As established in my previous blogs, it
has been identified that parents of children with ADHD experience or
have a higher probability of experiencing stress. Additionally, due
to this stress, parents of children with ADHD feel as though they
have less inability to be able to parent their children effectively.
Feelings of inadequacy have shown in studies that, as a result,
parent's stress not only increases, but their ability to empathize
can decrease while their symptoms of depression and anxiety can
increase (Anderson & Guthrey, 2015).The increase in stress for
parents of children with ADHD has also been known to be connected to
an exacerbation of their child's behavior, meaning that these two
variables can have the ability to influence one another(Neece, 2013).
Given the amount of research conducted
on parental stress in parents of children with ADHD, it would seem
appropriate for there to be an adequate of amount of research to
examine how to address useful interventions that may benefit a
parent's well-being when parenting a child with
inattentive/hyperactivity issues. Neece(2013) reports however that
“although parenting stress has been shown to be an important
predictor of several child outcomes, it is rarely directly addressed
in interventions targeting child behavior problems” (p. 174). Due
to this lack of research, I will be discussing the importance of
alternative interventions, particularly mindfulness based practices,
as a way to improve and enrich the quality of outcomes for children
with ADHD, as well as their families. Specifically, I will plan to
discuss the effectiveness of Mindfulness-Based Stress Reduction(MBSR)
for parents of children with ADHD, as well as address an approach
that was examined within a study completed by Oord, Bogels and
Peijnenburg(2012), which studied the effectiveness of mindfulness
training for both children and parents, using either
Mindfulness-Based Cognitive Therapy(MBCT) or MBSR.
Both Neece(2013) and Anderson and
Guthery(2015) discussed the alternative intervention of mindfulness
as a strategy to not only reduce parental stress, but to create an
environment that is more patient and empathetic to their children
with ADHD. Researchers posited in each study that creating this
environment will also help to improve child's behavior, or create
opportunity for the parent to be better able to manage challenging
behavior when it arises(Neece, 2013; Anderson & Guthery, 2015).
Anderson and Guthery(2015) focused on
introducing the idea of mindful parenting( rather than MBSR) in the
form of bibliotherapy, and did not specifically follow a therapeutic
protocol in which formal therapy was the focus. For the researchers,
the idea behind bibliotherapy helped to inform their theoretical
framework, which was based in social cognitive theory. Essentially,
by providing parents with information in a way that they could
independently work through , this was meant to create a sense of
self-efficacy which is a primary theme in social cognitive theory.
Anderson and Guthery(2015) utilized the work of Bandura(1977, 1991)
in order to show how learning the concept of mindfulness in a more
independent capacity can help parents to feel as though they are able
to control more of how they react. This is because they have learned
the skills through biblioherapy to be able to knowledgeable and
self-efficacious in the process of promoting and creating change for
how they respond to their child's behavior. Along with utilizing
bibliotherapy with the book Everyday
Blessings: The Inner Work of Mindful Parenting,
Anderson and Guthrey(2015) also used the Parenting Stress Index, 4th
edition(PSI-4
SF) as
a way to measure the outcomes. Below is a link to the book's
information if you are interested in checking it out for further
review:
Participants consisted of only 7 parents, although 20 participants
were originally asked to participate. Parents were asked to complete
the PSI-4 SF prior to reading the book, were given 8 weeks to read
the book, and then asked to complete the second PSI-4 SF following
the completion of the book. A post-project assessment was also
completed after the book was read as well. Results indicated that
there was a significant reduction in parental stress when parenting a
child with ADHD. Subscales that measured Difficult Child however were
not significant, as this study was particularly focused on measuring
parental stress rather than reducing challenging behavior of the
child(Anderson & Guthrey, 2015). While the Difficult Child
Subscale saw no difference, it is important to note that a lowering
of parental stress can ultimately change how challenging behavior is
addressed within the family structure, therefore creating an
opportunity for parents to be able to more effectively cope with
these behaviors.
While
this study was small in sample size, it provided an opportunity for
there to be more discussion and research created to address how
mindfulness techniques can be utilized in parenting a child with ADHD
in a way that is evidence based. Anderson and Guthrey(2015)
particularly noted that this intervention may be useful for families
that have values that go against the use of medications to assist
with ADHD symptoms. Other options for further research or adaptation
of this study included looking at this technique in a group setting,
considering how to utilize bibliotherapy with parents who have ADHD
themselves(by possible providing shorter material), how to include
fathers more effectively, and to consider how this intervention may
also be helpful to parents who have children that are affected by
autism spectrum disorder(Anderson & Guthrey, 2015).
Neece(2013)
also addressed the utilization of mindfulness into parenting a child
with ADHD but took an approach that reached across a span of
addressing any parent with a child that may have developmental
delay. Neece(2013) specifically focused on utilizing mindfulness
stress-based reduction interventions (MBSR) as a way to address
parental stress directly, rather than mainly focusing on behavioral
change therapy for the child. Neece's(2013) study included 46 parents
with children between the ages of 2.5-5 years old who were diagnosed
with a developmental delay. The MBSR intervention within this study
was utilized to capture three objectives which included:
psychoeducation on stress and anxiety, and how mindfulness can be a
useful tool to reduce these symptoms when they arise in the face of
behavior challenges, mindfulness homework or practice of it in group
sessions, and discussion in a larger group setting. The program was
designed to have 8 weekly sessions(2 hours long each), a mindfulness
retreat lasting 6 hours, and practice of mindfulness independently
everyday through assistance with a CD. Measure instruments to
determine outcomes included the Parenting Stress Index Short
Form(PSI-SF), the Family Impact Questionnaire, the Center for
Epidemiologic Studies Depression Scale,the Satisfaction with Life
Scale, the Child Behavior Checklist for ages 1.5-5, and the
Subjective Units of Distress Scale (Neece, 2013).Results indicated
that those receiving the intervention program had lower stress scores
on two scales and also reported less symptoms of depression and more
satisfaction with life. In addition to a decrease in parental stress,
the practice of MBSR also helped to alleviate in attentiveness in
child behavior. The study also noted that after completion of this
program, parents were more apt to continue to utilize mindfulness as
a technique to continue in their life. While this study brought forth
how MBSR can be utilized to reduce parental stress, researchers noted
that in order to further study the effectiveness of this
intervention, a study would need to be created that also included a
control treatment group for MBSR to be compared with.
While
it is apparent that there is growing research on the idea of
utilizing mindfulness as a way to address parental stress in
parenting a child with ADHD, more research still needs to be carried
out that will continue to provide evidence for this strategy as it
appears to be promising in addressing the family dynamic as a whole
rather than solely attending to behavior modification alone. While
MBSR and mindful parenting focuses on creating useful tools for
parents, the ultimate goal is for parent and child to receive tools
that they can both utilize when stressful times occur. It is here
where mindfulness training for both parent AND child seems to be a
promising area to research. Oord, Bogels and Peijnenburg (2011)
specifically target this approach of mindfulness as a tool for the
whole family structure to utilize, as it has been noted that parental
stress and parental issues and values both have a part to play in how
a child's behavior can be influenced. Given what is known about the
effectiveness of mindfulness training in both adults and children,
the researchers hypothesized that by utilizing mindfulness within a
family structure that has a child with ADHD, that “mindfulness
training would reduce children's and parents inattention and
impulsivity/hyperactivity, would improve parental mindful awareness,
would reduce parental stress and overreactivity, but would not affect
parent laxness” (p.140). To test this hypothesis, the researchers
utilized 22 parents and their children who were diagnosed with ADHD,
between age 8-12. Measures used to identify the hypothesized outcomes
were the Disruptive Behavior Disorder Scale, the Parenting Stress
Index, The Parenting Scale, The Mindfulness Attention and Awareness
Scale and The ADHD Rating Scale(Oord, Bogels, & Peijnenburg,
2011). The treatment was a combination of interventions rooted in
MBSR and Mindfulness-Based Cognitive Therapy(MBCT) for both children
and their parents. The treatment was additionally designed in a group
format, with their being 8 weekly 90 minute sessions, including
groups of 4-6 children and parents. The parents additionally received
an 8 week training on mindful parenting. The following link is to the
study itself, which includes a structure of each session and what the
child and parent were focusing on within each one.
Results
indicated that with the post-test of scales there was a reduction in
both parent and child of inattention and hyperactivity/impulsivity
symptoms, which are the base symptoms presented in ADHD. In addition
to this, the researchers also concluded that there was a significant
reduction in parental stress and less reactivity to challenging
behaviors(Oord, Bogels, & Peijnenburg, 2011). This research
examined a unique approach that incorporated the practice of
mindfulness into the family structure as whole, rather than relying
on either work from solely the child or the parent to improve
outcomes in the home. Researchers of this study indicated that this
approach would benefit from further study, to determine if the
combination of teaching mindfulness to both parent and child was
truly effective. Additionally, it is noted that this study was taken
place in the Netherlands, with families of high socioeconomic status,
and fairly high education status as well, which may have influenced
the results. The researchers also noted in their findings that an
addition of teacher interaction into the measure outcomes would be
useful so that these mindfulness techniques could be carried out in
all aspects of the child's daily life(Oord, Bogels, &
Peijnenburg, 2011).
The
practice of mindfulness seems to be increasing expanding into the
therapeutic realm as a successful and necessary adjunct to all forms
of treatment modalities. The study of mindfulness as an incorporation
into creating healthier and more positively functions family systems,
especially in families where there is a higher risk of stress, seems
to be the next logical step. The research however in this area has
made it apparent that more research needs to be done in order to
assess what the most effective structure will be to teach
mindfulness. Lastly, as Oord, Bogels and Peijnenburg(2011) noted, it
will be most important in future research to address how schools can
be involved in this collaborative process. This may serve to be
difficult, however, as teachers and schools will need to direct the
same amount of energy into learning mindfulness, if not more, as the
parents and child. The authors noted that this not only requires time
and commitment, but funds and resources of school districts as well.
Regardless of these barriers, utilizing the idea of mindfulness in
small and simple ways into one's family structure, particularly
families with children and/or parents who have ADHD, can be a step in
healthy direction. Below is a small clip to show how you and your
child can use mindfulness in your home:
References:
Anderson,
S. B., & Guthery, A. M. (2015). Mindfulness-based psychoeducation
for parents of children with attention-deficit/hyperactivity
disorder: An applied clinical project. Journal
of Child and Adolescent Psychiatric Nursing, 28(1),
43-49.
Neece,
C. L. (2013). Mindfulness-based stress reduction for parents of young
children with developmental delays: Implications for parental mental
health and child behavior problems. Journal
of Applied Research in Intellectual Disabilities,
27(2),
174-186.
Oord,
S. V., Bögels, S. M., & Peijnenburg, D. (2011). The
effectiveness of mindfulness training for children with ADHD and
mindful parenting for their parents. Journal
of Child and Family Studies, 21(1),
139-147.
