The impact of mindfulness education on elementary school students: Evaluation of the Master Mind Program

Mindfulness-based interventions for preadolescent children: A comprehensive meta-analysis

Among the many social and emotional learning (SEL) interventions available, mindfulness-based interventions (MBIs) have become increasingly popular, particularly for preadolescent children who were once thought to not possess the metacognitive abilities or cognitive resources to benefit from such training. Although previous research syntheses indicate that MBIs show promise in promoting positive outcomes across a range of domains, the effectiveness of MBIs for preadolescent children may be masked by the effects of older children who have comprised the majority of samples in past meta-analyses. Hence, to better understand the impact of mindfulness-based training on preadolescent children (ages 6-12 years), the present study reviewed treatment effect estimates across a range of outcomes, including mindfulness, attention, metacognition and cognitive flexibility, emotional and behavioral regulation, academic achievement and school functioning, positive emotion and self-appraisal, negative emotion and subjective distress, externalizing problems, internalizing problems, social competence and prosocial behavior, and physical health. Thirty-two studies (nparticipants = 3640) were identified and included in a random-effects meta-analyses. The results from multiple meta-analytical analyses conducted in the present study suggest that preadolescents have experienced significant benefits across attention, emotional and behavioral regulation, positive emotion and self-appraisal, and social competence and prosocial behavior (g = 0.19 to 0.39). However, the overall effect was deemed small (g = 0.34). Due to the lack of comparison studies with SEL interventions, it remains unclear whether MBIs are as effective as traditional approaches in promoting healthy development and academic achievement for preadolescent children. Additionally, results from the present meta-analysis suggest various recommendations for future studies to ensure a continued growth in understanding how MBIs can be used with children.

Rural sixth-grade teachers' and students' perceptions of a mindfulness-based mental health curriculum

Introduction

Mindfulness-based interventions (MBIs) have the potential to improve students' mood, behavior and cognitive functioning; yet, little is known about the feasibility and acceptability of adapting such programs for rural middle schools.

Methods

An exploratory qualitative evaluation was conducted to examine the feasibility and acceptability of an initial trial delivery of AttuneEd®, a trauma-informed, mindfulness-based mental health curriculum. In this single-group design study, 10 weekly lessons were taught in a middle school located in a rural town in the pacific northwest during 6th grade students' P.E. classes. Three P.E. teachers, 26 6th grade teachers, and one school counselor attended trainings before and mid-curriculum implementation, where they provided qualitative feedback. A total of 160 students completed acceptability surveys before and after curriculum delivery.

Results

Three themes were identified from qualitative data: cultural considerations, teacher self-efficacy, and barriers and facilitators to student acceptability. Student acceptability ratings were high. Students reported, on average, that the classes helped them better understand themselves and others.

Conclusion

Some identified needs for future MBIs include (1) the need for culturally sensitive, trauma-informed delivery strategies; (2) teachers' desire for more support in content delivery; and (3) students' desire to have their own teachers deliver the curriculum. Findings elucidate the nuances associated with implementing an MBI in a rural middle school and have notable implications for development, scalability, and sustainability.

A translational application of music for preschool cognitive development: RCT evidence for improved executive function, self-regulation, and school readiness

The benefits of active music participation and training for cognitive development have been evidenced in multiple studies, with this link leveraged in music therapy approaches with clinical populations. Although music, rhythm, and movement activities are widely integrated into children's play and early education, few studies have systematically translated music therapy-based approaches to a nonclinical population to support early cognitive development. This study reports the follow-up effects of the Rhythm and Movement for Self Regulation (RAMSR) program delivered by generalist preschool teachers in low socioeconomic communities. This randomized control trial (RCT) involved 213 children across eight preschools in disadvantaged communities in Queensland, Australia. The intervention group received 16-20 sessions of RAMSR over 8 weeks, while the control group undertook usual preschool programs. Primary outcome measures included executive function (child assessment of shifting, working memory, and inhibition) and self-regulation (teacher report), with secondary outcomes of school readiness and visual-motor integration. Data were collected pre- and post-intervention, and again 6 months later once children had transitioned into school. Results demonstrated significant intervention effects across the three time points for school readiness (p = 0.038, ηp 2  = 0.09), self-regulation (p < 0.001, ηp 2  = 0.08), and inhibition (p = 0.002 ηp 2  = 0.23). Additionally, the feasibility of building capacity in teachers without any music background to successfully deliver the program was evidenced. These findings are important given that children from low socioeconomic backgrounds are more likely to need support for cognitive development yet have inequitable access to quality music and movement programs. RESEARCH HIGHLIGHTS: Initial effects of self-regulation from a rhythm and movement program were sustained following transition into school for children from disadvantaged backgrounds. Delayed effects of inhibition and school readiness from a rhythm and movement program appeared 6 months post-intervention as children entered school. Generalist teachers can successfully implement a rhythm and movement program, which boosts critical developmental cognitive skills.

Effectiveness and mechanisms of change of a mindfulness-based intervention on elementary school children: A cluster-randomized control trial

Mindfulness-based interventions (MBIs) in the school context are increasingly widespread worldwide. The present study evaluates the effectiveness of a school-MBI (GrowingUp Breathing program) on children's socio-emotional and academic development. Three hundred thirteen elementary students from 7 to 12 years old from two schools in Madrid (Spain) participated. A cluster-randomized control trial was designed, assigning eight classrooms to the MBI-group (N = 155) and eight classrooms to the waiting-list control group (N = 158). Measures were evaluated at pre- and post-intervention in both groups and a 3-month follow-up was collected in the MBI-group. Children self-reported their mindfulness skills (i.e., dispositional mindfulness and psychological inflexibility) and well-being (i.e., anxiety and life satisfaction) and teachers evaluated children's social-emotional competence (i.e., emotion regulation, peer-relationship problems, and prosociality), well-being (i.e., emotional symptoms), and academic competence (i.e., student engagement and academic achievement). Mindfulness skills and emotional regulation were examined as potential mediators. Results revealed that children who received the MBI, compared to children in the WLC-group, improved their mindfulness skills, emotion regulation, prosociality, and emotional and behavioral engagement and decreased anxiety and peer-relationship problems. Positive changes in dispositional mindfulness led to reductions in children's anxiety and psychological inflexibility. Positive changes in emotional regulation led to improvements in prosociality and student engagement and decreased peer-relationships problems and emotional symptoms. Therefore, the results showed that a brief-MBI integrated in the Spanish regular school curriculum enhanced children's socio-emotional and academic development. Dispositional mindfulness and emotion regulation work as processes of change that underlie the intervention's impact.

School Mindfulness-Based Interventions for Youth, and Considerations for Anxiety, Depression, and a Positive School Climate-A Systematic Literature Review

Mindfulness-based interventions (MBIs) are growing in popularity, with research concerning their efficacy with youth populations. Following a preliminary analysis of the existing literature, and given the positive effects of such programs, we felt it relevant to assess whether research has considered the implications for MBIs on children and adolescents, with regard to depression, anxiety, and school climate.

OBJECTIVES

We aim to estimate the effect of MBIs as innovative interventions addressing youths in school settings, with special consideration for anxiety, depression, and school climate outcomes.

METHOD

This review investigates the existing literature in the field of mindfulness, using quasi-experimental and randomized control trial (RCT) models, targeted at youth (5-18 years) in school settings. A search was carried out in four databases-WebofScience, Google Scholar, PubMed, and PsycARTICLES. This resulted in 39 articles, which were sorted based on predetermined inclusion criteria; 12 articles qualified.

RESULTS

The results show discrepancies in terms of methodological and implementation variables, types of interventions, instructor trainings, assessment measures, and choice of practices and exercises, which make the effects of existing school MBIs difficult to compare. Consistencies were observed in emotional and behavioral regulation, prosocial behaviors, and reducing stress and anxiety in students. The results of this systematic review also suggest that MBIs could be potential mediators in improving student well-being and environmental factors, such as school and class climates. Specifically, children's sense of safety and community can be improved by an improved quality of relationships between students, their peers, and teachers. Future research should consider incorporating school climate perspectives, such as implementing whole-school MBI approaches and using replicable and comparable study designs and methods, whilst considering the capacities and limitations of the academic and institutional context.

A Qualitative Microanalysis of the Immediate Behavioural Effects of Mindfulness Practices on Students’ Self-Regulation and Attention

The study examined the immediate effects of mindfulness practices on students’ attention and self-regulation during mathematical problem-solving tasks. Participants were 15 4th-grade Finnish students and their teacher. Data were collected during six study sessions of mathematical problem-solving, with and without mindfulness practices. The sessions were video-recorded, and children responded to the Freiburg mindfulness inventory and the cognitive and affective mindfulness scale-revised. A qualitative video micro-analysis focused on coding the observable behaviours related to attention and self-regulation. Self-report instruments were scored and tabulated for comparison. The findings indicate microbehavioural changes indicating positive effects of mindfulness practices on students’ self-regulation, with higher signs of engagement and lower signs of disengagement after mindfulness practices. This study enlightens the use of mindfulness practices in school routines and discusses the impacts of these practices while evidencing that future research on the topic is needed.

Peer Victimization and Adolescent Non-Suicidal Self-Injury: The Mediating Role of Alienation and Moderating Role of Mindfulness

Peer victimization and non-suicidal self-injury (NSSI) are two major public health problems, with the former being associated with outward attack and the latter characterizing inward attack. Peer victimization has been shown to be associated with adolescents' NSSI. However, less is known about the mechanism underlying the association. Based on the experiential avoidance model of NSSI, this study tested whether the sense of alienation mediated the association between peer victimization and NSSI, and whether this process was weakened by mindfulness. A total of 1,574 Chinese adolescents (51.1% girls; ages 12-16 years) completed questionnaires concerning NSSI, peer victimization, alienation, and mindfulness. Regression-based analyses indicated that peer victimization predicted adolescents' NSSI through the indirect effect of alienation, and mindfulness weakened this indirect effect. These findings suggest that victimized adolescents may injure themselves as an emotion regulation strategy. The results highlight the importance to implement programs aimed to improve the school climate to reduce the risk of adolescent NSSI. Furthermore, we underscore the need to include emotion-regulation training (e.g., mindful practice) into bully intervention programs to prevent NSSI.

Self-management interventions for reducing challenging behaviors among school-age students: A systematic review

BACKGROUND

Challenging classroom behaviors can interfere with student social and academic functioning and may be harmful to everyone in schools. Self-management interventions within schools can address these concerns by helping students develop necessary social, emotional, and behavioral skills. Thus, the current systematic review synthesized and analyzed school-based self-management interventions used to address challenging classroom behaviors.

OBJECTIVES

The current study aimed to inform practice and policy by (a) evaluating the effectiveness of self-management interventions at improving classroom behaviors and academic outcomes and (b) examining the state of research for self-management interventions based on existing literature.

SEARCH METHODS

Comprehensive search procedures included electronically searching online databases (e.g., EBSCO Academic Search Premier, MEDLINE, ERIC, PsycINFO), hand-searching 19 relevant journals (e.g., School Mental Health, Journal of School Psychology), reference-list searching 21 relevant reviews, and searching gray literature (e.g., contacting authors, searching online dissertation/theses databases and national government clearinghouses/websites). Searches were completed through December of 2020.

SELECTION CRITERIA

Included studies employed either a multiple group-design (i.e., experimental or quasi-experimental) or single-case experimental research design and met the following criteria: (a) utilized a self-management intervention, (b) conducted in a school setting, (c) included school-aged students, and (d) assessed classroom behaviors.

DATA COLLECTION AND ANALYSIS

Standard data collection procedures expected by the Campbell Collaboration were used in the current study. Analyses for single-case design studies incorporated three-level hierarchical models to synthesize main effects, and meta-regression for moderation. Further, robust variance estimation was applied to both single-case design and group-design studies to account for dependency issues.

MAIN RESULTS

Our final single-case design sample included 75 studies, 236 participants, and 456 effects (i.e., 351 behavioral outcomes and 105 academic outcomes). Our final group-design sample included 4 studies, 422 participants, and 11 total behavioral effects. Most studies occurred in the United States, in urban communities, in public schools, and in elementary settings. Single-case design results indicated that self-management interventions significantly and positively impacted both student classroom behaviors (LRRi = 0.69, 95% confidence interval [CI] [0.59, 0.78]) and academic outcomes (LRRi = 0.58, 95% CI [0.41, 0.76]). Single-case results were found to be moderated by student race and special education status, whereas intervention effects were more pronounced for African American students (F = 5.56, p = 0.02) and students receiving special education services (F = 6.87, p = 0.01). Single-case results were not found to be moderated by intervention characteristics (i.e., intervention duration, fidelity assessment, fidelity method, or training). Despite positive findings for single-case design studies, risk of bias assessment indicated methodological shortcomings that should be considered when interpreting findings. A significant main effect of self-management interventions for improving classroom behaviors was also revealed for group-design studies (g = 0.63, 95% CI [0.08, 1.17]). However, these results should be interpreted with caution given the small number of included group-design studies.

IMPLICATIONS FOR POLICY PRACTICE AND RESEARCH

The current study, conducted using comprehensive search/screening procedures and advanced meta-analytic techniques, adds to the large amount of evidence indicating that self-management interventions can be successfully used to address student behaviors and academic outcomes. In particular, the use specific self-management elements (i.e., self-determining a performance goal, self-observing and recording progress, reflecting on a target behavior, and administering primary reinforcers) should be considered within current interventions as well as in the development of future interventions. Future research should aim to assess the implementation and effects of self-management at the group or classroom-level within randomized controlled trials.

Enhancing “Health-Promoting Schools” through Implementing Mental Health Program

BACKGROUND: The implementation of social and emotional learning program Social Emotional Learning (SEL) program is considered to be a low cost, simple method, and efficient intervention that shows a promise in promoting students’ mental health (MH). AIM: We aimed to enhance “The Health-Promoting Schools” initiative through the implementation of a MH promotion program. METHODS: The study is a school-based non-randomized controlled trial, in purposively selected schools. It included 460 students with a mean age of 11 (± 0.7) years old, all are boys, and were divided into two groups; intervention group (n = 230) and control group (n = 230). The ten components of the health-promoting school were assessed in the intervention school using the CDC tool “The School Health Index,” which enables the school team to identify the strengths and weaknesses of their school’s policies and programs. As a result, a tailored SEL program was developed fitting the Egyptian culture and students’ needs, along with the recommendations and trends. RESULTS: The baseline assessment results for the intervention school were in the medium range percentages (20–80%). The social and emotional part had not been a major concern given for our students. The students who participated in the SEL program evidenced significant improvements in grit, growth mindset, self-management, social awareness, and school safety compared to the control group. According to the teachers’ perception scale, 70% of the teachers reported that the learning strategies of students have been improved. CONCLUSION: The findings suggest that a relatively simple-to-administer SEL curriculum added to the regular school curriculum for a period of only 2–3 months can yield promising results as regard to positive behavioral and cognitive changes in students.

Short Mindfulness-Based Relaxation Training Has No Effects on Executive Functions but May Reduce Baseline Cortisol Levels of Boys in First Grade: A Pilot Study

(1) Background: Executive functions are important for academic performance and school readiness. Children’s executive function skills are found to be improved by mindfulness-based interventions, and these programs are also effective in stress reduction. The aim of this study was to evaluate the feasibility and the effects of a short mindfulness-based relaxation training compared to a passive control condition right before school entry on executive function skills and cortisol levels. (2) Methods: The feasibility and the effects of the intervention before school entry were tested with 61 preschoolers. The final sample consisted of 51 participants (Mage = 81.90 months, SD = 5.45; 41% male). Short-term memory, executive function skills and cortisol levels before and after the intervention were assessed. Additionally, cortisol levels were assessed one week and one month after school entry. (3) Results: There was a significant sex difference in the effects of the intervention on children’s cortisol levels (p = 0.026, η2 = 0.134). The mindfulness-based relaxation training applied before school entry prevented a rise in boys’ cortisol levels one week after starting school. (4) Conclusion: A short mindfulness-based intervention before starting school could be effective in fostering physiological stress management in boys.

Exploring the Effects of Meditation Techniques Used by Mindfulness-Based Programs on the Cognitive, Social-Emotional, and Academic Skills of Children: A Systematic Review

There is evidence for the positive impact of mindfulness in children. However, little is known about the techniques through which mindfulness practice results in differential outcomes. Therefore, this study intended to systematically review the available evidence about the efficacy of meditation techniques used by mindfulness-based programs on cognitive, socio-emotional, and academic skills of children from 6 to 12 years of age. The review was registered on the PROSPERO database, and the literature search was conducted according to PICO criteria and PRISMA guidelines. The EBSCO databases were searched, and 29 studies were eligible: nine randomized controlled trials and 20 quasi-experimental studies. All the included randomized controlled trials were rated as having a high risk of bias. Overall, the evidence for mindfulness techniques improving cognitive and socio-emotional skills was reasonably strong. Specifically, for cognitive skills, results showed that all the interventions used “body-centered meditations” and “mindful observations.” Regarding socio-emotional skills, although all the studies applied “body-centered meditations” and “mindful observations,” “affect-centered meditations” were also frequent. For academic skills, just one quasi-experimental trial found improvements, thus making it difficult to draw conclusions. Further research is crucial to evaluate the unique effects of different meditation techniques on the cognitive, social-emotional, and academic skills of children.

Systematic Review Registration: Identifier: RD42019126767.

Implementation of a teacher-led mindfulness program in a low-income pre- and early-elementary school as part of a trauma-responsive, resilience-building community initiative

Children living in disadvantaged communities experience higher rates of adverse childhood experiences (ACEs) which can lead to poor health outcomes. Mindfulness has been shown to help individuals who are exposed to cumulative stress build resilience and psychological well-being. This pilot study aimed to determine teachers' perceptions of a 6-week school-based, teacher-led mindfulness program in a Gainesville, Florida pre- and early elementary low-income school. The program was conducted as part of a trauma-responsive, resilient community initiative. Teachers were trained on a set of mindfulness skills and were asked to lead practices for 10-15 min per day, 3 or more times per week for 6 weeks. Teachers completed qualitative interviews to determine their perceptions of the program. A total of eight teachers participated, with 124 students receiving the program. Teachers reported high impressions of the program and that students were calmer and more relaxed as a result of the program. Training teachers to deliver mindfulness practices as part of their normal classroom activities is realistic, easily adaptable, and can lead to adoption of a community-wide mindfulness framework. Diffusing mindfulness programs more broadly as part of a preventive, trauma-responsive community has the potential to lessen the effects of ACEs.

Promoting Third Graders' Executive Functions and Literacy: A Pilot Study Examining the Benefits of Mindfulness vs. Relaxation Training

Research suggested that developing mindfulness skills in children improves proximal outcomes, such as attention and executive functions, as well as distal outcomes, such as academic achievement. Despite empirical evidence supporting this claim, research on the benefits of mindfulness training in child populations is scarce, with some mixed findings in the field. Here, we aimed to fill in this gap, by examining the effects of a mindfulness training on third graders' proximal and distal outcomes, namely, attention and executive functions (viz., inhibitory control, working memory, and cognitive flexibility) as well as literacy-related achievement (viz., handwriting fluency, text quality, Portuguese grades). These outcomes were measured with behavioral tasks and teacher ratings. Sixty-six Portuguese children were randomly allocated to an experimental group receiving mindfulness training (n = 29) or an active control group receiving relaxation training (n = 37). Both training programs were implemented by psychologists in two 30-min weekly sessions for 8 weeks. All students were assessed before and after the interventions. Three main findings are noteworthy: (a) mindfulness training enhanced teacher-rated cognitive flexibility and a performance-based composite score of executive functions among children with higher pretest scores; (b) relaxation training improved performance-based cognitive flexibility and the composite score of executive functions among children with lower pretest scores; (c) children receiving mindfulness training had higher handwriting fluency and better grades in Portuguese than those receiving relaxation training. These findings provide preliminary evidence on the benefits of mindfulness training in educational settings and highlight the moderating role of baseline performance on those benefits.

Somatic interventions to improve self-regulation in children and adolescents

TOPIC

Children and adolescents who are exposed to stress and trauma often experience, as a result, an inability to regulate their emotions. Self-regulation is necessary to accurately respond to situations and ensure success in the academic setting. Self-regulation skills have been identified as improving resiliency and mitigating the effects of trauma on children and adolescents.

PURPOSE

The purpose of this review of the literature is to synthesize the available research on somatic interventions to improve self-regulation in the child and adolescent population.

SOURCES USED

A scoping review of literature utilizing the Arksey and O'Malley framework was conducted by a university health science librarian from 2006 to 2018 using PubMed, Scopus, CINAHL, ERIC, and Web of Science to identify studies that examined somatic self-regulation skills in children and adolescents. Search terms included were mindfulness, yoga, deep breathing exercises, and self-regulation. The PRISMA methodology was utilized to synthesize the available research on somatic interventions to improve self-regulation in the child and adolescent population.

CONCLUSION

Somatic interventions have been shown to improve self-regulation in the child and adolescent population. Future research is needed to identify dose-specific interventions and opportunities to improve self-regulation for children and adolescents.

A Qualitative Study of a Mindfulness-Based Intervention in Educational Contexts in Chile: An Approach Based on Adolescents' Voices

The application of mindfulness-based interventions in school settings has increased considerably in recent years, showing that differences between the characteristics of programmes can impact on the receptivity and effectiveness of mindfulness training. However, few studies have explored the learning process from the perspective of the children and adolescents who participate in mindfulness practice. The goal of this paper is to analyse the subjective experience of a group of adolescents following the completion of a mindfulness-based intervention developed for schools in Chile. The intervention studied is the “.b curriculum”, which is part of the Mindfulness in School Project (MiSP) developed in the UK. Twenty adolescents participated in semi-structured interviews within their school, in which three key areas were explored: pedagogy, perceived effects, and mechanisms of action, each of them being analysed from the perspective of thematic analysis. The results support the view that pedagogy is a very relevant consideration in the implementation, development, and efficacy of mindfulness-based interventions within the school context. We propose that the inclusion of structure, contents, process/mindful practices, and teachers’ expertise provides the pedagogical-relational framework required for students to successfully develop mindfulness skills, which enables them to experience their cognitive, emotional, and somatic effects. These effects are linked to self-regulation strategies, based on paying attention to one’s somatic experience with kindness and curiosity, which works as an attentional anchor. It is hoped that these results will contribute to the spread of mindfulness research in adolescents in Latin America, thus facilitating cross-cultural and international comparisons.

Feasibility of a school-based mindfulness program for improving inhibitory skills in children with autism spectrum disorder

BACKGROUND

Executive dysfunction is prevalent in children with autism spectrum disorder (ASD), including prominent difficulties in the two facets of inhibition, as well as with selective attention. School-based mindfulness has been used in typically-developing children to improve executive functioning, though this has not been investigated in children with ASD. Therefore, the purpose of this study was to examine the efficacy of a school-based mindfulness program for improving inhibition (prepotent response inhibition and interference control) and selective attention in children with ASD.

METHOD

Using a quasi-experimental, pre-post design, an eight week school-based mindfulness program (Mindful Schools;https://www.mindfulschools.org/), was administered to students with ASD (n = 27) at a private, not-for-profit school for children with special needs. The Walk/Don't Walk test and the Color-Word Interference test were used to evaluate prepotent response inhibition and interference control, respectively. Selective attention was measured using a cancellation test.

RESULTS

Significant improvements followed the intervention for prepotent response inhibition and interference control (medium effect sizes), as well as for overall selective attention (large effect size).

CONCLUSIONS

The study's findings demonstrate that school-based mindfulness holds promise for increasing specific executive functioning abilities in children with ASD.

Effectiveness of mindfulness-based interventions on anxiety for children and adolescents: A systematic review and meta-analysis

AIM

This paper aims to investigate the extent to which mindfulness-based interventions serve to reduce anxiety in children and adolescents. A heterogeneous sample was used, including clinical and non-clinical population.

METHODS

A literature search of controlled intervention studies published up to December 31, 2016, was carried out in PubMed, Lilacs, Cochrane, Embase, PsycInfo, Opengrey and Teseo databases. The effect size was calculated by Cohen's d. The Cochran Q statistic and the I² index were used for the study of heterogeneity. An analysis was conducted using the random effects model.

RESULTS

829 articles were identified, of which 18 were finally selected. Of these, only three had statistically significant effect sizes. The overall combined result obtained was .013, but it did not result statistically significant (CI95% [-.102, .128].) The Q statistic was statistically significant (Q [18] = 28.497, P = . 39) and the I² index was 40.34%, indicating a moderate heterogeneity.

CONCLUSIONS

This meta-analysis did not obtain statistically significant results that could provide conclusions. In general, the studies analysed are small, of low power and have a marked heterogeneity, which implies that the findings are provisional and need to be supported by more robust studies. Although it cannot be ruled out that mindfulness-based interventions are not effective in the infant-juvenile population, it is also possible that this effect could not be detected due to the limited number of available studies. Larger investigations are needed, with sufficient statistical power and designs that control the variables potentially moderating, to establish clear conclusions.

How can adolescent aggression be reduced? A multi-level meta-analysis

Aggressive behaviour among adolescents has significant social and economic costs. Numerous attempts have been made to intervene to reduce aggression in adolescents. However, little is known about what factors enhance or diminish intervention effectiveness. The present systematic review and meta-analysis, therefore, seeks to quantify the effectiveness of interventions to reduce aggressive behaviour in adolescents and to identify when and for whom such interventions work best. Sixteen databases were searched for randomised controlled trials that assessed interventions to reduce aggression among adolescents. After screening 9795 records, 95 studies were included. A multi-level meta-analysis found a significant overall small-to-medium effect size (d = 0.28; 95% CI [0.17, 0.39]). More effective interventions were of shorter duration, were conducted in the Middle East, were targeted at adolescents with higher levels of risk, and were facilitated by intervention professionals. Potentially active ingredients were classified using the Behaviour Change Technique Taxonomy. Behavioural practice and problem solving were components of more effective interventions targeted at the general population. Overall the findings indicate that psychosocial interventions are effective in reducing adolescent aggression. Future trials need to assess the effect of individual techniques and their combination to identify the key components that can reduce aggression in adolescents.

The Effect of a Mindfulness-Based Intervention on Attention, Self-Control, and Aggressiveness in Primary School Pupils

The objective of this study was to examine the effect of Mindkeys Training, a mindfulness-based educational intervention, on attention, self-control, and aggressiveness in third-year primary school pupils. In order to achieve this aim, a switching replications design was used. Two groups of third year primary students (n_GE1 = 40; n_GE2 = 33), aged between 7 and 10 years old (M = 8.08; DT = 0.49), had the intervention at different time points, such that while one served as the experimental group, the other served as the control group. Longitudinal differences were examined in both groups, and cross-sectional differences were examined between the two groups at three time points; at the start of the study, and following the intervention with each group. To that end, measurements of problems of attention, deficits of self-control, and aggressiveness for students were obtained via a teacher rating scale. The intervention program demonstrated a positive effect on the reduction of pupils’ attention problems, deficits of self-control, and aggressiveness. The effects were greater on the cognitive variables that the intervention worked on directly (attention and self-control). Attention was the variable on which the intervention exhibited the longest term effects.

Brief Stress Reduction Strategies Associated with Better Behavioral Climate in a Crisis Nursery: A Pilot Study

Approximately 3.5 million children in the United States were reported to Child Protective Services in 2016. Effective, developmentally-informed programs are critically necessary to support under-resourced families at risk of child abuse. This study implemented a module of mindfulness-based stress reduction strategies in partnership with a community organization whose goal is to keep families together while reducing the risk of child abuse by providing short-term (3-day) overnight crisis care for birth through 6-year-olds. Group-level assessment of child behaviors was used to assess child functioning at the program level. Children's Services staff were trained in brief stress reduction strategies, with the intention that they be used with the children regularly throughout the day to help the children be emotionally calm and behaviorally regulated. Ordinal logistic regressions suggested that, over the six months preceding implementation (April - September 2017) compared to six months following completion of implementation (February - July 2018), the introduction of stress-reduction strategies was associated with significantly increased self-regulatory behavior and coping skills, but not decreased aggressive behavior. Additionally, staff frequently (approximately 65% of the time) endorsed the strategies as being effective. Though the evidence is preliminary, the unique context of the crisis nursery coupled with the measurement of program-level outcomes furthers our understanding of the scalable impact mindfulness-based stress reduction strategies can have with children experiencing chronic stress and/or trauma in a very hard-to-reach population. Implementation challenges are discussed, as are the implications of stress reduction strategies as a useful, efficient method to improve self-regulation in children experiencing adversity.

Applying Mindfulness-Based Practices in Child Psychiatry

Mindfulness-based interventions for adults, children, and families have grown considerably, and burgeoning evidence supports use of these approaches for a range of clinical presentations, including anxiety, depression, ADHD, and addiction. Research into the mechanisms of mindfulness suggests improvements in key brain-based functions including attentional control and emotional regulation. Mindfulness may be relevant for improving emotional and behavioral symptoms in children and families presenting for psychiatric care and also may be an important universal strategy to promote brain health. Child psychiatrists should be familiar with mindfulness-based clinical programs and also may seek to develop mindfulness-based strategies to use in clinical practice.

Research Review: The effects of mindfulness-based interventions on cognition and mental health in children and adolescents - a meta-analysis of randomized controlled trials

BACKGROUND

Mindfulness based interventions (MBIs) are an increasingly popular way of attempting to improve the behavioural, cognitive and mental health outcomes of children and adolescents, though there is a suggestion that enthusiasm has moved ahead of the evidence base. Most evaluations of MBIs are either uncontrolled or nonrandomized trials. This meta-analysis aims to establish the efficacy of MBIs for children and adolescents in studies that have adopted a randomized, controlled trial (RCT) design.

METHODS

A systematic literature search of RCTs of MBIs was conducted up to October 2017. Thirty-three independent studies including 3,666 children and adolescents were included in random effects meta-analyses with outcome measures categorized into cognitive, behavioural and emotional factors. Separate random effects meta-analyses were completed for the seventeen studies (n = 1,762) that used an RCT design with an active control condition.

RESULTS

Across all RCTs we found significant positive effects of MBIs, relative to controls, for the outcome categories of Mindfulness, Executive Functioning, Attention, Depression, Anxiety/Stress and Negative Behaviours, with small effect sizes (Cohen's d), ranging from .16 to .30. However, when considering only those RCTs with active control groups, significant benefits of an MBI were restricted to the outcomes of Mindfulness (d = .42), Depression (d = .47) and Anxiety/Stress (d = .18) only.

CONCLUSIONS

This meta-analysis reinforces the efficacy of using MBIs for improving the mental health and wellbeing of youth as assessed using the gold standard RCT methodology. Future RCT evaluations should incorporate scaled-up definitive trial designs to further evaluate the robustness of MBIs in youth, with an embedded focus on mechanisms of action.

Effectiveness of Universal Self-regulation-Based Interventions in Children and Adolescents: A Systematic Review and Meta-analysis

Importance

Childhood and adolescence self-regulation (SR) is gaining importance as a target of intervention because of mounting evidence of its positive associations with health, social and educational outcomes.

Objective

To conduct a systematic review and meta-analysis of rigorously evaluated interventions to improve self-regulation in children and adolescents.

Data Sources

Keyword searches of the PsycINFO, PubMed, EMBASE, CINAHL Plus, ERIC, British Education Index, Child Development and Adolescent Studies, and CENTRAL were used to identify all studies published through July 2016.

Study Selection

To be eligible for this review, studies had to report cluster randomized trials or randomized clinical trials, evaluate universal interventions designed to improve self-regulation in children and adolescents aged 0 to 19 years, include outcomes associated with self-regulation skills, and be published in a peer-reviewed journal with the full text available in English.

Data Extraction and Synthesis

A total of 14 369 published records were screened, of which 147 were identified for full-text review and 49 studies reporting 50 interventions were included in the final review. Results were summarized by narrative review and meta-analysis.

Main Outcomes and Measures

Self-regulation outcomes in children and adolescents.

Results

This review identified 17 cluster randomized trials and 32 randomized clinical trials evaluating self-regulation interventions, which included a total of 23 098 participants ranging in age from 2 to 17 years (median age, 6.0 years). Consistent improvement in self-regulation was reported in 16 of 21 curriculum-based interventions (76%), 4 of the 8 mindfulness and yoga interventions (50%), 5 of 9 family-based programs (56%), 4 of 6 exercise-based programs (67%), and 4 of 6 social and personal skills interventions (67%), or a total of 33 of 50 interventions (66%). A meta-analysis evaluating associations of interventions with self-regulation task performance scores showed a positive effect of such interventions with pooled effect size of 0.42 (95% CI, 0.32-0.53). Only 24 studies reported data on distal outcomes (29 outcomes). Positive associations were reported in 11 of 13 studies (85%) on academic achievement, 4 of 5 studies on substance abuse (80%), and in all studies reporting on conduct disorders (n = 3), studies on social skills (n = 2), studies on depression (n = 2), studies on behavioral problems (n = 2), and study on school suspensions (n = 1). No effect was seen on 2 studies reporting on academic achievement, 1 study reporting on substance abuse, and 1 additional study reporting on psychological well-being.

Conclusions and Relevance

A wide range of interventions were successful in improving self-regulation in children and adolescents. There was improvement in distal academic, health, and behavioral outcomes in most intervention groups compared with controls.

The Effectiveness of School-Based Mental Health Services for Elementary-Aged Children: A Meta-Analysis

OBJECTIVE

Given problems and disparities in the use of community-based mental health services for youth, school personnel have assumed frontline mental health service roles. To date, most research on school-based services has evaluated analog educational contexts with services implemented by highly trained study staff, and little is known about the effectiveness of school-based mental health services when implemented by school professionals.

METHOD

Random-effects meta-analytic procedures were used to synthesize effects of school-based mental health services for elementary school-age children delivered by school personnel and potential moderators of treatment response. Forty-three controlled trials evaluating 49,941 elementary school-age children met the selection criteria (mean grade 2.86, 60.3% boys).

RESULTS

Overall, school-based services demonstrated a small-to-medium effect (Hedges g = 0.39) in decreasing mental health problems, with the largest effects found for targeted intervention (Hedges g = 0.76), followed by selective prevention (Hedges g = 0.67), compared with universal prevention (Hedges g = 0.29). Mental health services integrated into students' academic instruction (Hedges g = 0.59), those targeting externalizing problems (Hedges g = 0.50), those incorporating contingency management (Hedges g = 0.57), and those implemented multiple times per week (Hedges g = 0.50) showed particularly strong effects.

CONCLUSION

Considering serious barriers precluding youth from accessing necessary mental health care, the present meta-analysis suggests child psychiatrists and other mental health professionals are wise to recognize the important role that school personnel, who are naturally in children's lives, can play in decreasing child mental health problems.

Systematic Review of Universal Resilience-Focused Interventions Targeting Child and Adolescent Mental Health in the School Setting

OBJECTIVE

To examine the effect of universal, school-based, resilience-focused interventions on mental health problems in children and adolescents.

METHOD

Eligible studies were randomized controlled trials (RCTs) of universal, school-based interventions that included strategies to strengthen a minimum of 3 internal resilience protective factors, and included an outcome measure of mental health problems in children and adolescents aged 5 to 18 years. Six databases were searched from 1995 to 2015. Results were pooled in meta-analyses by mental health outcome (anxiety symptoms, depressive symptoms, hyperactivity, conduct problems, internalizing problems, externalizing problems, and general psychological distress), for all trials (5-18 years). Subgroup analyses were conducted by age (child: 5-10 years; adolescent: 11-18 years), length of follow-up (short: post-≤12 months; long: >12 months), and gender (narrative).

RESULTS

A total of 57 included trials were identified from 5,984 records, with 49 contributing to meta-analyses. For all trials, resilience-focused interventions were effective relative to a control in reducing 4 of 7 outcomes: depressive symptoms, internalizing problems, externalizing problems, and general psychological distress. For child trials (meta-analyses for 6 outcomes), interventions were effective for anxiety symptoms and general psychological distress. For adolescent trials (meta-analyses for 5 outcomes), interventions were effective for internalizing problems. For short-term follow-up, interventions were effective for 2 of 7 outcomes: depressive symptoms and anxiety symptoms. For long-term follow-up (meta-analyses for 5 outcomes), interventions were effective for internalizing problems.

CONCLUSION

The findings may suggest most promise for using universal resilience-focused interventions at least for short-term reductions in depressive and anxiety symptoms for children and adolescents, particularly if a cognitive-behavioral therapy-based approach is used. The limited number of trials providing data amenable for meta-analysis for some outcomes and subgroups, the variability of interventions, study quality, and bias mean that it is not possible to draw more specific conclusions. Identifying what intervention qualities (such as number and type of protective factor) achieve the greatest positive effect per mental health problem outcome remains an important area for future research.

SYSTEMATIC REVIEW PROTOCOL AND REGISTRATION

Systematic Review of Universal Resilience Interventions Targeting Child and Adolescent Mental Health in the School Setting; http://dx.doi.org/10.1186/s13643-015-0172-6; PROSPERO CRD42015025908.

Evaluation of Yoga for Preventing Adolescent Substance Use Risk Factors in a Middle School Setting: A Preliminary Group-Randomized Controlled Trial

Adolescence is a key developmental period for preventing substance use initiation, however prevention programs solely providing educational information about the dangers of substance use rarely change adolescent substance use behaviors. Recent research suggests that mind-body practices such as yoga may have beneficial effects on several substance use risk factors, and that these practices may serve as promising interventions for preventing adolescent substance use. The primary aim of the present study was to test the efficacy of yoga for reducing substance use risk factors during early adolescence. Seventh-grade students in a public school were randomly assigned by classroom to receive either a 32-session yoga intervention (n = 117) in place of their regular physical education classes or to continue with physical-education-as-usual (n = 94). Participants (63.2 % female; 53.6 % White) completed pre- and post-intervention questionnaires assessing emotional self-regulation, perceived stress, mood impairment, impulsivity, substance use willingness, and actual substance use. Participants also completed questionnaires at 6-months and 1-year post-intervention. Results revealed that participants in the control condition were significantly more willing to try smoking cigarettes immediately post-intervention than participants in the yoga condition. Immediate pre- to post-intervention differences did not emerge for the remaining outcomes. However, long-term follow-up analyses revealed a pattern of delayed effects in which females in the yoga condition, and males in the control condition, demonstrated improvements in emotional self-control. The findings suggest that school-based yoga may have beneficial effects with regard to preventing males' and females' willingness to smoke cigarettes, as well as improving emotional self-control in females. However additional research is required, particularly with regard to the potential long-term effects of mind-body interventions in school settings. The present study contributes to the literature on adolescence by examining school-based yoga as a novel prevention program for substance use risk factors.

MINDFULNESS GOES TO SCHOOL: THINGS LEARNED (SO FAR) FROM RESEARCH AND REAL-WORLD EXPERIENCES

Mindfulness-based curricula are being implemented in K-12 schools across the nation. Many of these programs, although well-considered and implemented, have little or no research support for their effectiveness. Recognizing the paucity of published research in this area, a sampling of school-based programs currently being implemented in the schools is reviewed. The programs reviewed are Inner Explorer, Master Mind and Moment Program, Mindfulness and Mind-Body Skills for Children, Mindful Schools, Resilient Kids, Still Quiet Place, Stress Reduction and Mindfulness Curriculum and Mindful Moment, and Wellness and Resilience Program. We offer a summary of research support for each program and discussion of unpublished, mostly qualitative indicators of feasibility, acceptability, efficacy, and effectiveness. Strengths and limitations of each program are described, along with suggestions for bolstering informative and useful research. We encourage researchers, educators, and mindfulness practitioners to work collaboratively to conduct rigorous program evaluations.

Being present at school: implementing mindfulness in schools

Developmentally sensitive efforts to help students learn, practice, and regularly use mindfulness tactics easily and readily in and beyond the classroom are important to help them manage future stresses. Mindfulness emphasizes consciously focusing the mind in the present moment, purposefully, without judgment or attachment. Meditation extends this to setting aside time and places to practice mindfulness, and additionally, yoga includes physical postures and breathing techniques that enhance mindfulness and meditation. Several mindfulness programs and techniques have been applied in schools, with positive benefits reported. Some elements of these programs require modifications to be sensitive to the developmental state of the children receiving mindfulness training.