Abstract
Mindfulness-based therapies are rising in popularity. However, evidence for their effectiveness in reducing psychological distress and enhancing wellbeing for families living with autism spectrum disorder (ASD) is limited. A systematic search identified 10 independent studies, involving a pooled sample of 233 children and adults with ASD and 241 caregivers. Hedges’ g effect sizes with associated 95% confidence intervals, in addition to heterogeneity, were calculated using a random-effects model. Caregivers, children and adults who received mindfulness all reported significant gains in subjective wellbeing immediately post-intervention. Available data indicated intervention effects were maintained at 3-month follow-up. Mindfulness presents a promising intervention strategy in ASD populations, however more controlled research is required to determine its precise efficacy for affected families and subgroups.
Similar content being viewed by others
References
* Refers to study included in meta-analysis
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Association.
Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology, 10(2), 125–143. https://doi.org/10.1093/clipsy.bpg015.
Benn, R., Akiva, T., Arel, S., & Roeser, R. (2012). Mindfulness Training Effects for Parents and Educators of Children With Special Needs. Developmental Psychology. https://doi.org/10.1037/a0027537.supp.
Berger, D. (2015). Double-blinding and bias in medication and cognitive-behavioural therapy trials for major depressive disorder. F1000Research. https://doi.org/10.12688/f1000research.6953.1.
Bitsika, V., Sharpley, C. F., & Bell, R. (2013). The buffering effect of resilience upon stress, anxiety and depression in parents of a child with an Autism Spectrum Disorder. Journal of Developmental and Physical Disabilities, 25(5), 533–543. https://doi.org/10.1007/s10882-013-9333-5.
Blanck, P., Perleth, S., Heidenreich, T., Kröger, P., Ditzen, B., Bents, H., et al. (2018). Effects of mindfulness exercises as stand-alone intervention on symptoms of anxiety and depression: Systematic review and meta-analysis. Behaviour Research and Therapy, 102, 25–35. https://doi.org/10.1016/j.brat.2017.12.002.
Bluth, K., Roberson, P. N. E., & Girdler, S. S. (2017). Adolescent sex differences in response to a mindfulness intervention: A call for research. Journal of Child and Family Studies, 26(7), 1900–1914. https://doi.org/10.1007/s10826-017-0696-6.
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2009). Introduction to meta-analysis. Hoboken: Wiley.
Cachia, R. L., Anderson, A., & Moore, D. W. (2016a). Mindfulness in individuals with Autism Spectrum Disorder: A systematic review and narrative analysis. Review Journal of Autism and Developmental Disorders, 3(2), 165–178. https://doi.org/10.1007/s40489-016-0074-0.
Cachia, R. L., Anderson, A., & Moore, D. W. (2016b). Mindfulness, stress and well-being in parents of children with Autism Spectrum Disorder: A systematic review. Journal of Child and Family Studies, 25(1), 1–14. https://doi.org/10.1007/s10826-015-0193-8.
*Conner, C. M., & White, S. W. (2018). Brief report: Feasibility and preliminary efficacy of individual mindfulness therapy for adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 48(1), 290–300. https://doi.org/10.1007/s10803-017-3312-0.
Cooper, D., Yap, K., & Batalha, L. (2018). Mindfulness-based interventions and their effects on emotional clarity: A systematic review and meta-analysis. Journal of Affective Disorders, 235, 265–276. https://doi.org/10.1016/j.jad.2018.04.018.
Cummings, G. (2012). Understanding the new statistics: Effect sizes, confidence intervals, and meta-analysis. New York: Routledge.
*de Bruin, E. I., Blom, R., Smit, F. M., van Steensel, F. J., & Bogels, S. M. (2015). MYmind: Mindfulness training for Youngsters with autism spectrum disorders and their parents. Autism, 19(8), 906–914. https://doi.org/10.1177/1362361314553279.
Demir, T., Dogangun, B., Karacetin, G., Mukaddes, N. M., Demir, D., & Copur, M. (2008). Psychiatric disorders and symptoms in mothers of children with autistic disorder. Neurology Psychiatry and Brain Research, 15(4), 191–196.
Diener, E., Suh, E. M., Lucas, R. E., & Smith, H. L. (1999). Subjective well-being: Three decades of progress. Psychological Bulletin, 125(2), 276–302.
Donnchadha, S. O. (2018). Stress in caregivers of individuals with intellectual or developmental disabilities: A systematic review of mindfulness-based interventions. Journal of Applied Research in Intellectual Disabilities, 31(2), 181–192. https://doi.org/10.1111/jar.12398.
Dykens, E. M., Fisher, M. H., Taylor, J. L., Lambert, W., & Miodrag, N. (2014). Reducing distress in mothers of children with autism and other disabilities: a randomized trial. Pediatrics, 134(2), e454–e463. https://doi.org/10.1542/peds.2013-3164.
Ellis, P. D. (2010). The essential guide to effect sizes: statistical power, meta-analysis, and the interpretation of research results. Cambridge: Cambridge University Press.
*Ferraioli, S. J., & Harris, S. L. (2013). Comparative effects of mindfulness and skills-based parent training programs for parents of children with autism: Feasibility and preliminary outcome data. Mindfulness, 4(2), 89–101. https://doi.org/10.1007/s12671-012-0099-0.
Fish, J., Brimson, J., & Lynch, S. (2016). Mindfulness interventions delivered by technology without facilitator involvement: What research exists and what are the clinical outcomes? Mindfulness (N Y), 7(5), 1011–1023. https://doi.org/10.1007/s12671-016-0548-2.
Goldberg, S. B., Tucker, R. P., Greene, P. A., Simpson, T. L., Kearney, D. J., & Davidson, R. J. (2017). Is mindfulness research methodology improving over time? A systematic review. PLoS ONE. https://doi.org/10.1371/journal.pone.0187298.
Gotham, K., Brunwasser, S. M., & Lord, C. (2015). Depressive and anxiety symptom trajectories from school age through young adulthood in samples with autism spectrum disorder and developmental delay. Journal of the American Academy of Child and Adolescent Psychiatry, 54(5), 369–373.e363. https://doi.org/10.1016/j.jaac.2015.02.005.
Hayes, S. A., & Watson, S. L. (2013). The impact of parenting stress: A meta-analysis of studies comparing the experience of parenting stress in parents of children with and without autism spectrum disorder. Journal of Autism and Developmental Disorders, 43(3), 629–642. https://doi.org/10.1007/s10803-012-1604-y.
Higgins, J., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003). Measuring inconsistency in meta-analyses. The British Medical Journal, 327, 557–560. https://doi.org/10.1136/bmj.327.7414.557.
Hourston, S., & Atchley, R. (2017). Autism and mind–body therapies: A systematic review. Journal of Alternative and Complementary Medicine, 23(5), 331–339. https://doi.org/10.1089/acm.2016.0336.
Hudson, C. C., Hall, L., & Harkness, K. L. (2018). Prevalence of depressive disorders in individuals with autism spectrum disorder: A meta-analysis. Journal of Abnormal Child Psychology. https://doi.org/10.1007/s10802-018-0402-1.
*Hwang, Y. S., Kearney, P., Klieve, H., Lang, W., & Roberts, J. (2015). *Cultivating mind: Mindfulness interventions for children with autism spectrum disorder and problem behaviours, and their mothers. Journal of Child and Family Studies, 24(10), 3093–3106. https://doi.org/10.1007/s10826-015-0114-x.
Ingersoll, B., & Hambrick, D. Z. (2011). The relationship between the broader autism phenotype, child severity, and stress and depression in parents of children with autism spectrum disorders. Research in Autism Spectrum Disorders, 5(1), 337–344. https://doi.org/10.1016/j.rasd.2010.04.017.
Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144–156. https://doi.org/10.1093/clipsy.bpg016.
*Kiep, M., Spek, A. A., & Hoeben, L. (2015). Mindfulness-based therapy in adults with an Autism Spectrum Disorder: Do treatment effects last? Mindfulness, 6(3), 637–644. https://doi.org/10.1007/s12671-014-0299-x.
Knuppel, A., Telleus, G. K., Jakobsen, H., & Lauritsen, M. B. (2018). Quality of life in adolescents and adults with autism spectrum disorder: Results from a nationwide Danish survey using self-reports and parental proxy-reports. Research in Developmental Disabilities, 83, 247–259. https://doi.org/10.1016/j.ridd.2018.09.004.
Lever, A. G., & Geurts, H. M. (2016). Psychiatric co-occurring symptoms and disorders in young, middle-aged, and older adults with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 46(6), 1916–1930. https://doi.org/10.1007/s10803-016-2722-8.
Luhmann, M., Hofmann, W., Eid, M., & Lucas, R. E. (2012). Subjective well-being and adaptation to life events: A meta-analysis. Journal of Personality and Social Psychology, 102(3), 592–615. https://doi.org/10.1037/a0025948.
Mazzone, L., Postorino, V., De Peppo, L., Fatta, L., Lucarelli, V., Reale, L., et al. (2013). Mood symptoms in children and adolescents with Autism Spectrum Disorders. Research in Developmental Disabilities, 34(11), 3699–3708. https://doi.org/10.1016/j.ridd.2013.07.034.
McConachie, H., Livingstone, N., Morris, C., Beresford, B., Le Couteur, A., Gringras, P., et al. (2018a). Parents suggest which indicators of progress and outcomes should be measured in young children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 48(4), 1041–1051. https://doi.org/10.1007/s10803-017-3282-2.
McConachie, H., Mason, D., Parr, J. R., Garland, D., Wilson, C., & Rodgers, J. (2018b). Enhancing the validity of a quality of life measure for autistic people. Journal of Autism and Developmental Disorders, 48(5), 1596–1611. https://doi.org/10.1007/s10803-017-3402-z.
Milton, D. E. M., & Bracher, M. (2013). Autistics speak but are they heard? Medical Sociology online, 7, 61–69.
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. The British Medical Journal, 339, b2535. https://doi.org/10.1136/bmj.b2535.
Nah, Y. H., Brewer, N., Young, R. L., & Flower, R. (2018). Brief report: Screening adults with autism spectrum disorder for anxiety and depression. Journal of Autism and Developmental Disorders, 48(5), 1841–1846. https://doi.org/10.1007/s10803-017-3427-3.
Neece, C. L. (2014). 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. https://doi.org/10.1111/jar.12064.
Nicollet, C., Van Dooren, K., Sofronoff, K., Steel, E., Ware, R., Beaumont, R., et al. (2016). A systematic review and meta-analysis of psychological interventions for adolescents and adults on the autism spectrum with anxiety. Journal of Intellectual Disability Research, 60(7–8), 715.
Orwin, R. G. (1983). A fail-safe N for effect size in meta-analysis. American Educational Research Association and American Statistical Association, 8(2), 157–159.
Paz, N. S. D., & Wallander, J. L. (2017). Interventions that target improvements in mental health for parents of children with autism spectrum disorders: A narrative review. Clinical Psychology Review, 51, 1–14. https://doi.org/10.1016/j.cpr.2016.10.006.
Pelham, B. W., & Blanton, H. (2013). Counducting research in psychology: Measuring the weight of smoke (4th ed.). Belmont: Wadsworth, Cengage Learning.
Perestelo-Perez, L., Barraca, J., Peñate, W., Rivero-Santana, A., & Alvarez-Perez, Y. (2017). Mindfulness-based interventions for the treatment of depressive rumination: Systematic review and meta-analysis. International Journal of Clinical and Health Psychology, 17(3), 282–295. https://doi.org/10.1016/j.ijchp.2017.07.004.
Peters, M. D. (2017). Managing and coding references for systematic reviews and scoping reviews in EndNote. Medical Reference Services Quarterly, 36(1), 19–31. https://doi.org/10.1080/02763869.2017.1259891.
Potes, A., Souza, G., Nikolitch, K., Penheiro, R., Moussa, Y., Jarvis, E., et al. (2018). Mindfulness in severe and persistent mental illness: A systematic review. International Journal of Psychiatry in Clinical Practice. https://doi.org/10.1080/13651501.2018.1433857.
*Rayan, A., & Ahmad, M. (2016). Effectiveness of mindfulness-based interventions on quality of life and positive reappraisal coping among parents of children with autism spectrum disorder. Research in Developmental Disabilities, 55, 185–196. https://doi.org/10.1016/j.ridd.2016.04.002.
*Rayan, A., & Ahmad, M. (2017). Effectiveness of mindfulness-based intervention on perceived stress, anxiety, and depression among parents of children with autism spectrum disorder. Mindfulness, 8(3), 677–690. https://doi.org/10.1007/s12671-016-0595-8.
Reichow, B., Volkmar, F. R., & Cicchetti, D. V. (2008). Development of the evaluative method for evaluating and determining evidence-based practices in autism. Journal of Autism and Develoopmental Disorders, 38(7), 1311–1319. https://doi.org/10.1007/s10803-007-0517-7.
*Ridderinkhof, A., de Bruin, E. I., Blom, R., & Bogels, S. M. (2018). Mindfulness-based program for children with autism spectrum disorder and their parents: direct and long-term improvements. Mindfulness (N Y), 9(3), 773–791. https://doi.org/10.1007/s12671-017-0815-x.
Ridderinkhof, A., de Bruin, E. I., Brummelman, E., & Bögels, S. M. (2017). Does mindfulness meditation increase empathy? An experiment. Self and Identity, 16(3), 251–269. https://doi.org/10.1080/15298868.2016.1269667.
Rivet, T. T., & Matson, J. L. (2011). Review of gender differences in core symptomatology in autism spectrum disorders. Research in Autism Spectrum Disorders, 5(3), 957–976. https://doi.org/10.1016/j.rasd.2010.12.003.
Robertson, A. E., Stanfield, A. C., Watt, J., Barry, F., Day, M., Cormack, M., et al. (2018). The experience and impact of anxiety in autistic adults: A thematic analysis. Research in Autism Spectrum Disorders, 46, 8–18. https://doi.org/10.1016/j.rasd.2017.11.006.
Rosenthal, R. (1979). The “File Drawer Problem” and tolerance for null results. Psychological Bulletin, 86(3), 638–641.
*Ruiz-Robledillo, N., Sariñana-González, P., Pérez-Blasco, J., González-Bono, E., & Moya-Albiol, L. (2015). A mindfulness-based program improves health in caregivers of people with autism spectrum disorder: A pilot study. Mindfulness, 6(4), 767–777. https://doi.org/10.1007/s12671-014-0316-0.
Schaafsma, S. M., & Pfaff, D. W. (2014). Etiologies underlying sex differences in autism spectrum disorders. Frontiers in Neuroendocrinology, 35(3), 255–271. https://doi.org/10.1016/j.yfrne.2014.03.006.
Shean, G. (2014). Limitations of randomized control designs in psychotherapy research. Advances in Psychiatry, 2014, 1–5. https://doi.org/10.1155/2014/561452.
Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry, 47(8), 921–929. https://doi.org/10.1097/CHI.0b013e318179964f.
Singh, N. N., Lancioni, G. E., Manikam, R., Winton, A. S. W., Singh, A. N. A., Singh, J., et al. (2011a). A mindfulness-based strategy for self-management of aggressive behavior in adolescents with autism. Research in Autism Spectrum Disorders, 5(3), 1153–1158. https://doi.org/10.1016/j.rasd.2010.12.012.
Singh, N. N., Lancioni, G. E., Singh, A. D. A., Winton, A. S. W., Singh, A. N. A., & Singh, J. (2011b). Adolescents with Asperger syndrome can use a mindfulness-based strategy to control their aggressive behavior. Research in Autism Spectrum Disorders, 5(3), 1103–1109. https://doi.org/10.1016/j.rasd.2010.12.006.
Singh, N. N., Lancioni, G. E., Winton, A. S., Singh, J., Curtis, W. J., Wahler, R. G., et al. (2007). Mindful parenting decreases aggression and increases social behavior in children with developmental disabilities. Behaviour Modification, 31(6), 749–771. https://doi.org/10.1177/0145445507300924.
Singh, N. N., Lancioni, G. E., Winton, A. S. W., Fisher, B. C., Wahler, R. G., McAleavey, K., et al. (2006). Mindful parenting decreases aggression, noncompliance, and self-injury in children with autism. Journal of Emotional and Behavioral Disorders, 14(3), 169–177. https://doi.org/10.1177/10634266060140030401.
Singh, N. N., Lancioni, G. E., Winton, A. S. W., Karazsia, B. T., Myers, R. E., Latham, L. L., et al. (2014). Mindfulness-based positive behavior support (MBPBS) for mothers of adolescents with autism spectrum disorder: Effects on adolescents’ behavior and parental stress. Mindfulness, 5(6), 646–657. https://doi.org/10.1007/s12671-014-0321-3.
*Sizoo, B. B., & Kuiper, E. (2017). Cognitive behavioural therapy and mindfulness based stress reduction may be equally effective in reducing anxiety and depression in adults with autism spectrum disorders. Research in Developmental Disabilities, 64, 47–55. https://doi.org/10.1016/j.ridd.2017.03.004.
Spain, D., Harwood, L., & O’Neill, L. (2015). Psychological interventions for adults with autism spectrum disorders: a review. Advances in Autism, 1(2), 79–86. https://doi.org/10.1108/AIA-05-2015-0007.
*Spek, A. A., van Ham, N. C., & Nyklicek, I. (2013). Mindfulness-based therapy in adults with an autism spectrum disorder: A randomized controlled trial. Research in Developmental Disabilities, 34(1), 246–253. https://doi.org/10.1016/j.ridd.2012.08.009.
Strang, J. F., Kenworthy, L., Daniolos, P., Case, L., Wills, M. C., Martin, A., et al. (2012). Depression and anxiety symptoms in children and adolescents with autism spectrum disorders without intellectual disability. Research in Autism Spectrum Disorders, 6(1), 406–412. https://doi.org/10.1016/j.rasd.2011.06.015.
Suurmond, R., van Rhee, H., & Hak, T. (2017). Introduction, comparison, and validation of meta-essentials: A free and simple tool for meta-analysis. Research Synthesis Methods, 8(4), 537–553. https://doi.org/10.1002/jrsm.1260.
Viera, A. J., & Garrett, J. M. (2005). Understanding interobserver agreement: The kappa statistic. Family Medicine, 37(5), 360–363.
Wang, Y. Y., Li, X. H., Zheng, W., Xu, Z. Y., Ng, C. H., Ungvari, G. S., et al. (2018). Mindfulness-based interventions for major depressive disorder: A comprehensive meta-analysis of randomized controlled trials. Journal of Affective Disorders, 229, 429–436. https://doi.org/10.1016/j.jad.2017.12.093.
Weiss, J. A., Cappadocia, M. C., Tint, A., & Pepler, D. (2015). Bullying victimization, parenting stress, and anxiety among adolescents and young adults with autism spectrum disorder. Autism Research, 8(6), 727–737. https://doi.org/10.1002/aur.1488.
Willis, K., Timmons, L., Pruitt, M., Schneider, H. L., Alessandri, M., & Ekas, N. V. (2016). The relationship between optimism, coping, and depressive symptoms in hispanic mothers and fathers of children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 46(7), 2427–2440. https://doi.org/10.1007/s10803-016-2776-7.
Worley, J. A., & Matson, J. L. (2011). Psychiatric symptoms in children diagnosed with an autism spectrum disorder: An examination of gender differences. Research in Autism Spectrum Disorders, 5(3), 1086–1091. https://doi.org/10.1016/j.rasd.2010.12.002.
Zaboski, B. A., & Storch, E. A. (2018). Comorbid autism spectrum disorder and anxiety disorders: A brief review. Future Neurology, 13(1), 31–37. https://doi.org/10.2217/fnl-2017-0030.
Acknowledgments
The authors would like to thank Maureen Bell, Research Librarian at the University of Adelaide, in addition to Susan Staub and Belinda Fuss for assistance with the database searching, inter-rater reliability calculations and manuscript suggestions respectively. Thanks also to Henk Van Rhee, Erasmus University, for guidance and technical assistance on Meta-essentials. We also thank the authors of included studies who kindly responded to our requests for additional data.
Funding
This work was supported by an Australian Government Research Training Program Scholarship.
Author information
Authors and Affiliations
Contributions
MH was responsible for study design, data collection, analysis and interpretation and manuscript drafts; DD contributed to study design and assisted with data interpretation, manuscript draft and revisions; CD contributed to the study design and critically reviewed manuscript drafts. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare they have no conflict of interest.
Ethical Approval
This article does not contain any studies with human participants or animals performed by any of the authors.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Hartley, M., Dorstyn, D. & Due, C. Mindfulness for Children and Adults with Autism Spectrum Disorder and Their Caregivers: A Meta-analysis. J Autism Dev Disord 49, 4306–4319 (2019). https://doi.org/10.1007/s10803-019-04145-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10803-019-04145-3