Mindful Awareness: How to Combat ADHD Symptoms with Meditation
Research suggests that mindful meditation can train the ADHD brain to better concentrate and hold focus. Could this alternative treatment help you?
For many adults and children with ADHD, two persistent daily challenges are paying attention and maintaining self-regulation. So it stands to reason that some kind of attention training that also hones self-control would be invaluable — and incredibly powerful.
Well, it turns out one such treatment strategy has been around for thousands of years, and it’s a hot research topic at the UCLA Mindful Awareness Research Center (MARC). ADDitude’s Carl Sherman, Ph.D., spoke with psychiatrist Lidia Zylowska, M.D., who heads the center’s ADHD 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, stress, and mood disorders.
How can mindfulness help people with ADHD?
Unlike many tools for ADHD, mindfulness develops the individual’s inner skills. It improves your ability to control your attention by helping to strengthen your ability to self-observe, to train attention, and to develop different relationships to experiences that are stressful. In other words, it teaches you to pay attention to paying attention, and 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. The versatility and flexibility of mindfulness allows individuality in the approach, to make it work for you.
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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 ADHD 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 ADHD 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.
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 mental training 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.
You can actually practice mindfulness at any time, even during conversation with others. Turning on the mind-awareness state at any time during your day, even if only for a few minutes, is great training. It’s essentially letting go of the busy-ness of your thinking, and bringing your attention to what’s happening in the present moment in everyday life.
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 this technique especially helpful to someone who has ADHD.
It sounds logical, but just how effective is it?
In 2008, we completed a study involving 25 adults and 8 adolescents, half of whom had the combined [both inattentive and hyperactive] form of ADHD, 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 stressed out and sad by the end of study.
In 2012, the study titled “The Effectiveness of Mindfulness Training for Children with ADHD and Mindful Parenting for their Parents” was published in the Journal of Child and Family Studies. This research trial “evaluated the effectiveness of an 8-week mindfulness training for children aged 8–12 with ADHD and parallel mindful parenting training for their parents.” They found a significant reduction in parent-reported ADHD symptoms after the 8-week training, as well as a reduction in parental stress and over-reactivity. However, the study found no improvement in ADHD symptoms after the mindfulness program on teacher-completed rating scales.
More research is still needed on the efficacy of mindfulness on ADHD symptoms, but the research is promising so far.
Can children practice mindful awareness?
There seems to be a growing consensus that children can successfully practice mindfulness, 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 ADHD, but we plan to do future studies with them, and with ADHD 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 9 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 ADHD. Another study found a rise in the level of dopamine, the very neurotransmitter in short supply in ADHD brains, during meditative states.
Is there any evidence that mindfulness can reduce one’s need for ADHD 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.
A group of researchers began a study in conjunction with the National Institute of Health in 2016 to study mindfulness training versus stimulant medication in the treatment of childhood ADHD. The study is now ongoing, so these insights will be available in the near future.
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 several guided meditations. In each, you’ll be lead 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),
- Full Catastrophe Living, by Jon Kabat-Zinn (Piatkus Books),
- Growing Up Mindful: Essential Practices to Help Children, Teens, and Families Find Balance, Calm, and Resilience by Christopher Willard PsyD (Sounds True),
- Mindful Parenting for ADHD by Mark Bertin, M.D. (New Harbinger Publications),
- Fully Present, The Science, Art, and Practice of Mindfulness by Susan L. Smalley, Ph.D., founder and director of MARC, and Diana Winston, Director of Mindfulness Education at MARC (Da Capo Lifelong Books), and
- The Mindfulness Prescription for Adult ADHD by Lidia Zylowska, M.D. (Trumpeter)
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 ADHD, but it has a similar eight-week structure and is a good way to learn the technique.