Abstract
Adolescents with Attention Deficit/Hyperactivity Disorder (ADHD) often experience emotional and behavioural difficulties which contribute to stress and conflict in their family relationships. Mindfulness-based cognitive therapy (MBCT) is a promising intervention for these families. We evaluated the efficacy of an adaptation of a MBCT intervention for 13–18 year olds with ADHD and their parents. Adolescents (n = 18) and parents (n = 17) attended 8 weekly parallel group sessions. Participants completed questionnaires at four time points: 4 weeks before the intervention to control for general time effects, on the first and last days of the intervention, and 6 weeks after the intervention. Participants reported on adolescent ADHD symptoms, internalizing and externalizing problems, functional impairment, family functioning, parenting stress, and mindfulness. There were no significant changes on parent rated variables during the baseline period. Results of repeated measures ANOVA revealed reductions in the adolescents’ inattention, conduct problems, and peer relations problems after the intervention, according to parental report. Parents also reported reductions in parenting stress and increases in mindful parenting. Adolescents did not report improvements on any variables during the intervention period. Paired t-tests indicated that improvements in adolescent symptomatology and mindful parenting were maintained 6 weeks after the intervention ended. Parents reported additional reductions in parenting stress at follow-up. Adolescents reported reductions in internalizing problems at follow-up. Overall, our results support and extend the preliminary findings of previous investigations of MBCT showing it to be a promising treatment for adolescents with ADHD and their parents.
Similar content being viewed by others
References
American Psychiatric Association. (2000). Attention-deficit and disruptive behavior disorders. In Diagnostic and statistical manual of mental disorders 4th ed., text rev., Washington, DC: Author pp. 85–93.
Bagwell, C. L., Molina, B. S. G., Pelham, W. E., & Hoza, B. (2001). Attention-deficit hyperactivity disorder and problems in peer relations: Predictions from childhood to adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 1285–1292. doi:10.1097/00004583-200111000-00008.
Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 121, 65–94. doi:10.1037//0033-2909.121.1.65.
Barkley, R.A. (2004). Adolescents with attention-deficit/hyperactivity disorder: An overview of empirically based treatments. Journal of Psychiatric Practice, 10, 39–56. Retrieved from http://journals.lww.com/practicalpsychiatry/pages/default.aspx.
Barkley, R. A. (2005). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (3rd ed.). New York, NY: Guilford Publications, Inc.
Barkley, R. A., Anastopoulos, A. D., Guevremont, D. C., & Fletcher, K. E. (1992). Adolescents with attention deficit hyperactivity disorder: Mother-adolescent interactions, family beliefs and conflicts, and maternal psychopathology. Journal of Abnormal Child Psychology, 20, 263–288. doi:10.1007/BF00916692.
Barkley, R. A., Edwards, G., Laneri, M., Fletcher, K., & Metevia, L. (2001). The efficacy of problem-solving communication training alone, behavior management training alone, and their combination for parent-adolescent conflict in teenagers with ADHD and ODD. Journal of Consulting and Clinical Psychology, 69, 926–941. doi:10.1037//0022-006X.69.6.926.
Barkley, R. A., Fischer, M., Edelbrock, C., & Smallish, L. (1991). The adolescent outcome of hyperactive children diagnosed by research criteria: III. Mother-child interactions, family conflicts and maternal psychopathology. Journal of Child Psychology and Psychiatry, 32, 233–255. doi:10.1111/j.1469-7610.1991.tb00304.x.
Biederman, J., Monuteaux, M. S., Doyle, A. E., Seidman, L. J., Wilens, T. E., Ferroro, F., et al. (2004). Impact of executive function deficits and attention-deficit/hyperactivity disorder (ADHD) on academic outcomes in children. Journal of Consulting and Clinical Psychology, 72, 757–766. doi:10.1037/0022-006X.72.5.757.
Barkley, R.A. Guevremont, D.C., Anastopoulos, A.D., and Fletcher, K.E. (1992b). A comparison of three family therapy programs for treating family conflicts in adolescents with attention-deficit hyperactivity disorder. Journal of Consulting and Clinical Psychology, 60, 450–462. Retrieved from http://www.apa.org/pubs/journals/ccp/index.aspx.
Biondic. D. (2011). Parenting stress of parents of adolescents with attention-deficit/hyperactivity disorder (Master’s Thesis). Retrieved from https://tspace.library.utoronto.ca/handle/1807/30075.
Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., et al. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11, 230–241. doi:10.1093/clipsy.bph077.
Black, D. S., Milam, J., & Sussman, S. (2009). Sitting-meditation interventions among youth: A review of treatment efficacy. Pediatrics, 124, e532–e541. doi:10.1542/peds.2008-3434.
Blackledge, J. T., & Hayes, S. C. (2006). Using acceptance and commitment training in the support of parents of children diagnosed with autism. Child and Family Behavior Therapy, 1, 1–18. doi:10.1300/J019v28n01_01.
Bogels, S., Hoogstad, B., van Dun, L., de Schutter, S., & Restifo, K. (2008). Mindfulness training for adolescents with externalizing disorders and their parents. Behavioral and Cognitive Psychotherapy, 36, 193–209. doi:10.1017/S1352465808004190.
Burke, C. A. (2010). Mindfulness-based approaches with children and adolescents: A preliminary review of current research in an emergent field. Journal of Child and Family Studies, 19, 133–144. doi:10.1007/s10826-009-9282-x.
Carboni, J. A. (2012). The impact of mindfulness training on hyperactive behaviors demonstrated by elementary age children with a diagnosis of attention deficit hyperactivity disorder. (Doctoral dissertation). Retrieved from http://digitalarchive.gsu.edu/cps_diss/72.
Charach, A., Skyba, A., Cook, L., and Antle, B.J. (2006). Using stimulant medication for children with ADHD: What do parents say? A brief report. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 15, 75–83. Retrieved from http://www.cacap-acpea.org/en/cacap/Journal_p828.html.
Chorpita, B. F., Moffitt, C. E., & Gray, J. (2005). Psychometric properties of the revised child anxiety and depression scale in a clinical sample. Behaviour Research and Therapy, 43, 309–322. doi:10.1016/j.brat.2004.02.004.
Chorpita, B. F., Yim, L., Moffitt, C. E., Umemoto, L. A., and Francis, S. E. (2000). Assessment of symptoms of DSM-IV anxiety and depression in children: A revised child anxiety and depression scale. Behaviour Research and Therapy, 38, 835–855. Retrieved from www.elsevier.com/locate/brat.
Chronis, A. M., Chacko, A., Fabiano, G. A., Wymbs, B. T., & Pelham, W. E. (2004). Enhancements to the behavioural parent training paradigm for families of children with ADHD: Review. Clinical Child and Family Psychology Review, 7, 1–27. doi:10.1023/B:CCFP.0000020190.60808.a4.
Chronis, A. M., Jones, H. A., & Raggi, V. L. (2006). Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder. Clinical Psychology Review, 26, 486–502. doi:10.1016/j.cpr.2006.01.002.
Clark, C., Prior, M., and Kinsella, G.J. (2000). Do executive function deficits differentiate between adolescents with ADHD and oppositional defiant/conduct disorder? A neuropsychological study using the six elements test and hayling sentence completion test. Journal of Abnormal Child Psychology, 28, 403–414. Retrieved from http://www.springer.com/psychology/child+%26+school+psychology/journal/10802.
Coatsworth, J. D., Duncan, L. G., Greenberg, M. T., & Nix, R. L. (2009). Changing parent’s mindfulness, child management skills and relationship quality with their youth: Results from a randomized pilot intervention trial. Journal of Child and Family Studies, 19, 203–217. doi:10.1007/s10826-009-9304-8.
Conners, C. K. (2008). Conners-3rd edition. Toronto, ON: Multi-Health Systems Inc.
Deater-Deckard, K. (1998). Parenting stress and child adjustment: Some old hypotheses and new questions. Clinical Psychology: Science and Practice, 5, 314–332. doi:10.1111/j.1468-2850.1998.tb00152.x.
Deater-Deckard, K. (2001). Annotation: Recent research examining the role of peer relationships in the development of psychopathology. Journal of Child Psychology and Psychiatry and Allied Disciplines, 42, 565–579.
Duncan, L.G. (2007). assessment of mindful parenting among parents of early adolescents: Development and validation of the interpersonal mindfulness in parenting scale. (Doctoral dissertation). Retrieved from https://etda.libraries.psu.edu/paper/7740/3021.
Ebesutani, C., Bernstein, A., Nakamura, B. J., Chorpita, B. F., Weisz, J. R., & The research network on youth mental health. (2010). A psychometric analysis of the revised child anxiety and depression scale: Parent version in a clinical sample. Journal of Abnormal Child Psychology, 38, 249–260. doi:10.1007/s10802-009-9363-8.
Edwards, G., Barkley, R. A., Laneri, M., Fletcher, K., & Metevia, L. (2001). Parent–adolescent conflict in teenagers with ADHD and ODD. Journal of Abnormal Child Psychology, 29, 557–572. doi:10.1023/A:1012285326937.
Epstein, N., Baldwin, L. M., & Bishop, D. S. (1983). The McMaster family assessment device. Journal of Marital and Family Therapy, 9(2), 171–180. doi:10.1111/j.1752-0606.1983.tb01497.x.
Fabiano, G. A. (2007). Father participation in behavioral parent training for ADHD: Review and recommendations for increasing inclusion and engagement. Journal of Family Psychology, 21(4), 683–693. doi:10.1037/0893-3200.21.4.683.
Fabiano, G. A., Chacko, A., Pelham, W. E., Robb, J., Walker, K. S., Wymbs, F., et al. (2009). A comparison of behavioral parent training programs for fathers of children with attention-deficit/hyperactivity disorder. Behavior Therapy, 40, 190–204.
Friars, P. M., & Mellor, D. J. (2007). Drop out from behavioral management training programs for ADHD: A prospective study. Journal of Child and Family Studies, 16, 427–441. doi:10.1007/s10826-006-9096-z.
Gau, S. S. F., Shen, H., Chou, M., Tang, C., Chiu, Y., & Gau, C. (2006). Determinants of adherence to methylphenidate and the impact of poor adherence on maternal and family measures. Journal of Child and Adolescent Psychopharmacology, 16, 286–297. doi:10.1089/cap.2006.16.286.
Green, S. B., & Salkind, N. J. (2008). Using SPSS for windows and macintosh: Analyzing and understanding data (5th ed.). New Jersey: Pearson Education, Inc.
Harrison, L. J., Manocha, R., & Rubia, K. (2004). Sahaja yoga meditation as a family treatment programme for children with attention-deficit/hyperactivity disorder. Clinical Child Psychology and Psychiatry, 9, 479–497. doi:10.1177/1359104504046155.
Haydicky, J., Wiener, J., Badali, P., Milligan, K., & Ducharme, J. M. (2012). Evaluation of a mindfulness-based intervention for adolescents with learning disabilities and co-occurring ADHD and anxiety. Mindfulness, 3, 151–164. doi:10.1007/s12671-012-0089-2.
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44, 1–25. doi:10.1016/j.brat.2005.06.006.
Hayes, S. C., Strosahl, K. D., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., et. al. (2004). Measuring experiential avoidance: A preliminary test of a working model. The Psychological Record, 54, 553–578. Retrieved from http://opensiuc.lib.siu.edu/tpr/vol54/iss4/5/.
Hoza, B., Murray-Close, D., Arnold, L. E., Hinshaw, S. P., Hechtman, L., & The MTA Cooperative Group. (2010). Time-dependent changes in positively biased self-perceptions of children with attention-deficit/hyperactivity disorder: A developmental psychopathology perspective. Development and Psychopathology, 22, 375–390. doi:10.1017/S095457941000012X.
Johnston, C., & Mash, E. J. (2001). Families of children with Attention-Deficit/Hyperactivity Disorder: Review and recommendations for future research. Clinical Child and Family Psychology Review, 4, 183–207. doi:10.1023/A:1017592030434.
Kabat-Zinn, J., Massion, A. O., Kristeller, J., and Peterson, L. G. (1992). Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. American Journal of Psychiatry, 149, 936–943. Retrieved from http://ajp.psychiatryonline.org/.
Kazdin, A. E. (1995). Child, parent and family dysfunction as predictors of outcome in cognitive behavioral treatment of antisocial children. Behaviour Research and Therapy, 33, 271–281. doi:10.1016/0005-7967(94)00053-M.
Kazdin, A. E. (1997). Parent management training: Evidence, outcomes, and issues. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1349–1356. doi:10.1097/00004583-199710000-00016.
Kazdin, A. E., & Whitley, M. K. (2003). Treatment of parental stress to enhance therapeutic change among children referred for aggressive and antisocial behavior. Journal of Consulting and Clinical Psychology, 71, 504–515. doi:10.1037/0022-006X.71.3.504.
Khamis, V. (2006). Family environment and parenting as predictors of Attention-deficit and hyperactivity among Palestinian children. Journal of Social Service Research, 32, 99–116. doi:10.1300/J079v32n04_06.
Koerner, K., & Linehan, M. M. (2000). Research on dialectical behavior therapy for patients with borderline personality disorder. The Psychiatric Clinics of North America, 23, 151–167. doi:10.1016/S0193-953X(05)70149-0.
Ma, S. H., & Teasdale, J. D. (2004). Mindfulness-based cognitive therapy for depression: Replication and exploration of differential relapse prevention effects. Journal of Consulting and Clinical Psychology, 72, 31–40. doi:10.1037/0022-006X.72.1.31.
Majewicz-Hefley, A., & Carlson, J. S. (2007). A meta-analysis of combined treatments for children diagnosed with ADHD. Journal of Attention Disorders, 10, 239–250. doi:10.1177/1087054706289934.
Markel, C., & Wiener, J. (2012). Attribution processes in parent-adolescent conflict in families of adolescents with and without ADHD. Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement. doi:10.1037/a0029854.
Owens, J. S., Goldfine, M. E., Evangelista, N. M., Hoza, B., & Kaiser, N. M. (2007). A critical review of self-perceptions and the positive illusory bias in children with ADHD. Clinical Child and Family Psychology Review, 10, 335–351. doi:10.1007/s10567-007-0027-3.
Pelham, W. E., Wheeler, T., & Chronis, A. (1998). Empirically supported psychosocial treatments for attention deficit hyperactivity disorder. Journal of Clinical Child Psychology, 27(2), 190–205. doi:10.1207/s15374424jccp2702_6.
Prinz, R. J., Foster, S., Kent, R. N., & O’Leary, K. D. (1979). Multivariate assessment of conflict in distressed and non distressed mother-adolescent dyads. Journal of Applied Behaviour Analysis, 12, 691–700. doi:10.1901/jaba.1979.12-691.
Putnick, D. L., Bornstein, M. H., Hendricks, C., Painter, K. M., Suwalsky, J. T. D., & Collins, W. A. (2008). Parenting stress, perceived parenting behaviors, and adolescent self-concept in European American families. Journal of Family Psychology, 22, 752–762. doi:10.1037/a0013177.
Reid, R., Trout, A., and Schartz, M. (2005). Self-regulation interventions for children with attention deficit/hyperactivity disorder. Exceptional Children, 71, 361–377. Retrieved from http://journals.cec.sped.org/ec/.
Repetti, R. L., Taylor, S. E., & Seeman, T. E. (2002). Risky families: Family social environments and the mental and physical health of offspring. Psychological Bulletin, 128, 330–366. doi:10.1037//0033-2909.128.2.330.
Robin A. L. (1975). Communication Training: A Problem- Solving Approach to Parent Adolescent Conflict. (Doctoral dissertation).
Sergeant, J. A., Geurts, H., & Oosterlaan, J. (2002). How specific is a deficit of executive functioning for attention-deficit/hyperactivity disorder? Behavioural Brain Research, 130, 3–28. doi:10.1016/S0166-4328(01)00430-2.
Sheras, P.L., Abidin, R.R., and Konold, T.R. (1998). Stress index for parents of adolescents (SIPA). Lutz:Psychological Assessment Resources Inc.
Singh, N. N., Lancioni, G. E., Winton, A. S. W., Fisher, B. C., Wahler, R. G., McAleavey, K. M., et al. (2006). Mindful parenting decreases aggression, noncompliance, and self-injury in children with autism. Journal of Emotional and Behavioral Disorders, 14, 169–177. doi:10.1177/10634266060140030401.
Singh, N. N., Lancioni, G. E., Winton, A. S. W., Singh, J., Curtis, W. J., Wahler, R. G., et al. (2007). Mindful parenting decreases aggression and increases social behaviour in children with developmental disabilities. Behavior Modification, 31, 749–771. doi:10.1177/0145445507300924.
Singh, N. N., Singh, A. N., Lancioni, G. E., Singh, J., Winton, A. S. W., & Adkins, A. D. (2010). Mindfulness training for parents and their children with ADHD increases children’s compliance. Journal of Child and Family Studies, 19, 157–166. doi:10.1007/s10826-009-9272-z.
Smetana, J. G., Campione-Barr, N., & Metzger, A. (2006). Adolescent development in interpersonal and societal contexts. Annual Review of Psychology, 57, 255–284. doi:10.1146/annurev.psych.57.102904.190124.
Steinberg, L. (2001). We know some things: Parent-adolescent relationships in retrospect and prospect. Journal of Research on Adolescence, 11, 1–19. doi:10.1111/1532-7795.00001.
Teasdale, J. D., Segal, Z. V., Williams, J. M., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68, 615–623. doi:10.1037//0022-006X.68.4.615.
The MTA Cooperative Group. (1999). Archives of general. Psychiatry, 56, 1073–1086. doi:10.1001/archpsyc.56.12.1073.
Theule, J., Wiener, J., Tannock, R., & Jenkins, J. (2013). Parenting stress in families of children with ADHD: A meta-analysis. Journal of Emotional and Behavioral Disorders, 21, 3–17. doi:10.1177/1063426610387433.
Toplak, M. E., Connors, L., Shuster, J., Knezevic, B., & Parks, S. (2008). Review of cognitive, cognitive-behavioral, and neural-based interventions for attention-deficit/hyperactivity disorder (ADHD). Clinical Psychology Review, 28, 801–823. doi:10.1016/j.cpr.2007.10.008.
van de Weijer-Bergsma, E., Formsma, A. R., de Bruin, E. I., & Bogels, S. (2012). The effectiveness of mindfulness training on behavioral problems and attentional functioning in adolescents with ADHD. Journal of Child and Family Studies, 21, 775–787. doi:10.1007/s10826-011-9531-7.
van der Oord, S., Bogels, S., & 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, 139–147. doi:10.1007/s10826-011-9457-0.
Webster-Stratton, C. (1990). Stress: A potential disruptor of parent perceptions and family interactions. Journal of Clinical Child Psychology, 19, 302–312. doi:10.1207/s15374424jccp1904_2.
Wechsler, D. (1999). Wechsler abbreviated scale of intelligence. San Antonio, TX: Psychological Corporation.
Wells, K.C. et al. (2000). Parenting and family stress treatment outcomes in attention deficit hyperactivity disorder (ADHD): An empirical analysis in the MTA study. Journal of Abnormal Child Psychology, 28, 543–553. Retrieved from http://www.springer.com/psychology/child+%26+school+psychology/journal/10802.
Wilens, T.E., Biederman, J., and Spencer, T.J. (2002). Attention deficit/hyperactivity disorder across the lifespan. Annual Review of Medicine, 53, 113–131. Retrieved from http://www.annualreviews.org/journal/med.
Willcutt, E. G., Doyle, A. E., Nigg, J. T., Faraone, S. V., & Pennington, B. F. (2005). Validity of executive function theory of attention-deficit/hyperactivity disorder: A meta-analytic review. Biological Psychiatry, 57, 1336–1346. doi:10.1016/j.biopsych.2005.02.006.
Williams, M., Teasdale, J., Segal, Z., & Kabat-Zinn, J. (2007). The mindful way through depression: Freeing yourself from chronic unhappiness. New York, NY: Guilford Press.
Wolraich, M. L., Wibbelsman, C. J., Brown, T. E., Evans, S. W., Gotlieb, E. M., Knight, et al. (2005). Attention-deficit/hyperactivity disorder among adolescents: A review of the diagnosis, treatment, and clinical implications. Pediatrics, 115, 1734–1746. doi:10.1542/peds.2004-1959.
Zylowska, L., Ackerman, D. L., Yang, M. H., Futrell, J. L., Horton, N. L., Hale, T. S., et al. (2008). Mindfulness meditation training in adults and adolescents with ADHD: A feasibility study. Journal of Attention Disorders, 11, 737–746. doi:10.1177/1087054707308502.
Acknowledgments
Preparation of this paper was supported in part by the Social Sciences and Humanities Research Council of Canada. We extend our deepest appreciation to Susan Bogels and her colleagues who developed the MYmind program; Ashley Brunsek and her team of research assistants for their contributions to the implementation of the study; and Olesya Falenchuk for her guidance with data analysis. We are very grateful to our participants from whom we have learned a great deal.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Haydicky, J., Shecter, C., Wiener, J. et al. Evaluation of MBCT for Adolescents with ADHD and Their Parents: Impact on Individual and Family Functioning. J Child Fam Stud 24, 76–94 (2015). https://doi.org/10.1007/s10826-013-9815-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10826-013-9815-1