Mindfulness Meditation Training in Adults and Adolescents With ADHD: A Feasibility Study

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Lidia Zylowska
Deborah L. Ackerman
May H. Yang
J
ulie L. FutrellNancy L. Horton
T. Sigi Hale
University of California–Los Angeles
Caroly Pataki
University of Southern California
Susan L. Smalley
University of California–Los Angeles

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M ethod:Twenty-four adults and eight adolescents with ADHD
enrolled in a feasibility study of an 8-week mindfulness training program. R esults:T
he majority of participants completedthe training and reported high satisfaction with the training. Pre–post improvements in self-reported ADHD symptoms and
test performance on tasks measuring attention and cognitive inhibition were noted. Improvements in anxiety and depressive
symptoms were also observed. C onclusion:Mindfulness training is a feasible intervention in a subset of ADHD adults and
adolescents and may improve behavioral and neurocognitive impairments. A controlled clinical study is warranted.

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The primary practice (sitting or
walking meditation) involves three steps: (a) bringing
attention to an “attentional anchor” (usually a sensory
input such as breath), (b) noting that distraction occurs
and letting go of the distraction, and (c) refocusing or
reorienting attention back to the “attentional anchor.”
This sequence is repeated many times during the course
of meditation practice. As attention is stabilized in the
primary practice, open awareness or “hovering attention”
i
s introduced and other aspects of attention may beemphasized. In between sessions, the participants are
asked to “pay attention to attention” and bring their
a
ttention to the present moment frequently throughouttheir daily routine. These activities are likely to engage
diverse aspects of attention (e.g., alerting, orienting, and
conflict attention), metacognition, inhibition, and work-ing memory.

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During mindfulness training, par-ticipants learn to reduce aro
usal through breathing andrelaxation exercises and to bring an openness and accep-tance to their emotional experiences. This practice
teaches engagement in emotional states in a way that is
neither avoidance, flooding, nor dissociation but rather
“mindfully observing and being with the emotion.” In
addition, shifting attention to a neutral focus (breath or
soles of the feet) can be used to disengage from particu-larly intense emotional states. Reduction in negative
affective reactivity and volatility in response to aversive
visual stimuli (Arch & Craske, 2006) or emotionally
provocative events (Broderick, 2005) have been reported
w
ith

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R
esult

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Feasibility Assessment

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Twenty-five participants (18, or 75% of adults, and 7,
or 87% of adolescents) completed the study, indicating

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On average, participants attended seven of the eight
sessions, with a range of six to eight (in both adult and
adolescent groups). The adult group reported an average
of 90.3 (S D= 57.9; range = 1
0.3 to 194.4) min per weekof at-home meditation practice and an average of 4.9
(S D= 1.6; range = 1.5 to 7) days of practice per week. The

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adolescent group reported an average of 42.6 (S D= 1
5.4;range = 2
3.7 to 68.9) min per week of at-home practiceand an average of 4.02 (S D= 0.93; range = 2
.4 to 5.6)days of practice per week. Adults practiced significantly
more minutes per week than adolescents (p = .
03). Onthe visual analog scale measuring satisfaction from 1
(least satisfied) to 10 (most satisfied), satisfaction level
was high among both adults (M = 9 .40,S D= 0
.80) andadolescents (M = 9 .35,S D= 1

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Exploratory Pre- and
Posttraining Assessment

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Adult and adolescent ADHD self-report (comparable
D SM-IVcriteria items from ADHD Rating Scale–IV and
SNAP-IV) and neurocognitive data were combined to
examine pre–post training changes. As shown in Table 2,
there were significant pre- to posttest improvements in
ADHD self-reported symptoms and performance on sev-eral neurocognitive tasks.

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E
ighteen of the 23 (78%) participants reported areduction in their total ADHD symptoms, with 7 of the
23 (30%) participants reporting at least a 30% s
ymptomreduction (considered a clinically significant improvement).
On neurocognitive task performance, significant improve-ments were found for measures of attentional c
onflic

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(ANT conflict and Stroop color-word) and set-shifting
(Trails A and B) (all p < .01) but not for measures of
working memory. To further illustrate the observed
changes, we plotted individual performance on the ANT
conflict task (Figure 1) and compared them to the aver-age scores for other ADHD samples and/or the general
population. Of note, the mean posttraining ANT score in
our ADHD sample is comparable to mean scores found
elsewhere in non-ADHD adult (Fan, McCandliss,
Sommer, Raz, & Posner, 2002) or adolescent samples (S.
Smalley, personal communication, June 26, 2006).

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Note: ANT = Attention Network Test.. The graph shows the individ-ual response times on the conflict attention subset of ANT at pre- (Time

1. and posttraining (Time 2) assessments. Adults are represented by
   black circles and solid lines, and adolescents are represented by open
   circles and dashed lines. For comparison purposes, mean ANT conflict
   scores are found to be 132.2 ms (S D= 4
   0.1) in adolescents withADHD, 111.8 ms (S D= 39.4) in control adolescents (S. Smalley, per-sonal communication, June 26, 2006), and 84 ms (S D= 25) in a nor-mative sample of adults (Fan et al., 2002).

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We used linear regression models to evaluate the
effects of age, sex, stimulant medication status, and at-h
ome meditation practice time (in minutes per week) onchanges showing significant improvement (i.e., ADHD
symptoms, cognitive measures of ANT conflict and set-shifting, and adult mood and anxiety symptoms).
Baseline score was a significant predictor of all change
scores (data not shown); therefore, all regression models
i
ncluded the baseline score in an attempt to control forregression to the mean. Age was found to be inversely
associated with improvement in Trails A (p = .
03) (i.e.,younger age = more improvement), and at-home practice
time was marginally associated with improvement in
ANT conflict (p = .07). No other significant relationships
at p < .05 were found for any other dependent variables.

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Notes