mindfulness-based intervention for adhd...•4 mindfulness •3 yoga •adults: 6 rcts (n=339) •4...
TRANSCRIPT
![Page 2: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/2.jpg)
![Page 3: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/3.jpg)
![Page 4: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/4.jpg)
![Page 5: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/5.jpg)
Overview
1. Historical background
2. Mindfulness for ADHD
3. Own research
4. Future
![Page 6: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/6.jpg)
Historical background
• Past 2500 years: Buddhist practices
• 1970s: Mindfulness-based stress reduction (MBSR)
• 2000s: Mindfulness-based cognitive therapy (MBCT)
MBSR: Kabat-Zinn (1979) | MBCT: Segal, Williams, Teasdale (2002)| Bishop (2004) Clin Psychol| Crane (2017) Psychol Med
Jon Kabat-Zinn
![Page 7: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/7.jpg)
Definition mindfulness
Self-
regulation of
attention to
the present
Orientation
to
experience
Bishop (2004) Clin Psychol
![Page 8: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/8.jpg)
3-minute breathing space
Active creationDeliberate choices
![Page 9: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/9.jpg)
Mindfulness and ADHD – how does that fit together?!
![Page 10: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/10.jpg)
• Limitations of care-as-usual
• Targeting ADHD-related problems
• Neuropsychotherapy
Songua-Barke (2013) Am J Psychiatry | Bachmann | (2016) Front Psychiatry | Moffitt (2011) PNAS
Why mindfulness for ADHD?
![Page 11: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/11.jpg)
Tang et al. (2015) Nat Rev Neuroscience
Why mindfulness for ADHD?
![Page 12: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/12.jpg)
Siebelink, Greven (2019) ECAP
A
INATT
AC AE C E C E
HYP-IMPDispositional
mindfulness
√.65 √.61 √.35
.21
.37 .40
√.00 √.22 √.18
√. 21√.65
√. 13
• ADHD (traits) linked to lower dispositional mindfulness
• Genetic sharing
Why mindfulness for ADHD?
![Page 13: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/13.jpg)
Cairncross & Miller (2016) J Atten Dis
Limitations
• Few controlled and/or randomised studies
• Small samples• 9 studies• Effect size:
Children: d = -.47Adults: d = -.68
• 10 studies• Effect size:
Children: d = -.66 Adults: d = -.91
Inattentiveness
Hyperactivity-impulsivity
Meta-analysis: mindfulness for children and adults with ADHD
![Page 14: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/14.jpg)
Zhang, Díaz-Román & Cortese (2018) Evid Based Mental Health
• Children: 7 RCTs (n=270)
• 4 mindfulness
• 3 yoga
• Adults: 6 RCTs (n=339)
• 4 mindfulness-based intervention
• 1 dialectical therapy + meditation
• 1 CBT + meditation
Meta-analysis: meditation-based intervention for children and adults with ADHD
![Page 15: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/15.jpg)
Children: ADHD symptom reduction• Combined (g = -0.44)• Inattentiveness (g = -0.52)• Hyperactivity-impulsivity (g= -0.40)
Zhang, Díaz-Román & Cortese (2018) Evid Based Mental Health
Meta-analysis: meditation-based intervention for children and adults with ADHD
![Page 16: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/16.jpg)
Adults: ADHD symptom reduction• Combined (g = -0.66)• Inattentiveness (g = -0.70)• Hyperactivity-impulsivity (g= -0.40), n.s.
Zhang, Díaz-Román & Cortese (2018) Evid Based Mental Health
Meta-analysis: meditation-based intervention for children and adults with ADHD
![Page 17: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/17.jpg)
Zhang, Díaz-Román & Cortese (2018) Evid Based Mental Health
• Good news: mindfulness reduced ADHD symptoms!
• Stronger evidence for adults
• Stronger effects for inattentiveness
• But: “Despite statistical significance, methodological limitations mean there is insufficient evidence to support meditation-based therapies for ADHD.”
Meta-analysis: meditation-based intervention for children and adults with ADHD
![Page 18: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/18.jpg)
Zhang, Díaz-Román & Cortese (2018) Evid Based Mental Health
• Power
• Objective/ blinded outcomes
• Standardised intervention
• Few RCTs on mindfulness for ADHD
Limitations
![Page 19: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/19.jpg)
• RCT
• Adequately powered
• Pre-registration
• Protocol: Siebelink, Bögels, Boerboom, de Waal, Buitelaar, Speckens, Greven (2018). BMC Psychiatry
MindChamp
![Page 20: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/20.jpg)
=
Child: Mindfulness-based Cognitive
Therapy
Parent: Mindful parenting
+MYmind
• 8 weekly group sessions (1,5 hours)• 5-9 children and parents• Homework
Bögels (2008) | van de Weijer-Bergsma (2012) | Haydicky (2015) | Shecter (2013) | van der Oord (2012)
MYmind training
![Page 21: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/21.jpg)
c
![Page 22: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/22.jpg)
![Page 23: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/23.jpg)
• ADHD runs in families
• More parenting stress
Greven 2014 J Child Psychol Psychiatry | Theule 2013 J Empt Behav Disord
MYmind: involving parents
![Page 24: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/24.jpg)
Child
• 8 - 16 years
• Primary diagnosis of ADHD
• Medication allowed
• Receiving care-as-usual (CAU), has remaining symptoms
Child/ parent
• Previous mindfulness training
• Psychosis, bipolar, active suicidality, untreated PTSD, substance use
• IQ < 80
• Dutch inadequate
Inclusion criteria Exclusion criteria
![Page 25: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/25.jpg)
Mindfulness + CAU
Baseline
Endpoint (8 weeks)
Follow-ups (2 & 6 months)
CAU
Endpoint (8 weeks)
Follow-ups (2 & 6 months)
Children + parents
ParentTeacher
Child
N=104
N=55 N=49
![Page 26: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/26.jpg)
• Primary outcome: Self-control
• Parent-ratings (ecologically-valid)
• Teacher-ratings (probably-blinded)
• Neurocognitive tasks (objective)
• Secondary outcomes
• ADHD symptoms
• Comorbid symptoms
• Quality of life
• Outcomes in parents
Outcome measures
![Page 27: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/27.jpg)
MindChamp qualitative study
![Page 28: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/28.jpg)
‘purposive sampling’
19 parents
3 mindfulness teachers
17 children
QualitativeRCT
mindfulness group
MindChamp qualitative: design
![Page 29: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/29.jpg)
1. Feasibility: facilitators and barriers
2. Effects
MindChamp qualitative: aims
• Analyses: Grounded Theory
![Page 30: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/30.jpg)
Feasibility Facilitators Barriers
Contextual factorsA. FamilyB. Time and locationC. Time investment
A. Parent and childare co-teachers
C. Spending qualitytime together
A. Interference withfamily structure
B. Time of trainingC. Busy schedules
Training characteristicsA. Content of
trainingB. Other participantsC. Mindfulness
teachers
A. Variety, shortbreathing space, parallel training
B. Sharingexperiences, recognistion
C. Attitude, expertise and understanding
A. Homework + reward system
B. Strong personalities, disturbingbehaviour
C. Not alwaysdirective enough
Participant characteristicsA. Personal
characteristicsB. View on
mindfulnessC. Child age
A. Feeling responsible, being social
B. Alternative formedication, ‘planting a seed’
A. ADHD symptoms, comorbidities
B. Aversion tomindfulnessexercises
C. Being too young
Feasibility Facilitators Barriers
Contextual factorsA. FamilyB. Time and locationC. Time investment
A. Parent and childare co-teachers
C. Spending qualitytime together
A. Interference withfamily structure
B. Time of trainingC. Busy schedules
Training characteristicsA. Content of
trainingB. Other participantsC. Mindfulness
teachers
A. Variety, shortbreathing space, parallel training
B. Sharingexperiences, recognistion
C. Attitude, expertise and understanding
A. Homework + reward system
B. Strong personalities, disturbingbehaviour
C. Not alwaysdirective enough
Participant characteristicsA. Personal
characteristicsB. View on
mindfulnessC. Child age
A. Feeling responsible, being social
B. Alternative formedication, ‘planting a seed’
A. ADHD symptoms, comorbidities
B. Aversion tomindfulnessexercises
C. Being too young
MindChamp qualitative: feasibility
![Page 31: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/31.jpg)
Feasibility Facilitators Barriers
Contextual factorsA. FamilyB. Time and locationC. Time investment
A. Parent and childare co-teachers
C. Spending qualitytime together
A. Interference withfamily structure
B. Time of trainingC. Busy schedules
Training characteristicsA. Content of
trainingB. Other participantsC. Mindfulness
teachers
A. Variety, shortbreathing space, parallel training
B. Sharingexperiences, recognistion
C. Attitude, expertise and understanding
A. Homework + reward system
B. Strong personalities, disturbingbehaviour
C. Not alwaysdirective enough
Participant characteristicsA. Personal
characteristicsB. View on
mindfulnessC. Child age
A. Feeling responsible, being social
B. Alternative formedication, ‘planting a seed’
A. ADHD symptoms, comorbidities
B. Aversion tomindfulnessexercises
C. Being too young
Feasibility Facilitators Barriers
Contextual factorsA. FamilyB. Time and locationC. Time investment
A. Parent and childare co-teachers
C. Spending qualitytime together
A. Interference withfamily structure
B. Time of trainingC. Busy schedules
Training characteristicsA. Content of
trainingB. Other participantsC. Mindfulness
teachers
A. Variety, shortbreathing space, parallel training
B. Sharingexperiences, recognistion
C. Attitude, expertise and understanding
A. Homework + reward system
B. Strong personalities, disturbingbehaviour
C. Not alwaysdirective enough
Participant characteristicsA. Personal
characteristicsB. View on
mindfulnessC. Child age
A. Feeling responsible, being social
B. Alternative formedication, ‘planting a seed’
A. ADHD symptoms, comorbidities
B. Aversion tomindfulnessexercises
C. Being too young
MindChamp qualitative: feasibility
“My child then says: ‘Mum, breathe.’ And that we then can talk about it, that we need a short break to calm down.”
![Page 32: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/32.jpg)
Feasibility Facilitators Barriers
Contextual factorsA. FamilyB. Time and locationC. Time investment
A. Parent and childare co-teachers
C. Spending qualitytime together
A. Interference withfamily structure
B. Time of trainingC. Busy schedules
Training characteristicsA. Content of
trainingB. Other participantsC. Mindfulness
teachers
A. Variety, shortbreathing space, parallel training
B. Sharingexperiences, recognistion
C. Attitude, expertise and understanding
A. Homework + reward system
B. Strong personalities, disturbingbehaviour
C. Not alwaysdirective enough
Participant characteristicsA. Personal
characteristicsB. View on
mindfulnessC. Child age
A. Feeling responsible, being social
B. Alternative formedication, ‘planting a seed’
A. ADHD symptoms, comorbidities
B. Aversion tomindfulnessexercises
C. Being too young
Feasibility Facilitators Barriers
Contextual factorsA. FamilyB. Time and locationC. Time investment
A. Parent and childare co-teachers
C. Spending qualitytime together
A. Interference withfamily structure
B. Time of trainingC. Busy schedules
Training characteristicsA. Content of
trainingB. Other participantsC. Mindfulness
teachers
A. Variety, shortbreathing space, parallel training
B. Sharingexperiences, recognistion
C. Attitude, expertise and understanding
A. Homework + reward system
B. Strong personalities, disturbingbehaviour
C. Not alwaysdirective enough
Participant characteristicsA. Personal
characteristicsB. View on
mindfulnessC. Child age
A. Feeling responsible, being social
B. Alternative formedication, ‘planting a seed’
A. ADHD symptoms, comorbidities
B. Aversion tomindfulnessexercises
C. Being too young
MindChamp qualitative: feasibility
“What I found very positive, is the possibility to exchange experiences with others. It made me think ‘Ah.. So I’m not crazy, it isn’t always our fault!”
![Page 33: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/33.jpg)
Feasibility Facilitators Barriers
Contextual factorsA. FamilyB. Time and locationC. Time investment
A. Parent and childare co-teachers
C. Spending qualitytime together
A. Interference withfamily structure
B. Time of trainingC. Busy schedules
Training characteristicsA. Content of
trainingB. Other participantsC. Mindfulness
teachers
A. Variety, shortbreathing space, parallel training
B. Sharingexperiences, recognistion
C. Attitude, expertise and understanding
A. Homework + reward system
B. Strong personalities, disturbingbehaviour
C. Not alwaysdirective enough
Participant characteristicsA. Personal
characteristicsB. View on
mindfulnessC. Child age
A. Feeling responsible, being social
B. Alternative formedication, ‘planting a seed’
A. ADHD symptoms, comorbidities
B. Aversion tomindfulnessexercises
C. Being too young
Feasibility Facilitators Barriers
Contextual factorsA. FamilyB. Time and locationC. Time investment
A. Parent and childare co-teachers
C. Spending qualitytime together
A. Interference withfamily structure
B. Time of trainingC. Busy schedules
Training characteristicsA. Content of
trainingB. Other participantsC. Mindfulness
teachers
A. Variety, shortbreathing space, parallel training
B. Sharingexperiences, recognistion
C. Attitude, expertise and understanding
A. Homework + reward system
B. Strong personalities, disturbingbehaviour
C. Not alwaysdirective enough
Participant characteristicsA. Personal
characteristicsB. View on
mindfulnessC. Child age
A. Feeling responsible, being social
B. Alternative formedication, ‘planting a seed’
A. ADHD symptoms, comorbidities
B. Aversion tomindfulnessexercises
C. Being too young
MindChamp qualitative: feasibility
“What my daughter found the most difficult, is that they scored the children. That another child got full marks and she didn’t. That was painful.”
![Page 34: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/34.jpg)
Feasibility Facilitators Barriers
Contextual factorsA. FamilyB. Time and locationC. Time investment
A. Parent and childare co-teachers
C. Spending qualitytime together
A. Interference withfamily structure
B. Time of trainingC. Busy schedules
Training characteristicsA. Content of
trainingB. Other participantsC. Mindfulness
teachers
A. Variety, shortbreathing space, parallel training
B. Sharingexperiences, recognistion
C. Attitude, expertise and understanding
A. Homework + reward system
B. Strong personalities, disturbingbehaviour
C. Not alwaysdirective enough
Participant characteristicsA. Personal
characteristicsB. View on
mindfulnessC. Child age
A. Feeling responsible, being social
B. Alternative formedication, ‘planting a seed’
A. ADHD symptoms, comorbidities
B. Aversion tomindfulnessexercises
C. Being too young
Feasibility Facilitators Barriers
Contextual factorsA. FamilyB. Time and locationC. Time investment
A. Parent and childare co-teachers
C. Spending qualitytime together
A. Interference withfamily structure
B. Time of trainingC. Busy schedules
Training characteristicsA. Content of
trainingB. Other participantsC. Mindfulness
teachers
A. Variety, shortbreathing space, parallel training
B. Sharingexperiences, recognistion
C. Attitude, expertise and understanding
A. Homework + reward system
B. Strong personalities, disturbingbehaviour
C. Not alwaysdirective enough
Participant characteristicsA. Personal
characteristicsB. View on
mindfulnessC. Child age
A. Feeling responsible, being social
B. Alternative formedication, ‘planting a seed’
A. ADHD symptoms, comorbidities
B. Aversion tomindfulnessexercises
C. Being too young
MindChamp qualitative: feasibility
“I think she is mentally too young. To understand what it was really about.”
![Page 35: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/35.jpg)
MindChamp qualitative: effects
![Page 36: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/36.jpg)
MindChamp qualitative: effects
“I keep getting better and better in seeing how he deals with things and what kind of help he needs.”
![Page 37: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/37.jpg)
MindChamp qualitative: effects
• Warmer relationships
• Conversations
• Fewer fights
![Page 38: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/38.jpg)
MindChamp qualitative: effects
“We realized that it is extremely important that we let her be herself and not always try to fit her in the perfect picture.”
![Page 39: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/39.jpg)
MindChamp qualitative: effects
“My dad and I are both really impulsive and explode easily. That happens a lot less now after the mindfulness training.”
![Page 40: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/40.jpg)
MindChamp qualitative: effects
• Attention
• Planning
• Keeping structure
![Page 41: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/41.jpg)
MindChamp qualitative: effects
![Page 42: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/42.jpg)
MindChamp qualitative: effects
![Page 43: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/43.jpg)
MindChamp qualitative: effects
• No adverse effects!
• All except one recommended training
![Page 44: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/44.jpg)
• MYmind mindfulness training is feasible
• Effects are diverse
• Quantification of group-level effects?
MindChamp qualitative: conclusions
![Page 45: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/45.jpg)
• New adequately-powered RCTs are under way!
Future directions mindfulness for ADHD: Quo vadis?
![Page 46: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/46.jpg)
• Dedication conference to innovative topic
• Role mindfulness ADHD intervention
• Important: Mindfulness goes beyond ADHD symptom reduction: it is about how a person deals with ADHD!
• Useful addition to care-as-usual
Future directions mindfulness for ADHD: Quo vadis?
![Page 47: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/47.jpg)
Future directions mindfulness for ADHD: Quo vadis?
• Mechanisms?
• Long-term effectiveness?• Optimal frequency, intensity and duration?• Role of mindfulness teacher?
• Role of parents?• Blinded outcomes• Include medication-naïve participants/ examine interaction
medication; – mindfulness; stand-alone intervention or enhance effects of other interventions
![Page 48: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/48.jpg)
• Best evidence for prevention of depression relapse
• Also consistent evidence for pain, smoking, addictions
Kuyken (2016) JAMA Psychiatry | Goldberg (2018) Clin Psychol Rev
Mindfulness for other psychiatric disorders
![Page 49: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/49.jpg)
Kuyken et al. (2016) JAMA Psychiatry
• 9 RCTs (N=1258)
• Control: care-as-usual, anti-depressants, cognitive-psychological
• 60-week follow-up
Meta-analysis: mindfulness for recurrent depression
![Page 50: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/50.jpg)
• 142 RCTs, N=12,005 participantsPost-treatment
• Most consistent evidence for depression, pain, smoking, addictionsGoldberg (2018) Clin Psychol Rev
Meta-analysis: RCTs mindfulness for psychiatric disorders
![Page 51: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/51.jpg)
• Adverse side effects
• Mild: becoming aware of symptoms can make people feel worse → typically perceived as therapeutic in long-term
• Severe: sleeplessness, addition to meditation, boredom, pain, transient meditation-induced psychosis → case reports, long-term meditators
• Well-trained mindfulness trainers• Certain disorders require extra care and handling
• Beyond passive monitoring: ‘Safety toolbox’: https://www.brown.edu/research/labs/britton/resources/meditation-safety-toolbox
Can mindfulness do more harm than good?
![Page 52: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/52.jpg)
Summary
• Mindfulness refers to the self-regulation of attention to the present moment, with an attitude of non-judgment, friendliness and curiosity
• Meta-analyses: Mindfulness effective in reducing ADHD symptoms.
• Larger effect sizes for a) adults, b) for inattentiveness
• Yet: higher quality studies are needed
• My qualitative results showed that mindfulness may be a useful addition to existing interventions by targeting effect-domains beyond ADHD symptoms (e.g., acceptance, family-child relationships, generalisation).
![Page 53: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/53.jpg)
www.mindchamp.nl | [email protected]
MindChamp team• Dr Corina Greven• Prof Dr Jan Buitelaar • Prof Dr Anne Speckens• Prof Dr Susan Bögels• Nienke Siebelink (PhD student)• Shireen van Rosmalen-Kaijadoe, Fylis van Horrsen,
Josanne Holtland (MindChamp qualitative)• Janneke Dammers, Noor de Waal (research
assistants)• Ilse Dijkman (current stagiaire) • MindChamp interns• C. Aarnink, M. Fokkema, A. v. Steekelenburg
(mindfulness trainers• Henrieke Loman, Esther Leuning, Carin Demmers,
Loes Vinkenvleugel, Annemieke Brinkman, Mireille Huvenaars-Bakker (co-trainers)
Funding• Horizon 2020 (MiND)• Fonds Psychische Gezondheid• Karakter
![Page 54: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/54.jpg)
Grazie per l'attenzione!
![Page 55: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/55.jpg)
![Page 56: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/56.jpg)
![Page 57: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/57.jpg)
![Page 58: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/58.jpg)
Satisfaction parents with mindfulness training
1% 2%
16%
58%
23%heel ontevreden
ontevreden
neutraal
tevreden
heel tevreden
![Page 59: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/59.jpg)
1. Feasibility of MBCT
▪ Barriers to participation and at-home practicing
▪ Facilitators to participation and at-home practicing
1. Effects of MBCT
▪ On children with ADHD
▪ On parents (of children with ADHD)
▪ Relational effects
▪ Medication
▪ Adverse effects
1. Re-joining/recommending the MBCT; why?
![Page 60: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/60.jpg)
Participants (n=47)
¨ Primary outcome missing (n=4)
Analysed (ITT and PP n=43)
Participants (n=53) ¨ Primary outcome missing (n=6; 1 NC)
Analysed (ITT n=47; PP n=45)
B. Not included after contact (n=401)1
¨ Not meeting inclusion criteria (n=98)
¨ Meeting exclusion criteria (n=17)
¨ Declined to participate (n=303)
¨ Other reasons4 (n=29)
2-month follow-up (n=100)
Assessed for eligibility (n=1565):
A. Patient file screened only (n=1060)
B. Contact with Family (n=505)
Enrollment
A. Not included after screening (n=1060)1
¨ Not meeting inclusion criteria (n=437)
¨ Meeting exclusion criteria (n=250)
¨ Not possible to contact2 (n=415)
¨ Other reasons3 (n=106)
8-week family-MBI:
¨ Completers (n=50)
¨ Non-completers (NC)5 (n=5)
Participants (n=54)
¨ Primary outcome missing (n=1, NC)
Analysed8 (ITT n=53; PP n=50)
Participants (n=48)
¨ Primary outcome missing (n=1)
Analysed (ITT and PP n=47)
Lost to follow-up
(n=7; 2 NCs)
Lost to follow-up
(n=1)
Randomly allocated to CAU + Mindfulness (n=55)
Randomly allocated to CAU only (n=49)
Drop-out6 (n=1, NC)
Excluded7 (n=1)
Lost to follow-up
(n=1, NC)
)
Lost to follow-up
(n=1)
)
Analysed (ITT n=46; PP n=45)
Analysed (ITT and PP n=46)
6-month follow-up (n=92)
Endpoint (n=102)
Baseline (n=104)
![Page 61: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/61.jpg)
Child/adolescent studies
![Page 62: Mindfulness-based intervention for ADHD...•4 mindfulness •3 yoga •Adults: 6 RCTs (n=339) •4 mindfulness-based intervention •1 dialectical therapy + meditation •1 CBT +](https://reader035.vdocuments.us/reader035/viewer/2022071214/60435ae07fbfdb26470c9ea8/html5/thumbnails/62.jpg)
Adult studies