As a psychotherapist who predominantly works with children and adolescents, I have seen many patients who reported having a diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD). In the 1970’s approximately 2000 children in America were diagnosed as hyperactive (Levine, 2004, as cited in Stolzer, 2009). More recently it was estimated that 8-10 million children in America had been formally diagnosed with ADHD; a majority of these children were being prescribed psychostimulants to treat the disorder (Baughman, 2006, as cited in Stolzer, 2009).

A few years ago I took a course in mindfulness-based meditation. My own working definition of mindfulness is “the simple awareness of external and bodily sensations.” Many people identify characteristics of meditation in the practice of yoga. Yoga is a natural stress-reducer, and many adults use it for improvement of physical and mental health. Yet there are very few outlets similar to yoga aimed at children.

Research has shown that mindfulness-based treatment interventions may be effective for a range of mental and physical health disorders in adult populations, but little is known about the effectiveness of such interventions for treating adolescents or children. With the slow, focused, and calming aspects of mindfulness meditation, I wondered the effects it would have on children with ADHD who are often impulsive, unfocused, hyperactive, and fidgety.

After some research, I began incorporating mindfulness-based meditation into my work with children diagnosed with ADHD. When the meditation was used in conjunction with play or talk therapy, the results were extremely positive. I noticed many of the children were able to slow their thoughts and impulses, and were more aware of their actions both in the home and during school.

Today I focus on five mindfulness techniques: sitting meditation, breathing practice, re-directing attention, walking meditation, and what I coined the “freeze game.” I begin simply by introducing sitting meditation at the end of a session with a child. The child is instructed to sit with his feet flat on the floor, back straight, and hands on his knees. I speak in a gentle, slow voice and instruct the child in the following way:

“I want you to pick a spot on the wall to focus on. Keep your feet flat on the floor and your hands on your knees. Breathe in nice and slow, hold it, and let it out nice and slow. When you feel your feet or your fingers getting wiggly, just say in your head, ‘It’s okay that you’re feeling wiggly, but right now we have to be very still.’ Pretend you’re a statue and all you can do is focus on your breath. Pretend your hands are glued to your knees. Feel every single finger heavy and tight to your pants. Everything is feeling very heavy and still.

Whenever you feel wiggly think about where you’re feeling it and in your head tell that body part that it’s okay, but right now you’re going to be very still.” This meditation only lasts a minute or two this first session, but is expanded by one to two minutes each subsequent session.

The second form of mindfulness I utilize is a breathing practice. In this technique I instruct the child to lie on the floor with a favorite stuffed animal on his/her stomach. The child is instructed to take deep, slow breathes, while watching the movement of the stuffed animal during the process. The movement is discussed after the experience and the child learns to self-sooth and calm hyperactive behaviors during the experience.

The third technique is re-directing. Based on research of mindfulness practices, I created a technique in which the child was able to re-direct his or her focus. By becoming more aware of the feelings in his/her body, the child is able to begin re-focusing attention. As explained by Lee, Semple, Rosa, and Miller (2008) games can be utilized in mindfulness practices with children to encourage mindful seeing, hearing, and touching.

For this technique, I allow the child to pick out a toy or game she/he is interested in playing. Rather than jumping right in like his or her impulses usually dictate, I have the child talk about what the toy looks like, how he/she feels about it, why he/she is choosing it, and what he/she is looking forward to while using it. I then allow the child to begin playing with it. I participate in the play. Once the child becomes fully engaged in the play I say, “Switch!” and the child is then required to put everything back the way he found it and the process is re-started with a new toy or game.

The fourth technique I use is walking meditation. In Buddhist walking meditation, one becomes mindful of his experience while walking, and trying to keep the awareness involved with the experience of walking.

In a similar manner, I utilize the technique with the children I work with by helping the children become more aware of their bodies through walking. We walk around the office and sometimes down the hall being sure to go very slowly, step by step. I often give instruction while we walk which sounds something like this: “Take a very slow step forward. Feel the way your knee bends, and the way your foot feels when it touches the floor. When you feel yourself wanting to go faster or to not go in a straight line, just say in your head, ‘I’m getting tired of walking slow and straight but I’m going to keep on doing it.’ Make sure you breathe nice and slow and pay attention to the way it makes your body feel to go slow after going fast all day.”

Finally, the last technique I began using in my therapy sessions was the freeze game. Again, this was a technique created based on my understanding of the mindfulness-based practices. In this method I turn on music and have the child dance or be silly in the room. After a couple of minutes, I shout out, “Freeze!” The child is then instructed to freeze and remain perfectly still. During the period of stillness, I give the following assertion: “Notice how different your body feels standing perfectly still than it did when it was dancing. Try to stay very still in the position you’re stuck in. Notice if one part of your body wants to move or is getting tired. Instead of moving that body part, try and breathe nice and deep and slow and tell yourself, ‘It’s okay that you’re tired or want to wiggle, but for now you’re going to stay nice and still.’” The freeze lasts a minute or so and then the music resumes. The process re-starts and the freezing gets longer each time.

These methods are extremely beneficial for children to learn because once the techniques are taught, they are easily replicated at home. It is a nice way for parents to bond with their children through relaxed meditation practices before bed. I find a holistic approach (treating the whole child) is much more effective than simply medicating a child with ADHD. The use of mindfulness-based meditation with children, and especially with children diagnosed with ADHD, has proven to be an essential component of my psychotherapeutic practice.

References:

Stolzer, J.M. (2009). Attention deficit hyperactivity disorder: Valid medical condition or culturally constructed myth? Ethical Human Psychology and Psychiatry, 11(1), 5-15.

Lee, J., Semple, R., Rosa, D., & Miller, L. (2008). Mindfulness-Based Cognitive Therapy for Children: Results of a Pilot Study. Journal of Cognitive Psychotherapy, 22(1),     15-28.