Mindfulness Interventions for Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
1.1. Drug Treatments for ADHD
1.2. Non-Drug Treatments for ADHD
1.3. Alternative Approaches
2. Materials and Methods
2.1. Protocol Registration
2.2. Search Strategy
2.3. Eligibility Criteria
2.4. Data Collection
2.5. Quality Assessment
2.6. Data Analysis
3. Results
3.1. Risk of Bias and Quality Assessment
3.2. Study Design
3.3. Participants
3.4. Intervention Approaches
3.5. Outcome Measures
3.5.1. Adult Studies
3.5.2. Child Studies
3.5.3. Family Studies
3.5.4. Parent Studies
3.6. The Effects of Mindfulness Interventions
3.6.1. ADHD Symptoms Scales
3.6.2. Executive Function Scales
3.6.3. Emotional Dysregulation Scales
3.6.4. Objective Measures of ADHD-Related Behaviours
3.6.5. Wider Health Outcomes
- Quality of Life
- Depression and Anxiety
- Stress
- General behaviour
- Self-compassion
- Wellbeing
- Sleep
- Social skills
- Parenting Style
- Family Functioning
3.6.6. Mindfulness Practice
3.6.7. Intervention Feasibility and Satisfaction
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Study | Design | Sample | Mindfulness Condition | Control Condition | ADHD Status | Medication Permitted (Y/N/NR) | Other Therapy Permitted (Y/N/NR) | Excluded Comorbidities | Age range of ADHD Patients (Years) * | Gender of ADHD Patients (M:F) | Analysed Sample Size (Initial Sample) |
---|---|---|---|---|---|---|---|---|---|---|---|
Bachmann et al., 2018 [84] | RCT | Adult patients | Mindfulness Meditation (MM) ** | PE | DSM-IV; combined or inattentive | N (3 mths med-free) | N | SZ, BPD, SUD, ASD, SUI, SH, NEURO. | 18–65 | 18:22 | 40 (74) |
Behbahani et al., 2018 [85] | RCT | Mothers of child patients | Mindful Parenting training (MPT) | US control * | Child—US ADHD diagnosis | Y (risperi-done or Ritalin) | NR | DD, MOOD, PSY | 7–12 | 37:19 | 56 (60) |
Bueno et al., 2015 [86] | P-P | Adult patients & HC | Mindfulness Awareness Practice (MAP) | US control * | DSM-IV | Y (Methylph-enidate) | NR | NEURO, PSY, OCD, TS, DEP, ANX | 18–45 | ADHD 23:20 HC 7:10 | ADHD 43 (48) HC 17 (20) |
Edel et al., 2017 [87] | nRCT | Adult patients | Mindfulness-based training | Skills training | DSM-IV | Y | NR | DEP, BPD, PSY GAD or PD | MBT 33.8 ST 36.7 | 55:36 | 91 |
Gu et al., 2018 [88] | RCT | Under-graduates w/ADHD | Mindfulness-based Cognitive Therapy (MCBT) | WL | DSM-5 | Y | NR | DEP, BPD, SUD, SUI, PSY, LD. | 19–24 | 30:24 | 54 (56) |
Haydicky et al., 2012 [89] | nRCT | Children w/ADHD and LD | MBCT and martial arts training | WL | US ADHD diagnosis | Y | NR | All except LD and ANX | 12–18 | 28:0 | 28 |
Haydicky et al., 2015 [90] | P-P | Families with child patients | MBCT (MyMind) | N/A | Child -US ADHD diagnosis | NR | NR | ASD, BEH | 13–18 | 13:5 | 18 children, 17 parents (20 children, 18 mothers, 6 fathers) |
Hepark et al., 2019 [91] | RCT | Adult patients | MBCT | WL | DSM-IV | Y | N | SUD, PSY, PERS, LD, SUI, SH | 18–65 | 43:56 | 83 (103) |
Hoxhaj et al., 2018 [92] | RCT | Adult patients | MAP | PE | DSM-IV | N | N | SZ, BPD, SUD, ASD, SUI, SH, NEURO | MAP 40.51 PE 38.50 | 39:42 | 64 (81) |
Huguet et al., 2018 [93] | RCT | Child patients | Mindfulness programme based on MBCT and stress relief | TAU | DSM-5 | N | N | ASD, PSY, BPD | 7–12 | 51:19 | 55 (72) |
Janssen et al., 2019 [94] | RCT | Adult patients | MBCT ** + TAU | TAU | DSM-IV | Y | Y (TAU) | DEP w/PSY SUI, mania, PERS, SUD, ASD, tic disorder, LD. | 18+ | 56:64 | 100 (120) |
Kiani et al. (2017) [95] | RCT | Child patients | MM | WL | Elevated SNAP-IV scores | N | N | PSY, DEP, PERS, SUD, NEURO | 13–15 | 0:30 | 30 |
Liu et al., 2021 [96] | RCT | Parents of child patients | MPT | TAU | Child—DSM-IV | Y | Y | None | MPT 9.84 TAU 10.27 | 87:26 | 113 |
Lo et al., 2020 [97] | RCT | Families with child patients | Family-based mindfulness intervention (FBMI) | WL | Child score exceeds SWAN cut off and 74% US ADHD diagnosis | Y | NR | DD, ID, ASD | 5–7 | 83:17 | 100 children and parents |
Meyer et al., 2021 [98] | RCT | Child patients | Structured skills training group including mindfulness | PE | Existing ICD-10 diagnosis with DSM-5 study check | Y | N | DEP, SUI, PSY, BPD, ID, brain injury, ASD, SUD | 15–18 | 164:105 | 164 (184) |
Mitchell et al., 2017 [99] | RCT | Adult patients | MM ** | WL | DSM-IV | Y | NR | SUD, Axis I or II disorder, chronic medical problems, | 18–50 | 8:12 | 20 (22) |
Muratori et al., 2021 [100] | RCT | Child patients + parents | Mindfulness training | WL | Child -US ADHD diagnosis + ODD | N | N | ASD | 8–12 | 50:0 | 50 children, 20 couples, 30 mothers, 3 fathers |
Rynczak 2013 [101] | nRCT | Child patients | Mindfulness training | WL | DSM-IV-TR | Y | N | PSY, SUI, SUD | 12–15 | 8:4 | 12 |
Siebelink et al., 2021 [102] | RCT | Child patients + one parent | Family mindfulness-based intervention (MBI) | TAU | Child—DSM-IV or DSM-5 | Y | No previous or current mindful. Therapy | PSY, BPD, SUI, PTSD, SUD | 8–16 | 72:31 | 93 children and 93 parents (103 children and 103 parents) |
van de Weijer-Bergsma et al., 2012 [103] | P-P | Child patients + parents | Mindfulness training + Mindfulness Parent training | N/A | Child—DSM-IV | Y | NR | Not stated | 11–15 | 5:5 | 10 children, 10 mothers, 9 fathers |
van der Oord et al., 2012 [104] | nRCT | Child patients + parents | Mindfulness training + Mindfulness Parent training | WL | Child—DSM-IV | Y | N | CD, ASD | 8–12 | 16:6 | 18 children (22 children 21 mothers, 1 father) |
Zhang et al., 2017 [105] | P-P | Child patients + one parent | Mindfulness training + Mindfulness Parent training | N/A | Child -US ADHD diagnosis | Y | N | SUD, ASD, PERS, SUI, SH | 8–12 | 8:3 | 11 children, 11 parents |
Study | Measure | Mindfulness (g) | Control (g) |
---|---|---|---|
Beuno et al., 2015 (Adult Study) [86] | Hit Reaction Time (RT) | −0.36 | −0.35 |
Accuracy | 0.61 | 0.37 | |
Omission | −0.68 | −0.70 | |
Hit RT standard error (SE) | −0.45 | −0.88 | |
Variability of SE | −0.31 | −0.46 | |
Hit RT Block change | −0.71 | 0.54 | |
Hit SE block change | −0.55 | −0.52 | |
Gu et al., 2018 (Adult Study) [88] | Alerting error score (ES) | ||
Immediate | −1.04 | 0.10 | |
Follow-up | −1.15 | −0.11 | |
Orienting ES | |||
Immediate | −1.12 | −0.09 | |
Follow-up | −1.16 | −0.09 | |
Conflict ES | |||
Immediate | −0.29 | −0.12 | |
Follow-up | −0.45 | −0.11 |
Study | Study/Measure | Mindfulness (g) | Control (g) |
---|---|---|---|
Beuno et al., 2015 (Adult Study) Connor’s CPT II [86] | Commission Errors | −0.54 | 0.04 |
Omission Errors | −0.08 | −0.15 | |
Hit RT | 0.14 | 0.01 | |
Hit RT SE | −0.07 | 0.13 | |
Variability of SE | 0.08 | 0.12 | |
D prime | 0.07 | −0.15 | |
HIT RT block change | −0.16 | 0.03 | |
HIT SE block change | 0.23 | −0.17 | |
Hit RT ISI Change | 0.09 | 0.24 | |
Hit SE ISI Change | 0.11 | 0.39 | |
Response style | −0.22 | −0.23 | |
Perseverations | 0.39 | 0.20 | |
Kiani et al., 2017 (Child Study) Unspecified CPT [95] | Commission Errors | −0.51 | −0.28 |
Omission Errors | −0.21 | −0.30 | |
Correct Responses | 0.36 | 0.32 | |
Zhang et al., 2017 (Family Study) Connor’s CPT III [105] | Commission Errors | −2.19 | |
Omission Errors | 0.41 | ||
Hit RT | −0.05 | ||
Hit RT Standard Deviation | 0.20 | ||
Variability | 0.12 | ||
D Prime | −0.70 | ||
HIT RT block change | −0.27 | ||
Hit RT ISI Change | 0.12 |
Study | Measure | Mindfulness (g) | Control (g) |
---|---|---|---|
Bachman et al., 2018 (Adult Study) [84] | 1-Back Letter Test of WM * | ||
Reaction Time | −0.55 | −0.54 | |
Number of Correct Answers | 0.57 | 0.49 | |
Kiani et al., 2017 (Child Study) [95] | Tower of London Task | ||
Planning | 0.59 | 0.43 | |
Digital Span Test | |||
Backward span | 0.44 | 0.23 | |
Forward span | −0.07 | 0.19 | |
Total | 0.21 | 0.24 | |
Stroop Inhibition | −0.65 | −0.11 | |
Muratori et al., 2021 (Family Study) [100] | Bells-Test Revised | ||
Speed | 0.41 | 0.32 | |
Accuracy | 1.03 | 0.02 | |
MFFT | |||
Speed | −0.30 | −0.33 | |
Accuracy | −0.29 | −0.72 | |
Rynczak, 2013 [101] | Trail Making Task | ||
Trail A | −0.81 | −0.04 | |
Trail B | −0.39 | −0.08 | |
Van de Weijer-Bergsma et al., 2012 (Child Study) ** [103] | Baseline Speed | 0.23 | |
0.06 | |||
0.25 | |||
Sustained Attention Dots Task | |||
Speed | −0.86 | ||
−0.27 | |||
−0.09 | |||
Misses | −0.34 | ||
−0.80 | |||
−0.41 | |||
False Alarms | 0.00 | ||
−0.33 | |||
−0.11 | |||
Sustained Auditory Task | |||
Speed | 0.09 | ||
0.01 | |||
0.03 | |||
Misses | −0.22 | ||
−0.81 | |||
−0.34 | |||
False Alarms | −0.46 | ||
−0.65 | |||
−0.77 | |||
Zhang et al., 2017 (Family Study) [105] | TEA-Ch | ||
Sky Search | |||
No. correctly identified targets | −0.83 | ||
Time per target | −1.46 | ||
Attention score | −1.3 | ||
Score! | −0.73 | ||
Creature Counting | |||
Total correct | 0.78 | ||
Timing score | −0.75 | ||
Sky Search DT | −0.16 | ||
Map Mission | 1.22 | ||
Walk, Do Not Walk | 0.43 | ||
Opposite Worlds | |||
Same World Total | 0.15 | ||
Opposite World Total | −0.15 | ||
Code Transmission | −0.23 |
Study | Measure | Mindfulness (g) | Control (g) |
---|---|---|---|
Lui et al., 2021 (Parent Study) [96] | Hamilton Depression Scale | −0.47 | −0.18 |
Sieberlink et al., 2012 (Parent measure in Family Study) * [102] | Brooding in response to sadness | −0.08 −0.24 | −0.09 0.08 |
Study | Study/Measure | Mindfulness (g) | Control (g) |
---|---|---|---|
Gu et al., 2018 [88] * | BAI | −0.89 −0.88 | 0.15 −0.03 |
Lui et al., 2021 (Parent Study) [96] | Hamilton Anxiety Scale | −0.39 | −0.26 |
Study | Study/Measure | Mindfulness (g) | Control (g) |
---|---|---|---|
Behbahani et al., 2018 (Parent Study) * [85] | Total Score | −1.22 | −0.29 |
−1.27 | −0.14 | ||
Parent Distress | −1.87 | −0.95 | |
−1.75 | −0.87 | ||
Parent–Child Interactions | −0.83 | 0.17 | |
−1.04 | 0.28 | ||
Child Problematic Characteristics | −0.67 | 0.18 | |
−0.82 | 0.20 | ||
Lo et al., 2020 (Family Study) [97] | Total Score | −0.82 | 0.04 |
Parent Distress | −0.15 | 0.06 | |
Parent–Child Interactions | −0.12 | 0.04 | |
Child Problematic Characteristics | −0.26 | 0.03 | |
Lui et al., 2021 (Parent Study) [96] | Total Score | −0.41 | 0.03 |
Zhang et al., 2017 (Family Study) [105] | Total Score | 0.16 | |
Parent Distress | 0.28 | ||
Parent–Child Interactions | 0.18 | ||
Child Problematic Characteristics | −0.02 |
Study | Measure | Mindfulness (g) | Control (g) |
---|---|---|---|
Haydicky et al., 2012 (Child Study) * [89] | Externalising | −0.54 | −0.38 |
Social Problems | −0.68 | −0.40 | |
Rule Breaking | −0.59 | −0.12 | |
ADHD Problems | −0.19 | −0.44 | |
Oppositional Defiant | −0.83 | −0.01 | |
Conduct | −0.64 | −0.24 | |
Huguet et al., 2019 (Child Study) [93] | AAA (anxiety/depression, aggression and attention) | −0.51 | −0.07 |
Lo et al., 2020 (Family Study) [97] | Total | −0.37 | −0.04 |
Anxiety | −0.28 | −0.04 | |
Withdrawal/Depressed | −0.19 | −0.08 | |
Somatic | −0.31 | 0.00 | |
Attention | −0.49 | −0.05 | |
Aggression | −0.32 | −0.09 | |
Internalising | −0.31 | −0.04 | |
Externalising | −0.29 | −0.10 | |
Rynczak, 2013 (Child Study) [101] | Total | −1.72 | 0.00 |
Van den Weijer-Bergsma et al., 2012 (Family Study) ** [103] | Attention (mother rating) | −0.09 | |
−0.29 | |||
Attention (father rating) | −0.58 | ||
−1.43 | |||
Externalising (mother rating) | 0.18 | ||
−0.13 | |||
Externalising (father rating) | −0.19 | ||
−0.29 | |||
Internalising (mother rating) | −0.10 | ||
0.01 | |||
Internalising (father rating) | −0.42 | ||
−0.43 |
Study | Measure | Mindfulness (g) | Control (g) |
---|---|---|---|
Meyer et al., 2019 (Child Study) * [98] | Child Sheehan Disability Scale | ||
Functional impairment (parent rated) | −0.27 | −0.09 | |
−0.20 | −0.05 | ||
Functional impairment (child rated) | −0.18 | −0.22 | |
−0.30 | −0.14 | ||
Muratori et al., 2021 (Family Study) [100] | Strengths & Difficulties Questionnaire | ||
Conduct | −0.19 | −0.44 | |
Avoidance and Fusion Questionnaire for Youth | −0.65 | 0.13 | |
Modified Overt Aggression Scale | −1.12 | −0.91 | |
Hoxhaj et al., 2018 (Adult Study) ** [92] | BSI | ||
Somatization | −0.24 | −0.13 | |
−0.17 | −0.17 | ||
Obsession/Compulsion | −0.01 | −0.36 | |
−0.28 | −0.43 | ||
Interpersonal | −0.21 | −0.11 | |
−0.24 | −0.31 | ||
Depression | −0.08 | −0.25 | |
−0.04 | −0.32 | ||
Anxiety | −0.17 | −0.32 | |
−0.31 | −0.39 | ||
Hostility | −0.22 | −0.21 | |
−0.21 | −0.42 | ||
Phobic anxiety | −0.05 | −0.24 | |
0.08 | −0.27 | ||
Paranoia | −0.12 | −0.26 | |
0.01 | −0.21 | ||
Psychoticism | −0.27 | −0.36 | |
−0.15 | −0.40 | ||
Global Severity Index | −0.20 | −0.34 | |
−0.19 | −0.41 | ||
Positive symptom distress index | −0.30 | −0.29 | |
−0.11 | −0.34 | ||
Positive symptom total | −0.18 | −0.22 | |
−0.33 | −0.31 | ||
Zhang et al., 2017 (Family Study) [105] | Eyberg Child Behavior Inventory | ||
Intensity | −0.34 | ||
Problem | −0.24 |
Study | Measure | Mindfulness (g) | Control (g) |
---|---|---|---|
Hoxhaj et al., 2018 (Adult Study) * [92] | Description | 0.15 | 0.14 |
0.15 | 0.24 | ||
Observation | 0.52 | 0.01 | |
0.40 | 0.00 | ||
Acting with awareness | 0.18 | 0.40 | |
0.48 | 0.39 | ||
Non judging of inner experience | 0.19 | 0.18 | |
0.29 | 0.15 | ||
Non reactivity to inner experience | 0.64 | 0.05 | |
0.46 | 0.19 | ||
Lui et al., 2021 (Parent Study) [96] | Description | 0.14 | −0.07 |
Observation | 0.52 | −0.05 | |
Acting with awareness | −0.01 | −0.06 | |
Non judging of inner experience | −0.01 | 0.18 | |
Non reactivity to inner experience | 0.47 | −0.29 |
Study | Measure | Mindfulness (g) | Control (g) |
---|---|---|---|
Haydicky et al., 2015 (Child Study) * [90] | Total | 0.73 | |
1.03 | |||
Lo et al., 2020 (Family Study) [97] | Total | 0.02 | 0.02 |
Sieberlink et al., 2021 (Family Study) ** [102] | Total | 0.51 | 0.03 |
0.46 | 0.10 | ||
0.53 | 0.12 | ||
Lui et al., 2021 (Parent Study) [96] | Total | 0.08 | −0.09 |
Compassion for child | −0.11 | −0.97 | |
Emotional Awareness in parenting | 0.17 | −0.22 | |
Listening with full attention | −0.05 | −0.18 | |
Zhang et al., 2017 (Family Study) [105] | Compassion for child | 0.06 | |
Emotional Awareness of the self | −0.31 | ||
Emotional Awareness of the child | −0.09 | ||
Emotional non-reactivity in parenting | −0.11 | ||
Listening with full attention | −0.35 |
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Kretschmer, C.R.; Göz Tebrizcik, B.; Dommett, E.J. Mindfulness Interventions for Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-Analysis. Psychiatry Int. 2022, 3, 363-399. https://doi.org/10.3390/psychiatryint3040031
Kretschmer CR, Göz Tebrizcik B, Dommett EJ. Mindfulness Interventions for Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-Analysis. Psychiatry International. 2022; 3(4):363-399. https://doi.org/10.3390/psychiatryint3040031
Chicago/Turabian StyleKretschmer, Clara R., Burcu Göz Tebrizcik, and Eleanor J. Dommett. 2022. "Mindfulness Interventions for Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-Analysis" Psychiatry International 3, no. 4: 363-399. https://doi.org/10.3390/psychiatryint3040031
APA StyleKretschmer, C. R., Göz Tebrizcik, B., & Dommett, E. J. (2022). Mindfulness Interventions for Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-Analysis. Psychiatry International, 3(4), 363-399. https://doi.org/10.3390/psychiatryint3040031