Mindfulness is the practice of purposefully paying attention to the present moment without judgment. It involves meditation techniques that train awareness and attention.
Research shows mindfulness can help people better regulate behavior, emotions, and thought patterns.
By focusing the mind, it allows individuals to consciously respond to maladaptive impulses contributing to conditions like depression, anxiety, chronic pain, and ADHD. Practiced regularly, mindfulness skills enable people to calmly face daily stresses.
Kretschmer, C. R., Göz Tebrizcik, B., & Dommett, E. J. (2022). Mindfulness Interventions for Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-Analysis. Psychiatry International, 3(4), 363-399. https://doi.org/10.3390/psychiatryint3040031
Key Points
- Mindfulness interventions may benefit those with ADHD, but high-quality studies are still needed.
- Potential benefits include reduced ADHD symptoms, improved executive function, emotional regulation, quality of life, and self-compassion.
- Effects varied by age, with more evidence of benefit in adults than children.
- Limitations of current research include poor study quality, small samples, and lack of active control groups.
- Future research should use randomized controlled trials with blind assessment, appropriate controls, and longer follow-ups.
Rationale
Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by inappropriate levels of inattention, hyperactivity, and impulsivity.
It impacts children and adults and is associated with difficult relationships, poor school performance, increased injuries, illegal drug use, risky sexual behaviors, and unemployment.
Treatments have limitations – medications have considerable side effects, and psychosocial interventions require extensive trained staff. Alternative approaches, like mindfulness, are of interest as they are less staff-dependent and easier to integrate into daily life (Roberts & Neece, 2015).
Mindfulness has been proposed to target deficits seen in ADHD. Whilst reviews have examined mindfulness in ADHD, most focus on core symptoms or single ages (Barranco-Ruiz et al., 2019; Poissant et al., 2019).
This review aimed to provide a comprehensive analysis of mindfulness interventions for ADHD, considering a broad range of outcomes across children and adults.
Method
The authors systematically searched 5 databases using PRISMA guidelines. They included randomized controlled trials (RCTs), non-randomized controlled trials, and pre-post studies with participants who had an ADHD diagnosis or elevated symptoms.
Outcomes had to include scale or cognitive/behavioral measures of core symptoms, global/social functioning, or quality of life.
Study quality was assessed using NIH tools. Effect sizes (Hedge’s g) were calculated, and meta-analyses were conducted.
In total 22 studies were included containing data from 1237 individuals with ADHD (age range 7-65 years) and 525 parents. Diagnoses were made using DSM or ICD criteria, besides 2 studies.
Common comorbidities were permitted, but psychosis, bipolar disorder, and substance dependence were typically exclusion criteria. Most allowed stable medication use alongside mindfulness interventions.
Results
Evidence suggests mindfulness interventions may provide benefits across outcomes.
Considering core symptoms, scale measures indicated reduced inattentive symptoms in adults and children, with larger effects when parents provided ratings of children.
Some objective tests, like the continuous performance test, revealed decreased commission errors, indicating reduced impulsivity.
For other tasks, results varied. Executive function scales showed improvements in adults, but findings were inconsistent in children. Emotional regulation also seemed to benefit based on scale measures.
Wider health impacts were also indicated with improved quality of life and self-compassion in adults with ADHD, reduced anxiety and depressive symptoms in adults, and increased well-being in children and parents after mindfulness interventions. However, many studies also saw effects in control groups.
Insight
This comprehensive systematic review provides extensive insight into the effects of mindfulness interventions for ADHD across cognitive and health-related outcomes.
It demonstrates that mindfulness could provide benefits beyond core ADHD symptoms, like emotional dysregulation, but highlights that findings vary considerably by age and measure used.
The review emphasizes that whilst popular, mindfulness interventions do not yet have an extensive evidence base and lack high-quality trials.
The authors identified issues around small samples, failure to consider comorbidities and use of control groups that make it difficult to attribute effects specifically to mindfulness.
They provide guidance for improving research quality through appropriate controlled trials and stress the need for further work, especially around long-term impacts. This will inform whether mindfulness should be more routinely recommended alongside standard ADHD care.
Strengths
This review had several key methodological strengths:
- A comprehensive search strategy was used, incorporating five major research databases and following PRISMA guidelines. This reduces the chance of missing relevant papers.
- Study quality and risk of bias were formally assessed using validated NIH tools. Poor-quality studies were excluded to improve the validity of conclusions. This overcomes a common limitation in reviews.
- Effect sizes were calculated to allow quantitative analysis of results across the range of different outcomes measured. This provides a more robust data synthesis.
- Where possible, meta-analyses were conducted to statistically combine data and strengthen the conclusions. This accounts for varying sample sizes and variance between studies.
- The review looked beyond core ADHD symptoms to examine wider health impacts on quality of life, emotional regulation, well-being, etc. This provides a more comprehensive understanding of potential mindfulness benefits.
- The inclusion of child, adult, and family-based studies allows a lifespan perspective. It facilitates analysis of whether effects differ across age groups.
Limitations
However, there were also several limitations that restrict the implications of this review:
- In general, the quality of the included studies was poor. There were risks of bias due to issues like small sample sizes, lack of power calculations, inadequate randomization, and blinding. This reduces the reliability of individual study results.
- Sample sizes were often small across studies. There was also a lack of power calculations reported to determine if these samples were statistically adequate. This increases the chance of type II errors.
- Many studies failed to properly randomize participants into groups or conceal allocation. This raises the risk of selection bias.
- Blinding of participants to the intervention condition was not possible, given the nature of mindfulness. However, researcher blinding for outcome assessments was also rarely employed. This could bias results.
- There was considerable heterogeneity between studies in their methods, measures, and populations. This meant meta-analyses could generally not be run, limiting stronger conclusions.
- Active control groups were rarely used to account for non-specific effects like expectation, support, placebo, etc. This means positive results may not be fully attributable to mindfulness itself.
- Follow-up periods were short, with the maximum follow-up being 8 months. This provides limited data on whether apparent benefits are maintained long-term.
Implications
These results indicate mindfulness could provide a range of benefits for those with ADHD across cognitive, emotional, and behavioral domains. This is encouraging, given limitations around side effects and the availability of standard ADHD treatments.
However, better trials are imperative before clinical recommendations can be made, especially for child populations where less evidence currently exists.
Researchers should build on these findings using methodologically rigorous designs – randomized, double-blind controlled trials with active and non-active controls, concealed allocation, blind outcome assessment, and appropriate follow-ups spanning at least 6 months.
Comparing mindfulness to gold-standard treatments would also inform whether it should be an adjunct or alternative option. Replication with larger, more diverse samples is needed, along with better characterization of medication status and comorbidities.
References
Primary reference
Kretschmer, C.R., Göz Tebrizcik, B., & Dommett, E.J. (2022). Mindfulness interventions for attention deficit hyperactivity disorder: A systematic review and meta-analysis. Psychiatry International, 3(4), 363-399. https://doi.org/10.3390/psychiatryint3040031
Other references
Barranco-Ruiz, Y., Esturo Etxabe, B., Ramírez-Vélez, R., & Villa-González, E. (2019). Interventions based on Mind–Body therapies for the improvement of Attention-Deficit/Hyperactivity Disorder symptoms in youth: A systematic review. Medicina, 55(7), 325. https://doi.org/10.3390/medicina55070325
Poissant, H., Mendrek, A., Talbot, N., Khoury, B., & Nolan, J. (2019). Behavioral and cognitive impacts of mindfulness-based interventions on adults with attention-deficit hyperactivity disorder: A systematic review. Behavioural neurology, 2019. https://doi.org/10.1155/2019/5682050
Roberts, L. R., & Neece, C. L. (2015). Feasibility of mindfulness-based stress reduction intervention for parents of children with developmental delays. Issues in mental health nursing, 36(8), 592-602.
Keep Learning
Here are some suggested Socratic questions for students to critically analyze and discuss this research paper further:
- What might account for the differences in findings between adults and children? What developmental factors could be relevant?
- How could we improve the methodology of mindfulness trials to provide more conclusive results?
- If findings continue to show promise for mindfulness in ADHD, how should it be positioned alongside existing treatments? As an alternative? An adjunct?
- What processes might mindfulness target to improve outcomes like emotional dysregulation? Can we identify biological mechanisms of change?
- Are there any ethical issues around withholding mindfulness interventions if they seem beneficial or providing them if effects remain uncertain?
- Beyond randomized trials, what other evidence could support the use of mindfulness for ADHD in real-world settings?
