Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is the most prevalent neurodevelopmental disorder in children and adolescents. It is marked with deficits in behavioral symptoms of hyperactivity/impulsivity along with cognitive deficits in the domain of attention, self-regulation, and executive function. Mindfulness-Based Interventions (MBI) have come up as an intervention of choice for various psychological disorders such as anxiety disorder, depression, substance abuse, and eating disorder. Mindfulness at its core is paying non-judgmental attention to the present moment. Despite the robust evidence for both of the treatment modalities available, the cognitive symptoms of ADHD still progress towards adulthood affect the individual's achievement and overall psychosocial adjustment. A number of recent studies have found preliminary evidence about the effectiveness of MBI as an adjunct treatment in ADHD. The chapter will discuss the evidence-based interventions that incorporate mindfulness.
TopIntroduction
Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common developmental disorder of childhood, with a tendency to persist into adulthood. Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5), describes ADHD as a disorder of inattention and/or hyperactive/impulsive behaviour which is inconsistent with developmental level and also causes impairment in socio-occupational functioning (Chimiklis et al., 2018). For a diagnosis of ADHD, it is necessary for symptoms to be present prior to age 12, persist for at least six months with significant impairment in socio-occupational functioning. The worldwide prevalence of ADHD is 5.29% as estimated by a systematic review and meta-analysis (Polanczyk et al., 2007). Children or adult with ADHD generally present with following clinical features:
Hyperactivity: Hyperactivity implies the inappropriate excessive motor activity including restlessness, fidgeting, and appearing to be “driven by a motor.” These behaviours are often first noticed in the initial years of development, but can be normal phenomenon before age four. The level of hyperactivity usually decreases with age, however, the inner sense of restlessness may continue into young adult life. Children with ADHD display sustained levels of high activity in different settings such as home, school, and playgroup.
Impulsivity: Impulsive actions occur without forethought about consequences and may be associated with desire for immediate rewards or to avoid delay. Impulsivity might be evident when the child engages in dangerous activities, yells out in class, or interrupts or intrudes others during games or conversation. Symptoms of impulsivity can persist into adulthood, even after hyperactive symptoms have diminished.
Attentional Difficulties: Inattention includes difficulty sustaining focus, poor organizational skills, and being easily distracted by extraneous stimuli (Posner, 1995). The symptoms of inattention often become prominent in primary school when the child is approximately 8 to 9 years old. Attentional difficulties are commonly seen in routine settings wherein the children with ADHD must sit and do repetitions task with low levels of reinforcement and external motivation.
Assessment Scales for ADHD
Commonly used outcome measures in most of the studies are described in table 1.
Table 1. Detailed description of rating scales for ADHD
| Name of rating scales | Author/year | Age range | Items | Description |
| Behaviour assessment system for children (BASC-2) |
Kamphaus, 2014
| 2 years - 21 years | 161 | Integrated assessment system that includes various forms such as parent form, teacher form, self-report etc. It utilizes variety of methods and modes to gather information about a children’s emotions and behaviour to generate an interpretative profile |
| Connors - 3P and Connors 3 -SR | Connors, 2008 | 6 years – 18 years | 108 | It assesses ADHD and common co-morbid problems in children and adolescents as present in different settings such as home, social, and school |
| Youth Self Report (YSR) |
Ivarsson et al., 2002
| 11 years - 18 years | 112 items | Self-report measure designed for adolescents to assess the problem behaviour and behavioural competency |
| Child behaviour checklist (CBCL) |
Achenbach, 1999
| 2 years -18 years | 113 items | Most widely-used parent report measure in child psychology for evaluating the problem behaviours and emotional problems in children and adolescents |
Key Terms in this Chapter
Task Completion: The consummation of a given task with satisfactory standards within the stipulated time interval.
Attention Regulation: The ability to self-monitor one's deployment of attention, which includes maintaining attention, ignoring distracting or irrelevant stimuli, staying alert to task goals, and coordinating one's attention during a task.
Impulse Control: The ability to control an impulsive act or behaviour which is potentially harmful to self or others.
Self-Regulation: The autonomous and conscious management of arousal or activity in attention, emotion, and stress response systems in ways that progress towards attainment of goal-directed actions.
Mindfulness: Process of paying non-judgemental attention to the present moment.