Child and Parent Mindfulness-Based Training Versus Medication for Childhood ADHD: A Randomised Clinical Trial
Renée Meppelink, Esther I. de Bruin, Brett Kosterman Zoller, Frans J. Oort, Susan M. Bögels
Mindfulness February 1, 2024 DOI: 10.1007/s12671-024-02305-w (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial with an additional preference trial for families refusing randomization Peer reviewed |
|---|---|
| Sample size | 91 |
| Population | Children with ADHD (mean age 11.29 years, range 9-18, 71% boys) and their parents (91 mothers, 81 fathers), plus 81 teachers and 85 blind observers in the randomized controlled trial; a separate preference trial included 29 children (mean age 11.57, 55% boys), 52 parents, 24 teachers, and 26 observers |
| Intervention | methylphenidate |
| Duration | Mindfulness: 2 months of weekly 1.5-hour group sessions plus a follow-up session 2 months later; medication: 4 months of short-acting methylphenidate; follow-up at 2, 4, and 10 months |
| Topics | Meditation |
| Key findings | Medication (methylphenidate) was more effective than family mindfulness training at 2 and 4 months on multi-informant questionnaires, but not on objective neuropsychological or blind-observer measures. Differences between treatments diminished by mid-term and disappeared at 10 months, though treatment switching in the long term makes it unclear whether outcomes were due to mindfulness, medication, or their combination. Mindfulness was more easily accepted, with 2% discontinuing versus 26% for medication. |
Abstract
Abstract Objectives Medication is the predominant treatment for childhood attention-deficit hyperactivity disorder (ADHD) but has side effects and limited longer-term effects. Mindfulness for children and their parents could be an alternative as it targets children’s core symptoms and supports parents. This study compared the effectiveness of a family mindfulness-based intervention to methylphenidate in children with ADHD.
Method: We conducted a randomised controlled trial (RCT) and a preference trial (PT) for families who refused randomisation. Mindfulness (“MYmind”) consisted of 2-months weekly group-based 1.5-hr mindfulness sessions for children and parallel mindful parenting for their parents, plus a follow-up session 2 months later. Medication concerned 4-months short-acting methylphenidate. Intention-to-treat (ITT) and per-protocol (PP) analyses were performed using multilevel modelling. Both parents and adolescents (not children) completed questionnaires on child ADHD pre-treatment, and at 2-, 4-, and 10-months follow-up, whereas teachers and blind observers completed these questionnaires at pre-treatment and 2-months follow-up only. Similarly, neuropsychological attention measures were administered pre-treatment and at 2-months follow-up only.
Results: In the RCT, 91 children with ADHD (Mage=11.29, range 9–18, 71% boys), 172 parents (91 mothers, 81 fathers), 81 teachers, and 85 observers participated, and in the PT, 29 children (Mage=11.57, 55% boys), 52 parents (28 mothers, 24 fathers), 24 teachers, and 26 observers. Medication was more effective than family mindfulness at 2 and 4 months on multi-informant questionnaires but not on objective (neuropsychological and blind observer) measures. Differences between treatments diminished at mid-term even though in the medication group treatment was continued after 2 months while the mindfulness training was already finished at 2 months. Differences between treatment groups disappeared at 10 months, but note that in the long-term, children from the mindfulness arm started taking medication and vice versa, so that we cannot be sure to what extent the long-term results are caused by mindfulness, medication, or its combination. Findings in the PT and according to PP analyses were similar. Note moreover that 1 in 4 children (26%) discontinued taking medication during the first 2 months versus almost no families (2%) discontinued mindfulness, suggesting that mindfulness was more easily accepted.
Conclusions: Overall, although mindfulness alone might not be sufficient for some families, family mindfulness training in general can be considered a non-pharmacological alternative or addition in the treatment of childhood ADHD. Preregistration https://onderzoekmetmensen.nl/nl/trial/22179, 11.10.2013.