Running head : ADHD AND MINDFULNESS IN CHILDREN AND ADOLESCENTS 1 Attention Deficit Hyperactivity Disorder and Mindfulness Practice in Children and Adolescents : A Comprehensive Review of Evidence-Based Research

Attention Deficit Hyperactivity Disorder (ADHD) is the most common mental illness in the United States among male and female children and adolescents between the ages of 3 and 17. The emerging fields of neurobiology and neuroimaging have proposed a relationship between mindfulness meditation therapies—initially referred to as mindfulness-based stress reduction (MBSR) and now simply known as mindfulness—and improvements in attention and self-regulation, two major problem areas for ADHD sufferers. Furthermore, recent studies suggest that mindfulness therapies may be effective in reducing symptoms of ADHD in children and adolescents. The purpose of this paper is to review, analyze and synthesize the available evidence-based research that pertains to ADHD and mindfulness among this demographic. My methodology consisted of a comparison and analysis of peer-reviewed research articles, written in English, concerning controlled and non-controlled studies of the effects of mindfulness on children, adolescents, and ADHD individuals. The results suggested improvements in the quality of scientific research into mindfulness among children and adolescents with ADHD, as well as high potential for the application of mindfulness therapies to this population. However, I also identified persistent research flaws; these included small study sample sizes, insufficient random controlled trials, and insufficient focus on children and adolescents formally diagnosed with ADHD. Nonetheless, this research provides early empirical evidence of the efficacy and harmlessness of mindfulness therapies for children and adolescents. This subject warrants further research, incorporating larger, randomized control trials, which should ideally include ADHD children and adolescents of varying developmental levels, ages, gender, races, ethnicities, and socioeconomic backgrounds. ADHD AND MINDFULNESS IN CHILDREN AND ADOLESCENTS 6 Attention Deficit Hyperactivity Disorder and Mindfulness Practice in Children and Adolescents: A Comprehensive Review of Evidence-Based Research Attention Deficit Hyperactivity Disorder (ADHD) is listed as the most common mental illness in the United States among male and female children and adolescents between 3 and 17 years of age (Centers for Disease Control and Prevention [CDC], 2013). The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders, used globally for the formal diagnosis of ADHD, describes ADHD as a pattern of inattention and/or hyperactivity-impulsivity that interferes with development and shows symptoms in two or more settings (e.g., at home, school, or work); these symptoms negatively impact social, academic or occupational functions (American Psychiatric Association [APA], 2013). Specific symptoms of ADHD include restless or arousal states, inability to hold attention, focus, or concentration, impulsivity, and behavioral or conduct disorders. All of these symptoms may lead to higher emotional and physical risk for individuals with ADHD. Some of the most common consequences include limited academic development, accidents and injuries, medication and illicit drug abuse, addiction, emotional difficulties, and peer conflicts. The emerging fields of neurobiology and neuroimaging have proposed a relationship between mindfulness meditation therapies—initially called mindfulness-based stress reduction (MBSR), but now simply known as mindfulness—and improving individuals’ attention and selfregulation abilities, two salient problem areas for ADHD sufferers. Using neuroimaging techniques such as electroencephalography (EEG), researchers have begun to explore the neural mechanisms underlying Mindfulness practice (Davidson et al., 2003; Lutz, Slagter, Dunne, & Davidson, 2008) and functional magnetic resonance imaging (MRI) (Farb et al., 2007; Lutz et al., 2008; Farb et al., 2010; Goldin & Gross, 2010). Furthermore, as understanding of ADHD has ADHD AND MINDFULNESS IN CHILDREN AND ADOLESCENTS 7 evolved through the study of psychoneuroimmunology, genomics and epigenetics, so have the terms, themes, and concepts that allow for effective evaluation, diagnosis, and management. A wide range of interdisciplinary research has incrementally expanded our knowledge of ADHD in children and adolescents. Since being introduced to the West by Jon Kabat Zinn in 1979, the practice of mindfulness meditation has seen an incremental rise in professional interest for its applicability to ADHD treatment. Research now supports the concept that mindfulness is effective in enhancing attention, self-regulation, as well as emotional and mental flexibility in adults with ADHD. It has also shown to be effective against a host of their associated co-morbidities, such as depression and anxiety (Cassone, 2013; Tang, Rothbart, & Posner, 2012; Teper & Inzlicht, 2013; Flook et al., 2010; Swanson & Volkow, 2009; Zylowska et al., 2008; Schonert-Reichl & Lawlor, 2010; Burke, 2010; Lee, Semple, Rosa, & Miller, 2008; Biegel, Brown, Shapiro, & Schubert, 2009; Broderick & Metz, 2009; Thompson & Gauntlett-Gilbert, 2008; Jha, Krompinger, & Baime, 2007; Tang et al., 2007; Biederman et al., 2004). Although substantial evidence suggests that mindfulness can combat ADHD in adults, evidence is only beginning to suggest that mindfulness therapies and interventions can also be effective at reducing symptoms of ADHD in children and adolescents between the ages of 3 and 17. Over the past decade, a growing list of mindfulness centers and institutes, researchers, practitioners, and educators have been investigating the relationship between ADHD and mindfulness practices in children and adolescents. The practices under investigation have included: MBSR, which incorporates mindful breathing, sitting, supine walking, and body scan exercises (http://www.umassmed.edu/cfm/); mindfulness awareness practices (MAPS) using breath, sitting, walking, sound, play and eating (http://marc.ucla.edu); and mindful parenting, ADHD AND MINDFULNESS IN CHILDREN AND ADOLESCENTS 8 which is often available as school-based therapy and calls on mindfulness interventions from parents and teachers (Van der Oord, S., Bögels, S. M., & Peijnenburg, D., 2012). Other kinds of mindfulness interventions with children and adolescents are school and community-based practices, intended to foster social and emotional learning and inner resilience among children and adolescents by providing them with mindfulness training (Goleman, 2008). These mindfulness practices have demonstrated varying degrees of effectiveness at improving children and adolescents’ mental health and well-being. The purpose of this paper is to review, analyze and synthesize the literature on ADHD and mindfulness meditation in children and adolescents. More specifically, the paper will identify the availability of evidence-based research on mindfulness therapies involving breathing, sitting, and walking on children and adolescents with ADHD. I will focus on research pertaining to three specific aspects of ADHD: attention, self-regulation, and executive function. This review intends to identify new areas of focus for further research into ways that mindfulness can help manage the bio-psycho-emotional-social gaps identified for children and adolescents with ADHD.