Mindfulness as a Tool for Parents and Children

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, 4^th 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:

Everyday Blessings: The Inner Work of Mindful Parenting

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.

Session Layout for Child and Parent Mindfulness Training

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.