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Meditation, Anxiety, and ADHDCan meditation, which is a form of focused attention, help improve the attention of children with attention deficit hyperactivity disorder (ADHD)? A recent study looked at whether meditating to reduce stress could be a useful supplement to current ADHD treatments.
Characteristics of ADHDAttention deficit hyperactivity disorder is a widespread neurobiological condition. In 2005 the CDC estimated that 4.5 million children between the ages of 4 and 17 were diagnosed with ADHD and almost half were treated with medication. The cause of ADHD is thought to be abnormalities in the neurochemical connections among centers in the brain involved in attention and impulse control.
ADHD manifests differently depending on the child's age and developmental stage, and the demands of his or her environment. Studies have noted that 75-85% of children with ADHD also have emotional and/or learning problems.
People with ADHD have a hard time filtering out the many activities and stimuli that are present in the environment and deciding which deserve their attention. They have trouble concentrating on single tasks and their attention is easily pulled away to other activities. They have difficulty controlling their impulses and may talk out of turn, hit other children, or get into mischief in school. They have difficulty remaining organized and their poor sense of time makes it hard to keep tasks flowing smoothly and to judge how long it will take to complete projects. Their short term memory, or working memory, is poor and makes it difficult to hold lists of tasks or steps of activities in their minds long enough to complete them successfully and sequentially. These skills are all considered to be "executive functions" since, like the executive of a company, they are necessary to keep things running smoothly.
School age children with ADHD are especially challenged since the world of school makes many demands on children's behavior and attention that are particularly difficult for them to meet. ADHD also takes a toll on families by negatively impacting home routines and family outings.
Diagnosis and TreatmentIdeally, any diagnosis of ADHD should be investigated rigorously by a multidisciplinary team. Objective standardized neuropsychological tests are used to measure attention, distractibility, and other cognitive features. But it is also important to consider other possible conditions such as learning disabilities and social and emotional issues that may be behind various behaviors, such as poor impulse control. A child may be distracted and acting up for a variety of reasons.
Non-pharmacological treatment of ADHD is multidisciplinary and can include individual counseling, family therapy, school accommodations such as seating a child in place where teachers see easily when attention wanders, and attention to other educational weaknesses.
The medications used to treat ADHD for years include the stimulant medications methylphenidate and dextroamphetamine (Ritalin and Dexedrine, respectively). These are the mainstays of treatment in spite of concerns about short-term side effects and possible long-term consequences of prolonged use. Neither concern has proven prohibitive. Medications have been successfully used with many, many children and adults and helped failing students and poorly functioning adults become academically, socially and professionally successful.
Why Meditation? Why TM?This new study, published in the December issue of Current Issues in Education, suggests that anxietymay be both a cause and an effect of ADHD. The researchers noted that children with ADHD experience increased stress because of the challenges of their condition and this stress further impaired children's executive functioning. Increased vulnerability to stress can result from neurologic results of premature birth and from overly stressful early childhood experiences. The researchers decided to test the idea that such children might present symptoms similar to ADHD that were actually anxiety-based. They also noted that ADHD medications, since they are stimulants, could have the effect of increasing anxiety. The researchers reasoned that a strategy, such as meditation, that would decrease anxiety would improve ADHD symptoms, potentially decrease the dose or need for medications, and act as an adjunct to other treatments.
These researchers chose transcendental meditation because they felt TM could be easily learned and accessible to children with ADHD. TM does not involve directing the attention or controlling the mind but uses a mantra, a word or words, the sounds of which are repeated mentally to create a state of restful alertness. They wanted to see if the regular practice of the technique would reduce stress-related problems and symptoms associated with ADHD. They also wanted to test the idea that TM practice could specifically improve the executive functions because there is a growing body of research on the beneficial effects of meditation on brain function — altering neural activity and dopamine levels and changing EEG patterns. Studies have shown that TM is characterized by activation in frontal and parietal attentional areas of the brain responsible for attention, executive function and emotional stability.
This was a small pilot study with ten students, aged 11-14, who were previously diagnosed with ADHD. They also had language-based learning disabilities. Six had other learning and/or emotional problems, eight were taking stimulant medication and three were taking other medications. Of note, the students who were medicated for ADHD and psychological problems were still experiencing symptoms that were troubling at school and at home.
Over a three-month period, students were instructed in transcendental meditation and practiced it twice daily for 10-20 minutes in the morning and afternoon. Although weekend compliance was suggested, it was not rigorously monitored.
The study used the participants as their own controls in that they underwent a pre- and post-test battery of neuropsychological tests and student, parent, and teacher questionnaires to measure their functioning
Small Study, Significant ImprovementThe children in the study showed significant improvement of symptoms of stress, anxiety and ADHD from objective testing and from descriptive reports. Scores on neuropsychological tests of executive function also showed significant improvement, as did measures of behavioral regulation, metacognition, (awareness of your thought processes and the ability to regulate thought processes) and general executive composite scores.
The results of this small pilot study supported the idea that TM could be learned and practiced regularly by children with ADHD, would show significant pre- to post- test improvement of stress, anxiety and ADHD symptoms when rated by objective tests as well as reports from teachers, parents, and students, and would improve executive function. The researchers suggest further that as stress is reduced, students with ADHD will benefit more from other multidisciplinary and pharmacologic interventions.
Although this is a small pilot study using the subjects as their own controls, the researchers feel their results are significant enough to follow up with more research.
February 9, 2009
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