December 27, 2021
According to Dexing Zhang et al., writing in the British Medical Bulletin, "Mindfulness is a moment-by-moment awareness of thoughts, feelings, bodily sensations, and surrounding environment. ... These practices can be formal (e.g. breathing, sitting, walking, body scan) or informal (e.g. mindfulness in everyday life).... Mindfulness is rooted in Buddhist traditions. However, it has become popular in recent years among various secular populations in healthcare, educational, and workplace settings: from pre-schoolchildren to older adults across the world." The two most widely adopted mindfulness-based interventions (MBIs) are mindfulness-based stress reduction and mindfulness-based cognitive therapy (Zhang, 2021).
An Italian research team recently conducted a comprehensive search of the peer-reviewed literature to identify studies exploring the efficacy of mindfulness-based treatments for ADHD. It found 31 studies that qualified for review, ten of which met the criteria for meta-analysis, with a total of 596 participants.
A meta-analysis of seven studies with a combined total of 489 participants found MBIs reduced ADHD symptoms with medium effect size and no sign of publication bias. When split into subgroups with and without active controls - in this case, psychoeducation and skills training groups -the outcomes diverged. In the three studies with non-active controls (187 participants), there was a large reduction in ADHD symptoms. In the four with active controls (302 participants), there was no significant difference.
A meta-analysis of ten studies with 596 participants found MBIs reduced inattention symptoms, with a medium-sized effect. Pooling the five studies without active controls (261 participants) produced a very large reduction in inattention symptoms. Once again, in the five studies with active controls (335 participants), there was no significant difference.
After adjusting for publication bias, a third meta-analysis of nine studies with 563 participants found no significant effect of MBIs hyperactivity symptoms. However, when limited to the five studies with-active controls (261 participants), it found a large reduction in hyperactivity symptoms.
After adjusting for publication bias, the fourth meta-analysis of four studies with a combined 243 participants found no significant improvement in executive function.
After adjusting for publication bias, a fifth meta-analysis combining six studies with 449 participants reported a moderate improvement in mindfulness skills. There was no significant improvement when looking only at the three studies with active controls (262 participants).
The team concluded that MBIs seemed to be effective in treating ADHD, but no more so than psychoeducation and skills training groups.
Yet they cautioned that the use of a waiting list for non-active controls muddies that conclusion: "It could be suggested that any intervention seems to have a significantly higher effect than WL [waiting list]in improving ADHD symptoms." This is a known hazard of using waiting lists as control groups (Cunningham, 2013).
Noting "the low general methodological quality," they stated, "From a clinical standpoint, according to the poor available evidence, we cannot conclude that MBIs are superior to other active [psychological] interventions in ameliorating all the considered outcomes, suggesting a role complementation and not as a replacement of the psychoeducation in the management of patients with ADHD, consistently with some guidelines' recommendations."
Francesco Oliva, Francesca Malandrone, Giulia di Girolamo, Santina Mirabella, Nicoletta Colombi, Sara Carletto, Luca Ostacoli, "The efficacy of mindfulness-based interventions in attention-deficit/hyperactivity disorder beyond core symptoms: A systematic review, meta-analysis, and meta-regression," Journal of Affective Disorders(2021), vol. 292,475-486, published online,https://doi.org/10.1016/j.jad.2021.05.068.
Dexing Zhang, Eric K P Lee, Eva C W Mak, C Y Ho, and Samuel S Wong, "Mindfulness-based interventions: an overall review," BritishMedical Bulletin (2021), vol. 138, issue 1, 41-57, published online, https://doi.org/10.1093/bmb/ldab005.
John A Cunningham, KyprosKypri, and Jim McCambridge, "Exploratory randomized controlled trial evaluating the impact of a waiting list control design," BMC Medical Research Methodology (2013), vol. 13, article 150, published online, https://doi.org/10.1186/1471-2288-13-150.
Given the persistence of ADHD and its adverse effects on children and adolescents, one might expect caregivers to face greater parenting challenges, with potential effects on their own mental health.
To what extent do parenting stress, depression, and – at the extreme – even suicidal ideation manifest themselves among caregivers of ADHD patients as opposed to caregivers of children and adolescents without ADHD?
A pair of Korean researchers made use of their country’s single-payer health insurance system, which maintains records on virtually the entire population, to perform a nationwide population study. They used data from the Korean National Health and Nutrition Examination Surveys (KNHANES) covering the decade from 2011 to 2020. KNHANES is an annual survey using a sophisticated sampling design conducted by the Korean Ministry of Health and Welfare to represent the entire population of South Korea.
The analysis included 14,428 individuals who had children younger than 19 at the time of participation. All were asked whether their child had ever been diagnosed with ADHD by a physician. The mental health problems of the parents were assessed in terms of perceived stress, depressive symptoms, and suicidality.
Of the 14,428 participants, 8,298 (57.5 %) were mothers and 6,130 (42.5 %) were fathers. Of the mothers, 116 (1.4 %) had a child with ADHD, and of the fathers, 86 (1.4 %) had a child with ADHD.
The researchers adjusted for the following confounders: age of caregiver, education level, household income, area of residence, employment status, alcohol consumption, smoking status, cohabitation status, number of children, and child’s age.
After adjustment, mothers of ADHD patients fared significantly worse than mothers of typically developing children on all three categories of mental health problems. They were 67% more likely to report higher stress, three times as likely to report symptoms of depression, and 2.5 times more likely to report suicidal ideation.
Yet that pattern did not carry over to fathers, where there was no significant difference in mental health indicators between fathers of children with ADHD and fathers of children without ADHD.
The authors concluded, “Parents of children with ADHD, especially mothers, need community support and public health attention to help alleviate their mental health problems.”
Background:
ADHD is commonly accompanied by psychiatric comorbidities that complicate its diagnosis and treatment. Roughly two out of three affected children and adolescents have one or more comorbid psychiatric disorder.
Because the peak age of ADHD onset is typically a decade or more earlier than those for schizophrenia, depressive disorder, or bipolar disorder, it is essential to explore these comorbidities over an extended period. Populations studies help researchers identify broader patterns and trends within an entire population and includes adults as well as children. This type of study provides unique insights into the population at large, rather than a sample group.
In earlier studies the maximum follow-up period was twelve years, insufficient in view of the roughly ten years between onset of ADHD and onset of major psychiatric disorders. Also, previous nationwide population studies have included less than 150,000 participants.
This study, relying on data from South Korea’s universal single-payer health insurance system, included over one and a half million individuals. Persons previously diagnosed with depression, bipolar disorder, tic disorder, or schizophrenia were excluded.
382,434 individuals had been diagnosed with ADHD, while 1,169,279 were without an ADHD diagnosis.
Propensity score matching ensured that potential confounders, both sociodemographic and clinical, were equalized for the ADHD and control groups. After matching, there were 353,898 individuals in each group.
After these adjustments, individuals in the ADHD group were at least an order of magnitude more likely to subsequently be diagnosed with psychiatric disorders than their peers without an ADHD diagnosis:
Conclusion:
The Korean study team concluded, “Overall, our findings suggest that upon prolonged examination, the risk of subsequent diagnoses of other psychiatric disorders in individuals with ADHD appears to be higher than that reported previously. … Therefore, patients with ADHD should be carefully screened for the presence of other psychiatric symptoms on a regular basis from an earlier age … It is advisable to have a follow-up period extending beyond 10 years to sufficiently identify the occurrence of comorbid disorders in patients with ADHD.”
Children with ADHD often face challenges in social interactions, leading to long-term consequences if not properly addressed. While various interventions exist, many fail to consider the broader social context in which these children interact. A recent study conducted in Bergen, Norway, explored how primary school teachers perceive their role in supporting children with ADHD who struggle socially and the strategies they use to assist them.
Researchers conducted semi-structured interviews with five focus groups of primary school teachers. Using reflexive thematic analysis, they identified two major themes:
Rather than relying on standardized interventions, teachers tailored their strategies to foster an inclusive and supportive social environment. Their methods included both active participation in social situations and behind-the-scenes efforts to encourage peer inclusion and understanding.
This study underscores the need to move beyond labels and recognize children with ADHD as individuals with distinct social needs. Teachers play a crucial role in shaping these children’s experiences, using flexible and personalized approaches to promote positive social interactions. By integrating social context and individualized support, educators can help children with ADHD build meaningful connections and navigate their social world more effectively.
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