Evaluation of MBCT For Adolescents With ADHD and Their Parents - Impact On Individual and Family Functioning PDF

Doctorate in Educational and Child Psychology Amy Phipps
Case Study 1: An Evidence-Based Practice Review Report
Theme: Interventions for children with Special Educational Needs
What is the impact of mindfulness-based approaches for children with ADHD and their
parents?
Summary
Mindfulness is based on Eastern meditation techniques and helps to increase an individuals
awareness of the present moment, enhance non-judgemental observation and reduce automatic
responding (Kabat-Zinn, 2003). For children with attention deficit hyperactivity disorder (ADHD),
this seems an attractive intervention option although the evidence-base is only in its preliminary
stages. This systematic literature review synthesised the current research, exploring the impact of
mindfulness-based approaches (MBAs) for both children with ADHD and their parents. The
findings offer some early indications that that MBAs may have an impact on childrens ADHD
symptoms and overall parental stress. However, the results were inconsistent across informants
and methodological designs were weak. Future research with sufficient sample sizes, objective
measures and rigorous methodology must therefore be conducted before MBAs can be
confidently used as an intervention option.
Introduction
Mindfulness stems from Buddhist meditative practice and is based on the deliberate focus of
attention on thoughts, sensations and feelings as they arise on a moment-by-moment basis. In
mindfulness practice, mental events are attended to with an attitude of non-reactivity and
acceptance (Williams, Teasdale, Segal & Kabat-Zinn, 2007). In this sense, mindfulness can be
viewed as a form of mental training, encouraging individuals to wilfully direct and redirect their
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attention to particular kinds of events. As neatly described by Broderick and Metz (2009, p. 37),
this practice offers the opportunity to develop hardiness in the face of uncomfortable feelings that
otherwise might provoke a response that could be harmful, such as acting out by displaying
violent behaviour, or acting in by becoming more depressed. Indeed, initial research suggests
that mindfulness may promote emotion well-being, mental and physical health (Weare, 2012).
For children and young people, MBAs are currently being implemented across both educational
and clinical settings, although the programmes are diverse in content. In light of this, Iyadurai,
Morris and Dunsmuir (2014) have identified six core principles that they believe to be an
imperative part of mindfulness practice. These principles will be used as a definition of
mindfulness for this review and include: :
Attention to the present moment;
Non-judgemental acceptance;
Compassion for self and others;
Teaching of everyday mindfulness practices (e.g. mindful walking, mindful eating)
Teaching of mindfulness meditation (e.g. body scan, mindful stretches)
Personal embodiment of the qualities of mindfulness.
Whilst there are early indications that mindfulness may be an acceptable and feasible
intervention, it seems that research in this area has barely begun (Semple, Lee & Miller 2006,
p.164). So why might MBAs be a useful intervention for children with ADHD? ADHD is a highly
heritable disorder that affects between 8 and 12% of children worldwide (Polanczyk, de Lima,
Horta, Biederman & Rohde, 2007). The deficits in ADHD can be described at the structural,
neuropsychological and behavioural level. At a structural level, children with ADHD have been
shown to have a decreased functional connectivity within the fronto-striato-parietal network (Rubia
et al., 2009). At the neuropsychological level, this decreased functional connectivity contributes to
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poor performance on tasks of executive function such as response inhibition, attention, and time
reproduction (Kerns, McInerney & Wilde, 2001). At a behavioural level, children with ADHD also
demonstrate a chronic pattern of developmentally inappropriate inattention, hyperactivity and
impulsive behaviour (American Psychiatric Association 2013). With difficulties in self-regulation,
children with ADHD are also at greater risk of poor academic achievement (Massetti et al., 2008).
So what are the intervention options?
One option for improving the symptoms of ADHD is psychostimulant medication. However,
adherence to medication decreases sharply in adolescence, with up to 70% of teenagers
discontinuing their medication use by the age of 15 (Wolraich et al., 2005). With adverse effects,
forgetfulness and a fear of stigma cited as explanations for this; alternative intervention options are
essential (Charach, Skyba, Cook & Antle, 2006; Gau et al., 2006). In a meta-analysis of
behavioural interventions, Fabiano et al., (2009) reports an average effect size of 0.83 for
between-group studies and 0.70 for pre-post studies, suggesting that this may be an effective
approach. However, parental ADHD may reduce the effectiveness of behavioural interventions
(Sonuga-Barke, Daley & Thompson, 2002) - an important consideration given the highly heritable
nature of the disorder. This opens a window of opportunity for MBAs, but what is the rationale?
The rationale for MBAs being an effective intervention for children with ADHD lies in the three
levels of deficit that were mentioned previously. At the structural level, changes in functional
connectivity have been reported following mindfulness practice, reflecting a more consistent
attentional focus (Kilpatrick et al., 2011). At a neuropsychological level, research also shows that
mindfulness practice can improve tasks that tap into executive functioning, particularly in the
domains of metacognition and behavioural regulation (Flook et al., 2010). At the behavioural level,
mindfulness practice has also been shown to improve attention (Semple, Lee, Rosa, & Miller,
2010). But why parents as well? Parents of children diagnosed with ADHD experience higher
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levels of stress when compared to families without ADHD. As a result of their childs behaviour,
parents can become over-reactive, pay greater attention to disruptive behaviour and act more
impulsively. This behaviour, a response of parental stress, has also been linked to the severity of
ADHD symptoms (Theule, Wiener, Tannock & Jenkins, 2013). There is also evidence to suggest
that these behaviours can have a negative impact on the parent-child relationship, which adds
further stress to the system (Deault, 2010). As a result of parental stress, psychosocial
interventions such as parenting programmes have been shown to have high drop-out rates and a
poor implementation of new strategies in the home environment (Friars & Mellor, 2007). Clearly, a
stress management component for parents could be a useful addition in the treatment of ADHD,
particularly in light of the reciprocal parent-child relationship. In support, research has shown that
reductions in parenting stress are associated with increased treatment efficacy and better child
outcomes (Kazdin and Whitley 2003).
With this in mind, MBAs with both a child and parent component could be the way forward. Indeed,
the current SEN Code of Practice (2001, p.16) states that the work of professionals can be more
effective when parents are involved. There is also an increasing focus of the Educational
Psychologist (EP) as a therapeutic provider (MacKay, 2007), particularly in light of the increasing
demand on CAMHS and a lack of capacity to meet these requirements (Stallard, Udwin, Goddard
& Hibbert, 2007).
In light of the information presented above, the review question for this paper is: What is the
impact of MBAs for children with ADHD and their parents? As research in this area is preliminary,
many outcomes are being reported in the literature from internalising behaviour to functional
impairments. Based on the research cited above, this review paper will take a narrower viewpoint
and focus on four main areas; ADHD symptoms1, externalising behaviour, the parent-child
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ADHD symptoms are limited to those defined in the DSM-5 and include impulsivity, hyperactivity and inattention
(American Psychiatric Association, 2013).
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relationship and parenting stress. Throughout the review, the findings shall be reported in these
themes.
Literature Search:
An initial search was carried out on 29th November 2013 using the electronic databases
PsycINFO, Medline (EBSCO) and ERIC (Educational Resource Index and Abstracts). The
following search terms were used to locate studies:
Table 1: Search terms applied to PsycINFO, Medline and ERIC

Databases: Search terms:
PsycINFO/Medline/ERIC Contains mindfulness (title) AND ADHD (abstract) AND
parents (abstract)
As can be seen in Figure 1, the database search revealed ten studies; five from PsycINFO, three
from ERIC and two from Medline. Five studies were excluded as duplicates and the
inclusion/exclusion criteria (Table 2) were applied to the remaining studies. Four studies were then
identified for inclusion in the final review. As a relatively new area of research, this small N was
unsurprising. On 13th December 2013, an ancestral search was conducted to identify further
suitable literature. Using the reference list of the fouridentified studies, further potentially suitable
studies were selected based on title alone. As can be seen in Figure 1, this process yielded an
additional study that was deemed suitable. A total of five studies were then used in the final review
question, as shown in Table 3.
For a full list of excluded studies and rationale, see appendix 1.
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Figure 1: Literature screening process:
Database search:
Articles identified from PsycINFO, ERIC, and Medline

N = 10
N = 5 removed as duplicates
Article abstracts screened using inclusion and

exclusion criteria.
N=5
N = 1 excluded
No primary diagnosis of
Full articles screened using inclusion and exclusion ADHD
criteria
None excluded, N = 4
Ancestral search:
Articles identified from ancestral searches

N = 14
N = 9 removed as duplicates
Article abstracts screened using inclusion and

exclusion criteria.
N=5 N = 3 excluded
1 item was a review
paper
Full articles screened using inclusion and exclusion Mindfulness training not
criteria offered to parents
N=2
N = 1 excluded
No primary diagnosis of
Articles identified for final review question
ADHD
N=1
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Table 2: Inclusion and exclusion criteria
Inclusion criteria Exclusion criteria Rationale

Publication Type
1a. Study is in a peer reviewed Study is not in a peer Studies in a peer reviewed journal
journal reviewed journal have already received some
scrutiny and are therefore less
likely to contain errors
1b. Study contains primary Study does not collect By using primary empirical data,
empirical data primary empirical data the review is able to explore the
(e.g. review article) impact of MBAs and collate the
findings
1c. Study is written in English Study is not written in Feasible for time and cost
English constraints of reviewer
Participants and setting
2a. Children and young people Children and young Children and young people with
have a primary diagnosis of people do not have a ADHD are the population of
ADHD primary ADHD diagnosis interest
2b. Children and young people Children and young EPs are employed to work with
are between the age of 0-25 people are outside this this age group
age bracket
2c. Mindfulness practice is Mindfulness practice is Research indicates reciprocal

offered to young people and only offered to young effects of child and parent
their parents people or their parents behaviours, and this is the area of
interest
Study type
3a. The study collects outcome Outcome data is only This allows the review to explore
data, pre and post intervention collected after the the impact of MBAs over time
intervention
3b. The study collects data on: Outcome data is not This is the area of interest for the
ADHD symptoms and/or collected in these areas review question
externalising behaviour
Parenting stress and/or
child-parent relationship
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Final studies included in systematic literature review:
Table 3: List of studies eligible for the final review question
Full APA reference of studies included in final review:

Van der Oord, S., Bgels, S. M., & Peijnenburg, D. (2012). The effectiveness of mindfulness
training for children with ADHD and mindful parenting for their parents. Journal of Child and Family
Studies, 21(1), 139-147.
Haydicky, J., Shecter, C., Wiener, J., & Ducharme, J. M. (2013). Evaluation of MBCT for
Adolescents with ADHD and Their Parents: Impact on Individual and Family Functioning. Journal
of Child and Family Studies, 1-19.
Harrison, L. J., Manocha, R., & Rubia, K. (2004). Sahaja yoga meditation as a family treatment
programme for children with attention deficit-hyperactivity disorder. Clinical Child Psychology and
Psychiatry, 9(4), 479-497.
van de Weijer-Bergsma, E., Formsma, A. R., de Bruin, E. I., & Bgels, S. M. (2012). The
effectiveness of mindfulness training on behavioral problems and attentional functioning in
adolescents with ADHD. Journal of Child and Family studies, 21(5), 775-787.
Singh, N. N., Singh, A. N., Lancioni, G. E., Singh, J., Winton, A. S., & Adkins, A. D. (2010).
Mindfulness training for parents and their children with ADHD increases the childrens compliance.
Journal of Child and Family Studies, 19(2), 157-166
It should be noted here Harrison et al. (2004) extract both qualitative and quantitative data in
exploring the impact of MBAs for children with ADHD. The qualitative data was obtained from
semi-structured interviews but only some comments/direct quotations were offered in the final
report. As this data was not subject to a thematic analysis, a decision was made not to include
these qualitative findings in the review question.
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Table 4: Detailed analysis of the 5 studies selected for review
Authors Sample Design Measures Significant findings

van der Oord, Age of children: 8- Design: quasi- Waitlist, pre-test, post-test ADHD symptoms
Bgels & 12 years experimental and follow up (8 week later) Post-intervention: Parents reported a significant reduction of
Peijnenburg waitlist control hyperactivity/impulsivity and inattention scores, p <.01. Teachers also reported a
(2012) N of participants: design Behavioural Outcomes: reduction of inattention symptoms, p <.10.
Children, N = 22 Disruptive Behaviour Follow-up: The reductions in hyperactivity/impulsivity and inattention scores were
Parents, N = 21 Weeks: 8 x 90 Disorder Rating maintained (p<.01), for parent-report only.
minute sessions Scale
Parenting Stress:
Delivery: group Parenting Stress: Follow-up: There was a significant reduction in parenting stress (p<.10) and
format (both Parenting Stress and parental over-reactivity at follow-up (p<.10)
parents and Index
children) The Parenting Scale
van de Weijer- Age of Children: Design: Non- Pre-test, post-test and follow ADHD symptoms:
Bergsma, Range; 11-15 experimental, up (8 weeks and 16 weeks Post intervention: Fathers reported a significant reduction in attention problems, p
Formsma, de years non-controlled later) < .10
Bruin & Bgels pre-post follow up 8 weeks: Adolescents reported a significant reduction in attention problems (p
(2012) N of participants: design Behavioural Outcomes: <.05) and this was supported by father reports (p <.01).
Children, N = 10 Youth Self Report Child
Parents, N = 19 Weeks: 8 x 90 Behaviour Checklist Attention (computerised task)
Teachers, N = 7 minute sessions Teacher Report Form Post intervention: Reduction in reaction speed to the visual targets (p <.01) and
reduction in the number of false alarms to the auditory targets (p <.05).
Delivery: group Attention (computerised): 8 weeks: There was a significant reduction in the number of misses to the auditory
format (both Sustained Attention Dots target (p <.05) and a reduction in the number of false alarms (p <.10)
parents and Sustained Attention 16 weeks: Reduction in the number of false alarms to the auditory target (p<.10)
children) Auditory
Externalising behaviour:
Parenting Stress: Post-intervention: Externalising behaviours of child were reported as significantly
Parenting Stress Index lower by fathers, p < .05.
The Parenting Scale 8 weeks: The initial reduction in externalising behaviours was also maintained
according to the father reports (p < .05). Reduced externalising behaviour were
also reported by adolescents (p < .10)
16 weeks; Adolescents reported a sustained reduction in externalising problems
(p <.10)
Parenting outcomes:
Post-intervention: Significant reduction in parenting stress after training was
reported by fathers (p <.01). There was a significant decrease in parental over-
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reactivity for both mothers and fathers (p <.05)

8 weeks: The reduction in parenting stress reported by fathers was maintained at
8-week follow-up (p <.01).
Singh, Singh, Age of Children: Design: multiple Measures were taken across Compliance:
Lancioni, Singh, 10-12 years baseline across the intervention and follow-up Following Mother Mindfulness: For child 1, there was a small effect (67%) of
Winton & participants period (total = 55 weeks) mother mindfulness on child compliance derived from Percentage of Non-
Adkins (2010) N of participants: design overlapping Data (PND). For child 2, there was no effect (17%).
Children, N = 2 Child compliance: Following Child Mindfulness: For both child 1 and 2, there was a large effect of
Parents, N = 2 Weeks: 12 week Defined by an child mindfulness on compliance, 100% and 92% respectively.
mindfulness appropriate and prompt Follow up: The effects of mindfulness on child compliance were maintained to
program (mother response to a clear follow up, with effect sizes of 88% and 100% respectively.
program delivered instruction given by the
first, followed by mother. Parent-child relationship:
child program) Following Mother Mindfulness: Across participants, there was an increase in
Parent-child relationship: satisfaction with self in interaction and in units of happiness with child.
Delivery: Satisfaction with self in Following Child Mindfulness: Increase in ratings were much more marked
individual format interaction with child Follow up: Ratings of satisfaction stayed at the same level, or increased slightly
(parents and Satisfaction units of during follow-up
child) happiness with my child
Harrison, Age of children = Design: Quasi- Pre-test, post-test measures Behavioural symptoms:
Manocha & 4-12 years experimental, Parents reported a reduction in their childs ADHD symptoms following the MBA (p
Rubia (2004) control- group Behavioural Outcomes: <.001)
N of participants design Conners Parent-Teacher
Children, N = 48 Questionnaire Child-parent relationships:
Parents, N = 48 Weeks: 12 x 90 Parents also reported a significant impact of the intervention on the childparent
minute sessions Child-Parent Relationship relationship (p<.01). This change was accounted for by lower scores for
(over a 6-week Child-Parent relationship conflict. (p<.01).
period) Relationship Scale
Haydicky, Age of children: Design: Baseline, pre-test, post-test, Externalising behaviours:

Shecter, Wiener 13-18 years Non- follow-up (6 weeks later) Post-intervention: There was significant reduction in parent-reported conduct
& Ducharme experimental, pre- problems (p<.05).
(2013) N of participants post follow up Behavioural Outcomes:
Conners (3 edition)
rd
Children, N = 20 design Parenting stress:
Parents, N = 20 parent and adolescent Post-test to follow up: Parents reported significant reductions in parent domain
Weeks: version stress (p<.05) and total parenting stress (p<.05), indicating that they continued to
8 x 90 minute experience benefits after the intervention had ended.
session Parenting Stress:
The Stress Index for
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Delivery: group Parents of Adolescence

format (both
adults and
children).
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Evaluation
The five selected studies were appraised using the Weight of Evidence (WoE) approach (Gough,
2007). This provides extensive, but clear criteria that enable the review process to be as
systematic as possible. WoE is designed to appraise studies based on methodological quality
(WoE A); methodological relevance (WoE B) and appropriateness of the study focus to the review
question (WoE C). By averaging the weights for each factor, an overall WoE is produced (WoE D).
For an overview of the ratings received by each study, see Table 5. A rationale for each of these
ratings can also be found in appendix 4.
The methodological quality of each study was rated using generally accepted criteria for
evaluating evidence - either Horner et al. (2005) or Gersten et al. (2005). The protocol used was
dependent on the research design. Full coding protocols can be found in Appendix 2. The
methodological relevance and appropriateness of the study were weighted according to the
protocol described in Appendix 3. This is specific to the current review and has been designed
informatively by the reviewer.
Methodological. Methodological. Study topic Overall
Table 5: An overview of the ratings received by each study
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quality relevance relevance weighting

(WoE A) (WoE B) (WoE C) (WoE D)
Harrison et al. Low Low Low Low
(2004) (1) (1) (1) (1)
van der Oord High Medium High High

et al. (2012) (3) (2) (3) (2.6)
Haydicky et High Low High Medium

al. (2013) (3) (1) (3) (2.3)
van de Weijer- High Low High Medium

Bergsma et al. (3) (1) (3) (2.3)
(2012)
Singh et al. Medium Low Low Low

(2010) (2) (1) (1) (1.3)
Critical comparison of the selected studies
Participants
The total number of participants across the five studies was 100 (range = 2-48). The age of
participants in this review ranged from 4-18 years, therefore encompassing both primary and
secondary-aged children .There was a gender imbalance in the studies, with 77% of the total
number of participants being male. However, this may reflect the discrepancy that exists in the
male-to-female ratio (9:1) of children diagnosed with ADHD (Arnold, 1996).
Three studies in this review reported recruiting predominantly white and/or middle-class families
(Harrison et al., 2004; Haydicky et al,, 2013; van der Oord et al., 2011) whilst the remaining two
studies did not make reference to demographic characteristics. This bias may be explained by
findings among the generation population that high socio-economic status and being white are
associated with complementary alternative medicine use (Tindle, Davis, Philips, & Eisenberg,
2005) but may also make generalisation to the wider ADHD population difficult.
Only two studies included both parents in the parent mindfulness practice (Harrison et al., 2004;
van de Weijer-Bergsma et al., 2012). The three remaining studies used predominantly mothers in
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the parent component (Singh et al., 2010; Haydicky et al., 2013; van der Oord et al., 2012). This
finding is important as the inclusion of fathers can improve child outcomes and engagement
(Fabiano, 2007) which could explain key differences in the results. These will be discussed in the
findings section.
Intervention
A range of MBAs were used in this review question, including MyMind (Haydicky et al., 2013),
adaptions of both the Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive
Therapy programmes (van der Oord et al., 2012) and practices adapted from the Fontana and
Slack (1997) book on teaching meditation to children (Singh et al., 2010). Whilst these variations
make it very difficult to measure efficacy, all studies provided clear descriptions of the programmes
that were used, in either a narrative or table form. This was used to determine whether each
programme met the core principles of mindfulness (Iyadurai, Morris & Dunsmuir, 2014) and was
reflected in their WoE C rating.
Fidelity in implementing a pre-designed programme was considered an important part of the WoE
A rating with only three studies reporting fidelity checks (van der Oord et al., 2012; Haydicky et al.,
2013; van de Weijer-Bergsma et al., 2012). The remaining two studies were unable to receive a
high WoE A rating as a result of this drawback.
Two of the studies did not report that the training was delivered by an experienced mindfulness
practitioner, which was reflected in their WoE C rating (Singh et al., 2010; Harrison et al., 2004).
The remaining studies commented nicely on the mindfulness teachers own practice. According to
Crane et al. (2012, p.80) embodiment in the qualities of mindfulness is an important element of
mindfulness teaching and hence, was given high value in this review.
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Design
Both single-case designs (Singh et al., 2010) and pre-test-post-test designs (Haydicky et al., 2013;
van der Oord et al., 2011; Harrison et al., 2004; van de Weijer-Bergsma et al., 2012) were used in
this review. Whilst WoE B tried to make some distinction in the appropriateness of each
methodology for addressing the review question, there are some further important elements that
warrant discussion.
The time between pre and post-test varied among studies from 6 weeks (Harrison et al. 2004) to 8
weeks (van der Oord et al., 2012; van de Weijer-Bergsma et al., 2012; Haydicky et al., 2013). The
follow-up period was also variable and ranged from 6 weeks (Haydicky et al., 2013) to 16 weeks
(van de Weijer-Bergsma et al., 2012). With no active control group used, threats to internal validity
such as maturational trends and regression to the mean must be considered. This was reflected in
the WoE B rating where no studies were able to achieve a high weighting.
Despite the drawbacks of a pre-test post-test designs, some efforts were made to control for the
effects of time and repeated assessment by van der Oord et al. (2011) who used a waitlist control
group (mean waiting time = 9 weeks, range = 0-20 weeks). However, it was assumed that the
delay between waiting and pre-test was representative of the change between pre-test and follow-
up. This would have been better achieved by using a randomised control group, with established
group equivalence. As a result, this study only received a medium weighting on WoE B. For
Harrison et al. (2004), a waitlist control group was also used, with results showing that ADHD
scores remains consistent across the two time points. However, no efforts were made to assess
changes over time in the parent-child relationship, an important part of this review question. This
was reflected in the WoE B rating.
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Measures
For monitoring ADHD symptoms and externalising behaviour, twostudies (van de Weijer-Bergsma
et al., 2012; Haydicky et al., 2013) used the Achenbach System of Empirically Based Assessment
(ASEBA) and therefore drew on questionnaire approaches such as the Child-Behaviour Checklist
and the Teacher Report Form. The reliability of these measures ranges from 0.79 to 0.95 whilst
their validity has also been established in ADHD populations. This contributed to their WoE A
weighting.
Studies that used a range of measures and/or different informants (e.g. parent, teacher, and child)
were more likely to receive a high weighting for WoE A (van der Oord et al., 2012; Haydicky et
al., 2013; van de Weijer-Bergsma et al., 2012). Interestingly, only one study (van de Weijer-
Bergsma et al., 2012) took an objective measure of attention. By triangulating this data with
parent, teacher and child questionnaires, it is clear how this studied received a high weighting for
WoE A.
For monitoring parent-child relationships, the Stress Index for Parents of Adolescents was used by
Haydicky et al. (2013) whilst the Parent-Child Relationship Scale was used by Harrison et al.
(2004). Singh et al. (2010) used a single-item rating scale to measure changes in the mother-child
relationship, whose psychometric properties had not been established. This drawback contributed
to the medium weighting awarded to this study for WoE A. When exploring parenting outcomes,
the Parenting Stress Index, Parenting Scale and Stress Index for Parents of Adolescents were
used each of which had strong internal consistency ranging from 0.8- 0.93. However, the test re-
test reliability was only measured in the Parenting Scale. As a result of repeated assessments
over time, this was given high value and was reflected in WoE A ratings.
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Findings
As can be seen in Appendix 5, the studies selected for this review used different methods for
calculating effect sizes (ESs). To make comparisons across the five studies possible, these ESs
Outcome Study Informant Effect Sizes WoE D

Pre-post Pre-follow-up
ADHD Harrison Parent Large*** - L
Type of effect size Small Medium Large

Percent Non-Overlapping Data points (PNDs) 50-69% 70-89% 90-100%
Partial Eta Square (Cohen, 1988) 0.01 0.06 0.14
Cohens d (Cohen, 1988) 0.20 0.50 0.80
will be referred to as small, medium or large within this section. This is based on the information
provided in Table 6.
Table 6: Indicators of a small, medium or large ES depending on the method used for calculation
(Green & Salkind, 2008; Scruggs & Mastropieri, 1998)
For Haydicky et al. (2013), ESs were calculated by the reviewer, based on changes from pre-post
and pre-follow up, rather than post-follow-up which were calculated by the author. This means that
indications of significance were not available.
1) Childs ADHD symptoms
Table 7: Questionnaire-rated ADHD symptoms
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symptoms
Hyperactivity/ van der Oord et al. Parent Medium** Medium** H
Impulsivity Haydicky Parent Small Small M
Haydicky Child No effect No effect M
Inattention Van der Oord Parent Large** Large** H
van de Weijer-Bergsma Father Medium Large** M
van de Weijer-Bergsma Mother No effect Small M
Haydicky Parent Medium No effect M
Van der Oord Teacher Small Small H
van de Weijer-Bergsma Teacher Small - M
van de Weijer-Bergsma Child Medium Large* M
Haydicky Child No effect No effect M
*= Statistical analyses significant to p<.05
**= Statistical analyses significant to p<.01
*** = Statistical analyses significant to p <.001
Overall, only three studies demonstrated a significant change in ADHD symptoms from pre-post
intervention. By follow-up, four studies were able to demonstrate significant change. On this basis,
one might conclude that MBAs are not a promising intervention for children with ADHD. However,
the majority of studies used in this review recruited a small number of participants, suggesting that
the studies may be unpowered.
It is encouraging to note that most of the ESs achieved after post-test were sustained to follow-up.
For studies with a high WoE D and significant outcomes (Van der Oord et al., 2012), this is
particularly impressive. For studies with significant effects and a low WoE D, findings should be
interpreted with caution. For example, the work of Harrison et al. (2004) was marked by high
attrition which can introduce bias, make the sample unrepresentative and be a threat to validity
(Howard, Krause & Orlinsky, 1986).
Also worthy of discussion are the findings of van de Weijer-Bergsma et al. (2012) who report
significant findings from father-reports and child-reports of ADHD symptoms over time. However,
these findings were not consistent across informants, with both mother and teacher-reports
yielding small ESs over time (0.3 and 0.21, respectively) and non-significant results. This lack of
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data triangulation makes it difficult to make solid conclusions about whether MBAs have a positive
impact on childrens ADHD symptoms.
Finally, the calculated effect size for inattention, as rated by children, was remarkably different in
the Haydicky et al. (2013) study compared to the van de Weijer-Bergsma et al. (2012) study. With
similar WoE D ratings, the inclusion of fathers could explain these key differences in child outcome
(Fabiano, 2007).
Table 8: Computer-rated ADHD symptoms

Only one of the studies in this review used an objective measure of ADHD symptoms, but with
inconsistent results across both auditory and visual stimuli. The results also show that some
effects appeared directly after training whilst others appeared at follow-up. With little known about
the duration required to see treatment effects on ADHD symptoms and the findings here being
Outcome Study Attention Effect Sizes WoE D

Element Pre-post ES Pre-follow-up
Visual stimuli van de Weijer-Bergsma Speed Large** Small M
van de Weijer-Bergsma Misses Small Medium M
van de Weijer-Bergsma False Alarms No effect Small M
Auditory van de Weijer-Bergsma Speed No effect No effect M
stimuli van de Weijer-Bergsma Misses Small Medium-Large M
van de Weijer-Bergsma False Alarms Medium* Medium M
based on a small sample (n = 20), more research with greater samples will be required to elicit
more stable and convincing data.
2) Externalising behaviours
Table 9: Questionnaire-rated externalising behaviours
19

All 5 studies selected for this review explored externalising behaviours however, one only study
Outcome
Outcome Study
Study Informant
Informant Effect
Effect Sizes
Sizes WoE
WoE D
D
Pre-post ES Pre-follow-up
ODD Singh (Child 1) Observation Medium Medium L
Singh (Child 2) Observation Small Large L
Van der Oord Teacher Small - H
Haydicky Child Small Small M
Haydicky Parent No effect Small M
Conduct Haydicky Parent Medium Small M
problems Haydicky Child No effect Small M
Externalising van de Weijer-Bergsma Child No effect Medium M
behaviour van de Weijer-Bergsma Father Small* Small* M
van de Weijer-Bergsma Mother Small Small M
van de Weijer-Bergsma Teacher Small - M
reported a significant change from pre-test to follow-up (van de Weijer-Bergsma et al., 2012).
Whilst inadequate sample sizes may affect significance levels, mostly small ESs were yielded
across studies and across informants. These findings suggest that MBAs may not be best targeted
at eliciting change in externalising behaviours. ForSingh et al. (2010), medium-large ESs were
calculated from pre-follow-up (PND = 88% and 100%, respectively) although the WoE D received
by this study means that the findings must be interpreted with caution.
It is also interesting to note that for child-rated externalising behaviour, there was an increase in
ES over the follow-up period for both van de Weijer-Bergsma et al. (2012) and Haydicky et al.
(2013). Due to the design adopted by these studies, it is possible that spontaneous recovery or
repeated assessment may explain these findings. However, with a medium weighting for WoE D,
this should not be ruled out as a positive finding particularly when little is known about the
duration required to see treatment effects on externalising behaviours.
3) Parent-child relationship
20
Overall relationship Harrison Parent Medium** - L
Haydicky Parent No effect Small M
Conflict sub-scale Harrison Parent Large** - L
Openness sub-scale Harrison Parent Large - L
Warmth sub-scale Harrison Parent No effect - L
Table 10: Parent-child relationship outcomes

Two of the studies included in this review question explored the overall parent-child relationship.
For Harrison et al. (2004), the medium effect size (d = 0.64), and significance to p<.01 seems to
be reflected by changes in the conflict sub-scale but could also be explained by the joint parent-
child sessions used in this study. This is because it may have provided key opportunities to
develop the parent-child relationship an opportunity that was not present in Haydicky et al.
(2013).
4) Parenting stress
Table 11: Parenting stress outcomes

Three studies included in this review question explored overall parenting stress, with some
Outcome Study Informant Effect Sizes WoE D

Parental Van der Oord Parent Small Medium** H
stress Haydicky Parent Small Medium M
van de Weijer-Bergsma Father Medium** Large** M
van de Weijer-Bergsma Mother Medium Small M
Parental Van der Oord Parent Medium Large** H
over- van de Weijer-Bergsma Mother Large* Medium M
reactivity van de Weijer-Bergsma Father Large* Medium M
encouraging findings. Given the WoE D rating for these three studies, medium-large ESs
computed at follow-up are particularly promising.
21
An interesting difference emerges at follow-up between mothers and fathers in van de Weijer-
Bergsma et al. (2012), with reported ESs of d = 0.2 and d = 1.1 and significant findings for fathers
only. A similar pattern of significance is also evident for father-rated inattention (Table 7) and
father-rated externalising behaviour (Table 9). With research suggesting that reduced parental
stress can impact on ratings of a childs behaviour, (Langberg et al., 2010) the possibility of a
causal link should not be ruled out.
Two of the studies included in this review explored parental over-reactivity. From pre-post, these
results are fairly promising especially considering the WoE D ratings for both studies. However,
the effects of the intervention were not maintained to follow-up for van de Weijer-Bergsma et al.
(2012). This highlights the importance of providing on-going support to the family system, as well
as encouragement to continue with mindfulness practice at home.
Conclusions and recommendations
In a previous review of mindfulness, Burke (2010, p.142) argued that methodologies and designs
were weak, limiting subsequent data analysis and precluding attribution of causality or
generalisation of results outside the intervention contexts. Unfortunately, this remains the case in
this review with only one study receiving a high rating for WoE D. This lack of quality lies primarily
in the absence of control groups, lack of fidelity checks and lack of objective measures which
make it difficult to ascertain whether change can be attributed to the intervention alone. It is
therefore recommended that high quality studies are conducted before MBAs are confidently used
as an intervention option for children with ADHD and their parents.
Despite the conclusions made above, there are three main areas of this review that warrant further
discussion. For childrens ADHD symptoms, there is some initial evidence that MBAs are an
effective intervention option. However, a lack of consistent reports across informants makes it
difficult to establish a firm conclusion. For parents, direct involvement in the research may have
22
meant that more time and effort was invested into experiencing change and that as a result, a
more biased rating was given (Barker, Pistrang & Elliot, 2002). For teachers, small ESs and non-
significant results may be explained by a more objective viewpoint, suggesting that change may
not have occurred. However, there is also evidence in the literature to suggest that reduced
parental stress can have an impact on ratings of a childs behaviour (Langberg et al., 2010).
Considering the parent-mindfulness element to this intervention, this cannot be ruled out as an
explanation, with further research in this area being encouraged.
One of the more promising findings from this review relates to reductions in parental stress, a
finding that was consistent across studies. Again, there is the possibility that investment in the
programme may have altered parents perception of change, although this finding of reduced
stress is consistent with other research where more rigorous metholodgy has been used (Chiesa,
& Serretti, 2009). It is therefore recommended that MBAs for children with ADHD continue to
include a parent-component, particularly in light of research showing that parental stress is linked
to the severity of a childs ADHD symptoms (Theule, Wiener, Tannock & Jenkins, 2013).
Finally, there was evidence of predominantly small ESs and non-significance for child-rated
outcomes. Hoza et al. (2010) argue that for children and adolescents with ADHD, there may be a
tendency to under-estimate difficulties and over-estimate competence, particularly when compared
to parent, teacher and objective ratings. This in itself warrants further investigation perhaps
adopting a qualitative approach where richer data can be obtained. This finding also highlights the
need for future research to triangulate all data as well as include more objective measures of
change. This is because it will help to determine whether true change is occurring, particularly in
child-related outcomes, or whether change simply lies in the eye of the beholder.
23
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30
Appendix 1; Studies excluded from the review
Database search; studies excluded by abstract
Excluded paper Rationale for exclusion

Haydicky, J., Wiener, J., Badali, P., Milligan, K., & Ducharme, J. M. Exclusion criteria: 2a
(2012). Evaluation of a Mindfulness-based Intervention for Sample do not have a
Adolescents with Learning Disabilities and Co-occurring ADHD primary diagnosis of ADHD
and Anxiety. Mindfulness, 3(2), 151-164.
Ancestral search; studies excluded by abstract

Burke, C. (2010). Mindfulness-based approaches with children and Exclusion criteria: 1b
adolescents: a preliminary review of current research in an Study is a review article
emergent field. Journal of Child and Family Studies, 19(2), 133-
144.
Zylowska, L., Ackerman, D. L., Yang, M. H., Futrell, J. L., Horton, Exclusion criteria: 2c
N. L., Hale, T. S., ... & Smalley, S. L. (2008). Mindfulness Mindfulness training is
meditation training in adults and adolescents with ADHD a offered to young people and
feasibility study. Journal of Attention Disorders, 11(6), 737-746. not their parents
Grosswald, S. J., Stixrud, W. R., Travis, F., & Bateh, M. A. (2008). Exclusion criteria: 2c
Use of the transcendental meditation technique to reduce Mindfulness training is
symptoms of attention deficit hyperactivity disorder (ADHD) by offered to young people and
reducing stress and anxiety: an exploratory study. Current Issues not their parents
in Education, 10(2), 1-16.
Ancestral search; studies excluded by full text

Bgels, S., Hoogstad, B., van Dun, L., de Schutter, S., & Restifo, Sample do not have a
K. (2008). Mindfulness training for adolescents with externalizing primary diagnosis of ADHD
disorders and their parents. Behavioural and Cognitive
Psychotherapy, 36(02), 193-209. Exclusion criteria: 2a
31
Appendix 2: Coding protocol for Methodological Quality (WoE A)
As advised by Gough (2007), the methodological quality (WoE A) of each study was rated using a
generally accepted criteria for evaluating evidence. As two different designs were included in this
review, two different coding protocols were used:
Single case design: Horner, R. H., Carr, E. G., Halle, J., Mcgee, G., Odom, S., & Wolery, M.
(2005). The use of single-subject research to identify evidence-based practice in special
education. Exceptional Children, 71(2), 165-179.
Quasi-experiment: Gersten, R., Fuchs, L. S., Compton, D., Coyne, M., Greenwood, C., &
Innocenti, M. S. (2005). Quality indicators for group experimental and quasi-experimental
research in special education. Exceptional children, 71(2), 149-164.
Study ID Number: 1
Research Design: Single Case
Name of Coder: Amy Phipps Date: 17/1/2013
Full Study Reference in proper format: Singh, N. N., Singh, A. N., Lancioni, G. E., Singh, J.,
Winton, A. S., & Adkins, A. D. (2010). Mindfulness training for parents and their children with
ADHD increases the childrens compliance. Journal of Child and Family Studies, 19(2), 157-166
Intervention Name (description of study): Mindfulness training for children with ADHD, and their
parents
Type of Publication:
Book/Monograph
Journal Article
Book Chapter
Other (specify):
Description of Participants and Settings
Participants are described with sufficient detail to allow others to select individuals with similar
characteristics (e.g. age, gender, disability, diagnosis)
Yes The participants are 2 children with diagnosed ADHD and their mothers
No
N/A
Unknown/unable to code
The process for selecting participants is described with replicable precision

Yes
No Participant recruitment not described, but explanation that the mothers chose to take part.
N/A
32
Critical features of the physical setting are described with sufficient precision to allow replication
Yes
No There is no description of where the mindfulness training took place
N/A
Overall Rating of Evidence: 3 2 1 0

This score was given because there was no description of the specific conditions under which
mindfulness training took place. The selection process was also not explained.
Dependent Variable
Dependent variables are described with operational precision

Yes A clear definition for child compliance was reported
No
N/A
Each dependant variable is measured with a procedure that generates a quantifiable index.
Yes The frequency of child compliance was recorded on a Palm PDA whilst satisfaction with child was
scored on a 1-5 and 1-100 scale
No
N/A
Measurement of the dependant variable is valid and described with replicable precision.
Yes
No The satisfaction survey was scored on a 1-5 and 1-100 scale however, there were no indicators of
what the values between these extremes indicated. Child compliance was not defined with a valid index.
N/A
Dependant variables are measured repeatedly over time

Yes For child compliance, 30 data points are collected over the 3 intervention phases. For satisfaction,
data points are recorded after each experimental phase.
No
N/A
Data are collected on the reliability or inter-observer agreement associated with each dependant
variable, and IOA levels meet minimal standards
Yes The inter-observer agreement for child compliance is 0.92
No
N/A

This score was given because there was a clear operationalized definition for child compliance.
Each DV was also quantifiable, 3+ data points were recorded and inter-rater reliability was high.
33
Independent Variable
Independent variable is described with replicable precision

Yes Mindfulness programme is clearly outlined in Table 1
No
N/A
Independent variable is systematically manipulated and under the control of the experimenter
Yes Mindfulness training is manipulated so that it is delivered to mother and child in succession
No
N/A
Overt measurement of the fidelity of implementation for the independent variable is highly
desirable
Yes
No The training was interactive, with the meditation practices being customised for each child
N/A

This score was given because whilst a structured programme was outlined, the text describes
each programme being customised for the child on a session by session basis.
Experimental control/internal validity
The design provides a baseline phase that gives repeated measurements (3+) of a dependent
variable
Yes
No There are 3+ baseline measures of child compliance. The satisfaction with my child variable was
only measured at 1 time point in the baseline period.
N/A
The design provides at least three demonstrations of experimental effect at three different points in
time
Yes There are 3+ demonstrations of child compliance across the intervention phases. The satisfaction
with my child variable was also measured at 3 different time points.
No
N/A
The design controls for common threats to internal validity (e.g. permits elimination of rival
hypotheses)
Yes
No Both childrens medication was discontinued during the intervention, there may have been a
selection bias in recruitment, the mindfulness program was not delivered consistently to this children and
there may have been a data collector bias.
N/A
34
The results document a pattern that demonstrates experimental control

Yes Each participant acted as their own control, there was little overlap between baseline and
intervention phases.
No
N/A

This score was given because little appeared to be done with regard to controlling the effects of
extraneous variables. There were however, 3+ data points at both baseline and experimental
phases.
Social validity
Experimental effects are replicated across participants, settings, or materials to establish external
validity
Yes Experimental effects are replicated across both participants and their mothers
No
N/A
Selection and attribution biases (e.g., the selection of only certain participants, or the publication of
only successful examples) are minimized
Yes
No
N/A
The dependent variable is socially important

Yes Poor child compliance is linked to later maladaptive behaviour. The research tried to increase child
compliance.
No
N/A
Implementation of the independent variable is practical and cost effective

Yes
No
N/A
Social validity is enhanced by implementation of the independent variable over extended time
periods, by typical intervention agents, in typical physical and social contexts
Yes
No
N/A

The key criteria for a high weighting (identified by Horner, 2005) was that the effects are replicated
across either participants or setting. This was the case for both the children and their mothers.
35
Average WoE A across the 5 judgement areas:
Sum of X / N = 11/5 = 2.2
X = individual quality rating for each judgement area

N = number of judgement areas
Study ID Number: 2
Research Design: Quasi-experimental
Full Study Reference in proper format: Harrison, L. J., Manocha, R., & Rubia, K. (2004). Sahaja
yoga meditation as a family treatment programme for children with attention deficit-hyperactivity
disorder. Clinical Child Psychology and Psychiatry, 9(4), 479-497
parents
Study ID Number: 1
Essential Quality Indicators

Quality Indicators for Describing Participants
Was sufficient information provided to determine/confirm whether the participants demonstrated

the disability or difficulties presented?
Yes - All children had a formal diagnosis of ADHD and met the DSM-IV criteria
No
N/A
Were appropriate procedures used to increase the likelihood that relevant characteristics of
participants in the sample were comparable across conditions?
Yes
No
N/A
Sufficient information regarding the treatment providers is provided. If so, does the research
indicate that they are comparable across conditions?
Yes- All training was provided by an experienced instructor
No
N/A
36
Quality Indicators for Implementation of the Intervention and Description of Comparison Conditions
Was the intervention clearly described and specified?

Yes- Short summary of the intervention programme was described in text
No
N/A
Was the fidelity of implementation described and assessed?

Yes
No
N/A
Was the nature of services provided in comparison conditions described?

Yes
No
N/A
Quality Indicators for Outcome Measures and for Data Analysis
Were multiple measures used to provide an appropriate balance between measures closely
aligned with the intervention and measures of generalized performance?
Yes
No Only one measure of ADHD symptoms was used (parent informant) and only one measure of child-
parent relationship (parent)
N/A
Were outcomes for capturing the interventions effect measured at the appropriate times?
Yes Pre-test-post-test design (outcomes therefore measured at week 1 and week 6)
No
N/A
Were the data analysis techniques appropriately linked to key research questions and
hypotheses? Were they appropriately linked to the unit of analysis in the study?
Yes
No
N/A
Did the research report include not only inferential statistics but also effect size calculations?
Yes
No Inferential statistics included but effect sizes not computed
N/A
Desirable Quality Indicators

Was severe overall attrition documented? If so, is attrition comparable across samples? Is overall
attrition less than 30%?
37
Yes
No Only 26/48 participants fully completed the intervention, allowing their data to be analysed.
However, Comparison of mean ADHD scores showed that there were no differences between the
participants that completed and those that did not.
N/A
Did the study provide further reliability data, such as internal consistency reliability, test-retest
reliability and inter-rater reliability (when appropriate) for outcome measures?
Yes Internal reliability reported for Conners Parent-Teacher Questionnaire (range = .74 - .86), internal
consistency reported for Child-Parent relationship scale (.84 and .86).
No
N/A
Were outcomes for capturing the intervention's effect measured beyond an immediate posttest?
Yes
No
N/A
Was evidence of the criterion-related validity and construct validity of the measures provided?
Yes
No
N/A
Did the research team assess not only surface features of fidelity implementation (e.g., number of
minutes allocated to the intervention or teacher/interventionist following procedures specified), but
also examine quality of implementation?
Yes Intervention delivered by an experienced instructor
No
N/A
Was any documentation of the nature of instruction or series provided in comparison conditions?
Yes
No
N/A
8. Were results presented in a clear, coherent fashion?

Yes Table used to demonstrate changes in child outcomes and parent-child relationship from pre-to-
post test
No
N/A

This score was given because all but three of the essential criteria have been met; multiple
measures were not used to triangulate the findings, effect sizes were not computed and fidelity
was not assessed. The methodology also met at least 1 of the desirable criteria.
38
Study ID Number: 3
Full Study Reference in proper format: Haydicky, J., Shecter, C., Wiener, J., & Ducharme, J. M.
(2013). Evaluation of MBCT for Adolescents with ADHD and Their Parents: Impact on Individual
and Family Functioning. Journal of Child and Family Studies, 1-19
parents
Study ID Number: 3


Yes - All children had a formal diagnosis of ADHD, given by a qualified health professional
No
N/A
Yes
No
N/A
Yes- All training provided by doctoral students with Masters degrees in Clinical Child Psychology and
therapeutic experience with children and families
No
N/A

Yes- Table 1 presents a detailed summary of both parent/child interventions on a week by week basis
No
N/A
39
Yes Report states that facilitators followed the manual closely to ensure treatment fidelity
No
N/A

Yes
No
N/A
Quality Indicators for Outcome Measures and Data Analysis
Yes
No Only one measure of ADHD symptoms was used (although parent and child informant) and only one
measure of parenting stress (parent informant)
N/A
Yes Measures taken at baseline, pre-test, post-test and follow up (6 weeks after)
No
N/A
Yes Time effects were explored using ANOVA. Post-hoc pairwise comparisons were used when
significant time effects were indicated
No
N/A
Yes Effect sizes offered (both partial eta2 and Cohens d)
No
N/A

Yes Attrition reported (only 2 out of 20 participants did not complete treatment)
No
N/A
40
Yes - Internal consistency, test-retest reliability or other appropriate measure was reported for all
measures used. Range = .77 -.97
No
N/A
Yes- 6 week follow up data provided
No
N/A
Yes
No Validity reported in other research for Connors (Conners, Sitarenious, Parker & Epstein, 1998). Lack
of research found on SIPA for this sample.
N/A
Yes 8 week programme, 90 minutes for each intervention, trained professional to deliver intervention
No
N/A
Yes
No
N/A

Yes Table used to demonstrate changes in child outcomes and parent-child relationship from pre-to-
post test
No
N/A
Overall Rating of Measurement: 3 2 1 0

This score is given because all but one of the essential criteria was met and at least 4 of the
desirable criteria.
41
Study ID Number: 4
Full Study Reference in proper format: van de Weijer-Bergsma, E., Formsma, A. R., de Bruin, E.
I., & Bgels, S. M. (2012). The effectiveness of mindfulness training on behavioral problems and
attentional functioning in adolescents with ADHD. Journal of child and family studies, 21(5), 775-
787
parents
Study ID Number: 4


No
N/A
Yes
No
N/A
Yes- All training was provided by experienced CBT professionals who were also experienced
mindfulness practitioners
No
N/A

Yes- Short summary of the mindfulness programme was described in text
No
N/A

Yes - Therapists met of a weekly basis to discuss the group process and to ensure treatment integrity
42
No
N/A

Yes
No
N/A
Quality Indicators for Outcome Measures and Data Analysis
Yes- Multiple measures were used to assess ADHD symptoms and externalising behaviour; Youth Self
Report (YSR), Child Behaviour Checklist (CBCL), Teacher Report Form (TRF) and Computerised Attention
Task. To explore parenting, two measures were also used; Parenting Stress Index (PSI) and Parenting
Scale (PS)
No
N/A
Yes Outcomes were measured at baseline, post, after 8 weeks and after 16 weeks
No
N/A
Quality Indicators for Data Analysis

Yes
No
N/A
Yes Cohens d effect sizes are reported
No
N/A

Yes
No Only 2 adolescents dropped out from baseline to 16-week follow-up. However, high attrition for
parents at 8 and 16-week follow up (data therefore not analysed).
N/A
43
Yes Internal consistency, test-retest reliability or other appropriate measure was reported for all
measures used.
No
N/A
Yes Outcome measures taken at 8 and 16 weeks
No
N/A
Yes Validity not reported for any measures but references provided. The YSR, CBCL and TRF are
specifically for adolescents and used to detect behavioural and emotional problems.
No
N/A
Yes Intervention delivered by an experienced instructor
No
N/A
Yes
No
N/A

Yes Table used to demonstrate change across time (M and SD provided for all outcomes)
No
N/A

This score is given because all of the relevant essential criteria are met. At least 4 of the desirable
criteria are also met.
44
Study ID Number: 5
Full Study Reference in proper format: Van der Oord, S., Bgels, S. M., & Peijnenburg, D. (2012).
The effectiveness of mindfulness training for children with ADHD and mindful parenting for their
parents. Journal of Child and Family studies, 21(1), 139-147
parents
Study ID Number: 5


No
N/A
Yes
No
N/A
Yes- All training was provided by experienced CBT professionals
No
N/A

Yes- Short summary of the mindfulness programmes (both parent and child) were described in text
No
N/A

Yes - Therapists met of a weekly basis to discuss the group process and to ensure treatment integrity
No
N/A
45

Yes
No
N/A
Quality Indicators for Outcome Measures
Yes
No Only one measure of ADHD symptoms and externalising behaviour used (Disruptive Behaviour
Disorder Rating Scale) but two measures of parenting stress used: Parenting Stress Index (PSI) and
Parenting Scale (PS)
N/A
Yes Outcomes were measured pre-test, post-test and 8 weeks after. Note: a group of within-group
waitlist controls were used which were designed to control for the effects of time and repeated assessment.
However, mean waiting was 9 weeks (range = 0-20) which assumes that any changes are comparable with
the duration of the treatment group (programme takes 16 weeks).
No
N/A
Quality Indicators for Data Analysis

Yes Multi level modelling used to demonstrate the estimated deviations from pre-test score
No
N/A
Yes Cohens d effect sizes are reported in text for significant outcomes only
No
N/A

Yes 4 participants dropped out over the course of the programme to leave n = 18
No
N/A
Did the study provide reliability data, such as internal consistency reliability, test-retest reliability
and inter-rater reliability (when appropriate) for outcome measures?
Yes Reliability provided for DBDRS (alpha range = .88.94) and PSI (alpha range = 0.920.95).
46
No
N/A
Yes Outcome measures taken at 8 weeks follow-up
No
N/A
Yes The DBDRS has been validated with ADHD samples, references provided in text. The PSI has
been validated in other research (Abidin, 1997) as well as the PS (Arnold, OLeary, Wolff & Acker, 1993).
No
N/A
Yes Intervention delivered by an experienced instructor following an extensive study manual
No
N/A
Yes Within-group waitlist controls were used which were designed to control for the effects of time and
repeated assessment
No
N/A

Yes Clear table used to demonstrate the estimated deviations from pre-test score (multi-level modelling)
No
N/A

This score is given because all but one of the relevant essential criteria are met; multiple
measures are not used for ADHD symptoms and externalising behaviours. At least 4 of the
desirable criteria are also met.
47
Appendix 3: Weight of Evidence Criteria
The application of the WoE criteria to each of the 5 selected studies can be found in appendix 4.
Methodological Quality (WoE A) for Single Case Designs
The WoE A criteria for single-case designs is derived from Horner et al. (2005). This paper
describe 5 professional standards (denoted by a *) that are considered crucial for a high quality
study. These can be observed in the criteria below. For medium and low weightings, the
reviewer has drawn on criteria from both Horner et al. (2005) and Kratochwill (ref).
a) Description of participants and settings
For a rating of 3 (high For a rating of 2 (medium For a rating of 1 (low

weighting), the study weighting), the study must weighting), the study
must have: have: must at least 1/2 criteria
A clear definition of the A clear description of listed:
context in which the participant A clear description of
practice is to be used* characteristics participant
Clear selection process characteristics
It may also have: Clear selection
A clear description of process
participant
characteristics
Clear selection process
Note: If the criteria for a low weighting are not met, a score of 0 is awarded.
b) Dependant variable

weighting), the study weighting), the study must weighting), the study
must have: have: must have at least 2/3
A clearly A quantifiable index for criteria listed:
operationalized each dependant A quantifiable index
dependant variable* variable for each dependant
At least 3+ data points variable
It could also meet the Inter-rater reliability of At least 3+ data points
following criteria: 0.85 or higher Inter-rater reliability of
A quantifiable index for 0.70 or higher
each dependant
variable
At least 3+ data points
Inter-rater reliability of
80%+
48
c) Independent variable
For a rating of 3 (high For a rating of 2 For a rating of 1 (low

weighting), the study must (medium weighting), the weighting), the study
have: study have: must have at least 1/2
Documentation that the A precise description criteria listed:
practice was of the IV A precise description
implemented with Evidence that the IV of the IV
fidelity* has been Evidence that the IV
systematically has been
It could also meet the manipulated systematically
following criteria: manipulated
A precise description of
the IV
Evidence that the IV
has been systematically
manipulated
d) Experimental control

have: study must have: must have at least 1/2
Evidence of controlling 3+ baseline points criteria listed:
for the effects of 3+ demonstrations of 3+ baseline points
extraneous variables* experimental effect 3+ demonstrations of
experimental effect
It could also meet the
following criteria:
3+ baseline points
3+ demonstrations of
experimental effect
e) Social validity

have: study must have: must have at least 2/3
Effects are replicated The DV is socially criteria listed:
across either important The DV is socially
participants or setting* Implementation is important
practical and cost Implementation is
It could also meet the effective practical and cost
49
following criteria: IV is implemented by effective

The DV is socially typical change agents, IV is implemented by
important in typical social typical change agents,
Implementation is contexts in typical social
practical and cost contexts
effective
IV is implemented by
typical change agents,
in typical social
contexts
Methodological Quality (WoE A) for Quasi-Experimental Designs
The WoE A criteria for quasi-experimental designs is derived from Gersten et al. (2005). In this
paper, Gersten et al. (2005) propose a set of dichotomous criteria to rate the quality of research
(either high quality or acceptable quality). However, he also explains that these definitions are
tentative and as a result, this review had adapted his criteria slightly to produce criteria for high,
medium and low weighting.

weighting), the study weighting), the study must weighting), the study must
must meet: meet: meet:
All but one of the All but two of the All but three of the
essential criteria essential criteria essential criteria
At least 4 of the At least 2 of the At least 1 of the desirable
desirable criteria desirable criteria criteria
Note: an unknown/unable to code is scored as not meeting the criteria due to insufficient
information
Methodological Relevance (WoE B)
Methodological relevance considers whether the design was suitable for evaluating the impact of
mindfulness training with children diagnosed with ADHD, and their parents. For WoE B, criteria are
based on evidence hierarchies (Brannan, 1992). These hierarchies typically place studies with
high threats to internal validity at the bottom (e.g. no control group) and those less prone to such
validity threats towards the top (e.g. active control group). The additional criterion of multiple
sources and/or methods is in place to support the triangulation of data. This was considered
important due to mindfulness being a relatively novel intervention, with its validity in this sample
still being explored. :
For a rationale of coding for each study, see appendix 3.
To gain a high weighting For a medium For a low weighting, the

for methodological weighting, the study must study must have the
relevance, the study must have: following:
have: A comparison group Outcome data collected
An active control group e.g. waitlist control pre and post intervention
Plus: Plus: Multiple sources and/or
Outcome data collected Outcome data collected multiple methods of
50
pre and post intervention pre and post measurement for each
Multiple sources and/or intervention outcome
methods of Multiple sources and/or
measurements for each methods of
outcome measurements for each
outcome
Note: If the criteria for a low weighting are not met, a score of 0 (no evidence) is awarded.
Relevance of Evidence (WoE C)
Relevance of evidence (WoE C) explores the extent to which the study, and its findings, is relevant
to the review question. The rationale for each criterion is as follows:
To explore the broader impact of MBAs, multiple methods/sources of data collection were
considered as important criteria. As a relatively novel intervention, it was also felt that
triangulation could enhance the validity of the findings (Barker, Pistrang & Elliot, 2002).
The second criterion was considered important due to research indicating that the time
spent engaging in home practice is significantly related to outcomes (Carmody & Baer,
2008).
A full description of the mindfulness programme ensured that its content could be checked
against the six core principles of mindfulness identified by Iyadurai, Morris and Dunsmuir
(2014).
Finally, Crane et al. (2012, p.80) state that embodiment in the qualities of mindfulness is an
important element of mindfulness teaching and hence, the skills of the mindfulness practitioner
were considered.
To gain a high weighting To gain a medium To gain a low weighting

for the relevance to the weighting for the for the relevance to the
review question, the study relevance to the review review question, the study
must have the following: question, the study must must at least 1 of the
Multiple methods/sources have three of the following: following:
of data collection for Multiple Multiple methods/sources
ADHD symptoms and methods/sources of of data collection for
parenting outcomes data collection for ADHD symptoms and
Efforts made to monitor ADHD symptoms and parenting outcomes
and record the frequency parenting outcomes Efforts made to monitor
of home practice Efforts made to monitor and record the frequency
The mindfulness training and record the of home practice
programme is fully frequency of home The mindfulness training
described, for both practice programme is fully
parents and children The mindfulness described, for both
The programme is training programme is parents and children
delivered by those that fully described, for both The programme is
practice mindfulness parents and children delivered by those that
themselves. The programme is practice mindfulness
delivered by those that themselves.
practice mindfulness
themselves.
Note: If the criteria for a low weighting are not met, a score of 0 (no evidence) is awarded.
51
Overall Weight of Evidence (WoE D)
Using the criteria explained above, each study was given a weighting of 3 (high), 2 (medium), or 1
(low) for WoE A, B and C. These scores were then averaged to correspond to an overall weight
(WoE D) for each study. These scores are based on the premise that to obtain a high overall WoE,
the study must have obtained a high weighting twice in either WoE A, B or C. Similarly, to obtain
a medium overall WoE, the study must have obtained a medium weighting twice in either WoE A,
B or C. The scores are as follows:
High overall weight of evidence: Average score of at least 2.5
Medium overall weight of evidence: Average score of between 1.5 and 2.4
Low overall weight of evidence: Average score of less than 1.4
52
Appendix 4: Application of the WoE Criteria to the 5 selected studies
Reviewed Study WoE A WoE B WoE C

Harrison et al. Low: Low: Low:
(2004) Fidelity of the intervention was not Wait-list control used but only The mindfulness training is
assessed, effect sizes were not assessed on 1 measure. Outcome partially described. There is no
computed and multiple measures data collected pre and post mentioned that the programme is
not used for each outcome. intervention. delivered by a mindfulness
practitioner. Efforts made to
monitor home practice.
Van der Oord et al. High: Medium: High:
(2012) Formal diagnosis of ADHD Within group wait-list control was The mindfulness training is clearly
discussed, fully qualified training used. Multiple sources of described, in detail. It is delivered
providers used, fidelity checks measurement for ADHD symptoms. by experienced mindfulness
made and effect sizes computed. Pre and post data. practitioners Efforts made to
monitor home practice. Multiple
sources of measurement.
Haydicky et al High: Low: High:
(2013) Formal diagnosis of ADHD No control used and instead, a Mindfulness training is clearly
discussed, fully qualified training pre/post-test design was used. described. It is delivered by
providers used, fidelity checks Multiple sources of measurement for mindfulness practitioners. Efforts
made and effect sizes computed. ADHD symptoms. made to monitor home practice.
Multiple sources.
van de Weijer- High: Low: High
Bergsma et al. Through description of the No control used and instead, a Mindfulness training described. It
(2012) methodology, including; fidelity pre/post-test design was used. is delivered by experienced
checks, multiple measures, Multiple sources and methods of mindfulness practitioners. Efforts
computation of effect sizes measurement for each outcome. made to monitor home practice.
Multiple measures taken.
Singh et al. (2010) Medium: Low: Low:
This study gave a clearly Outcome data was collected pre No effort made to monitor home
operationalized DV and used and post intervention. Multiple practice. Mindfulness training is
multiple participants. Little attempt baseline across participants design. described. No mention of a trained
to control for threats to internal mindfulness practitioner.
53
validity and poor fidelity.

Harrison, L. J., Manocha, R., & Rubia, K. (2004). Sahaja yoga meditation as a family treatment programme for children with attention deficit-
hyperactivity disorder. Clinical Child Psychology and Psychiatry, 9(4), 479-497.
*Cohens d was calculated by researcher using Mpost Mpre / SDpre. Data for this calculation was extracted from Table 2 in Harrison et al. (2004).
Significant Who was What was Source Treatment Outcome Reliability Effect Size 1. A
Outcomes targeted for targeted for Information Measure Used
change change
DHD-
Outcome 1 Child Behaviour Self Report Mindfulness ADHD High internal T1-T6 (pre and related
Teacher Attitude Parent Report training symptoms consistency post) = 1.57* sympto
ADHD Parent/Sig.A Knowledge Teacher Report (measured by (coefficient (Cohens d, ms
symptoms Ecology Other Observation Conners alpha ranged Becker 1998)
Other Unknown Test Parent-Teacher from .74-.86 in
Unknown Other Questionnaire) this study)
Unknown
Significant Who was What was Source Treatment Outcome Reliability Effect Size
change change
Outcome 2 Child Behaviour Self Report Mindfulness Child-Parent Internal T1-T6 (pre and
Teacher Attitude Parent Report training relationship consistency was post) = 0.64*
2. Pa
rent-
child relationship
54
Parent-child Parent/Sig.A Knowledge Teacher Report (measured by high (alphas

relationship Ecology Other Observation the Pianta ranged from
Other (relationship) Test Child-Parent 0.84-0.86 in this
Unknown Unknown Other Relationship study)
Unknown Scale)
Outcome 3 Child Behaviour Self Report Mindfulness Child-Parent Internal T1-T6 (pre and
Teacher Attitude Parent Report training relationship consistency was post) = 1.08*
Non-Significant Ecology
relationship Who was Other
What was Observation
Source Note null/ the
Outcome
Pianta ranged
Reliability
from Effect Size
(Conflict
Outcomes Other
targeted for (relationship)
targeted for Test negative Child-Parent
Measure Used 0.84-0.86 in this
sub-scale) Unknown
change Unknown
change Other outcomes Relationship study)
Outcome 4 Child Behaviour Unknown
Self Report - Scale)
Child-Parent Internal T1-T6 (pre and
Teacher Attitude Parent Report relationship consistency was post) = 0.18*
relationship Ecology Other Observation the Pianta ranged from 0.84-
(warmth scale) Other (relationship) Test Child-Parent 0.86 in this study)
Unknown Unknown Other Relationship
Unknown Scale)
Outcome 5 Child Behaviour Self Report - Child-Parent Internal T1-T6 (pre and
Teacher Attitude Parent Report relationship consistency was post) = 1.47*
relationship Ecology Other Observation the Pianta ranged from 0.84-
(open scale) Other (relationship) Test Child-Parent 0.86 in this study)
Unknown Unknown Other Relationship
Unknown Scale)
55
Van der Oord, S., Bgels, S. M., & Peijnenburg, D. (2012). The effectiveness of mindfulness training for children with ADHD and mindful
parenting for their parents. Journal of Child and Family studies, 21(1), 139-147.
*Effect sizes (Cohens d) for significant findings were reported in text by the author. Effect sizes were calculated for non-significant outcomes using the data
provided
Significant Who was What was Source Treatment Outcome Reliability Effect Size in Table
Outcomes targeted for targeted for Information Measure Used 2. By
change change looking at
Outcome 1 Child Behaviour Self Report Mindfulness Disruptive Good reliability Pre - post = the mean
Teacher Attitude Parent Report training Behaviour (alpha range = 0.80* difference
scores
and
calculated
effect
sizes for
the
significant
outcomes
, the SD
was
establishe
d for each
measure/
data set.
By using
the
equation of SEM = Mpost Mpre / SDpre, further ES were calculated.
56
Non- Who was What was Source Note null/ Outcome Reliability Effect Size
Inattention
Significant Parent/Sig.A
targeted for Knowledge
targeted for Teacher Report negative Disorder
Measure UsedRating 0.88 0.94) Pre - follow up 1. A
symptoms
Outcomes Ecology
change Other
change Observation outcomes Scale (DBSRS) = 0.80* DHD
Outcome 4 Other
Child Unknown
Behaviour Test
Self Report - Disruptive Good reliability Pre-follow-up = sympto
Unknown
Teacher Attitude Other Report
Parent Behaviour (alpha range = 0.21* ms
Outcome 2
Inattention Child
Parent/Sig.A Behaviour
Knowledge Self Report
Teacher Report Mindfulness Disorder
Disruptive
Rating 0.88 Good reliability
0.94) Pre - post =
symptoms Teacher
Ecology Attitude
Other Parent Report
Observation training Behaviour
Scale (DBSRS) (alpha range = 0.56*
Hyperactivity/ Parent/Sig.A
Other Knowledge
Unknown Teacher Report
Test Disorder Rating 0.88 0.94) Pre - follow up
impulsivity Ecology Other Observation Scale (DBSRS) = 0.59*
Other Unknown Test
Unknown Other
Outcome 3 Child Behaviour Self Report Mindfulness Disruptive Good reliability Pre - post =
Teacher Attitude Parent Report training Behaviour (alpha range = 0.39*
Inattention Parent/Sig.A Knowledge Teacher Report Disorder Rating 0.88 0.94)
symptoms Ecology Other Observation Scale (DBSRS)
Other Unknown Test
Unknown Other
57
Outcome 5 Child Behaviour Self Report - Disruptive Good reliability Pre - post = cannot
Teacher Attitude Parent Report Behaviour (alpha range = compute
Hyperactivity/ Parent/Sig.A Knowledge Teacher Report Disorder Rating 0.88 0.94) Pre - follow up =
impulsivity Ecology Other Observation Scale (DBSRS) cannot compute
Other Unknown Test
2.
Significant Who was What was Source Treatment Outcome Reliability Effect Size xternalis
Outcomes targeted for targeted for Information Measure Used ing
change change
behavio
Outcome 6 Child Behaviour Self Report Mindfulness Disruptive Good reliability Pre - post =
Teacher Attitude Parent Report training Behaviour (alpha range = 0.39* urs
ODD Parent/Sig.A Knowledge Teacher Report Disorder Rating 0.88 0.94)
symptoms Ecology Other Observation Scale (DBSRS)
Other Unknown Test
Unknown Other
Significant targeted for targeted for negative Measure Used
Outcomes change change outcomes
58
Outcome 7 Child Behaviour Self Report - Disruptive Good reliability Pre - post = cannot
Significant Who was
Teacher What was
Attitude Source
Parent Report Treatment Behaviour Outcome (alpha range
Reliability
= computeEffect Size
Outcomes
ODD targeted for
Parent/Sig.A targeted for
Knowledge Teacher Report Information Disorder
Measure
RatingUsed
0.88 0.94) Pre - follow up =
symptoms change
Ecology change
Other Observation Scale (DBSRS) cannot compute
Outcome 8 Child
Other Behaviour
Unknown Self
Test Report Mindfulness Parenting Excellent Pre - follow up
Teacher
Unknown Attitude Parent
Other Report training Stress Index reliability (alpha = 0.57*
Parental Parent/Sig.A Knowledge Teacher Report range from
stress Ecology Other Observation 0.92-0.95)
Other (relationship) Test
Unknown Unknown Other
Outcome 9 Child Behaviour Self Report Mindfulness Parenting Scale Adequate Pre - follow up 3.
Teacher Attitude Parent Report training internal = 0.85*
Parenting Parent/Sig.A Knowledge Teacher Report consistency arenting-
(over- Ecology Other Observation reported/ test- stress
reactivity Other (relationship) Test retest reliability
scale) Unknown Unknown Other (Arnold, 1993)
59
Outcome 10 Child Behaviour Self Report - Parenting Excellent Pre - post = 0.24*
Teacher Attitude Parent Report Stress Index reliability (alpha
Parental Parent/Sig.A Knowledge Teacher Report range from 0.92-
stress Ecology Other Observation 0.95)
Other Unknown Test
Outcome 11 Child Behaviour Self Report - Parenting Scale Adequate Pre - post = 0.41*
Teacher Attitude Parent Report internal
Parenting Parent/Sig.A Knowledge Teacher Report consistency
(over- Ecology Other Observation reported/ test-
reactivity Other (relationship) Test retest reliability
scale) Unknown Unknown Other (Arnold, 1993)
Outcome 12 Child Behaviour Self Report - Parenting Scale Adequate Pre - post = cannot
Teacher Attitude Parent Report internal compute
Parenting Parent/Sig.A Knowledge Teacher Report consistency/test
(permissive Ecology Other Observation -retest reliability Post-follow-up =
scale) Other Unknown Test (Arnold, 1993) cannot compute
60
Haydicky, J., Shecter, C., Wiener, J., & Ducharme, J. M. (2013). Evaluation of MBCT for Adolescents with ADHD and Their Parents: Impact on
Individual and Family Functioning. Journal of Child and Family Studies, 1-19.
*To investigate time effects, a one-way repeated measures ANOVA was conducted. The effect size reported for the overall model is partial n2. When
significant time efforts were indicated, post hoc pairwise comparisons were conducted. The effect sizes for these are reported as Cohens d. It will be clearly
labelled
in the
following
2 table
Outcome 1 Child Behaviour Self Report - ADHD Internal Partial eta squared (n )
which
Teacher Attitude Parent Report symptoms consistency = 0.16*
effect
Inattention Parent/Sig.A Knowledge Teacher Report (measured by coefficients
size is
Ecology Other Observation Conners Parent- range from No effect of time on
being
Other Unknown Test Teacher 0.77-0.97 inattention symptoms
reported.
Unknown Other Questionnaire)
2
Outcome 2 Child Behaviour Self Report - ADHD Internal Partial eta squared (n )
1. A
Inattention Parent/Sig.A Knowledge Teacher Report (measured by coefficients
DHD
Ecology Other Observation Conners Parent- range from No effect of time on related
sympto
ms
61
Significant Other
Who was Unknown
What was TestSource Treatment Teacher
Outcome 0.77-0.97
Reliability inattention symptoms
Effect Size
Outcomes Unknown
targeted for targeted for Other Information Questionnaire)
Measure Used
Outcome 3 Child
change Behaviour
change Self Report - ADHD Internal Partial eta squared (n2)
Hyperactivity/ Parent/Sig.A Knowledge Teacher Report (measured by coefficients
Impulsivity Ecology Other Observation Conners Parent- range from No effect of time on
Other Unknown Test Teacher 0.77-0.97 hyperactivity/impulsivity
Unknown Other Questionnaire) symptoms
Outcome 4 Child Behaviour Self Report - ADHD Internal Partial eta squared (n2)
Hyperactivity/ Parent/Sig.A Knowledge Teacher Report (measured by coefficients
Impulsivity Ecology Other Observation Conners Parent- range from No effect of time on
Other Unknown Test Teacher 0.77-0.97 hyperactivity/impulsivity
Unknown Other Questionnaire) symptoms
2. Externalising behaviour
62
Outcome 5 Child Behaviour Self Report Mindfulness ADHD symptoms Internal Partial eta squared (n2)
Non- Who was
Teacher What was
Attitude Source
Parent Report Note null/
training Outcome
(measured by Reliability
consistency = 0.35*Effect Size
Significant
Conduct targeted for
Knowledge Teacher Report negative MeasureParent-
Conners Used coefficients
Outcomes
problems change
Ecology change
Other Observation outcomes Teacher range from Pre - post = 0.70*
Other Unknown Test Questionnaire) 0.77-0.97 (Cohens d)
Unknown Other
Outcome 6 Child Behaviour Self Report Mindfulness ADHD symptoms Internal Partial eta squared (n2)
Teacher Attitude Parent Report training (measured by consistency = 0.31*
ODD Parent/Sig.A Knowledge Teacher Report Conners Parent- coefficients
symptoms Ecology Other Observation Teacher range from Baseline to pre = 0.65*
Other Unknown Test Questionnaire) 0.77-0.97 (Cohens d)
Unknown Other
Conduct Parent/Sig.A Knowledge Teacher Report (measured by coefficients
problems Ecology Other Observation Conners Parent- range from
Other Unknown Test Teacher 0.77-0.97
ODD Parent/Sig.A Knowledge Teacher Report (measured by coefficients
symptoms Ecology Other Observation Conners Parent- range from
Other Unknown Test Teacher 0.77-0.97
3. Parent-child relationship
63
Outcome 9 Child Behaviour Self Report - Stress Index for High internal Partial eta squared (n2)
Teacher Attitude Parent Report Parents of consistency = 0.29*
Parent-child Parent/Sig.A Knowledge Teacher Report Adolescents (range from
relationship Ecology Other Observation (SIPA) 0.80-0.90)
Other (relationship) Test
4. Parenting stress
Outcome 10 Child Behaviour Self Report - Stress Index for High internal Partial eta squared
Teacher Attitude Parent Report Parents of consistency (n2) = 0.23*
Parenting Parent/Sig.A Knowledge Teacher Report Adolescents (range from
Stress (as a Ecology Other Observation (SIPA) 0.80-0.90)
function of the Other (stress) Test
adolescent)
Parenting Parent/Sig.A Knowledge Teacher Report Adolescents (range from
Stress (as a Ecology Other Observation (SIPA) 0.80-0.90)
function of the Other (stress) Test
parent) Unknown Unknown Other
Total Parent/Sig.A Knowledge Teacher Report Adolescents (range from
parenting Ecology Other Observation (SIPA) 0.80-0.90)
stress Other (stress) Test
64
Life stressors Parent/Sig.A Knowledge Teacher Report Adolescents (range from
Ecology Other Observation (SIPA) 0.80-0.90)
Other (stress) Test
65
van de Weijer-Bergsma, E., Formsma, A. R., de Bruin, E. I., & Bgels, S. M. (2012). The effectiveness of mindfulness training on behavioral
problems and attentional functioning in adolescents with ADHD. Journal of child and family studies, 21(5), 775-787.
*Effect
Significant Who was What was Source Treatment Outcome Reliability Effect Size sizes were
Outcomes targeted for targeted for Information Measure Used calculated
change change by the
Outcome 1 Child Behaviour Self Report Mindfulness Youth Self Good Internal Adolescent author
Teacher Attitude Parent Report training Report (YSR) consistency Pre FU1 = 0.9* (Cohens
Attention Parent/Sig.A Knowledge Teacher Report (alpha range d) and
Ecology Other Observation Child Behaviour = 0.80 to Father provided
Other Unknown Test Checklist 0.95) Pre - post = 0.6* in Table 1
Unknown Other (CBCL) Pre FU1 = 1.5* by van de
Weijer-
Bergsma
et al.
(2012)
1. A
DHD
related
sympto
ms
66
Outcome 2 Child Behaviour Self Report Mindfulness Amsterdam Valid and Speed
Non- Who was
Teacher What was
Attitude Source
Parent Report Note null/
training Outcome
Neuropsycholog Reliability
sensitive tool Effect
Pre-post Size
= 0.9*
Significant
Attention targeted for
Knowledge Teacher Report negative Measure
ical Tasks Used
(ANT) Gunther et al.
Outcomes change
Ecology change
Other Observation outcomes 2009)
Sustained 4
Outcome Child
Other Behaviour
Unknown Self
Test Report - Youth Self Good Internal Adolescent
Attention Dots Unknown Other
(SAD)
Outcome 3 Child Behaviour Self Report Mindfulness Amsterdam Valid and Misses
Teacher Attitude Parent Report training Neuropsycholog sensitive tool Pre-FU1 = 0.8*
Attention Parent/Sig.A Knowledge Teacher Report ical Tasks (ANT) Gunther et al.
Ecology Other Observation 2009) False alarms
Sustained Other Unknown Test Pre-post = 0.5*
Attention Unknown Other Pre-FU1 = 0.7*
Auditory Pre-FU2 = 0.7*
(SAA)
67
Teacher Attitude Parent Report Report (YSR) consistency Pre - post = 0.5 *
Attention Parent/Sig.A Knowledge Teacher Report (alpha range Pre FU2 = 1.0*
Ecology Other Observation Child Behaviour = 0.80 to
Other Unknown Test Checklist 0.95) Mother
Unknown Other (CBCL) Pre - post = 0.1 *
Pre FU1 = 0.3*
Teacher Report
Form (TRF) Tutor
Pre-post = 0.3*
Outcome 5 Child Behaviour Self Report - Amsterdam Valid and Speed

Teacher Attitude Parent Report Neuropsycholog sensitive tool Pre-FU1 = 0.3*
Attention Parent/Sig.A Knowledge Teacher Report ical Tasks (ANT) Gunther et al. Pre-FU2 = 0.5*
Ecology Other Observation 2009)
Sustained Other Unknown Test Misses
Attention Dots Unknown Other Pre-post = 0.4*
(SAD) Pre-FU1 = 0.8*
Pre-FU2 = 0.5*
False alarms
Pre-post = 0.0*
Pre-FU1 = 0.3*
Pre-FU2 = 0.1*
Outcome 6 Child Behaviour Self Report - Amsterdam Valid and Speed
Teacher Attitude Parent Report Neuropsycholog sensitive tool Pre-post = 0.1*
Attention Parent/Sig.A Knowledge Teacher Report ical Tasks (ANT) Gunther et al. Pre-FU1 = 0.0*
Ecology Other Observation 2009) Pre-FU2 = 0.1*
Sustained Other Unknown Test
Attention Unknown Other Misses
Auditory Pre-post = 0.2*
(SAA) Pre-FU2 = 0.4*
68
2. E
Significant Who was What was Source Treatment Outcome Reliability Effect Size xternalis
change change ing
Outcome 7 Child Behaviour Self Report Mindfulness Youth Self Good Internal Adolescent behavio
Teacher Attitude Parent Report training Report (YSR) consistency Pre FU1 = 0.5* urs
Externalising Parent/Sig.A Knowledge Teacher Report (alpha range Pre FU2 = 0.9*
behaviour Ecology Other Observation Child Behaviour = 0.80 to
Other Unknown Test Checklist 0.95) Father
Unknown Other (CBCL) Pre - post = 0.2*
Pre FU1 = 0.3*
Significant targeted for targeted for negative Measure
Outcomes change change outcomes Used
Outcome 8 Child Behaviour Self Report Mindfulness Youth Self Good Internal Adolescent
Teacher Attitude Parent Report training Report (YSR) consistency Pre - post = 0.1*
Externalising Parent/Sig.A Knowledge Teacher Report (alpha range =
behaviour Ecology Other Observation Child 0.80 to 0.95) Mother
Other Unknown Test Behaviour Pre - post = 0.2*
Unknown Other Checklist Pre FU1 = 0.1*
(CBCL)
Tutor
Teacher Pre-post = 0.2*
Report Form
(TRF)
69
change change
Outcome 9 Child Behaviour Self Report Mindfulness Parenting stress High internal Father
Teacher Attitude Parent Report training index (PSI) consistency Pre - post = 0.7*
Parental Parent/Sig.A Knowledge Teacher Report (alpha of Pre FU1 = 1.1*
stress Ecology Other Observation 0.95 in this 3. P
Other (relationship) Test study) arenting
Unknown Unknown Other stress
Outcome 10 Child Behaviour Self Report Mindfulness Parenting Scale Adequate Father
Teacher Attitude Parent Report training (PS) test-retest Pre - post = 0.9*
Parenting Parent/Sig.A Knowledge Teacher Report reliability (r =
style (over- Ecology Other Observation 0.84) Mother
reactivity) Other (relationship) Test Pre-post = 1.0*
Non- Who was What was Source Treatment Outcome Reliability Effect Size
Significant targeted for targeted for Information Measure Used
Outcomes change change
Outcome 11 Child Behaviour Self Report Mindfulness Parenting stress High internal Mother
Teacher Attitude Parent Report training index (PSI) consistency Pre - post = 0.5*
Parental Parent/Sig.A Knowledge Teacher Report (alpha of Pre FU1 = 0.2*
stress Ecology Other Observation 0.95 in this
Other (relationship) Test study)
70
Outcome 12 Child Behaviour Self Report Mindfulness Parenting Scale Adequate Father
Teacher Attitude Parent Report training (PS) test-retest Pre FU1 = 0.3*
Parenting Parent/Sig.A Knowledge Teacher Report reliability (r =
style (over- Ecology Other Observation 0.84 Mother
reactivity) Other (relationship) Test Pre- FU1 = 0.6*
Significant Unknown
Who was Unknown
What was OtherSource Treatment Outcome Reliability Effect Size
change change
Outcome 1 Child Behaviour Self Report Mindfulness Observation High levels of Pre Mother
Teacher Attitude Parent Report training (parent and inter-rater Mindfulness = 67%
Child Parent/Sig.A Knowledge Teacher Report experimenter) reliability (r =
compliance Ecology Other Observation 0.92, range = Pre Child
(Child 1) Other Unknown Test 0.87 1) Mindfulness =100%
Singh, N. N., Singh, A. N., Lancioni, G. E., Singh, J., Winton, A. S., & Adkins, A. D. (2010). Mindfulness training for parents and their children
with ADHD increases the childrens compliance. Journal of Child and Family Studies, 19(2), 157-166.
*Effect sizes were calculated by using the Percentage of Non-Overlapping Data (PND) from Figure 1. This approach is described in Scruggs (1998).
1. ADHD-related symptoms
71
Pre- Follow-up = 88%

Outcome 2 Child Behaviour Self Report Mindfulness Observation High levels of Pre Mother
Teacher Attitude Parent Report training (parent and inter-rater Mindfulness = 17%
Child Parent/Sig.A Knowledge Teacher Report experimenter) reliability (r =
compliance Ecology Other Observation 0.92, range = Pre Child
(Child 2) Other Unknown Test 0.87 1) Mindfulness = 92%
Pre- Follow-up =
100%
2. Parent-child relationship
72
change change
Outcome 3 Child Behaviour Self Report Mindfulness Single item Psychometric Could not be
Teacher Attitude Parent Report training rating scale properties computed
Satisfaction Parent/Sig.A Knowledge Teacher Report satisfaction with not
with self in Ecology Other Observation self in established
interaction Other Unknown Test interaction with
with child my child
(SSIMC)
Outcome 5 Child Behaviour Self Report Mindfulness Single item Psychometric Could not be
Teacher Attitude Parent Report training rating scale properties computed
Satisfaction Parent/Sig.A Knowledge Teacher Report satisfaction with not
units of Ecology Other Observation self in established
happiness Other Unknown Test interaction with
with child my child
(SSIMC)
73

Evaluation of MBCT For Adolescents With ADHD and Their Parents - Impact On Individual and Family Functioning PDF

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Doctorate in Educational and Child Psychology Amy Phipps

Case Study 1: An Evidence-Based Practice Review Report

Theme: Interventions for children with Special Educational Needs

Mindfulness is based on Eastern meditation techniques and helps to increase an individuals

confidently used as an intervention option.

attention on thoughts, sensations and feelings as they arise on a moment-by-moment basis. In

imperative part of mindfulness practice. These principles will be used as a definition of

mindfulness for this review and include: :

Attention to the present moment;

Compassion for self and others;

Teaching of everyday mindfulness practices (e.g. mindful walking, mindful eating)

Teaching of mindfulness meditation (e.g. body scan, mindful stretches)

Personal embodiment of the qualities of mindfulness.

demonstrate a chronic pattern of developmentally inappropriate inattention, hyperactivity and

impulsive behaviour (American Psychiatric Association 2013). With difficulties in self-regulation,

So what are the intervention options?

adherence to medication decreases sharply in adolescence, with up to 70% of teenagers

outcomes (Kazdin and Whitley 2003).

& Hibbert, 2007).

following search terms were used to locate studies:

Table 1: Search terms applied to PsycINFO, Medline and ERIC

question, as shown in Table 3.

For a full list of excluded studies and rationale, see appendix 1.

Figure 1: Literature screening process:

Articles identified from PsycINFO, ERIC, and Medline

Article abstracts screened using inclusion and

Articles identified from ancestral searches

Article abstracts screened using inclusion and

Table 2: Inclusion and exclusion criteria

Inclusion criteria Exclusion criteria Rationale

2c. Mindfulness practice is Mindfulness practice is Research indicates reciprocal

Final studies included in systematic literature review:

Table 3: List of studies eligible for the final review question

Full APA reference of studies included in final review:

these qualitative findings in the review question.

Table 4: Detailed analysis of the 5 studies selected for review

Authors Sample Design Measures Significant findings

reactivity for both mothers and fathers (p <.05)

Haydicky, Age of children: Design: Baseline, pre-test, post-test, Externalising behaviours:

Delivery: group Parents of Adolescence

systematic as possible. WoE is designed to appraise studies based on methodological quality

ratings can also be found in appendix 4.

informatively by the reviewer.

Methodological. Methodological. Study topic Overall

Table 5: An overview of the ratings received by each study

quality relevance relevance weighting

van der Oord High Medium High High

Haydicky et High Low High Medium

van de Weijer- High Low High Medium

Singh et al. Medium Low Low Low

Critical comparison of the selected studies

male-to-female ratio (9:1) of children diagnosed with ADHD (Arnold, 1996).

adaptions of both the Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive

reflected in their WoE C rating.

high WoE A rating as a result of this drawback.

was reflected in the WoE B rating.

Outcome Study Informant Effect Sizes WoE D

Type of effect size Small Medium Large

Partial Eta Square (Cohen, 1988) 0.01 0.06 0.14

Cohens d (Cohen, 1988) 0.20 0.50 0.80

(Green & Salkind, 2008; Scruggs & Mastropieri, 1998)

indications of significance were not available.

1) Childs ADHD symptoms