still very little information in regards to the efficacy of a mindfulness-based intervention
program for children younger than 10 years.
Consequently, we believe the next step in evaluating the efficacy of a mindfulness-based
intervention program on improving cognitive performance of children with ADHD is to begin by
highlighting a specific cognitive task related to the typical cognitive dysfunction associated with
the condition. Because areas associated with executive function, such as the frontal cortices, are
particularly impaired in children with ADHD, an intervention approach designed to improve this
function would be desirable. According to Baddeley and Hitch’s (1974) model of working
memory, the central executive (executive function center) of the brain is responsible for
controlling the flow of information that travels in and out of two specific centers of short-term
MINDFULNESS AND CHILDREN WITH ADHD
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memory storage (Baddeley & Hitch, 1974). These two systems are the phonological loop,
responsible for storing verbal information, and the visuo-spatial loop, responsible for storing
visual and spatial information. This model could suggest that dysfunction in the central executive
could be a primary contributor to impaired performance in learning and memory. Based on this
model, if executive function can be improved, then attention may be allocated more efficiently to
specific systems of the brain responsible for learning, memory and behavior. Potentially, such an
improvement could lead to more generalized improvements in academic performance and daily
cognitive tasks.
The present study is going to focus particularly on the impact that a mindfulness-based
intervention program may have on spatial learning in children with ADHD. It has been
demonstrated that such learning may require the proper functioning of the central executive
portion of the brain and therefore improvements of this system should lead to improvements in
learning (Purser et al., 2012). This study will consist of four groups with two of the groups
comprised of children with diagnosed ADHD and two groups of normal functioning children.
One ADHD group and one normal functioning group of children will participate in a 16-week
mindfulness-based intervention program as well as their parents, while the other two groups will
participate in a control program not affiliated with any type of mindfulness practice. We will
measure each group’s spatial-cognitive learning over three different time points through the use
of a virtual version of the Morris Water Maze (Morris, 1981). It is hypothesized that the group of
children with diagnosed ADHD will demonstrate improved spatial-cognitive learning as an
outcome of the Mindfulness-Based Program, and may achieve acquisition performance on par
with their normal functioning same age peers. In addition, we expect to observe improvements in
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the normal cognitive functioning children who participate in the Mindfulness-Based Program
when compared to those who did not participate.
Method
Participants
The participants gathered for this study consisted of 50 children with diagnosed Attention
Deficit Hyperactivity Disorder and 50 children with no identifiable cognitive impairments.
Children ranged from 8-9 years-of-age, were all in the third grade, and were English-speaking.
Apart from ADHD, none of the children in any of the groups had any associated disabilities that
may have interfered with performance in this study. All children were also diverse in race, socioeconomic status, and gender. The children with ADHD were recruited from The Center for
ADHD in Cincinnati, Ohio, one of the largest centers in the United States devoted to the research
and care of individuals diagnosed with ADHD. For recruitment, a 50 slot sign-up sheet was
made available to parents in the center informing them of the study and briefly what it involved.
Because the nature of the study required that children not take medications during the
experiment, for it very well may have confounded the results of the Mindfulness-based
intervention, parents of newly diagnosed children and parents who were seeking a naturalistic
approach to treatment were among the majority who signed up.
The 50 third grade children with normal cognitive abilities were recruited from three of
the surrounding elementary schools including Maple Dale Elementary School, Hoffman
Elementary School, and Lincoln Heights Elementary School. A brief description of the study
was sent out to children’s homes in the schools’ monthly newsletters and information regarding
the sign up procedure was included in the explanation. Parents from both The Center for ADHD
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and the elementary schools were assured that there were no health-risks associated with the
experiment and were compensated with $100.00 cash for participation.
Materials
The Virtual Morris Water Maze task was executed on a computerized program designed
to replicate the environment and apparatus of the original Morris Water Maze. The program used
was the NeuroInvestigations Virtual Navigation Software Morris Water Task Version 1.2 and
was displayed on a Sony VAIO laptop model VGN-A260. Participants received audio feedback
via Sony MDR-ZX100 Stereo Headphones and used the arrow keys on the keyboard to navigate
around the water maze. For reference, Hamilton and Sutherland (1999) provided a detailed
description of the environment within the computerized program.
In summary, the virtual environment consisted of a circle shaped pool with white pool
walls. The pool walls had no distinguishable features and looked the same at every angle. The
room in which the pool was in had 4 walls, each the same length and width and each containing
one distinguishable cue. These cues served as distal cues, however were placed in such a way
that the target could not be reached by directly approaching one specific cue head on.
The target platform was placed in the center of the Northeast quadrant of the circular pool
and took up approximately 2% of the surface area of the pool. The target remained invisible until
it was reached, at which time it rose from the water and was visible to participant. The UP arrow
key allowed the participant to move forward in the maze, while the RIGHT and LEFT arrow
keys enabled turning directions in the maze. The DOWN arrow key was not used, as the
participant could not move backwards in the maze.
Procedure
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This study used a 2x2 factorial design consisting of a total of 4 groups. The 50 children
with ADHD were assigned to two groups of 25 by flipping a coin, one group receiving the
mindfulness intervention treatment and the other receiving no treatment. The 50 children with
normal cognitive functioning were assigned to two groups of 25 as well by flipping a coin, one
receiving the mindfulness treatment and the other receiving no treatment. Children completed the
virtual spatial-cognitive learning task at three different time points: before the 16-week
intervention, after the 9th week, and after the 16th week. Children in the no treatment group
completed the task at these time points as well, just did not participate in the mindfulness
intervention program. So as to not deny some children treatment, parents were informed before
agreeing to allow their children to participate in the study that if their child was placed in the no
treatment group, they would be given the opportunity to receive the mindfulness treatment
intervention free of charge if they so chose to after the study was completed.
The mindfulness intervention treatment was a 16-week program that required the parents
and children to attend an hour-long initial mindfulness introduction session the first week
followed by 15 hour-long sessions that were held once a week. Twelve of the children in the
ADHD treatment group met on Monday nights at 6:00 pm and the other 13 children in the
ADHD treatment group met on Tuesday nights at 6:00 pm. Twelve of the children in the normal
functioning treatment group met on Wednesday nights at 6:00 pm and the remaining 13 children
in the normal function treatment group met on Thursday nights at 6:00 pm.
During the initial session, two professional mindfulness instructors who both had over 10
years of experience studying and practicing mindfulness trained parents and children. Children
and parents during this time were given an introduction to mindfulness as a practice and were
informed of what the following 15 weeks were to entail. Children were instructed to keep a daily
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journal of their experience with the exercises taught each week. Parents were instructed to
practice the exercise taught each week with the child twice every day. The session ended with a 5
minute guided meditation for both the parents and the children.
During the following 8 weeks, parents and children were taught techniques and exercises
to improve attention and focus. One mindfulness concept and exercise was taught each week.
The concepts included awareness of an object, awareness of self in the environment, attending to
the senses, awareness of movement, meditation on the breath, attending to the thinking process,
meditation on the bubble, and finally visualization meditation. A more detailed description of
each of the concepts and related exercises was provided by Hooker and Fodor (2008). These
exercises were taught and explained to each child and the child, trainer and parent would all
practice the exercise together. Each of these 8 sessions concluded with a 5 minute guided
meditation.
The sessions during the last 7 weeks were based mostly around group discussion and
sharing of experiences with mindfulness. Children would talk about their experience of
mindfulness with the other children. Each child in the group discussion was given an opportunity
to share what they liked, disliked, what was difficult, what was easy, how they felt when they
were mindful and how they have been practicing. The parents shared their experiences with
mindfulness as well and discussed what exercises were the most challenging, what was the most
helpful, and any improvements they had seen in their children. Parents were instructed to
continue their practice of different exercises with their child twice a day and children were to
continue their daily journals of their experiences. Each of these sessions concluded with a 5
minute guided meditation.
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For the Spatial-Cognitive Learning Task, there were two testing rooms with five
computers in each room. Ten children could complete the task at a time and the entire process
took approximately 20-30 minutes per child. Testing at each time period for all children took
place on one day. There was one experimenter for each room that gave a specific set of
directions to each group of children regarding how to complete the task. The children were
instructed to use the arrow keys as noted above to maneuver around the water maze. The task
consisted of 3 main phases: practice trials, place-learning trials, and a probe trial.
For the first phase, there were four practice trials, during which time the platform was
visible and the participants were told to swim to the platform. For each trial the participants had
an opportunity to practice swimming from each of the four potential starting points (North, East,
South, West). This was to get each participant accustomed to the nature of the task and have
them practice using the arrow keys to swim.
Next, there were 20 place-learning trials, during which time participants were told that
their goal was to swim to a hidden platform in the water pool. Once the goal was approached, the
platform would rise and the participant would be given a five second time interval to look around
and observe the environment. If the target was not approached within a 60 second time frame,
the platform became visible and the participant was notified by a beep and visual instruction that
the platform was visible and to swim to it. The target platform remained in a stable location in
the center of the N/E quadrant for all of the place-learning trials, but the starting location of the
participant changed from trial to trial between the four possible start points. Each participant was
informed of the platform location constancy prior to beginning the task. During this time, escape
latency (time in seconds that it took from the point in which the participant began moving to the
time the platform was approached) was calculated in order to measure place-learning.
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Finally, there was one 45 second probe trial, in which the platform was removed from the
pool and the participants were pseudo-randomly placed at a one of the two furthest starting
points from the target area in the place-learning phase. At this point, duration of time in seconds
spent in each quadrant was calculated in order to measure place-learning.
Results
Using a 2x2 (Cognitive Function x Mindfulness Treatment) factorial analysis of variance
(ANOVA), we examined whether an escape latency change on the Virtual Morris Water Maze
Task would occur following a 16-week mindfulness training program in children with ADHD
and in an age-matched control group without ADHD. Escape latency measures for each group
are displayed in Figure 1. There was no significant main effect of the cognitive function level of
the children [F (1,36) = 1.073, p > .05]. Likewise, there was no significant main effect of the
Mindfulness Treatment manipulation [F (1,36) = .800, p > .05]. However, the results showed that
there was a significant interaction between cognitive function level and the meditation treatment
manipulation [F (1,36) = 12.262, p < .01].
As reflected in Figure 1, there was a crossover interaction between the mindfulness
treatment and the children’s level of cognitive function. The children with no ADHD escaped
slower in response to the mindfulness treatment as opposed to when there was no treatment. The
opposite occurred in children with ADHD, however, as they escaped faster following the
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mindfulness treatment in comparison to a condition in which there was no treatment.
Figure 1: Mean escape latencies for control and treatment groups among children with ADHD
and children with No ADHD.
Discussion
There is a growing body of research supporting that mindfulness-based interventions may
have positive implications for individuals suffering from a wide variety of mental health
problems (Chan & Woollacott, 2007; Chiesa et al., 2011; Kabat-Zinn, 1995; Kozhevnikov et al.,
2009; Miller et al., 1995). This research has been overwhelmingly limited to adolescents or
adults, however, and much less has been evaluated in regards to children’s responses to
mindfulness. Our analysis of the performance of children with ADHD on a spatial-cognitive
learning task following a mindfulness intervention supports the hypothesis that children with
ADHD may benefit cognitively from practicing mindfulness. Following a 16-week mindfulness
intervention, children diagnosed with ADHD did, in fact, demonstrate improved learning
performance on the Virtual Morris Water Maze task in comparison to those children with ADHD
who did not participate in the treatment. Part of what we hypothesized, however, was that the
children with no ADHD would benefit from the mindfulness treatment as well. Contrary to this
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18
prediction, our findings suggest that the mindfulness treatment actually impaired performance on
the Virtual Morris Water Maze task in normal cognitive functioning children. As suggested by
our results, it seems that a mindfulness intervention may be a useful treatment tool for improving
learning in children with ADHD, but may be detrimental to the spatial-cognitive learning
performance of children with no diagnosed cognitive dysfunction.
Although past mindfulness research that has specifically involved child participants with
ADHD is limited, there has been some research to suggest that mindfulness practice could very
well lead to cognitive and behavioral improvements among this population. The improvements
observed in the learning performance of children with ADHD as a response to the mindfulness
based treatment during our study are consistent with past studies, and provide useful information
to add to this developing collection of research. For example, Oord et al. (2012) also found
improvements in children with ADHD following an 8-week mindfulness program. Specifically,
these researchers found that the treatment reduced the children’s parent-rated ADHD behavior
and parental stress related to the child’s ADHD. Likewise, Singh et al. (2010) observed
improved compliance of children with ADHD following a 12-session mindfulness training
program for both the child with ADHD and mother. These improvements were most robust in
cases in which the training was given to both the children and the mother, rather than just the
mother. This further suggests that the child, in fact, benefitted from the training itself and not just
from the mother’s reaction to the training. It should be noted, as well, that during the course of
the mindfulness treatment, the children involved in the study were slowly stripped off of their
medication for ADHD without any recognizable adverse effects.
By the same token, the specific improvements observed in the ADHD participants in our
study also are consistent with the past research regarding the impact of mindfulness on specific
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19
cognitive processes, although not specifically in children. Kozhevnikov et al. (2009) also found
evidence that practicing mindfulness meditation may directly impact an individual’s performance
on tasks of mental rotation and spatial memory in a positive way. Likewise, our results support
the findings of Chan and Woollacott (2007), whose evidence suggested that mindfulness practice
was associated with an improvement in the allocation of attentional resources during a test of
executive function. This finding may provide some insight as to why a mindfulness-based
intervention was so beneficial to the children with ADHD in our study. The Virtual Morris Water
Maze task would require a level of executive function that children with ADHD generally lack.
Therefore, perhaps as a function of regular mindfulness practice, their ability to allocate their
attentional resources efficiently during the Virtual Water Maze task improved, thus leading to
some of the improvements demonstrated in our results.
We did find, however, that children functioning at a normal cognitive level did not
benefit from the mindfulness-based intervention like the children with ADHD did. In fact, these
children were actually impaired by the treatment. This finding was unexpected, as it does not so
smoothly fall in line with the past research regarding mindfulness. Nonetheless, these results are
important findings that provide us with more insight as to how some children may react to
mindfulness-based treatments. Grant et al. (2013) found evidence to suggest that elevated selfratings of mindfulness practice absorption were positively correlated with increased grey matter
thickness in areas of the brain responsible for attention processes. This may provide us with a
potential explanation as to why a lack of improvement occurred among this population. It is
possible that the parents of the normal functioning children were less motivated during the
treatment than the parents of children with ADHD to practice consistently with their children.
Therefore, there may have been less home practice and less absorption of mindfulness. This
MINDFULNESS AND CHILDREN WITH ADHD
20
possibility, however, does not provide a sufficient explanation as to why their performance was
so greatly impaired following the treatment rather than just remaining unchanged. Perhaps these
children may have responded in a negative way to the mindfulness treatment due to an inability
to grasp the concept of the mindfulness practice. These children may have become frustrated
with the training and this, in turn, may have negatively impacted their performance on the
Virtual Water Maze task. Why this effect was not observed among the children with ADHD
remains rather ambiguous, however, and should be evaluated further in future studies.
It is important to address some of the potential downfalls of the study and how they may
have impacted the results. As mentioned above, the motivation of both the parents of the children
with ADHD and the parents of the children with no ADHD could have been more heavily
controlled for. Whereas the parents of the children with ADHD were highly motivated to
hopefully observe improvements in their children following the treatment, the parents of the
normal functioning children had less of a reason to desire to see these types of changes. Parents
were informed during the introductory session of the many positive outcomes associated with
mindfulness practice, however, which should have promoted some level of motivation within all
parents involved.
In addition, regulation of the parent and child’s practice at home could not be completely
controlled. It was impossible to be sure that each parent was consistent with practicing with the
child over the full 16-week period. Therefore, while some children may have experienced
extensive practice in mindfulness, other children may not have had much more practice than
what was done during the weekly sessions.
Ultimately, for the main purposes of this study, we found much of the evidence we
intended to find. The mindfulness-based intervention did seem to improve the spatial-cognitive
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21
learning performance of children with ADHD. For a population of children generally
characterized by their impaired learning ability and poor academic performance, this evidence
provides much promise in regard to the development of new, safe treatment alternatives for
children with ADHD. This potential is crucial, as the majority of mothers rate behavioral
treatments as a more acceptable form of treatment than stimulant medication for their children
(Johnston, Hommersen, & Seipp, 2008). Still, further investigation of the specific impact of
mindfulness treatments on this population is necessary before they should be regarded as an
appropriate equal alternative to medication. Perhaps future research could explore possible
academic improvements in this population in response to a mindfulness intervention. These
studies could follow children with ADHD throughout the course of a school year and investigate
the impact of a school-based mindfulness program on their grades and teacher-ratings of
academic performance. Furthermore, it would also be necessary to continue investigating the
impact of mindfulness on normal functioning children, and why it might impair their
performance on various levels of cognitive functioning. Perhaps these studies could focus on
how well the children are able to grasp the concepts taught in the interventions and track their
feelings and frustrations in regards to their practice. It might also be beneficial to explore what
might be going on at the neurophysiological level in normal functioning children compared to
children with ADHD over the course of a mindfulness-based intervention program.
In conclusion, because there is so much yet to discover related to the potential benefits of
mindfulness on children with ADHD, surely there are an abundance of avenues for future
investigation on the topic. Indeed, while this study might have brought us one step closer to
understanding the effects of mindfulness on the brain and its processes, there is still so much
more information about this incredible practice to unearth and explore.
MINDFULNESS AND CHILDREN WITH ADHD
22
Figure Captions
Figure 1: Average escape latencies on Virtual Morris Water Maze are demonstrated in response
to either the Treatment condition or the control condition for both the ADHD group and the No
ADHD group. Error bars reflect the standard errors of the means.
MINDFULNESS AND CHILDREN WITH ADHD
23
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