Posted 04.24.2018 | by AMRA

Attention-Deficit Hyperactivity Disorder (ADHD) is a childhood developmental disorder that can persist into adulthood, affecting 2.5% of the adult population. Adult ADHD symptoms include inattentiveness, distractibility, and difficulty staying organized. Stimulant medications remain the standard first-line treatment for adult ADHD, sometimes supplemented by cognitive-behavioral interventions. Some adults object to stimulant medication, some experience adverse medication-related side-effects, and some fail to achieve complete symptom remission through its use.

As a result, there is interest in developing psychosocial treatments as adjunctive or alternative treatments. Mindfulness-based interventions may be good candidates for such treatments, as they improve attentional regulation in healthy populations, and strengthen the brain regions associated with it. Janssen et al. [Psychological Medicine] tested the efficacy of Mindfulness-Based Cognitive Therapy (MBCT) as an adjunctive treatment for adults with ADHD in a multi-center, randomized, controlled study.

Researchers recruited 120 participants (50% male; average age = 39 years) from three Dutch specialty outpatient clinics for adult ADHD, as well as through media recruitment, physician referral, and a patient support-and-advocacy group. Participants were randomly assigned to either treatment-as-usual (TAU) or treatment-as-usual plus MBCT.

TAU consisted of medication for 59% of participants, while 59% received previous or current psycho-educational/skills training, and 55% received previous or current psychosocial treatment. MBCT was offered in 8 weekly 2.5-hour group sessions and a 6-hour silent retreat.

Modifications were made in the standard MBCT format: the length of meditations gradually increased to 30 minutes, and material relevant to depression was replaced by material relevant to ADHD. There was also greater emphasis on mindfulness in daily life, mindful listening, and mindful speaking. Participants were encouraged to practice at home 6 days a week.

Participants were assessed at baseline, post-treatment, and at 3- and 6-month follow-up using both blind clinician and self-report ratings of ADHD symptoms, as well as self-report measures of executive function, general functioning, emotional and social wellbeing, self-compassion, and mindfulness (using the Five Facet Mindfulness Questionnaire).

At post-treatment, clinicians rated MBCT participants as exhibiting significantly fewer ADHD symptoms (Cohen’s d=.41) than controls. More MBCT participants (31%) were rated as significantly clinically improved than TAU participants (5%). Clinician-rated differences persisted and remained stable through 6-month follow-up.

On self-report measures, MBCT participants showed significantly greater improvements in ADHD symptoms (d=.37), mindfulness (d = .36), self-compassion (d=.42) and emotional and social wellbeing (d=.32) than controls. Between group differences in self-rated ADHD symptoms increased over time, with Cohen’s d increasing to .79 at 6-months. MBCT group executive functioning improved from post-treatment to 6-month follow-up, first becoming statistically significant at 6 months (d=.49).

The study shows adjunctive MBCT alleviates both clinician-rated and self-rated ADHD symptoms and improves self-rated mindfulness, self-compassion and emotional and social wellbeing in adults with effects lasting up to 6 months.

The study is limited by its use of a TAU control rather than an active control because of the possible variations in TAU between treatments, as well as the lack of control for extra attention received by the MBCT group.

Reference:

Janssen, L., Kan, C. C., Carpentier, P. J., Sizoo, B., Hepark, S., Schellekens, M. P., . . . Speckens, A. E. (2018). Mindfulness-based cognitive therapy v. Treatment as usual in adults with ADHD: A multicentre, single-blind, randomised controlled trial. Psychological Medicine.

[Link to abstract]