Mindfulness-based psychoeducation for parents of children with attention-deficit/hyperactivity disorder: an applied clinical project

Centering Diverse Communities within Mindful Parenting Interventions in the U.S.: A Narrative Literature Review

BACKGROUND

While mindfulness-based interventions targeted toward parents (and families) in the U.S. offer promise for the treatment and prevention of youth psychological disorders, current research has established the underrepresentation of diverse participants in the research literature. The full extent of inequalities in the demographics of participation in parent mindfulness intervention is less understood.

OBJECTIVE

This study aimed to utilize a narrative literature review approach to examine and describe the degree to which research on mindful parenting interventions is inclusive of BIPOC (Black, Indigenous, and People of Color) communities, non-clinical samples (no diagnosed disorder), cultural adaptions, and skills specific to parenting.

METHODS

An electronic database search of US-based studies was undertaken for empirical studies that primarily focused on parent mindfulness interventions, which reported outcomes related to either parenting behaviors or child mental health outcomes. After a full-text review, the search resulted in 34 articles. A narrative literature review of the 34 studies was conducted to assess the inclusion of BIPOC communities, non-clinical samples, cultural adaptions, and skills specific to parenting.

RESULTS

This review found notable gaps in the degree to which mindful parenting research (1) included BIPOC populations in study samples; (2) focused on non-clinical samples; (3) adapted interventions to align with the cultural needs of participants; and (4) included the application of mindfulness to enhancing knowledge, skills, and behaviors specific to parenting.

CONCLUSIONS

Given these gaps in the parent mindfulness literature, greater research attention is needed on mindful parenting interventions targeted toward BIPOC communities with no clinical diagnoses, interventions optimized by cultural adaptations, and explicit applications to parenting.

The Efficacy of Health Promotion Program Among Parents Who Had Children With Attention-Deficit/Hyperactivity-Disorder

OBJECTIVES

To explore the effect of health promotion program (HPP) on stress, quality of life, health-promoting lifestyles, and children's attention-deficit/hyperactivity disorder (ADHD) symptoms in parents of children with ADHD.

METHODS

Sixty parents of children with ADHD were equally randomized into the intervention (health promotion program) and control (usual care) groups. Outcomes included parents' stress, quality of life, health-promoting lifestyles, and children's ADHD symptoms before, immediately after, and 1, 3, and 6 months after the intervention. The GEE was used to evaluate the effectiveness.

RESULTS

The intervention group reported significant improvement in the children's hyperactivity/impulse and opposition at the 6- and 3-month, respectively. Parental overall stress significantly improved at 3 and 6 months. Parents' quality of life had significant effects at the immediate, 3-month, and 6-month. Self-actualization behavior for health-promoting lifestyles had significant effects at the immediate follow-up.

CONCLUSION

HPP can promote the mental well-being of parents of children with ADHD.

Co-designed Mindful Parenting for Parents of Children with ADHD: A Pilot and Feasibility Study

This mixed-methods single arm pilot study examined the feasibility, acceptability, and preliminary outcomes of a co-designed mindful parenting intervention for parents of children with ADHD, Parents that Mind (PTM). The 5-week parent-only intervention comprised two face-to-face group retreats and 5 weeks home practice. Eighteen parents of children with ADHD participated in PTM, completing self-report questionnaires and semi-structured interviews. Indicating high acceptability, 100% of parents interviewed reported PTM was helpful and they would recommend PTM. High feasibility of parents attending one face-to-face retreat was observed, with all parents attending the first retreat, however intervention adherence was challenging, with 55% of parents attending the second retreat. Barriers to intervention adherence included: lack of time, work commitments, illness and exhaustion. Quantitative data indicate promising preliminary effects for parents and children. Addressing the barriers raised by parents in this pilot appear necessary, before examining efficacy in a blinded RCT.

Effectiveness of mindfulness parent training on parenting stress and children’s ADHD-related behaviors: A systematic review and meta-analysis

Background/Objective

Literature shows that there is a circular relationship between children’s ADHD-related behaviors and parenting stress. This systematic review and meta-analysis aimed to understand if mindfulness parent trainings have benefits for both parenting stress and the problem behaviors in children with ADHD.

Methods

Five databases, CINAHL, Embase, PsycINFO, PubMED, and Web of Science, were searched. Within-group effects at post-treatment and follow-up assessment, and between-group effects at post-treatment were analyzed. Effect sizes (Hedges’ g) were also calculated.

Results

Ten studies (5 RCTs and 5 non-RCTs) met the selection criteria and were selected for systematic review, and nine of them were included for meta-analysis. Among these 10 studies, five studies involved mindfulness training for both parents and children, while the other five studies involved mindfulness training for parents only. Within-group effects at post-treatment were small-to-large for all outcomes. Hedges’ g ranged between −0.17 [95% CI (−0.98, 0.64)] and 4.70 [95% CI (3.59, 5.81)] for parenting stress; 0.17 [95% CI (−0.03, 0.37)] and 4.03 [95% CI (2.97, 5.09)] for children’s problem behaviors; and 0.20 [95% CI (−0.10, 0.50)] and 2.98 [95% CI (2.16, 3.80)] for children’s ADHD symptoms. Between-group comparisons showed mindfulness parent training was superior to other active controls on all outcomes.

Conclusion

Findings suggest that mindfulness parent training may be beneficial for parenting stress and children’s ADHD-related behaviors, and due to the small number of studies reviewed, cautions should be taken when interpreting the results.

Parenting Stress during Late Adolescence in Mothers of Individuals with ADHD with and without ODD

Although children with ADHD continue to experience impairment well into adolescence, research exploring the experiences of their parents during late adolescence is lacking. Thus, we examined changes in parenting stress and family conflict in mothers of adolescents with ADHD during the transition to early adulthood. We also explored predictors of these changes in addition to investigating differences in these trajectories due to comorbid ODD. Forty-nine mothers of adolescents with ADHD only and thirty-seven mothers of adolescents with ADHD/ODD reported on parenting stress and perceptions of family conflict at baseline (mean age = 16.88) and at 3-month, 9-month, and 15-month follow up assessments. Growth curve modeling indicated that both groups of mothers reported relative declines in parenting stress and family conflict across time. However, the mothers of adolescents with ADHD/ODD persistently reported more stress and conflict. Furthermore, decreases in family conflict were more predictive of reduced parenting stress in families of adolescents only diagnosed with ADHD. Our findings suggest that comorbid ODD is associated with parenting stress during late adolescence. Thus, interventions should focus on further reducing this stress as adolescents with ADHD/ODD transition to adulthood.

Feasibility of a brief mindfulness intervention: Examining stress, anxiety and mindfulness for Thai parents of children with developmental disabilities

AIM

To examine the feasibility of using a 2-weekend Brief Culturally Tailored Thai Mindfulness intervention (BCTTMi) to affect stress, anxiety, and mindfulness in Thai parents of children with developmental disabilities (DDs), based on eight feasibility study criteria.

METHODS

A BCTTMi was implemented with 22 Thai parents and caregivers of children with DDs with an experimental waitlist control crossover design. All participants were Thai and Buddhist; more than half had practiced meditation. The outcomes (stress, anxiety, mindfulness) were assessed with three Thai translated questionnaires, which had reported acceptable reliabilities. To address the feasibility criteria, data were gathered using virtual engagement, diary recordings, and a pre-, post-test trial.

RESULTS

Assessment of the eight qualities of feasibility indicated: 1) acceptability: the BCTTMi appealed to the participants; 2) demand: the participants practiced mindfulness at home; 3) implementation: the mindfulness practitioner was qualified; 4) practicality: anxiety was the only outcome measure sensitive to the BCTTMi (p = .005); 5) adaptation: there was no attrition with the shortened mindfulness intervention; 6) integration: the BCTTMi may be included as part of the participants' routine club meeting; 7) expansion: a home visit and booster sessions may add strength; 8) limited efficacy: future work with 50 participants will allow adequate power when anxiety is the outcome.

CONCLUSIONS

Further studies testing the BCTTMi are warranted in broader populations and across varied settings. However, it will be important to do preliminary work to identify outcomes measures, other than anxiety, that are sensitive to the BCTTMi.

Evaluating the Feasibility and Acceptability of the Lifestyle Enhancement for ADHD Program

OBJECTIVE

To evaluate the feasibility and acceptability of the Lifestyle Enhancement for Attention Deficit Hyperactivity Disorder (ADHD) Program (LEAP), a novel parent behavior management training program that promotes physical activity (PA) and positive health behaviors and is enhanced with mobile health technology (Garmin) and a social media (Facebook) curriculum for parents of children with ADHD.

METHODS

The study included parents of children ages 5-10 years diagnosed with ADHD who did not engage in the recommended >60 min/day of moderate to vigorous PA based on parent report at baseline. Parents participated in the 8-week LEAP group and joined a private Facebook group. Children and one parent wore wrist-worn Garmin activity trackers daily. Parents completed the Treatment Adherence Inventory, Client Satisfaction Questionnaire, and participated in a structured focus group about their experiences with various aspects of the program.

RESULTS

Of 31 children enrolled, 51.5% had ADHD combined presentation, 36.3% with ADHD, predominately inattentive presentation, and 12.1% had unspecified ADHD (age 5-10; M = 7.6; 48.4% female). Parents attended an average of 86% of group sessions. On average, parents wore their Garmins for 5.1 days/week (average step count 7,092 steps/day) and children for 6.0 days/week (average step count 9,823 steps/day). Overall, parents and children were adherent to intervention components and acceptability of the program was high.

CONCLUSIONS

Findings indicate that the LEAP program is an acceptable and feasible intervention model for promoting PA among parents and their children with ADHD. Implications for improving ADHD symptoms and enhancing evidence-based parent training programs are discussed.

Effectiveness of a Web-Based Intervention on Parental Psychological Flexibility and Emotion Regulation: A Pilot Open Trial

"Parenting Forest" is an informed contextual therapy parenting program for improving parental emotion regulation strategies and psychological flexibility. The aim of this study was to evaluate the preliminary effectiveness of a self-guided web-based intervention of the Parenting Forest program. The intervention program consists of six self-applied sequential modules that use strategies from contextual therapies for providing a parenting style open to experience, mindful and committed to its actions. A pilot controlled open trial was conducted. Eligible parents (n = 12) enrolled in the web-based intervention completed baseline (T1) and post-intervention (T2) assessment instruments. Parental psychological flexibility, avoidance, emotional regulation, parental stress, satisfaction with life, children's psychological adjustment and client satisfaction were measured to assess the effects of the intervention. Mood, coping, and value-related actions were assessed as measures of progress. The results showed positive effects on the parents' psychological flexibility and emotion regulation. Parents' mood and coping skills improved throughout the intervention program. These results provide preliminary evidence of the web-based Parenting Forest's efficacy, although further research is needed to assess its effectiveness for prevention and in clinical populations.

Mindfulness-based skills training group for parents of obsessive-compulsive disorder-affected children: A caregiver-focused intervention

BACKGROUND AND PURPOSE

Parents of children with obsessive-compulsive disorder (OCD) report significant emotional and socio-occupational impacts. There is, however, currently insufficient support for these parents. This study examined a mindfulness-based intervention for parents of OCD-affected children, investigating its feasibility and impact on parental ability to tolerate their child's OCD-related distress, in addition to exploring potential indirect effects.

MATERIALS AND METHODS

Parents of OCD-affected children (n = 39) completed an eight-week baseline observation period followed by eight, weekly manualized mindfulness-based intervention group sessions. Measures of parental tolerance of child distress, dispositional mindfulness, family accommodation, family functioning, and OCD symptom severity were collected.

RESULTS

In comparison to the baseline observation period, parental tolerance of child distress and dispositional mindfulness significantly improved following mindfulness training. No other temporal differences were observed. Parents reported high satisfaction.

CONCLUSION

Mindfulness-based skills training for parents of OCD-affected youth appears to be feasible and to significantly increase tolerance related to the child's distress.

CLINICAL TRIAL REGISTRATION NUMBER

NCT03212703.

Mindfulness-Based Strategies: A Cost-Effective Stress Reduction Method for Parents in the NICU

Stress in parents who have an infant in the NICU is well documented in literature. Prematurity and related comorbid conditions, high-tech NICU environments, presence of multidisciplinary health care professionals, altered parenting roles, and concerns of health outcomes in the infant are common stress factors. Further, inadequate management of stress can result in poor parent-infant bonding, poor infant outcome, and postpartum depression in parents. Effective stress management strategies may help parents adapt to their parental role thereby improving infant outcomes. Research has shown mindfulness-based strategies help reduce stress in the general population. Can this strategy be applied in the context of parents of infants in the NICU? Literature is scant on the impact of mindfulness-based strategies on parents of infants in the NICU and on the infant's health outcomes. This article explores the application of mindfulness-based strategies to reduce stress in parents of infants in the NICU.

A systematic review of mindfulness based interventions for children and young people with ADHD and their parents

Objective

Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent disorders in childhood, which may pose risks in later life such as academic underachievement and anti-social behaviour. It has been suggested that mindfulness-based interventions (MBI) may contribute to positive outcomes with child and adult populations. In this article, we aim to systematically review the literature regarding the effectiveness of MBI on both children with ADHD and their parents.

Method

Seven databases were searched using the PRISMA criteria and included peer-reviewed journals and grey literature.

Results

Ten studies met the inclusion criteria. Findings suggested that MBI had positive results in addressing attention deficits in children with ADHD, but in terms of hyperactivity, the evidence was conflicting. MBI interventions also appear to effectively address parental stress and family functioning. However, the rating from the quality assessment showed several methodological limitations.

Discussion

The current evidence on the impact of MBI on ADHD symptoms is non-conclusive. However, promising data indicated the potential for MBI in addressing parental stress and family functioning. Further research is recommended to overcome the current methodological limitations.

Systematic review of meditation-based interventions for children with ADHD

Meditation-based interventions such as mindfulness and yoga are commonly practiced in the general community to improve mental and physical health. Parents, teachers and healthcare providers are also increasingly using such interventions with children. This review examines the use of meditation-based interventions in the treatment of children with Attention-Deficit Hyperactivity Disorder (ADHD). Electronic databases searched included PsycINFO, Medline, CINAHL, and AMED. Inclusion criteria involved children (aged to 18 years) diagnosed with ADHD, delivery of a meditation-based intervention to children and/or parents, and publication in a peer-reviewed journal. Studies were identified and coded using standard criteria, risk of bias was assessed using Risk of Bias in Non-randomised Studies- of interventions (ROBINS-I), and effect sizes were calculated. A total of 16 studies were identified (8 that included children in treatment, and 8 that included combined parent-child treatment). Results indicated that risk of bias was high across studies. At this stage, no definitive conclusions can be offered regarding the utility of meditation-based interventions for children with ADHD and/or their parents, since the methodological quality of the studies reviewed is low. Future well designed research is needed to establish the efficacy of meditation-based interventions, including commonly used practices such as mindfulness, before recommendations can be made for children with ADHD and their families.

Mindfulness programming for parents and teachers of children with ADHD

BACKGROUND

Parents and teachers of children with attention-deficit/hyperactivity disorder (ADHD) are at-risk for a range of suboptimal psychosocial outcomes, including mental health difficulties and heightened stress, problems perhaps ameliorated through mindfulness-based programming.

OBJECTIVE

To show pilot data from an investigation of the outcomes of a purpose-built mindfulness training for parents and teachers of children with ADHD (N = 26).

METHODS

The program represents a purpose-driven modification of the Mindfulness-Based Stress Reduction (MBSR) curriculum. Namely, we reduced participant time commitment and added psychoeducation about ADHD with brief parent training. The measurement protocol included measures of stress, anxiety, depression, and mindfulness.

RESULTS

Following the 8-week program, parents and teachers reported reduced perceived stress, reduced self-reported anxiety, and improvements in some facets of mindfulness.

CONCLUSION

The work highlights the promise of specialized mindfulness-based interventions in promoting positive psychosocial outcomes in specific at-risk groups, such as the carers of children with ADHD.

Mindfulness-Based Cognitive Behavioral Therapy as an Adjunct Treatment of Attention Deficit Hyperactivity Disorder in Young Adults: A Literature Review

Attention deficit hyperactivity disorder (ADHD) is a childhood-onset neurological disorder that often continues into adult age. Stimulants medication are the mainstay of treatment, however, in the recent years, there has been a lot of studies conducted to understand the effectiveness and feasibility of mindfulness-based cognitive behavioral therapy for treatment of attention deficit hyperactivity disorder in children and adults. In this article, we have reviewed 17 articles to look for the beneficial effects of such therapy in adults. Overall, we found that there is a clear beneficial effect of such therapies, especially when used in adjunct with stimulant medication and may increase overall compliance. For better understanding, we suggest that large, well-designed studies should be conducted with robust strategies, allowing more comparison studies with the better analytical outcome.

Mindfulness-Based Childbirth Education: Incorporating Adult and Experiential Learning With Mindfulness-Based Stress Reduction in Childbirth Education

Informed choice is an expectation of today's parents. Concern is evident around whether education models are evolving to ensure flexibility for parents to access options perceived as meeting their needs. Historical and current evidence around childbirth education models including the introduction of mindfulness to parent education will be presented. The aim of this article is to describe the rationale for incorporating adult and experiential learning with mindfulness-based stress reduction in a childbirth education program implemented in Western Australia. The curriculum of the Mindfulness Based Childbirth Education 8-week program is shared with corresponding learning objectives for each session. Examples of educational materials that demonstrate how adult and experiential learning were embedded in the curriculum are presented.