Mindfulness for children and adolescents with ADHD and

Mindfulness for children and adolescents with ADHD and their parents Susan Bögels University of Amsterdam, Research Institute CDE Uv. A-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. 5 Ext 1. 1 Social. 6 Think. 4 Att 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 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 (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 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 ** Inattention * Hyperactivity ADHD behavior child (Parent rated DBDRS) q sign reduction pre-post Inattention & Hyperactivity/Impulsivity q Large effect size for inattention, medium for hyperactivity q effects stable from post > FU

Results on parental ADHD * * Hyperactivity Inattention ADHD rating scale Adults (Kooij et al. , 2005) q sign reduction pre-post inattention and hyperactivity q. Medium effect size q 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 * 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, 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