Examining the Effectiveness of Mindfulness for Treating Children with ASD and ADHD

Background: Children with autism spectrum disorders (ASD) and attention deficit disorders (ADHD) often experience significant social impairment and academic challenges. One contributing factor for some of these children is poor regulation of attention, behavior, and emotions (Barkley, 1998; Grossman, Klin, Carter, & Volkmar, 2000; Prizant, Wetherby, Rubin, & Laurent, 2003; Solomon, Goodlin-Jones, & Anders, 2004). Treatments aimed at improving self-regulation have been primarily cognitive and behavioral. Mindfulness is an intervention strategy that has been minimally studied as a means of helping children with self-regulation struggles, but may prove effective for clinical pediatric populations.

Mindfulness is a meditative practice that increases awareness of one’s sensory experiences and thoughts, and focuses attention on the present moment (Allen, Blashki, & Gullone, 2006). It has been shown to effectively treat a range of medical and psychological conditions with adults, including chronic pain, stress, anxiety, depression, and eating disorders (Baer, 2003; Kabat-Zinn, Lipworth, Burney, & Sellers, 1987). Studies with neurotypical children reported improved concentration, mood regulation, self-control, and management of anxiety, and pain (Fodor & Hooker, 2008; Greco, Blackledge, Coyne, & Ehrenreich, 2005; Thompson & Gauntlett-Gilbert, 2008). However, its effectiveness in treating self-regulation in children with ASD and ADHD is not yet empirically supported.

Objectives: Our objective was to assess the efficacy of a Mindfulness Based and Stress Reduction (MBSR) intervention for improving self-regulation among children with ASD and ADHD. We conceptualized self-regulation as effective modulation of attention, behavior, and emotions. We hypothesized that children in the treatment group would show improved self-regulation and self-awareness relative to a wait-list control group.

Methods: A day treatment school implemented a nine-week MBSR group intervention. Children (8-12 years) with average intellect and either ASD or ADHD were eligible. The study included two treatment groups split by age and one control group (n=6 each group). Group assignment was determined through a modified randomization process. Treatment groups included mixed diagnoses, with children having either ASD (n=7) or ADHD (n=5); the control group included children with ASD (n=5) and ADHD (n=1). Outcome measures for attention, behavior/emotion regulation, and self-awareness were measured with standardized direct assessments [Nepsy-II, Test of Everyday Attention for Children (TEA-Ch), Conners' Continuous Performance Test II] and behavior rating scales (Behavior Assessment System for Children, Second Edition, Conners 3; Child Acceptance Mindfulness Measure).

Results: The MBSR group intervention successfully improved attention in children with ASD and ADHD. The treatment group scored significantly higher on self-report of attention at post-test compared to the control group (U=4.0, p=.012, Cohen’s d=1.21). When looking at within group effects for the treatment group, paired t-tests (pre-to-post) showed significant effects of training on auditory and visual attention measures from both the Nepsy-II and the TEA-Ch (p≤.032, Cohen’s d≥.3). Results indicated that pre-to-post treatment effects were primarily driven by improvements within the ASD group.

Conclusions: The MBSR group intervention successfully improved attention in children with ASD and ADHD. These data provide preliminary empirical support for MBSR as an effective intervention to improve attention in pediatric ASD and ADHD populations and ideas for future studies.