Mindfulness for children and adolescents with ADHD and their parents

1
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

2
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

3
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.

4
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

5
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

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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

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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

8
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!)

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Coping

• High way -Walking way (breathing space)
• When your parents are on the high way suggest
  them to take a breathing space!

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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

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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

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Parallel mindful parenting

• Mindfulness training for parents, for three
  reasons
• 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)

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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)
14
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

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Results on child ADHD


Hyperactivity
Inattention

• 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 gt FU

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Results on parental ADHD


Hyperactivity
Inattention

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

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(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)

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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 childrens inattentiveness, but not on their
  hyperactivity

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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
  helped

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Mindfulness for adolescents with ADHD and their
parents

• 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)

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Results on adolescents perceived attention
problems

adolescents
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, ES1.0), fathers (sign,
ES1.8) Mothers no changes
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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)

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Results on parental stress

• sign. improvement reported by fathers (at post
  FU)
• Mothers dont show improvement on any measures