Child and Parent Mindfulness-Based Training Versus Medication for Childhood ADHD: A Randomised Clinical Trial

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.