Mindfulness meditation for people with ADHD? It may seem like a stretch, since difficulty with mindfulness is the very challenge for those with attention deficit hyperactivity disorder. And yet recent research shows that mindfulness training can be adapted for this condition and that it can improve concentration. Various clinicians and educators are already teaching mindfulness to people with ADHD as well as to overly stressed school children.
Scientists have been trying for several decades to understand how attention works. Recent studies on mindfulness and attention have demonstrated that with a little work, participants can develop greater ability to focus and self-regulate.
Lidia Zylowska, M.D, a psychiatrist and founding member of the Mindful Awareness Research Center (MARC), Susan Smalley, Ph.D, professor of psychiatry and director of MARC, and colleagues at the University of California-Los Angeles have investigated the effects of the Mindful Awareness Practices for ADHD (MAP) program with 25 adults and 8 adolescents. (Eighteen adults and seven adolescents finished the program). Self-report and other measurements demonstrated “that it is feasible to teach people with ADHD mindfulness. On the surface it looks like a contradiction, but if you look at it, if you look at the nature of self-regulation, it’s not,” says Zylowska.
How the MAPs for ADHD Program Works
The team at UCLA MARC tailored a mindfulness program to make it more gradual and flexible for people with ADHD. Participants started meditating for just five minutes at a time and increased slowly to 20 minutes. If they found it too difficult to sit, they could choose to do mindful walking instead.
The MAPs for ADHD program uses visual aids because people with ADHD tend to be visual learners. For example, the trainers used the picture of the blue sky to explain what mindful awareness is. The blue sky represents the space of awareness, and the clouds represent all the thoughts, feelings, and sensations that pass by. The participants learn to observe their inner experience from a witnessing and nonjudgmental stance. In addition, the educational component of the program addresses some of the self-esteem issues of people with ADHD. It emphasizes observing negative emotional states without identifying with them and with practicing positive emotions. The later was done by a common mindfulness practice called “lovingkindness meditation,” which involves wishing well to self and others.
“Mindfulness starts with attention, and that skill is applied to increase awareness of thoughts, emotions and behaviors. In this way mindfulness also leads to increased choice,” says Zylowska. At the heart of training are two steps:
- focusing on the present moment;
- having an attitude of openness, curiosity and acceptance (i.e., being nonjudgmental).
These two steps are practiced during meditation and throughout the day. In this way, students of mindfulness learn to pay attention to patterns and to subtle changes that happen moment to moment. For example, says Zylowska, a person might notice they interrupt a lot when they are talking with someone. Once they have become more aware of their urge to interrupt, they may choose not to do it the next time the impulse arises.
The majority of participants in the MARC study rated the training highly and reported improvement in attention and hyperactivity. A battery of tests given before and after to measure cognitive impairment and attention showed improvement in conflict attention and some of the inhibition-implying measures, though working memory wasn’t strongly affected. The “conflict” aspect of attention—the ability to stay focused despite distractions– showed the biggest improvement, said Zylowska. These initial findings are encouraging, she says, but the pilot study focused on program development and feasibility outcomes and did not have a control group. More research is needed to validate these initial findings in a controlled study.
Other Programs and Research
Because of her previous research at MARC and current clinical work with adults with ADHD in her private practice, Zylowska often serves as a consultant to other researchers. “Interest in mindfulness applications for ADHD is getting to be a trend,” she says. “More and more clinicians and researchers are realizing the usefulness of this approach for ADHD and individuals and their families.”
Research relevant to mindfulness and ADHD is happening at several universities in the United States and abroad. Some are using MARC’s MAPs for ADHD program, others apply the Mindfulness Based Stress Reduction program developed by Jon Kabat-Zinn at the University of Massachusetts, and others are developing new mindfulness programs. For example, there is an ongoing study adapting the UCLA program for children with ADHD at Deakin University in Australia, and Amishi Jha at University of Pennsylvania is looking into the effects of mindfulness on attention and working memory.
Nirbhay N. Singh, a professor of psychiatry at Virginia Commonwealth University and director of the Commonwealth Institute for Child and Family Studies, Richmond, Va., and his colleagues performed a study at ONE Research Institute in Midlothian, Va., on two mothers of children with ADHD. The mothers underwent mindfulness training. Their behavior toward their children subsequently changed, resulting in better compliance from their children. When the children were given similar training, compliance increased, and it was maintained during followup. The mothers reported increases in satisfaction with the interactions with their children and happiness with parenting.
A study with direct applications for ADHD by Susan Smalley of MARC and Lisa Flook, Ph.D, research scientist at the Center for Investigating Healthy Minds, at the University of Wisconsin-Madison, examined an InnerKids program on mindfulness and effects on behavior and executive function in elementary school children. Executive function is the ability to organize behavior, plan things sequentially, hold attention on a task and follow it. The study, published in the Journal of Applied School Psychology, showed that mindfulness improved executive function in the children, particularly those who started out with lower executive functioning.
These studies show that the field of mindfulness research in ADHD and the effects of mindfulness practice on attention is growing. It is also true that research on applications of mindfulness for other mental health conditions is underway. Smalley and Diana Winston, director of Mindfulness Education at MARC, recently published Fully Present: The Science, Art, and Practice of Mindfulness. It explains the science of mindfulness and its affects on attention, ADHD, and a range of applications such as coping with pain, negative emotions, and enhancing happiness.
Mindfulness Applications in the Field
As the research on mindfulness and attention proliferates, clinicians and educators are seeking ways to apply it in practice. In her private practice in west Los Angeles, Zylowska is involved in teaching adults with ADHD as well as other clinicians working with this population how to use mindfulness for ADHD. Her website, listed below, has an overview of the MAPs for ADHD program as well as a compact disc, “Mindful Solutions for Adult ADD/ADHD,” which provides ADHD education and mindfulness practices similar to those used in the MAPs for ADHD study.
In addition, mindful awareness training often is conducted in education centers and yoga studios. Though they do not always gdirectly address ADHD, they help people who have learning and emotional challenges as well as trouble with focus or concentration. For example, Susan Kaiser Greenland, founder of InnerKids in Los Angeles, is a former corporate lawyer who has worked with children ages 4 to 12 since 2000. She is actively writing and speaking about mindfulness training for children. Greenland says on the InnerKids website that mindfulness helps children deal with stress and intellectual challenges. Jennifer Cohen at Little Flower Yoga in New York City has used yoga and mindfulness (through guided imagery) to help children with physical and learning challenges. She has been a presenter at the Center for Mind Body Medicine’s Mindfulness in Education conference (Omega Institute, New York, August, 2010).
Mindfulness can help everyone in today’s hectic world, Zylowska said. “There are a lot of ways to be distracted, and we can all apply mindfulness. The key is to use mindfulness in daily life by checking where your attention is as you are doing routine activities. If you notice yourself distracted or lost in thinking, gently bring the attention to the present moment. The returning to the present moment is what trains attention. This technique is also very helpful for dealing with stress and emotional overwhelm.”
For more information, see these websites:
Mindfulness and Psychotherapy
Mindful Awareness Research Center
Lidia Zylowska, MD (author site)
Center for Mindfulness in Medicine, Health Care and Society
The Inner Kids Foundation
Susan Kaiser Greenland (author site)
Yoga Service Council
Jha, A.P., Stanley, Elizabeth A., Kiyonaga, A., Wong, L., Gelfand, L (2010). Examining the Protective Effects of Mindfulness Training on Working Memory Capacity and Affective Experience of Emotion. Emotion, Vol. 10, No. 1, 54–64
Flook L., Smalley S.L., Kitil, M.J., Galla, B., Kaiser-Greenland, S., Locke, J., Kretzmann M., Ishijima, E., Kasari, C (2010). Mindful Awareness Practices Improve Executive Function in Elementary School Children. Journal of Applied School Psychology, Vol. 26, No. 1, 70-95.
Singh, N. N., Singh, A. N., Lancioni, G. E., et al. (2010). Mindfulness training for parents and their children with ADHD increases the children’s compliance. Journal of Child and Family Studies, Vol. 19, No. 2, 15.
Zylowska, L., Ackerman, D. L., Yang, M. H., Futrell, J. L., Horton, N. I., Hale, S., et al. (2008). Mindfulness meditation training in adults and adolescents with ADHD: A feasibility study. Journal of Attention Disorders, 11(6), 737-746.
Zylowska L, Smalley SL: Mindful Awareness for ADHD. In Mindfulness and its Clinical Applications Didonna F (ed). Springer, 2008.