Effect Mindfulness Based Training on Attention, Hyperactivity and Emotion Regulation Among Children With ADHD: A Randomized Controlled Trails
Phase: NA
Conditions: A
Sponsor: Alexandria University

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Effect Mindfulness Based Training on Attention, Hyperactivity and Emotion Regulation 
Among Children with ADHD: A Randomized Controlled Trails 
Contributing Authors: 
Mohamed Hussein Atta *,   
Lecturer, Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Alexandria 
University, Egypt. (mohamed-hussein@alexu.edu.eg) 
*Corresponding author (mohamed-hussein@alexu.edu.eg.) 
Corresponding author at: Admeon Freemon st, Semoha, Alexandria, Egypt, Faculty of Nursing, 
Psychiatric Nursing Department, telephone +201067043760. 
   
Abstract 
Background:  
The aim: 
Setting: 
 Subjects  
Tools:  
Results: 
 Recommendation:  
Keyword:. 
 
 
 
 
 
 
 
 

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   Introduction 
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that 
commonly affects children and adolescents and can persist into adulthood (Azzam et al., 2021; Liu 
et al., 2018). It is one of the leading causes for children to be referred to psychology and psychiatric 
clinics. A recent systematic review found that the global prevalence of ADHD is 7.6% (Salari et 
al., 2023), with higher estimates among children aged 3-17 years varying from 6% to 16% 
(Danielson et al., 2022). In Egypt, epidemiological studies indicate that ADHD is a widespread 
condition that affects 9.4 to 21.8% of children, which is higher than the worldwide incidence 
(Aboul-ata & Amin, 2015; Bishrry et al., 2018; EL-Gendy et al., 2017).  
While research on the prevalence of ADHD in Egypt is limited, and further studies are 
needed to better understand the extent of this disorder in the country. Hence, implementing 
evidence-based practices to address the symptoms of ADHD is crucial to improving the well-being 
of both affected children and families (Aboul-ata & Amin, 2015; Bishrry et al., 2018; EL-Gendy 
et al., 2017). 
ADHD symptoms can have a significant impact on the child and their family. The 
symptoms of hyperactivity, inattention, and impulsivity can affect the child's academic 
performance, social interactions, and overall quality of life. Children may struggle with tasks, 
organizing activities, and following instructions, and their emotions may be difficult to control. 
The family of a child with ADHD may also be affected, experiencing stress, frustration, and a 
sense of helplessness. This can lead to emotional exhaustion and financial strain for parents and 
caregivers due to the cost of treatment and missed work (Bishry et al., 2008; Peñuelas-Calvo et al. 
2020) 
Attention deficit is one of hallmark symptom of ADHD, making it difficult for them to 
concentrate, stay focused, and complete tasks. This can have a significant impact on their academic 
performance, social interactions, and self-esteem. In the classroom, children with ADHD may 
struggle with following instructions, organizing their work, and controlling their behavior. 
However, with proper support and intervention, children with ADHD can learn to manage their 
symptoms and lead successful lives (Bruno et al., 2023; Singh et al., 2015). 
Moreover, hyperactivity is a common symptom of ADHD and can take various forms, such 
as fidgeting, restlessness, excessive talking, and impulsiveness. This can make it challenging for 
children to engage in calm activities, follow rules, and finish tasks. Additionally, they may find it 
difficult to socialize and maintain friendships as their behavior can be disruptive and 
overwhelming for others. The constant movement and restlessness can cause fatigue and difficulty 
sleeping, further affecting their daily life. This can be stressful for family members who may have 
difficulty managing the child's behavior and needs. However, with appropriate interventions and 
support, children with hyperactivity can learn to manage their symptoms and improve their overall 
well-being. (Hinshaw et al., 2021; Fioravante, Lozano-Lozano, Martella, 2022). 

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Emotion regulation is the ability to manage and control one's emotional responses to 
different environmental stimuli. Children diagnosed with (ADHD) often experience difficulties 
with emotion regulation. These challenges can take various forms, such as difficulty with 
emotional self-awareness and self-monitoring due to inattentive symptoms, impulsive emotional 
reactions due to impulsivity, and heightened emotional arousal and difficulty calming down due 
to hyperactivity (Soler-Gutiérrez, Pérez-González, & Mayas, 2023). These emotion regulation 
difficulties can have significant negative consequences for children with ADHD, including 
increased risk for anxiety and depression, social difficulties, and academic and occupational 
impairments (Walter et al., 2023). Therefore, it is crucial to address difficulties in emotion 
regulation, attention, and behavior as part of the comprehensive treatment of ADHD. Effective 
interventions, such as cognitive-behavioral therapy, mindfulness-based interventions, and 
medication management, can assist people with ADHD in developing effective emotion regulation 
skills and enhancing their overall functioning. (Haugan et al., 2022; Jenkins, et al., 2020; Lee, 
Chen & Lin, 2022). 
Mindfulness training is a promising form of training for children with ADHD, as it focuses 
on attention and has gained empirical support as a complementary or alternative intervention. It 
involves increasing awareness and nonjudgmental observation of present-moment experiences 
while reducing automatic responding (Cairncross, & Miller 2016; Santonastaso et al., 2020). 
Attention regulation is a fundamental mechanism of mindfulness meditation, which involves 
training to sustain focus on present-moment experiences and gently shifting attention back to the 
meditation object when the mind drifts (Bishop, et al., 2004). Mindfulness meditation is a 
relatively new approach for reducing stress and emotion regulation difficulties among children. 
While researching the efficacy of mindfulness training in children is a new domain, existing 
evidence suggests that it has positive effects on psychological well-being, pain management, 
emotion dysregulation, negative behaviors, and cognitive/executive functions and attention (Evans 
et al., 2018; Zhang, Díaz-Román, & Cortese,2018). 
Nurses have an important role in caring for children with ADHD, particularly in the context 
of mindfulness-based interventions. They can provide education and support to both parents and 
children regarding the benefits of mindfulness practice and can help implement mindfulness 
programs in clinical and community settings. Nurses can assist children with ADHD to develop 
mindfulness skills, including paying attention to present-moment experiences and managing their 
emotions. This can be done through individual or group sessions, where nurses can guide children 
through various mindfulness exercises and provide feedback and support. Collaborating with other 
healthcare professionals such as psychologists and psychiatrists, nurses can ensure that children 
with ADHD receive comprehensive and coordinated care. By integrating mindfulness into their 
care approach, nurses can help enhance attention, emotion regulation, and overall well-being in 
children with ADHD. 

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The aim of the study is to: 
The research questions:  
 
MATERIALS AND METHOD 
MATERIALS 
I. 
Research design:  
II. 
Setting:  
        
III. 
Subjects: 
     Tools: 
Four tools were used for data collection in this study: 
Tool I: A Socio-demographic and Academic Data Questionnaire:  
       
Part 1 Socio-demographic data:  
Part 2 Academic data:  
      
 
Tool III:  
          
Tool IV:   
 
Ethical approval and consent to participate. 
All methods were carried out according to the relevant guidelines and regulations of the 
Declaration of Helsinki (DoH-Oct2008). Study procedures were revised and approved by the 
research ethics committee of the faculty of nursing, Alexandria University and the Human Rights 
Protection Committee of the General Secretariat of Mental Health, Ministry of Health, and 
Population in Cairo (IRB). An informed written consent was obtained from all patients after 
explaining the purpose and nature of the study and who agreed to participate in the study. 
Declaration   

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Consent for publication  
Not applicable. 
Availability of data and materials  
The datasets used and/or analyzed during the current study are available from the corresponding 
author on reasonable request.  
Competing interests 
No potential conflict of interest was reported by the authors. 
Funding  
This research did not receive any specific grant from funding agencies in the public, commercial, 
or not-for-profit sectors. 
Authors contributions  
Acknowledgements 
Our sincere thanks go to all participants of the study. 
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