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Mindfulness for children and adolescents with ADHD and their parents


Mindfulness for children and adolescents with ADHD and their parents – PowerPoint PPT presentation

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Title: Mindfulness for children and adolescents with ADHD and their parents

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 Parent
  • Post Fu Post Fu
  • Int .5 .5 -.1 .3
  • Ext 1.1 1.2 .3 .4
  • Social .6 .5 .2 .3
  • Think .4 .3 .0 .1
  • Att 1.0 .9 .3 .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
  • Bringing attention to attentional anchors
  • Noting that distraction occurs and letting go of
    the distraction
  • 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
  • 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 (n22, 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
  • Following the breath from 10 seconds to 5
  • 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!)

  • 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
  2. Home in my body
  3. Breath
  4. Distractors
  5. Freeze!
  6. High way-Walking way
  7. Practice, practice
  8. On my own
  1. Being attentive
  2. Home in my body
  3. Breath
  4. Answering
  5. Patterns and habits
  6. Rupture and repair
  7. Acceptance
  8. The future

What have we learned..
  • Remove meditation pillows (they throw them at
  • Watch your cookies (they steal them and have
    sugar highs)
  • Some children meditate better when lying
  • Heads facing wall works best for sitting
  • Children are excellent meditation and yoga
  • Children love using the bell

Parallel mindful parenting
  • Mindfulness training for parents, for three
  • To guide the child
  • For own attention/impulsivity issues
  • Because raising a child with ADHD is a challenge
  • Every night parents practice 5-10 minutes with
    their child in the childs 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 (Kabat-Zinn 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
  • 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

  • ADHD behavior child (Parent rated DBDRS)
  • sign reduction pre-post Inattention
  • Large effect size for inattention, medium for
  • effects stable from post gt FU

Results on parental ADHD

  • ADHD rating scale Adults (Kooij
    et al., 2005)
  • sign reduction pre-post inattention and
  • Medium effect size
  • effects stable from post gtFU

(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
  • Teachers report medium effect size improvements
    on childrens inattentiveness, but not on their

Parents process descriptions
  • First I thought oh how soft. But now precisely
    not! You become aware of your own actions. I
    learned that I dont 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

Mindfulness for adolescents with ADHD and their
  • Van de Weijer-Bergsma, Formsma, de Bruin Bögels
    (in progress)
  • N10 (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

YSR (self-report), CBCL (parent report), TRF
(teacher report) Pre-post adolescents (trend),
fathers (sign), teachers (trend),ES.60 Pre-FU
adolescents (sign, ES1.0), fathers (sign,
ES1.8) Mothers no changes
Results on adolescents objective attention
  • Sustained attention dots (visueel)
  • faster reaction times (pre-post, ES1.8)
  • 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
  • Mothers dont show improvement on any measures
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