A meta-analytic investigation of the impact of mindfulness-based interventions on ADHD symptoms

Jiaming Xue, Yun Zhang, Ying Huang, Jiaming Xue, Yun Zhang, Ying Huang

Abstract

Background: Mindfulness-based interventions (MBIs) have been reported to be efficacious in treating attention deficit hyperactivity disorder (ADHD). However, the value of the control effect of MBIs on ADHD core symptoms remains controversial. To clarify the literature on the control effect of MBIs on the symptoms of ADHD and guide future researches, an effect-size analysis was conducted.

Methods: A systematic search in PubMed, Embase, Web of Science, Medline, Cochrane Library, China National Knowledge Infrastructure, and Wangfang Data databases was performed up to January 11, 2019. The overall effect size of MBIs on ADHD core symptoms (ie, inattention and hyperactivity/impulsivity) was recorded by the metric of Hedges' g with 95% confidence interval, Z-value, and P-value.

Results: Eleven eligible studies featuring 682 participants were included in the meta-analysis. The overall results indicated that MBIs had large effects on inattention (Hedges' g = -0.825) and hyperactivity/impulsivity (Hedges' g = -0.676) relative to the control group. Results from subgroup analyses between self- and observer rating on ADHD symptoms revealed that the effect of MBIs both remained in a large range and self-rated ADHD core symptom had a greater impact on heterogeneity across the studies. Meta-regression found that the overall effect might be moderated by participant age group and control condition.

Conclusion: The present meta-analysis suggested that MBIs had large effects in reducing ADHD core symptoms in comparison with the control group. Future researches are needed to assess follow-up effects of MBIs on ADHD core symptoms and explore the correlation between the individual level of mindfulness and reduction of ADHD symptoms.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flow diagram of literature selection for meta-analysis.
Figure 2
Figure 2
Primary analysis of inattention. CI = confidence interval.
Figure 3
Figure 3
Primary analysis of hyperactivity/impulsivity. CI = confidence interval.
Figure 4
Figure 4
Subgroup analysis of inattention by informant report. CI = confidence interval.
Figure 5
Figure 5
Subgroup analysis of hyperactivity or impulsivity/informant report. CI = confidence interval.
Figure 6
Figure 6
Publication bias in inattention studies.
Figure 7
Figure 7
Publication bias in hyperactivity/impulsivity studies.

References

    1. American Psychiatric Publishing, Diagnostic D. Statistical Manual of Mental Health Disorders: DSM-5. 5. 2013.
    1. Polanczyk GV, Willcutt EG, Salum GA, et al. ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis. Int J Epidemiol 2014;43:434–42.
    1. Faraone SV, Biederman J, Mick E. The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychol Med 2006;36:159–65.
    1. Simon V, Czobor P, Balint S, et al. Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis. Br J Psychiatry 2009;194:204–11.
    1. Das D, Cherbuin N, Butterworth P, et al. A population-based study of attention deficit/hyperactivity disorder symptoms and associated impairment in middle-aged adults. PloS One 2012;7:e31500.
    1. Voigt RG, Katusic SK, Colligan RC, et al. Academic achievement in adults with a history of childhood attention-deficit/hyperactivity disorder: a population-based prospective study. J Dev Behav Pediatr 2017;38:1–1.
    1. Kirino E, Imagawa H, Goto T, et al. Sociodemographics, comorbidities, healthcare utilization and work productivity in Japanese patients with adult ADHD. PloS One 2015;10:e0132233.
    1. National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management. NICE Guideline [NG87] 2018.
    1. Cunill R, Castells X, Tobias A, et al. Efficacy, safety and variability in pharmacotherapy for adults with attention deficit hyperactivity disorder: a meta-analysis and meta-regression in over 9000 patients. Psychopharmacology 2016;233:187–97.
    1. Wilens TE, Morrison NR, Prince J. An update on the pharmacotherapy of attention-deficit/hyperactivity disorder in adults. Expert Rev Neurother 2011;11:1443–65.
    1. Cairncross M, Miller CJ. The effectiveness of mindfulness-based therapies for ADHD: a meta-analytic review. J Atten Disord 2016;doi: 10.1177/1087054715625301.
    1. Zylowska L, Ackerman DL, Yang MH, et al. Mindfulness meditation training in adults and adolescents with ADHD: a feasibility study. J Atten Disord 2008;11:737–46.
    1. Baijal S, Gupta R. Meditation-based training: a possible intervention for attention deficit hyperactivity disorder. Psychiatry (Edgmont (Pa: Township)) 2008;5:48–55.
    1. Janssen L, Kan CC, Carpentier PJ, et al. Mindfulness-based cognitive therapy v. treatment as usual in adults with ADHD: a multicentre, single-blind, randomised controlled trial. Psychol Med 2019;49:55–65.
    1. Gu Y, Xu G, Zhu Y. A randomized controlled trial of mindfulness-based cognitive therapy for college students with ADHD. J Atten Disord 2018;22:388–99.
    1. Behbahani M, Zargar F, Assarian F, et al. Effects of mindful parenting training on clinical symptoms in children with attention deficit hyperactivity disorder and parenting stress: randomized controlled trial. Iran J Med Sci 2018;43:596–604.
    1. Mitchell JT, McIntyre EM, English JS, et al. A pilot trial of mindfulness meditation training for ADHD in adulthood: impact on core symptoms, executive functioning, and emotion dysregulation. J Atten Disord 2013;21:1105–20.
    1. Lo HHM, Wong SWL, Wong JYH, et al. The effects of family-based mindfulness intervention on ADHD symptomology in young children and their parents: a randomized control trial. J Atten Disord 2017;doi:10.1177/1087054717743.
    1. Bueno VF, Kozasa EH, da Silva MA, et al. Mindfulness meditation improves mood, quality of life, and attention in adults with attention deficit hyperactivity disorder. Biomed Res Int 2015;doi: 10.1155/2015/962857.
    1. Schoenberg PLA, Hepark S, Kan CC, et al. Effects of mindfulness-based cognitive therapy on neurophysiological correlates of performance monitoring in adult attention-deficit/hyperactivity disorder. Clin Neurophysiol 2014;125:1407–16.
    1. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996;17:1–2.
    1. The Cochrane Collaboration, Higgins J, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1. 0. 2011.
    1. Hedges L, Olkin I. Statistical Models for Meta-analysis. New York: Academic Press; 1985.
    1. Borenstein M, Hedges L, Higgins J, et al. Comprehensive Meta-Analysis (Version 3) [Computer Software]. Englewood, NJ: Biostat. Inc; 2014.
    1. Sage, Rosenthal R. Meta-analytic Procedures for Social Research. 1991;Vol 6.
    1. Lipsey MW, Wilson DB. The efficacy of psychological, educational, and behavioral treatment: confirmation from meta-analysis. Am Psychol 1993;48:1181–209.
    1. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ 2003;327:557–60.
    1. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002;21:1539–58.
    1. Sterne JA, Egger M, Moher D. Addressing reporting biases. Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series. 2008;297–333.
    1. Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ (Clinical research ed) 1997;315:629–34.
    1. Rosenthal R. The file drawer problem and tolerance for null results. Psychol Bull 1979;86:638–41.
    1. Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000;56:455–63.
    1. Hoxhaj E, Sadohara C, Borel P, et al. Mindfulness vs psychoeducation in adult ADHD: a randomized controlled trial. Eur Arch Psychiatry Clin Neurosci 2018;268:321–35.
    1. Bachmann K, Lam AP, Soros P, et al. Effects of mindfulness and psychoeducation on working memory in adult ADHD: a randomised, controlled fMRI study. Behav Res Ther 2018;106:47–56.
    1. Fleming AP, McMahon RJ, Moran LR, et al. Pilot randomized controlled trial of dialectical behavior therapy group skills training for ADHD among college students. J Atten Disord 2015;19:260–71.
    1. Edel MA, Holter T, Wassink K, et al. A comparison of mindfulness-based group training and skills group training in adults with ADHD. J Atten Disord 2017;21:533–9.
    1. Delta, Kabat-Zinn J, Hanh TN. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. 2009.
    1. Holzel BK, Lazar SW, Gard T, et al. How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspect Psychol Sci 2011;6:537–59.
    1. Keng SL, Smoski MJ, Robins CJ. Effects of mindfulness on psychological health: a review of empirical studies. Clin Psychol Rev 2011;31:1041–56.
    1. Shapiro SL, Carlson LE, Astin JA, et al. Mechanisms of mindfulness. J Clin Psychol 2006;62:373–86.
    1. Heath CL, Curtis DF, Fan W, et al. The association between parenting stress, parenting self-efficacy, and the clinical significance of child ADHD symptom change following behavior therapy. Child Psychiatry Hum Dev 2015;46:118–29.
    1. Baer RA, Smith GT, Hopkins J, et al. Using self-report assessment methods to explore facets of mindfulness. Assessment 2006;13:27–45.
    1. Cash M, Whittingham KJM. What facets of mindfulness contribute to psychological well-being and depressive, anxious, and stress-related symptomatology? Mindfulness 2010;1:177–82.
    1. Pepping CA, O’Donovan A, Davis PJ. The positive effects of mindfulness on self-esteem. J Posit Psychol 2013;8:376–86.
    1. Lopez-Pinar C, Martinez-Sanchis S, Carbonell-Vaya E, et al. Long-term efficacy of psychosocial treatments for adults with attention-deficit/hyperactivity disorder: a meta-analytic review. Front Psychol 2018;doi: 10.3389/fpsyg.2018.00638.

Source: PubMed

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