Monday, December 15, 2014

Does Mindfulness Meditation Training Help Adults With ADHD?

Though yoga and consequential mindfulness and meditation practices were initially introduced to me to help with my insomnia, I wanted to pursue practice to help with my adult ADHD.  Since my ADHD is a big contributing factor to my insomnia, I knew it would be worth looking in to.  Yes, I might have hobby ADHD and in an effort to not let yoga, mindfulness practice, and meditation turn into something I fall in love with and abandon, I wanted to fully embrace and understand as much as I could and turn this into more than a hobby.  I wanted this to be a treatment.

The more I embrace this, the more I see that becoming a personal truth and I have absolute certainty that this is something that will stick with me.

To reinforce the effectiveness of yoga, mindfulness, and meditation on ADHD, I've set out to study it and found the following article both helpful and informative:

As aware­ness of ADHD in adults increases, so do efforts to develop effec­tive treat­ments for adults that can com­ple­ment, or sub­sti­tute for, med­ica­tion. One promis­ing treat­ment is mind­ful­ness med­i­ta­tion train­ing. In mind­ful­ness train­ing, indi­vid­u­als learn to ori­ent their atten­tion pur­pose­fully towards the present moment and to approach their one’s expe­ri­ence with curios­ity, open­ness, and acceptance.
Mind­ful­ness med­i­ta­tion may be par­tic­u­larly well-suited to address ADHD in adults because it focuses on pro­mot­ing the reg­u­la­tion of atten­tion. Prior stud­ies also sug­gest that mind­ful­ness train­ing can enhance aspects of exec­u­tive func­tion­ing and may con­tribute to bet­ter emo­tion reg­u­la­tion, areas where many adults with ADHD struggle.
A study recently pub­lished online in the Jour­nal of Atten­tion Dis­or­ders, A pilot trial of mind­ful­ness med­i­ta­tion train­ing for ADHD in adult­hood: Impact on core symp­toms, exec­u­tive func­tion­ing and emo­tion dys­reg­u­la­tion, pro­vides the most rig­or­ous inves­ti­ga­tion to date of mind­ful­ness med­i­ta­tion train­ing for adults with ADHD.
Twenty-two adults with ADHD (aver­age age 38, 12 females) were ran­domly assigned to an 8-week group-based mind­ful­ness med­i­ta­tion train­ing pro­gram or a wait-list con­trol con­di­tion. This ran­dom assign­ment method­ol­ogy had not been uti­lized in ear­lier research on this approach and rep­re­sents an impor­tant strength of the study. Nearly all par­tic­i­pants were on ADHD med­ica­tion and con­tin­ued with their treat­ment dur­ing the study.
Mind­ful­ness Training
Each ses­sion last 2.5 hours and was sup­ple­mented with daily at-home prac­tice. Weekly ses­sions began with a brief open­ing med­i­ta­tion, fol­lowed by a dis­cus­sion of in-home prac­tice, intro­duc­tion of new exer­cises and prac­tice, a review of at-home prac­tice for the upcom­ing week, and a clos­ing med­i­ta­tion. As noted above, the over­all goal of mind­ful­ness train­ing is to help indi­vid­u­als learn to ori­ent their atten­tion pur­pose­fully towards the present moment and to approach their one’s expe­ri­ence with curios­ity, open­ness, and acceptance.
You can learn more about this approach, and read an inter­est­ing inter­view with the psy­chol­o­gist who devel­oped the pro­gram, here.
To eval­u­ate the impact of mind­ful­ness train­ing, mul­ti­ple mea­sures were col­lected from inter­ven­tion and con­trol par­tic­i­pants before treat­ment began, dur­ing sev­eral days in the 8-week pro­gram, and imme­di­ately after treat­ment ended. These mea­sures are sum­ma­rized below.
Core ADHD symt­poms — Adults com­pleted an ADHD symp­tom rat­ing scale in which all 18 core symp­toms of ADHD were rated. They also rated the extent to which ADHD symp­toms were impair­ing their func­tion­ing in dif­fer­ent domains, e.g., work, rela­tion­ships, etc. Rat­ings of core symp­toms were also obtained from trained clin­i­cians who inter­viewed par­tic­i­pants before and after treatment.
Exec­u­tive func­tion­ing (EF) — Rat­ings of EF were col­lected using the Deficits in Exec­u­tive Func­tion­ing Scale (DEFS) and the Behav­ior Rat­ing Inven­tory of Exec­u­tive Func­tion­ing– Adult Ver­sion (BRIEF-A). Items on the DEFS and the BRIEF-A assess mul­ti­ple aspects of exec­u­tive func­tion­ing includ­ing self-management, self-organization, self-discipline, self-motivation, self-regulation of emo­tion, work­ing mem­ory, behav­ioral inhi­bi­tion, plan­ning skills, etc. As with core ADHD symp­toms, EF rat­ings were also obtained from clinicians.
Emo­tion Dys­reg­u­la­tion — Emo­tion dys­reg­u­la­tion was assessed via the Dif­fi­cul­ties in Emo­tion Reg­u­la­tion Scale (DERS), a 36-item scale that assesses how often var­i­ous types emo­tion­ally dys­reg­u­lated behav­ior occurs. A sec­ond scale — the Dis­tress Tol­er­ance Scale — was also admin­is­tered. These scales were com­pleted by par­tic­i­pants only.
Eco­log­i­cal Momen­tary Assess­ment (EMA) — A novel fea­ture of this study was the use of an expe­ri­ence sam­pling strat­egy in which hand-held com­put­ers were used to obtain adults’ratings of their ADHD symp­toms and EF dur­ing 2 days in the first and last week of the study. The com­puter was pro­grammed to beep at ran­dom inter­vals dur­ing these days; the beep prompted par­tic­i­pants to indi­cate their cur­rent sit­u­a­tion, affect, and to rate their level of ADHD and EF symp­toms. This tech­nique pro­vides a valu­able addi­tion to the typ­i­cal rat­ing scale data by obtain­ing repeated assess­ments of indi­vid­u­als in their nor­mal daily environment.
Lab­o­ra­tory assess­ments of EF — In addi­tion to the self– and clin­i­cian report mea­sures sum­ma­rized above, a num­ber of lab­o­ra­tory tasks were included to mea­sure dif­fer­ent aspects of EF. These included a com­put­er­ized test of atten­tion, an assess­ment of work­ing mem­ory, as well as sev­eral other objec­tive assessments.
Core ADHD symp­toms — Com­pared to con­trol par­tic­i­pants, adults who received mind­ful­ness med­i­ta­tion train­ing reported sta­tis­ti­cally sig­nif­i­cant and clin­i­cally mean­ing­ful declines in core ADHD symp­toms, both inat­ten­tive symp­toms and hyperactive-impulsive symp­toms. Nearly 64% of adults receiv­ing treat­ment reported at least a 30% decline in inat­ten­tive and hyperactive-impulsive symp­toms com­pared to 0% in the con­trol group. Inter­ven­tion par­tic­i­pants also reported sig­nif­i­cant reduc­tions in the impair­ment caused by ADHD symp­toms. Rat­ings pro­vided by clin­i­cians were con­sis­tent with adults’ self-reports as were rat­ings obtained via the expe­ri­ence sam­pling method­ol­ogy described above.
Exec­u­tive Func­tion­ing — Adults receiv­ing mind­ful­ness treat­ment reported sig­nif­i­cant gains in mul­ti­ple EF domains rel­a­tive to con­trol par­tic­i­pants. These included gains in self-management, self-organization, and self-discipline. Clin­i­cians who inter­viewed inter­ven­tion and con­trol par­tic­i­pants reported sim­i­lar gains for the for­mer. How­ever, no treat­ment group dif­fer­ences were found for lab­o­ra­tory mea­sures of EF.
Emo­tion Dys­reg­u­la­tion — Inter­ven­tion par­tic­i­pants reported sig­nif­i­cant gains in their abil­ity to reg­u­late emo­tions and tol­er­ate dis­tress. The mag­ni­tude of group dif­fer­ences would be con­sid­ered large.
Fea­si­bil­ity and Sat­is­fac­tion — The mind­ful­ness treat­ment was fea­si­ble to imple­ment and highly accept­able to par­tic­i­pants. Inter­ven­tion adults attended nearly 90% of sched­uled ses­sions and the aver­age treat­ment sat­is­fac­tion rat­ing was 5.91 on a 7 point scale; this reflects a high degree of sat­is­fac­tion. Nearly all par­tic­i­pants felt con­fi­dent that they would con­tinue to use the tech­niques they had been taught.
Sum­mary and Implications
Results from this study sug­gest that mind­ful­ness med­i­ta­tion train­ing for adults with ADHD holds sig­nif­i­cant promise. Par­tic­i­pants attended nearly all ses­sions, were quite sat­is­fied with the treat­ment, and reported gains rel­a­tive to con­trol sub­jects on a vari­ety of mea­sures. This included core ADHD symp­toms, mul­ti­ple aspects of EF, and the abil­ity to reg­u­late affect and tol­er­ate dis­tress. These gains were echoed in rat­ings pro­vided by clin­i­cian interviewers.
The only mea­sures for which treat­ment related improve­ments were not evi­dent was lab­o­ra­tory assess­ments of exec­u­tive func­tion­ing. This may reflect the fact that lab­o­ra­tory assess­ments of EF do not accu­rately cap­ture the daily deficits in EF that adults with ADHD expe­ri­ence. Because most adults were tak­ing med­ica­tion dur­ing the study, there may also have been lim­ited room for improve­ment on these mea­sures. On the other hand, because these were the only ‘objec­tive’ mea­sures col­lected in the study, the null find­ings raise ques­tions as to whether the self– and clin­i­cian report data accu­rately reflects changes that actu­ally occurred.
Although these are promis­ing results, the study has sev­eral lim­i­ta­tions that are impor­tant to rec­og­nize. First, the sam­ple is rel­a­tively small and repli­cat­ing the find­ings with a larger sam­ple would be important.
Sec­ond, pos­i­tive find­ings were obtained only for self-report mea­sures and for rat­ings pro­vided by clin­i­cians who were aware of par­tic­i­pants’ sta­tus. This is akin to test­ing a new ADHD med­ica­tion when every­one rat­ing par­tic­i­pants is aware that they took med­ica­tion. The study would have been strength­ened had clin­i­cians been blind to treat­ment vs. con­trol sta­tus and if infor­ma­tion had also been obtained from par­tic­i­pants’ spouses or other adults who knew them well.
It should also be noted that the com­par­i­son group was adults in wait­list con­trol con­di­tion rather than an active con­trol con­di­tion. As a result, whether it was mind­ful­ness train­ing specif­i­cally that con­tributed to the appar­ent treat­ment gains, or sim­ply the extra atten­tion that treat­ment par­tic­i­pants received, can­not be deter­mined with any certainty.
While these lim­i­ta­tions will be impor­tant to address in future work, find­ings from this study add to a grow­ing lit­er­a­ture point­ing towards the ben­e­fits of mind­ful­ness train­ing for adults with ADHD. The results cer­tainly sup­port the value of con­duct­ing a larger, randomized-controlled trial that addresses the lim­i­ta­tions noted above. Hope­fully, results from such a study will be avail­able shortly.

David Rabiner Attention Research Update– Dr. David Rabiner is a child clin­i­cal psy­chol­o­gist and Direc­tor of Under­grad­u­ate Stud­ies in the Depart­ment of Psy­chol­ogy and Neu­ro­science at Duke Uni­ver­sity.  His research focuses on var­i­ous issues related to ADHD, the impact of atten­tion prob­lems on aca­d­e­mic achieve­ment, and atten­tion train­ing.  He also pub­lishes Atten­tion Research Update, a com­pli­men­tary online newslet­ter that helps par­ents, pro­fes­sion­als, and edu­ca­tors keep up with the lat­est research on ADHD.

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