Mindful Awareness: ADHD Treatment with Meditation

ADHD treatment information about how meditation can focus the attention of children and adults with attention deficit.

by Carl Sherman, Ph.D.

What's the core issue of attention deficit disorder (ADD ADHD)? For many adults and children with ADHD, it's paying attention. So it stands to reason that some kind of attention training would be just what the doctor ordered.

Well, there is such a thing. It's been around for thousands of years, and it's now a hot research topic at the UCLA Mindful Awareness Research Center. Recently, ADDitude's Carl Sherman, Ph.D., spoke with psychiatrist Lidia Zylowska, M.D., who heads the center's AD/HD program.

“Mindful awareness” sounds spiritual. Is it?
Mindful awareness, or mindfulness, is part of many religious traditions. For example, Buddhism features a form of mindfulness meditation known as vipassana.

But mindfulness is not necessarily religious or spiritual. It involves paying close attention to your thoughts, feelings, and bodily sensations; in other words, developing a greater awareness of what’s going on with you from moment to moment.

It can be used as a tool to foster wellness, especially psychological well-being. Similar techniques have been used to lower blood pressure and to manage chronic pain, anxiety, and depression.

How can mindfulness help people with AD/HD?
It improves your ability to control your attention. In other words, it teaches you to pay attention to paying attention. Mindful awareness can also make people more aware of their emotional state, so they won’t react impulsively. That's often a real problem for people with ADHD.

Researchers have talked about using mindfulness for ADHD for some time, but the question was always whether people with ADHD could really do it, especially if they're hyperactive.

How does your center teach the practice of mindful awareness?
We've tried to make the technique user-friendly. Our eight-week program consists of weekly two-and-a-half-hour training sessions, plus at-home practice. We start with five-minute, seated meditations at home each day, and gradually work up to 15 or 20 minutes. We also give the option to practice longer or to substitute mindful walking for the seated meditation.

We use visual aids, like a picture of a cloudy sky, to explain the basic concepts, because people with AD/HD tend to be visual learners. The blue sky represents the space of awareness, and the clouds represent all the thoughts, feelings, and sensations that pass by.

That's it? You do something for just a few minutes a day, and it makes your AD/HD better?
Not quite. The meditation sessions are important practice, but the key is to use mindfulness throughout your daily life, always being aware of where your attention is focused while you are engaged in routine activities. For example, you might notice while you drive that your attention wanders to an errand you must run later that day. Lots of people practice mindfulness while eating. Once you get used to checking in with yourself and your body, you can apply the technique anytime you start to feel overwhelmed.

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Can I learn to practice mindfulness on my own?
Yes, the basic practice is very simple. Just sit down in a comfortable place where you won't be disturbed and spend five minutes focusing on the sensation of breathing in and breathing out—pay attention to how it feels when your stomach rises and falls. Soon, you may notice that you're thinking of something else—your job or some noise you just heard or your plans for later in the day. Label these thoughts as "thinking," and refocus your attention on your breath.

Do this daily. Every couple of weeks, increase the length of time you spend on the exercise—10 minutes, 15, up to 20 or more if you feel you can. Try the same thing throughout each day, focusing on your breath for a few minutes as you walk from place to place, or when you're stopped at a red light or sitting at the computer.

What if you just can't keep your mind focused? Will the exercise still do any good?
It’s the nature of the mind to be distracted. Mindful awareness isn’t about staying with the breath, but about returning to the breath. That’s what enhances your ability to focus.

And this emphasis on re-shifting your attention, of outwitting the mind's natural tendency to wander, is what makes us think this technique could be especially helpful to someone who has AD/HD.

This article comes from the August/September 2006 issue of ADDitude.

To read this issue of ADDitude in full, purchase the back issue and SUBSCRIBE NOW to ensure you don't miss a single issue.

Attention Training, Part 2

It sounds logical, but just how effective is it?
We just completed a study involving 25 adults and eight adolescents, half of whom had the combined [both inattentive and hyperactive] form of AD/HD, and the results were very promising. We observed significant improvements in both inattention and hyperactivity.

In cognitive tests, the participants got better at staying focused, even when different things were competing for their attention. Many of them also felt less anxious and depressed by the end of study.

But keep in mind that this study is only a first step into understanding the effectiveness of this approach. More research is still needed to confirm these early findings.

Can children practice mindful awareness?
There seems to be a growing consensus that that's the case, although the program would have to be modified for young children. In fact, there is one mindfulness program that's designed just for preschool and elementary school children [InnerKids.org], and it has been quite successful. The program has yet to be used specifically for children who have AD/HD, but we plan to do future studies with them, and with AD/HD adolescents and adults.

What did the study participants think of mindful awareness? Did they think it worked?
Most stuck with the program, and, when asked to rate their overall satisfaction with it, they rated it an average of nine out of 10. And the participants' comments were mostly positive. Adults said things like, "I feel that I better understand what goes on in my head, and I'm less critical of myself, less reactive, and more forgiving of myself."

One teenager said, "Now, whenever I feel my mind wandering, I'm able to realize that it's wandering. I can let go of the feeling and stop giving in to distractions."

Does scientific evidence support the effect of mindful awareness on the brain?
Researchers have shown that, compared with people who don't meditate, long-time meditators have different EEG and MRI patterns, particularly in the brain's frontal region—the region that is involved with AD/HD. Another study found a rise in the level of the neurotransmitter dopamine during meditative states. Lowered levels of dopamine have been found regularly in people with AD/HD.

Is there any evidence that mindfulness can reduce one's need for AD/HD medication?
We didn't specifically measure this effect in our study because we did not manage our participants' medications. Only about half of our participants were taking stimulant medication, and the benefits they reported were similar to those reported by participants who were not taking stimulants. We hope that, by practicing mindfulness, one can learn to better self-regulate and, over time, lower the need for medication. But we need to study this question further.

Where can I learn more about mindful awareness?
If you'd like an expert to guide you through the process, visit the “Mindful Meditations” page at UCLA.edu. There, you can download three mp3s recorded by Diana Winston, the mindfulness trainer from our program. In each, she'll lead you through a mindful awareness exercise.

There are also several good books on mindfulness meditation. I recommend Tibetan Wisdom for Western Life, by Joseph Arpaia, M.D., and Lobsang Rapgay, Ph.D., (Beyond Words Publishing) and Full Catastrophe Living, by Jon Kabat-Zinn (Piatkus Books).

The Center for Mindfulness at the University of Massachusetts has been offering mindfulness-based stress reduction classes for more than two decades. You can find a directory of trainers on its Web site. The UMass program is designed for stress-related conditions and is not adapted to AD/HD, but it has a similar eight-week structure and is a good way to learn the technique.

This article comes from the August/September 2006 issue of ADDitude.

To read this issue of ADDitude in full, purchase the back issue and SUBSCRIBE NOW to ensure you don't miss a single issue.