13May

Reciprocating Interventions

by Renae Stevenson

Renae Stevenson is an active police officer in Abbotsford, BC, with more than 20 years of investigative experience and 15 years of coaching experience with youth in community sports. Prior to policing, she was a youth worker. She is trained as a mindfulness teacher from UC San Diego's School of Medicine (MBSR), holds a Bachelor’s Degree in Criminology from the University of Alberta, and completed a Master’s Degree in Leadership from Trinity Western University in 2018.

  

Abstract

The diagnostic categorization for Attention Deficit/Hyperactivity Disorder (ADHD) has changed from a behavioural to a neuro-developmental one with the advance of magnetic imaging (APA, 2013).  Neuroimaging research shows structural differences in regions of the brain in both children and adults with ADHD compared to those without diagnoses (Hoogman et al., 2017).

In addition, neuroscience research is beginning to map mindfulness-based intervention’s impact on brain function improving attention skills and increasing cortical thickness in brain regions associated with executive function (Valk, Bernhardt, Trautwein, Bockler, Kanske, Guizard, Collins & Singer, 2017).  The changing perspective for understanding ADHD as neuro-developmental instead of behavioural allows a pedagogical shift to socio-affective and socio-cognitive skill-building, inclusivity versus exclusivity, and sparks a light of hope for ADHD children, their family and their peers, their educators and their communities supporting them.

 

Introduction   

Reciprocal determinism is the continuous interaction and rippling effect of behaviour and its operating conditions within humankind (Bandura, 1971).  Humans don’t live in a hermetically-sealed environment and they especially don’t find the dynamic organism of a classroom static.  It’s not unreasonable to assume in an average British Columbia (BC) classroom of 25 students (McElroy, 2014), at least one student is challenged by Attention-Deficit/Hyperactivity Disorder (ADHD); one teacher is tasked with managing its symptoms; and, 24 other students are impacted by the effect of both.

The lenses through which we’re viewing these kids will have a major influence on the stance we take toward them and the strategies we employ in our efforts to help… Challenging kids are challenging because they’re lacking the skills to not be challenging. (Greene, 2016, p. 4-5)

Only five percent of students are labelled as ADHD, but there is 100% impact to everyone involved – the students, the teachers and the parents.  You can look at a glass as half empty or half full; or, you can engage in the glass and its liquid from the perspective of the liquid denied its freedom by an almost invisible wall.  Stress was historically considered bad for our health until scientists revealed it’s our perception of it as good or bad, which determines its physiological effect as such (McConigal, 2015).

Students with physical disabilities such as seeing-impaired or hearing-impaired are accommodated without dispute, yet those with neurodiverse needs such as ADHD are still struggling.  New guidelines in the Special Education Manual are being reviewed by BC’s Ministry of Education, so students with ADHD will be categorized as learning disabled – a change precipitated by the DSM-5’s reclassification of ADHD from a behavioural category to a neurodevelopmental one (Tomasi, 2017).  It’s a necessary change, responding to the neurological root instead of reacting to its symptoms, and a fundamental step in moving toward appropriate action plans (Searle, 2013).

Attention Deficit/Hyperactivity Disorder is defined by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a condition characterized by a pattern of behaviour in two categories: (a) inattention and hyperactivity and (b) impulsivity (“DSM-5 ADHD Fact Sheet”, 2013).  The pattern of behaviour must also present in multiple settings such as social, educational, and occupational resulting in performance issues (“DSM-5 ADHD Fact Sheet”, 2013).  The Canadian Mental Health Association of British Columbia (CMHABC) states ADHD is a mental illness causing serious problems for school-aged children (2018).  The CMHABC states the illness appears hereditary, more prevalent in boys, often accompanied by another behaviour condition such as a mood or anxiety disorder, and associated with learning and communication problems (2018).

It’s estimated approximately five percent of school-aged children deal with Attention-Deficit Hyperactivity Disorder (ADHD) in Canada (Statistics Canada, 2018).  The onset of ADHD is most typical in children aged three to five, three times more prominent in boys, prevalent into adolescence in 75% of cases and into adulthood in 50% of cases (Statistics Canada, 2018).  Approximately 30-40% of students with ADHD drop out of high school (Tomasi, 2017).

The cause of ADHD is unknown but correlational data suggests genetic influences play a role, as well as non-genetic factors including premature birth, lead exposure in early childhood, brain injuries, and maternal use of stimulants such as alcohol and tobacco (Statistics Canada, 2018).  Neuroimaging research shows structural differences in regions of the brain in both children and adults with ADHD compared to those without diagnoses (Hoogman et al., 2017). Hoogman et al. investigated those differences and found reductions in ADHD subjects in brain volume specific to the amygdala, accumbens, and hippocampus – areas of the brain associated with emotion, behaviour, motivation and memory.  Significant in Hoogman et al.’s research is the finding that the presence of comorbid psychiatric disorders, symptom scores, and psychostimulant medication did not influence results (2017).

 

Mindfulness-Based Interventions

Inquiry into the effectiveness of mindfulness-based interventions (MBI) for children with ADHD is in its infancy; however, the volume of research demonstrating the efficacy of its positive influence on performance including attention and awareness, socio-affective skill development, and socio-cognitive skill improvement is mounting (Hanson & Mendius, 2009; Siegel, 2007).  The emphasis is on building skills – which are lacking – and solving problems with the student, not to him (Greene, 2016).  “Skills are the engine pulling the train; motivation is the caboose (Greene, 2016, p. 22)”.  In addition, neuroscience research is beginning to map MBI’s impact on brain function improving attention skills and increasing cortical thickness in brain regions associated with executive function (Valk, Bernhardt, Trautwein, Bockler, Kanske, Guizard, Collins & Singer, 2017).

Burke (2009) conducted a review of research involving MBI with children and adolescents finding evidence for the feasibility of such interventions, but lacking generalized empirical evidence to larger samples.  Burke found the research is novel: they’re limited to small samples indicating the interventions were acceptable, well-tolerated, and without reports of adverse effects (2009).  For example, a pre-school intervention with children aged 4-5 years found significant improvements in certain domains of executive functioning on teacher ratings but the small sample size limits its generalization (Smalley et al., in Burke, 2009).  A positive outcome of Smalley et al.’s study is the indication children as young as four years old can successfully participate in group meditation practices (Burke, 2009).

When we nurture our sensitivity to experience, we enhance the integration of creativity and flexibility, or right-brain activity, in tandem with sequential ordering and analytic ability, or left-brain activity. When students are taught from within a mindfulness framework, the teacher also benefits from becoming receptive to the students’ many perceptual frameworks for instructional material. (Abrams, in Napoli, Krech, & Holley, 2005, p. 102).

Saltzman and Goldin’s preliminary analysis (2008, in Burke, 2009) found feasibility and improvement in the areas of attention, emotional reactivity, and meta-cognition.  Flook, Smalley, Kitil, Galla, Kaiser-Greenland, Locke, Ishijima and Kasari (2010) studied a school-based mindful awareness practice program with children aged 7-9, and found those students with poor initial executive function showed gains in overall global executive control and in behavioural regulation and metacognition.  Both teachers and parents reported these findings, suggesting the possibility of improvements across various settings (Flook et al., 2010).

The empirical research on MBI specifically with children with ADHD is extremely scarce and limited to small sample sizes.  When Singh, Sing, Lancioni, Singh, Winton, and Adkins (2010) provided a mindfulness intervention to the parent, the child with ADHD found it enhanced positive interactions and improved compliance.  Although their study was limited to only two children, the researchers theorized “mindfulness training produces personal transformations, both in parents and children, rather than teaching strategies for changing behavior” (2010, p. 155).  Zylowska, Ackerman, Yang, Furtrell, Horton, Hale, and Smalley (2008) investigated an 8-week mindfulness intervention with adults and adolescents with ADHD or probable ADHD and found significant improvement in self-reported symptoms, as well as significant differences in neurocognitive measures.  Bogels, Hoogstad, van Dun, de Schutter, and Restifo (2008) noted significant improvements on attention measures following a Mindfulness-Based Cognitive Therapy (MBCT) intervention with adolescents diagnosed with externalizing disorders, including ADHD.  Also of note in their study is that parents of the adolescents participated in a concurrent MBCT program (Bogels et al., 2008). Van der Oord, Bogels, and Peijnenburg (2011) evaluated an 8-week MBI with children aged 8-12 with a parallel mindful training for their parents, and found significant reductions in parent-reported ADHD symptoms (for both themselves and their children) and reductions in parental stress and over-reactivity.  Van der Oord et al. (2011) found teacher-reported ratings of ADHD symptoms of the sample group were non-significant – but teachers didn’t receive concurrent mindfulness training.  The results weren’t reciprocated with the teachers.

 

Conclusion

The study of MBI in child and adolescent ADHD populations is in its infancy. The body of research across diverse general population demographics (including age, race, ethnicity and neurodiversity) shows promising potential for its intervention with ADHD – both for the targeted student, that student’s peers, parents, and teachers. Reciprocating awareness ripples into empathy and compassion – which neuroscience increasingly demonstrates helps executive function. A perspective shift by scientists, administration, and community members toward a continued attitude of neuro-development, a focus on socio-affective and socio-cognitive skills building, and inclusivity versus exclusivity sparks a light of hope – is where transformation truly begins and its reciprocation lasts.

 

References

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