Mindfulness-based Interventions with Children and Adolescents

Research and Practice

Nirbhay N. Singh, Subhashni D. Singh Joy, Nirbhay N. Singh, Subhashni D. Singh Joy

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781317190769
• Edition: 1
• Topic: Psicología
• Subtopic: Psicoterapia

This book comprehensively reviews mindfulness-based interventions for specific areas of functioning in children and adolescents, with refreshing insights and perspectives. Based on a solid foundation of research and practice, it presents the nature of mindfulness, examines the psychological processes that may underlie mindfulness, and explores how to assess it.

Mindfulness is about how we can be attentive to and present for everything that happens in our daily lives. This book draws upon current research in the field in order to explore topics such as the fundamentals of teaching mindfulness to children and adolescents; assessment of mindfulness in this population; use of mindfulness in educational settings; and clinical applications in mental health, including substance abuse, hyperactivity, and intellectual and developmental disabilities. With contributions from internationally-renowned clinicians and scholars, this book provides a balanced account of the strengths and weaknesses of current research, and how mindfulness-based programs can be used to enhance wellbeing and reduce suffering.

This book will be of great interest for academics, scholars and post graduate students involved in the study of the mental health of children and adolescents. It will also appeal to psychologists, psychiatrist, nurses, social workers, rehabilitation therapists and others, such as school counsellors, who provide clinical care to children and adolescents.

Part I

Foundations

Chapter 1

Mindfulness-based interventions with children and adolescents

Nirbhay N. Singh and Subhashni D. Singh Joy

Introduction

Victor Hugo, the French poet and novelist, once said, “You can resist an invading army; you cannot resist an idea whose time has come.” We could say that the time for mindfulness has come. It took around 2,600 years for it to arrive, but it is now firmly entrenched in the consciousness of Western culture. While there is no general consensus as to what the term “mindfulness” encompasses, as Shakespeare noted, “A rose by any other name would smell as sweet.” Mindfulness has been understood in different ways in different wisdom traditions across centuries to refer to how we engage with our moment-to-moment experience of emotions, sensations, perceptions, and thoughts. Western understanding of mindfulness has been heavily influenced by Buddhist philosophy, and most of the current definitions and measures come from that tradition. This is not to be understood as Buddhism being a monolithic tradition, because there is much diversity within it, as it spread throughout Asia from the days of early Buddhism (Anālayo, 2020). Furthermore, there is much diversity among current Buddhist lineages in terms of how mindfulness is understood, developed, and practiced.

One of the most commonly known definitions of mindfulness was advanced by Kabat-Zinn (1994, p. 4): “Paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.” The consensus definition developed by researchers holds that mindfulness is “[a] kind of nonelaborative, nonjudgmental, present-centered awareness in which each thought, feeling, or sensation that arises in the attentional field is acknowledged and accepted as it is” (Bishop et al., 2004, p. 232). In terms of the cultivation of mindfulness through personal meditation practice or participation in a mindfulness-based intervention, it is the “moment-to-moment, non-judgmental, non-reactive attending, and the awareness, insight, and potential liberation that can arise from that intentional cultivation” (Kabat-Zinn, 2019, p. xi). Munindra noted that when mindfulness becomes second nature in our daily life, we can be mindful

even while eating, drinking, dressing, seeing, hearing, smelling, tasting, touching, thinking. Whatever you are doing, everything should be done mindfully, dynamically, with totality, completeness, thoroughness. Then it becomes meditation, meaningful, purposeful. It is not thinking, but experiencing from moment to moment, living from moment to moment, without clinging, without condemning, without judging, without criticizing—choiceless awareness…. It should be integrated into our whole life. It is actually an education in how to see, how to hear, how to smell, how to eat, how to drink, how to walk with full awareness.

(Knaster, 2010, p. 1)

Mindfulness is one of the fastest growing therapeutic interventions in adult mental health, focusing on psychological problems such as the daily hassles of life, worry, stress, anxiety, and depression, because it ameliorates the intense emotional states that give rise to these problems. Research has focused on evaluating the efficacy and effectiveness of mindfulness-based interventions (MBIs) in a wide range of clinical populations. Meta-analyses of such studies indicate that MBIs are effective in reducing psychological suffering and in enhancing personal well-being and quality of life in healthy populations (Chiesa & Serretti, 2009; Khoury et al., 2015), in people with mental health problems (Cavanagh et al., 2014), and in others with chronic somatic illnesses (Abbott et al., 2014; Zainal et al., 2013).

There is also an emerging research base on MBIs in children and adolescents, with most of the studies focused on adolescents. The first critical review provided evidence that MBIs can reduce symptoms of anxiety as well as inattention and behavioral problems (Burke, 2010). Another review from the same period suggested that sitting meditation leads to effective treatment of physiologic, psychosocial, and behavioral problems in youth aged 6 to 18 years across school, clinic, and community settings (Black et al., 2009). Research suggests that MBIs can be successfully used with adolescents who display symptoms of attention deficit hyperactivity disorder (Cairncross & Miller, 2016) or have externalizing disorders (Bögels et al., 2008). MBIs have been reported to be effective in decreasing symptoms of depression in minority children (Liehr & Diaz, 2010) and in reducing anxiety and increasing social skills in adolescents with learning disorders (Beauchemin et al., 2008). In the Sibinga et al. (2011) study with urban youth who were HIV-positive and at risk for other disorders, an MBI was effective in reducing hostility and emotional discomfort, and qualitative data suggested improvements in academic performance, interpersonal interactions, stress levels, and physical health. Meta-analyses of MBIs in schools show significant improvements in cognitive performance and resilience and nonsignificant changes in emotional problems (Zenner et al., 2014). These findings were further confirmed in updated meta-analyses that additionally showed significant improvements in the mental health of students (Carsley et al., 2018; Zoogman et al., 2015). All these research studies and meta-analyses of these studies point to the fact that MBIs for children and adolescents is a priority area for research and implementation.

This book provides a scholarly and practical examination of what we currently know about MBIs with children and adolescents. The book begins with foundational chapters on mindfulness, followed by chapters on current research in key areas in which most research has been published on this population, and finally includes practice chapters that cover research-based mindfulness programs that have had the most success with children and adolescents. The last chapter presents something a little different—how teaching mindfulness to parents, caregivers, and teachers cascades or spills over to the children and adolescents in their care.

Foundations

In the first foundational chapter (Chapter 2), Ajahn Amaro and Singh begin with a wide-ranging discussion of the definitions of mindfulness, beginning with the Buddha’s own definitions of sati—the Pali word for what has come to be called mindfulness in English. The Buddha presented the most comprehensive account of right mindfulness in the Satipaṭṭhānas—known as “the four establishments of mindfulness” or more commonly as “the four foundations of mindfulness.” The four foundations of mindfulness referred to in this sutta are the body, feelings, mind, and mind-objects. Of course, the Buddha expounded on mindfulness in other suttas as well, and these are covered briefly. Ajahn Amaro and Singh then present a selection of definitions offered by Buddhist practitioners, academics, and philosophers. This is followed by a discussion of the attributes of mindfulness based on the similes and metaphors the Buddha used as explanatory tools. They present a detailed account of four qualities of mindfulness that bear close examination because we can engage in mindfulness at different levels. This aspect of mindfulness is rarely mentioned in academic research on mindfulness, but without it the research is almost rudderless. This is followed by a brief discussion of the social dimensions of mindfulness. The final section touches on the emerging understanding of the mechanisms that underlie the changes seen as a result of MBIs.

The second foundational chapter (Chapter 3) is on the assessment of mindfulness in children and adolescents. Potts, Twohig, Butcher, and Levin begin with a series of concerns regarding measuring mindfulness in this population, with emphasis on age-appropriateness of rating scale items, perceived comprehension ability, ability to self-reflect, and tailoring factor structure and sophistication to the children’s developmental stage. Then they examine child and adolescent measures in some detail. There is a very thoughtful section on key factors to consider when choosing an appropriate measure for a child or adolescent. In contrast to self-report rating scales, there is a section on behavioral observations of overt correlates of mindfulness that can be used for individual children across specific settings. They discuss how to assess constructs related to mindfulness, such as psychological flexibility. Finally, they cover issues and possible assessments of parental mindfulness that may affect their children in bidirectional transactions. Given that the field of mindfulness in children and adolescents is still in the nascent stages of development, this chapter presents researchers and clinicians with essential information on how to begin assessing mindfulness in this population.

Research

There has been much interest in how MBIs can be used in school settings. In the earliest review of mindfulness training with K–12 education, Meiklejohn et al. (2012) reported on early studies that indicated the potential of MBIs in improving working memory, attention, academic skills, social skills, emotional regulation, and self-esteem and in decreasing anxiety, stress, and fatigue. This was followed by special issues on mindfulness in education in Research in Human Development (Frank et al., 2013), Mindfulness (Felver & Jennings, 2016), and Psychology in the Schools (Renshaw & Cook, 2017) and the seminal book on the topic, Handbook of Mindfulness in Education (Schonert-Reichl & Roeser, 2016). In Chapter 4, Schutt and Felver synthesize current research on the use of MBIs with children and adolescents in school settings. First, they summarize extant systematic reviews and meta-analyses from 2005 to 2014 to provide a feel for where the field has been. Second, they review the research conducted in the last five years. Third, they provide recommendations for future research and guidance on implementing MBIs in school settings. Overall, Schutt and Felver conclude that MBIs are acceptable and feasible to implement in schools, are effective, and do not appear to cause any harm to the students. While acknowledging that a substantial amount of research on mindfulness in education is still preliminary and needs replication, they note several benefits for students, including reduction in psychopathology symptoms and improving psychosocial well-being, cognitive functioning, and academic outcomes.

There is a plethora of research reviews and meta-analyses of psychopharmacological treatment of attention deficit hyperactivity disorder (ADHD) in children and adolescents. Essentially, these reviews attest to the effectiveness of medication for ADHD, with low doses of medication combined with multimodal behavioral intervention being most effective and cost-efficient (Smith et al., 2019). At the same time, some children are known to decline drug treatment, poorly tolerate it, or have low long-term compliance with the drug regimen, while others may be nonresponders. In Chapter 5, de Bruin, Meppelink, and Bögels begin by discussing the core symptoms of children with ADHD, the impact of this disorder on the children’s lives, the personal and emotional burdens on the families, and the economic health care costs in caring for children and adolescents with ADHD. They discuss why drug treatments are the first-line treatment and the adverse effects of such treatment on the lives of the children. They then present the argument that perhaps mindfulness may offer a safer alternative to drug treatment. This is followed by a review of meta-analyses of mindfulness research with children with ADHD and with their parents. Then follows the main part of the chapter, which reviews individual and group-based mindfulness interventions for children with ADHD and for their parents. Finally, they touch upon a specific MBI, MYmind, that has shown great potential as a research-based approach for mindfulness training of children and adolescents with ADHD and autism spectrum disorder (ASD). Given the personal, educational, and economic burdens of ADHD on children and their families, a concerted effort needs to be made to find practical non-pharmacological interventions that they can use to self-regulate their attention. This chapter provides the basis for doing so using mindfulness-based approaches.

Among children aged 3 to 17 years, about 17.8% are estimated to have a developmental disability (Zablotsky et al., 2019). This includes 2.5% with ASD and 1.2% with an intellectual disability. These children exhibit mild to profound levels of functioning due to medical, cognitive, and mental health issues. Psychopharmacological treatments were the first-line treatments for decades until it was apparent that their side effects far outweighed their benefits. Currently, behavioral interventions are the most used, particularly applied behavior analysis and positive behavior support. While very effective, these interventions are labor intensive and often stressful for the caregivers to implement. Over the last two decades, MBIs have been increasingly used to reduce the suffering of children and adolescents with intellectual and developmental disability (IDD), along with their caregivers. In Chapter 6, Singh and Hwang provi...