Kelley: Lidia, Thank you for taking the time to speak with me this afternoon!  I'd like to talk about your research on the impact of mindfulness on adolescents and adults diagnosed with ADHD - why don't you tell me a little bit about the work that you've just done?  I've read the study several times but I'd love to hear your perspective.

Lidia:  Sure, so what we did with the study was to take typical mindfulness training and make it user friendly for people with ADHD.  We then looked at the feasibility of the training for both adults with ADHD as well as going a little bit younger - to include teenagers - and we hope that this kind of training can be studied with children in the future.

We developed this program called 'Mindful Awareness Practices for ADHD', or MAPS for ADHD, which is an 8-week course similar to other mindfulness intervention models.  We wanted to make the so-called formal practice (i.e. sitting or walking meditation) very gradual, keeping in mind that people with ADHD - particularly those with hyperactivity - may having difficulty sitting for longer periods of time.  At the same time, we also emphasized the so-called informal practice aspect of mindfulness training or paying attention in daily life.  For example, really paying attention to sensation of taste when you are eating, paying attention to your breath throughout your day, noticing how you are sitting in a chair in front of a computer, noticing your body while playing sports, and so on.  A big component of the MAPS course was talking about "What is ADHD?" and reframing it as a neurobiological difference that exists on a continuum and can have different types of self-regulation difficulties associated with it.  In this re-framing, curiosity and openness is brought to self-observation, encouraging awareness of both difficulties as well as potential unique positive characteristics that come with ADHD and ultimately developing a better way to work with one's weaknesses.  Another modification of the course over the traditional 8-week interventions was an emphasis on developing loving kindness - which is sometimes part of mindfulness training and sometimes not.  We thought that aspect was important because there's often low self-esteem in people with ADHD; a kind of reactivity to yourself, negative thoughts, self-criticism, or feeling different.  Overall, the course emphasizes acceptance and self-compassion as a way to promote change.

Looking at the change before and after the course, we found improvement in self-report of ADHD symptoms.  The symptoms of in-attention and hyperactivity improved significantly - measured before the class, at the conclusion, and - although we did not report this in the paper - we also repeated the measurement 3 months after the training was completed.  We found that there was actually even more improvement at the post 3 month mark than right after the training which was very encouraging.

Kelley: Yes, I would have expected that, that's great.

Lidia:  We also looked at measures of predicting anxiety and depression before and after and we found anxiety and depression improved in adults, although not so much in adolescents.  In addition, we used a battery of tests that are often used to look at cognitive impairment in ADHD.  Even though cognitive impairments are not necessary for a diagnosis of ADHD, it is common to have some trouble with working memory or the ability to hold information "online" for short periods of time. In ADHD, there are frequently so-called cognitive inhibitions or executive function problems, or difficulty being able to ignore distracting information,  to stay focused on a task, or to be organized. 

So we used an executive function test battery that taps into inhibition as well as working memory abilities.  We found improvements on measures of conflict attention and some of the inhibition-implying measures, but not so much improvement on the working memory measures.

In our study we used a computer test of the aspects of attention. The test is called 'Attention Network Test' or 'ANT' and looks at three aspects of attention - alerting, orienting and conflicting. Alerting is the ability to just be alert enough to pay attention, orienting is the ability to shift attention to the target and movement of attention, and then conflict attention is the ability to again pay attention when something else is distracting - and then being able to ignore that distracting information.  Among those 3 aspects, the conflicting attention aspect improved the most significantly.

We think at multiple levels mindfulness can be helpful with attention training, emotional regulation and lowering stress, as well as learning how to relate to yourself in a more loving, kind or compassionate way.

Kelley: That's great - thanks for that summary. So then are you planning a subsequent study?

Lidia: While our study is currently finished, other groups are interested in doing similar work at UCLA's Mindful Awareness Research Center (MARC) and elsewhere, wanting to do a follow-on with children or adults.  That would be a really nice way to further validate this study.

Kelley: I have been asked many times if I think using eMindful's live, interactive virtual classroom (where students and participants can see and hear each other) to teach children about mindfulness would be a good idea.  The rational is children are so great with computers.  Do you think that would be effective? 

Lidia:  That's a good question. I have definitely thought about that - there are a lot of lives touched by ADHD and there have been lots of requests from people not just in the Los Angeles area where we are, but from other states and even all over the world - so I think it would be nice to be able to reach people beyond LA to offer this kind of training.

Kelley:  Yes, I'm wondering if you think the live online class would be as effective or not?

Lidia:  Yes, well I think if there is an interactive component, and members can really interact with each other, and participants really feel like they are a part of a group, then, yes, I think it would be effective. 

Involving parents in this kind of learning can also be helpful as parents are natural teachers to their children, can model mindful communication, and can use mindfulness as a tool for their own well-being and managing stress of parenting.

Another application is adults with ADHD who were diagnosed as adults, grew up thinking that they were different and not quite knowing why.  As a result there is a need for adults with ADHD to connect with other people who are like them and to have a sense of belonging.  The idea of creating an online community of these adults has always been interesting to me.   A community in which you can bring mindfulness to this issue of learning about yourself and accepting yourself as you are - but at the same time being able to keep working at it.  We often talk about balancing when talking to individuals with ADHD - being able to accept something that is difficult, but not giving up - you can work with the difficulties of ADHD and still bring compassion to that work.