Mindfulness Therapy Promising for ADHD in Children

Michael Vlessides

October 16, 2019

CHICAGO ― A mindfulness-based intervention appears feasible, acceptable, and effective in children with attention-deficit/hyperactivity disorder (ADHD), early research suggests.

In fact, preliminary results from the Mindfulness-Based ADHD Treatment for Children (MBAT-C) pilot study are so encouraging that the National Institutes of Health has funded the next phase of the investigation ― a three-arm, randomized controlled trial comparing the mindfulness-based intervention with a medication-only intervention and a combined mindfulness-medication intervention.

"Although these are very preliminary measures of efficacy, we nonetheless found them very interesting," said David C. Saunders, MD, PhD, a clinical fellow at the Yale University Child Study Center in New Haven, Connecticut. "Then again, with an N of nine, how much can you really claim about efficacy?"

The findings were published online in the October issue of the Journal of Child and Adolescent Psychiatry and were presented here at the American Academy of Child & Adolescent Psychiatry (AACAP) 66th Annual Meeting.

Challenges in Kids

Although ADHD medications are effective, their use is limited by a variety of side effects. Previous research has shown that mindfulness improves attention in both children and adults with ADHD, Saunders noted.

In two previous small studies in teenagers with ADHD, preliminary evidence indicated efficacy of mindfulness therapies. However, said Saunders, there are currently no standardized interventions for children with ADHD, and the efficacy of mindfulness therapy has not been rigorously studied in pediatric patients.

"People outside the clinical world and meditation world who hear about this study invariably ask me, 'How on earth are you going to teach 7- to 11-year-old kids with ADHD mindfulness? That sounds crazy,' " Saunders said. "And in some ways, I think they're right. But fortunately, there is some early evidence to suggest that mindfulness is a worthwhile treatment to pursue."

In addition, parents of the children with ADHD have regularly expressed a willingness to explore mindfulness practices as a way of treating the disorder. Mindfulness appears to induce structural and functional changes in brain regions implicated in ADHD.

The single-arm pilot study included 16 twice-weekly, 30-minute mindfulness sessions, with an average of two instructors for every five participants. The study included nine children aged 7 through 11 years.

The first session was an introduction to the course and its associated mindfulness practices. Sessions two through six focused on mindfulness of body, and sessions seven through 11 focused on mindfulness of the mind. Sessions 12 to 15 targeted mindfulness of community, and the last session served as a review of the course.

The primary aim of the MBAT-C trial was to finalize the intervention manual, which dictates the nature and structure of the mindfulness-intervention program, for subsequent research.

The researchers finalized the MBAT-C manual through focus groups and feedback from participants and parents. In doing so, they identified the ideal sequence of meditation practices, discussion topics, and logistical considerations.

High Engagement

The investigators also evaluated the program's feasibility, as measured by attendance, retention, homework completion, and engagement.

The third goal was to estimate the program's preliminary efficacy, as measured by multiple objective and subjective indices of ADHD symptoms, including attention, behavior, executive function, and clinical severity by self-report, parent report, and neuropsychiatric assessment.

The results exceeded pretrial benchmarks in several indices of feasibility and acceptability, including attendance, retention, homework completion, and engagement.

"Kids came to 86.8% of the classes, which we thought was pretty remarkable. It's a simple finding, but we thought it pretty remarkable, given the difficult circumstances that a lot of these kids come from," said Saunders.

Patients experienced improvements in multiple subjective and objective indices of ADHD symptoms. On the ADHD Rating Scale, scores decreased from 33.43 to 25.29.

Scores on the Child Behavior Checklist (CBCL)–Attention Problem subscale also improved, from 10.43 to 8.14. Children also demonstrated improvements with regard to the CBCL-DSM5 attention scale, for which scores improved from 9.14 to 7.57.

Working memory, as assessed by the NIH Toolbox List Sorting Working Memory Test, also improved.

On the other hand, several measures showed no improvement. These included objective measures of sustained attention, executive function, and non-attention-related outcomes in the CBCL, such as depression and anxiety.

Saunders was quick to note that the results of the pilot study were not robust enough to demonstrate efficacy of the mindfulness program. However, he was encouraged by the early findings.

"We recently received a grant from the NIH to study this intervention on a broader scale. There will be approximately 45 participants, with 15 in each group, and this will be the first-ever randomized controlled trial to compare mindfulness vs medication in children. So we're pumped," said Saunders.

Frontline Research

Commenting on the study for Medscape Medical News, Jim Hudziak, MD, who served as the session discussant, acknowledged the importance of the work.

"Dr Saunders is part of a phenomenal team that understands the importance of doing careful research," said Hudziak, who is the creator and director of the University of Vermont's Wellness Environment.

"Furthermore, he's doing his research in a very ecologically valid way. He's not doing it in a population of privileged children; he's not doing it in a group where you would necessarily expect it to work. He's doing it in the trenches," he added.

Hudziak added that any mindfulness intervention program that targets children must also target their parents. "No matter what you do for a kid, if that kid is going home to chaos, it's undone," he said.

The research was supported by the AACAP Pilot Research Award for General Psychiatry Residents, Pfizer Inc, and Arbor Pharmaceuticals, LLC. The investigators and Hudziak have disclosed no relevant financial relationships.

American Academy of Child & Adolescent Psychiatry (AACAP) 66th Annual Meeting. Presented October 15, 2019.

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