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Mindfulness-Based Intervention for Chinese Children with ADHD and Their Parents: a Pilot Mixed-Method Study

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Abstract

This was a pilot pre–post-intervention study with added qualitative focused group discussions and interviews to examine the feasibility, acceptability, and effects of a mindfulness-based intervention (the 8-week MYmind course) for Chinese children with attention deficit hyperactivity disorder (ADHD) aged 8 to 12 years (n = 11) and one of their parents (n = 11). Outcomes included feasibility and acceptability of MYmind, objective measures of children’s attention and related problems, parent-reported child executive function and behavior problems, and parents’ parental stress, parenting styles, and mindful parenting. The attendance rate of MYmind (≥6 out of 8 sessions) was 91%: only one family withdrew from the course. Participants expressed overall positive views about MYmind. They also expressed their changes after the course, barriers and facilitators for course participation and completion, and suggestions on course improvement. The overall satisfaction scores were 7.3 (2.1) and 8.0 (1.2) out of 10 among the children and parents, respectively. With respect to the quantitative results, after multiple testing correction, positive results with large effect sizes only occurred on the objective attention tests: “time per target,” “attention score,” and “map mission” of the Test of Everyday Attention for Children (TEA-Ch) and “omissions” of the computerized Conners’ Continuous Performance Test 3rd Edition (CPT 3), whereas no statistically significant changes were seen in other measures, i.e., children’s other results in the TEA-Ch and CPT 3, parents’ perceived child problems on the Eyberg Child Behavior Inventory (ECBI) and the Behavior Rating Inventory of Executive Function (BRIEF), as well as parents’ scores of the Parenting Stress Index (PSI), Parenting Scale (PS), and Interpersonal Mindfulness in Parenting (IM-P). The MYmind course is a feasible and acceptable intervention among Chinese children with ADHD and their parents. The preliminary significant quantitative results should be interpreted with much caution due to potential effects from learning on neurocognitive outcomes. Larger studies with a control group are needed.

This pilot trial is registered in the World Health Organization (WHO) Registry Network—Chinese Clinical Trial Register (ChiCTR). The reference number is ChiCTR-OPC-15006686.

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References

  • Aickin, M., & Gensler, H. (1996). Adjusting for multiple testing when reporting research results: the Bonferroni vs Holm methods. American Journal of Public Health, 86(5), 726–728.

    Article  PubMed  PubMed Central  Google Scholar 

  • Arnold, D. S., O’Leary, S. G., Wolff, L. S., & Acker, M. M. (1993). The parenting scale: a measure of dysfunctional parenting in discipline situations. Psychological Assessment, 5(2), 137.

    Article  Google Scholar 

  • Arnold, L. E. (2001). Alternative treatments for adults with attention-deficit hyperactivity disorder (ADHD). Annals of the New York Academy of Sciences, 931, 310–341.

    Article  PubMed  Google Scholar 

  • Bögels, S. M., Lehtonen, A., & Restifo, K. (2010). Mindful parenting in mental health care. Mindfulness, 1(2), 107–120.

    Article  PubMed  PubMed Central  Google Scholar 

  • Briggs-Gowan, M. J., Carter, A. S., & Schwab-Stone, M. (1996). Discrepancies among mother, child, and teacher reports: examining the contributions of maternal depression and anxiety. Journal of Abnormal Child Psychology, 24(6), 749–765.

    Article  PubMed  Google Scholar 

  • Burch, N. (1970). Four stages of learning any new skill. Solana Beach, CA: Gordon Training International.

    Google Scholar 

  • Cassone, A. R. (2015). Mindfulness training as an adjunct to evidence-based treatment for ADHD within families. Journal of Attention Disorders, 19(2), 147–157.

    Article  PubMed  Google Scholar 

  • Cairncross, M., & Miller, C. J. (2016). The effectiveness of mindfulness-based therapies for ADHD: a meta-analytic review. Journal of Attention Disorders, 1, 17.

    Google Scholar 

  • Chan, A. S., Cheung, M. C., Han, Y. M., Sze, S. L., Leung, W. W., Man, H. S., & To, C. Y. (2009). Executive function deficits and neural discordance in children with autism spectrum disorders. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology, 120(6), 1107–1115.

    Article  Google Scholar 

  • Chan, R. C., Wang, L., Ye, J., Leung, W. W., & Mok, M. Y. (2008). A psychometric study of the test of everyday attention for children in the Chinese setting. Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists, 23(4), 455–466.

    Article  Google Scholar 

  • Chang, L. R., Chiu, Y. N., Wu, Y. Y., & Gau, S. S. F. (2013). Father’s parenting and father-child relationship among children and adolescents with attention-deficit/hyperactivity disorder. Comprehensive Psychiatry, 54(2), 128–140.

    Article  PubMed  Google Scholar 

  • Chi, T. C., & Hinshaw, S. P. (2002). Mother-child relationships of children with ADHD: the role of maternal depressive symptoms and depression-related distortions. Journal of Abnormal Child Psychology, 30(4), 387–400.

    Article  PubMed  Google Scholar 

  • Chiesa, A., & Serretti, A. (2010). A systematic review of neurobiological and clinical features of mindfulness meditations. Psychological Medicine, 40(8), 1239–1252.

    Article  PubMed  Google Scholar 

  • Chronis, A. M., Lahey, B. B., Pelham Jr., W. E., Kipp, H. L., Baumann, B. L., & Lee, S. S. (2003). Psychopathology and substance abuse in parents of young children with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 42(12), 1424–1432.

    Article  PubMed  Google Scholar 

  • Conners, C. K. (2015). Conners Continuous Performance Test 3rd edition™ (Conners CPT 3™), Conners Continuous Auditory Test of Attention (Conners CATA™) manual. Canada: Multi-Health Systems Incorporated.

    Google Scholar 

  • Connor, D. F., Edwards, G., Fletcher, K. E., Baird, J., Barkley, R. A., & Steingard, R. J. (2003). Correlates of comorbid psychopathology in children with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 42(2), 193–200.

    Article  PubMed  Google Scholar 

  • Daley, D., van der Oord, S., Ferrin, M., Danckaerts, M., Doepfner, M., Cortese, S., Sonuga-Barke, E. J., & European ADHD Guidelines Group (2014). Behavioral interventions in attention-deficit/hyperactivity disorder: a meta-analysis of randomized controlled trials across multiple outcome domains. Journal of the American Academy of Child & Adolescent Psychiatry, 53(8), 835–847.

    Article  Google Scholar 

  • de Bruin, E. I., Zijlstra, B. J. H., Geurtzen, N., van Zundert, R. M. P., van de Weijer-Bergsma, E., Hartman, E. E., Nieuwesteeg, A. M., Duncan, L. G., & Bögels, S. M. (2014). Mindful parenting assessed further: psychometric properties of the Dutch version of the interpersonal mindfulness in parenting scale (IM-P). Mindfulness, 5(2), 200–212.

    Article  PubMed  Google Scholar 

  • Duncan, L. G. (2007). Assessment of mindful parenting among parents of early adolescents: development and validation of the interpersonal mindfulness in parenting scale. The Pennsylvania State University: Unpublished Dissertation.

    Google Scholar 

  • Edel, M. A., Holter, T., Wassink, K. & Juckel, G. (2014). A comparison of mindfulness-based group training and skills group training in adults with ADHD: an open study. Journal of Attention Disorders, 1–7. doi: 10.1177/1087054714551635.

  • Evans, S. (2010). Review: Mindfulness-based therapies effective for anxiety and depression. Evidence-Based Mental Health, 13(4), 116.

    Article  PubMed  Google Scholar 

  • Eyberg, S. M., & Ross, A. W. (1978). Assessment of child behavior problems: the validation of a new inventory. Journal of Clinical Child & Adolescent Psychology, 7(2), 113–116.

    Article  Google Scholar 

  • Gau, S. S. F., & Chang, J. P. C. (2013). Maternal parenting styles and mother-child relationship among adolescents with and without persistent attention-deficit/hyperactivity disorder. Research in Developmental Disabilities, 34(5), 1581–1594.

    Article  PubMed  Google Scholar 

  • Gioia, G. A., Isquith, P. K., Guy, S. C., & Kenworthy, L. (2000a). Behavior rating inventory of executive function: BRIEF. Odessa, FL: Psychological Assessment Resources.

    Google Scholar 

  • Gioia, G. A., Isquith, P. K., Guy, S. C., & Kenworthy, L. (2000b). Test review behavior rating inventory of executive function. Child Neuropsychology, 6(3), 235–238.

    Article  Google Scholar 

  • Gioia, G. A., Isquith, P. K., Retzlaff, P. D., & Espy, K. A. (2002). Confirmatory factor analysis of the behavior rating inventory of executive function (BRIEF) in a clinical sample. Child Neuropsychology, 8(4), 249–257.

    Article  PubMed  Google Scholar 

  • Graziano, P. A., McNamara, J. P., Geffken, G. R., & Reid, A. (2011). Severity of children’s ADHD symptoms and parenting stress: a multiple mediation model of self-regulation. Journal of Abnormal Child Psychology, 39(7), 1073–1083.

    Article  PubMed  Google Scholar 

  • Greenfield, B., & Hechman, L. (2005). Treatment of attention deficit hyperactivity disorder in adults. Expert Review of Neurotherapeutics, 5(1), 107–121.

    Article  PubMed  Google Scholar 

  • Haydicky, J., Shecter, C., Wiener, J., & Ducharme, J. M. (2015). Evaluation of MBCT for adolescents with ADHD and their parents: impact on individual and family functioning. Journal of Child and Family Studies, 24(1), 76–94.

    Article  Google Scholar 

  • Heaton, S. C., Reader, S. K., Preston, A. S., Fennell, E. B., Puyana, O. E., Gill, N., & Johnson, J. H. (2001). The Test of Everyday Attention for Children (TEA-Ch): patterns of performance in children with ADHD and clinical controls. Child Neuropsychology, 7(4), 251–264.

    Article  PubMed  Google Scholar 

  • Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 169–183.

    Article  PubMed  PubMed Central  Google Scholar 

  • Holm, S. (1979). A simple sequential rejective method procedure. Scandinavian Journal of Statistics, 6, 65–70.

    Google Scholar 

  • Holzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science, 6(6), 537–559.

    Article  PubMed  Google Scholar 

  • Hou, R. J., Wong, S. Y., Yip, B. H., Hung, A. T., Lo, H. H., Chan, P. H., Lo, C. S., Kwok, T. C., Tang, W. K., Mak, W. W., Mercer, S. W., & Ma, S. H. (2014). The effects of mindfulness-based stress reduction program on the mental health of family caregivers: a randomized controlled trial. Psychotherapy and Psychosomatics, 83(1), 45–53.

    Article  PubMed  Google Scholar 

  • Jensen, C. G., Vangkilde, S., Frokjaer, V., & Hasselbalch, S. G. (2012). Mindfulness training affects attention—or is it attentional effort? Journal of Experimental Psychology: General, 141(1), 106–123.

    Article  Google Scholar 

  • Julian, T. W., McKenry, P. C., & McKelvey, M. W. (1994). Cultural variations in parenting: perceptions of Caucasian, African-American, Hispanic, and Asian-American parents. Family Relations, 43(1), 30–37.

    Article  Google Scholar 

  • Kabat-Zinn, J. (1990). Full catastrophy living. New York: Delta Publishing.

    Google Scholar 

  • Kelley, E. E. (2008). Parental depression and negative attribution bias in parent reports of child symptoms. ProQuest.

  • Lam, D. (1999). Parenting stress and anger: the Hong Kong experience. Child and Family Social Work, 4, 337–346.

    Article  Google Scholar 

  • Lee, M. T., Wong, B. P., Chow, B. W. Y., & McBride-Chang, C. (2006). Predictors of suicide ideation and depression in Hong Kong adolescents: perceptions of academic and family climates. Suicide and Life-threatening Behavior, 36(1), 82–96.

    Article  PubMed  Google Scholar 

  • Leung, C., Chan, S., Pang, R., & Cheng, W. (2003). Validation of the Chinese version of the Eyberg Child Behavior Inventory for use in Hong Kong. Wanchai, Hong Kong: Education and Manpower Bureau.

    Google Scholar 

  • Leung, P. W., Hung, S. F., Ho, T. P., Lee, C. C., Liu, W. S., Tang, C. P., & Kwong, S. L. (2008). Prevalence of DSM-IV disorders in Chinese adolescents and the effects of an impairment criterion: a pilot community study in Hong Kong. European Child & Adolescent Psychiatry, 17(7), 452–461.

    Article  Google Scholar 

  • Lifford, K. J., Harold, G. T., & Thapar, A. (2008). Parent–child relationships and ADHD symptoms: a longitudinal analysis. Journal of Abnormal Child Psychology, 36(2), 285–296.

    Article  PubMed  Google Scholar 

  • Manly, T., Anderson, V., Nimmo-Smith, I., Turner, A., Watson, P., & Robertson, I. H. (2001). The differential assessment of children’s attention: the Test of Everyday Attention for Children (TEA-Ch), normative sample and ADHD performance. Journal of Child Psychology and Psychiatry, 42(08), 1065–1081.

    Article  PubMed  Google Scholar 

  • Manly, T., Robertson, I. H., Anderson, V., & Nimmo-Smith, I. (1999). The Test of Everyday Attention (TEA-CH). Bury St. Edmunds, England: Thames Valley Test Company.

    Google Scholar 

  • Mehta, S., Mehta, V., Shah, D., Motiwala, A., Vardhan, J., Mehta, N., & Mehta, D. (2011). Multimodal behavior program for ADHD incorporating yoga and implemented by high school volunteers: a pilot study. International Scholarly Research Notices: Pediatrics, 2011, 780745. doi:10.5402/2011/780745.

    Google Scholar 

  • Mehta, S., Shah, D., Shah, K., Mehta, N., Mehta, V., Motiwala, S., & Mehta, D. (2012). Peer-mediated multimodal intervention program for the treatment of children with ADHD in India: one-year followup. International Scholarly Research Notices: Pediatrics, 2012, 419168. doi:10.5402/2012/419168.

    Google Scholar 

  • Mitchell, J. T., McIntyre, E. M., English, J. S., Dennis, M. F., Beckham, J. C., & Kollins, S. H. (2013). A pilot trial of mindfulness meditation training for ADHD in adulthood: impact on core symptoms, executive functioning, and emotion dysregulation. Journal of Attention Disorders, 2013. doi:10.1177/1087054713513328.

  • Modesto-Lowe, V., Chaplin, M., Godsay, V., & Soovajian, V. (2014). Parenting teens with attention-deficit/hyperactivity disorder: challenges and opportunities. Clinical Pediatrics (Phila), 53(10), 943–948.

    Article  Google Scholar 

  • Netson, K. L., Conklin, H. M., Ashford, J. M., Kahalley, L. S., Wu, S., & Xiong, X. (2011). Parent and teacher ratings of attention during a year-long methylphenidate trial in children treated for cancer. Journal of Pediatric Psychology, 36, 438–450.

    Article  PubMed  Google Scholar 

  • Polanczyk, G. V., Salum, G. A., Sugaya, L. S., Caye, A., & Rohde, L. A. (2015). Annual research review: a meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of Child Psychology and Psychiatry, 56(3), 345–365.

    Article  PubMed  Google Scholar 

  • Qian, Y., Shuai, L., Cao, Q., Chan, R. C., & Wang, Y. (2010). Do executive function deficits differentiate between children with attention deficit hyperactivity disorder (ADHD) and ADHD comorbid with oppositional defiant disorder? A cross-cultural study using performance-based tests and the behavior rating inventory of executive function. The Clinical Neuropsychologist, 24(5), 793–810.

    Article  PubMed  Google Scholar 

  • Sanger, K. L., & Dorjee, D. (2015). Mindfulness training for adolescents: a neurodevelopmental perspective on investigating modifications in attention and emotion regulation using event-related brain potentials. Cognitive, Affective & Behavioral Neuroscience, 15(3), 696–711.

    Article  Google Scholar 

  • Searight, H. R., Robertson, K., Smith, T., Perkins, S., & Searight, B. K. (2012). Complementary and alternative therapies for pediatric attention deficit hyperactivity disorder: a descriptive review. International Scholarly Research Notices: Psychiatry, 2012, 804127. doi:10.5402/2012/804127.

    Google Scholar 

  • Segal, Z. V., Williams, J. M., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression. A new approach to preventing relapse. New York: Guilford Press.

    Google Scholar 

  • Sharma, M., & Rush, S. E. (2014). Mindfulness-based stress reduction as a stress management intervention for healthy individuals: a systematic review. Journal of evidence-based complementary & alternative medicine, 19(4), 271–286.

    Article  Google Scholar 

  • Smalley, S. L., Loo, S. K., Hale, T. S., Shrestha, A., McGough, J., Flook, L., & Reise, S. (2009). Mindfulness and attention deficit hyperactivity disorder. Journal of Clinical Psychology, 65(10), 1087–1098.

    Article  PubMed  PubMed Central  Google Scholar 

  • Srivastava, A., & Thomson, S. B. (2009). Framework analysis: a qualitative methodology for applied policy research. Journal of Administration & Governance, 4(2), 72–79.

    Google Scholar 

  • Tam, K. K., Chan, Y. C., & Wong, C. K. M. (1994). Validation of the parenting stress index among Chinese mothers in Hong Kong. Journal of Community Psychology, 22(3), 211–223.

    Article  Google Scholar 

  • Thapar, A., Harrington, R., Ross, K., & McGuffin, P. (2000). Does the definition of ADHD affect heritability? Journal of the American Academy of Child and Adolescent Psychiatry, 39(12), 1528–1536.

    Article  PubMed  Google Scholar 

  • van de Weijer-Bergsma, E., Formsma, A. R., de Bruin, E. I., & Bögels, S. M. (2012). The effectiveness of mindfulness training on behavioral problems and attentional functioning in adolescents with ADHD. Journal of Child and Family Studies, 21(5), 775–787.

    Article  PubMed  Google Scholar 

  • van der Oord, S., Bögels, S. M., & Peijnenburg, D. (2012). 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.

    Article  PubMed  Google Scholar 

  • Ward, D. J., Furber, C., Tierney, S., & Swallow, V. (2013). Using framework analysis in nursing research: a worked example. Journal of Advanced Nursing, 69(11), 2423–2431.

    PubMed  Google Scholar 

  • Yeh, C. H., Chen, M. L., Li, W., & Chuang, H. L. (2001). The Chinese version of the parenting stress index: a psychometric study. Acta Paediatrica, 90(12), 1470–1477.

    Article  PubMed  Google Scholar 

  • Zylowska, L., Ackerman, D. L., Yang, M. H., Futrell, J. L., Horton, N. L., Hale, T. S., Pataki, C., & Smalley, S. L. (2008). Mindfulness meditation training in adults and adolescents with ADHD: a feasibility study. Journal of Attention Disorders, 11(6), 737–746.

    Article  PubMed  Google Scholar 

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Acknowledgements

This study was funded by the Direct Grant for Research, The Chinese University of Hong Kong. We also thank all the children and parents of this study and workers and helpers in Heep Hong Society for the support.

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Authors and Affiliations

  1. Division of Family Medicine and Primary Health Care, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, Hong Kong, China

    Dexing Zhang, Tiffany Ting Gao & Samuel Yeung Shan Wong

  2. Heep Hong Society, Hong Kong, China

    Stanley Kam Chung Chan & Christina Ying Ha Chan

  3. The Department of Applied Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China

    Herman Hay Ming Lo

  4. The Division of Educational Psychology, Hong Kong Psychological Society, Hong Kong, China

    Jenny Ching Yin Chan

  5. Kowloon Hospital, Hospital Authority, Kowloon, Hong Kong, China

    Ka Tsun Ting

  6. Department of Psychiatry, The Chinese University of Hong Kong, Sha Tin, Hong Kong, China

    Kelly Yee Ching Lai

  7. Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands

    Susan M. Bögels

  8. 4/F, JC School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, NT, Hong Kong, China

    Samuel Yeung Shan Wong

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  1. Dexing Zhang
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Zhang, D., Chan, S.K.C., Lo, H.H.M. et al. Mindfulness-Based Intervention for Chinese Children with ADHD and Their Parents: a Pilot Mixed-Method Study. Mindfulness 8, 859–872 (2017). https://doi.org/10.1007/s12671-016-0660-3

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