Mindfulness as an Intervention for Anxiety and Attention-Deficit/Hyperactivity Disorder
University of British Columbia
Research Proposal
Emily Walker
Tina Gunn
MINDFULNESS INTERVENTION FOR ANXIETYAND ADHD 2
Introduction
Generalized anxiety disorder (GAD) can present itself as excessive worry, apprehension
or uneasiness of the mind over an anticipated or impending event or activity (Diagnostic and
Statistical Manual of Mental Disorders, 4th edition (DSM-IV), 2000; Semple, Reid & Miller,
2005). An individual with a GAD diagnosis can experience clinically significant distress or
impairment in school and social functioning, find it difficult to concentrate, experience muscle
tension, be restless and easily become fatigued or irritable (DSM-IV, 2000). Attention-
Deficit/Hyperactivity Disorder (ADHD) can present itself as a combination of inattention and
hyperactive-impulsive symptoms that can also cause an individual with an ADHD diagnosis to
experience clinically significant impairments in social and academic functioning (DSM-IV,
2000). Some of these symptoms include: difficulties sustaining attention in tasks or play
activities, difficulties organizing tasks, being easily distracted, often avoiding or is reluctant to
engage in tasks that require sustained mental effort, often leaving their seat in classrooms and has
difficulties waiting their turn and interrupts others (DSM-IV, 2000).
A child who has characteristics of both of these diagnoses will experience anxiety in a
classroom setting and could engage in off task and problem behaviour during classroom time
meant for teaching and academic work. Therefore, it is important for research to focus on the
development of effective interventions to decrease anxiety and problem behaviours and increase
on task behaviour in the classroom for children diagnosed with GAD and ADHD.
ADHD and has been effectively treated with cognitive behaviour therapy, parent
management training, and medication (Van der Oord, Bogels, & Peijnenburg, 2008). However,
these treatments are not ideal due to several limitations. First, cognitive behaviour therapy has
short-term effects on children with ADHD and generalization of skills is often low (Chambles &
MINDFULNESS INTERVENTION FOR ANXIETYAND ADHD 3
Ollendick 2001; Pelham & Fabiano, 2008). Second, parent management training, although
effective, a non-response to this treatment is predicted when parents also have ADHD (Sonuga-
Barke, Daley, & Thompson, 2002; Van den Hoofdakker et al., 2010). Furthermore, the effects of
parent management training appear to be better in pre-adolescent children than in adolescent
children (Barkley, 2004; Chronis et al. 2004). Third, medication is effective in the short term
and is often accompanied by side effects. Findings also indicate that treatment fidelity decreases
with adolescent children (Schachter, Pham, King, Langford, & Moher, 2001). The risk for
suicide is nearly three times higher for children with ADHD (James, Lai, & Dahl, 2004);
therefore, there is a need to investigate alternative treatments to children with ADHD.
Cognitive behaviour therapy has been shown to be effective in treating children with
anxiety disorders (Flannery-Schroeder & Kendall, 2000; Kendall, 1994; Kendall et al., 1997).
Although one study has reported effects lasting more than three years (Kendall & Southam-
Gerow, 1996), others have reported inconsistent results (Last, Hansen, & Franco, 1998) and have
questioned whether treatment gains can be sustained (Hayward et al., 2000). Due to inconsistent
findings and the prevalence of anxiety in children, it is important to investigate alternate
treatments.
One model for intervention draws from the construct of mindful awareness. Mindfulness
is a state of awareness of your own mind at any given moment; it means to pay attention and to
be focused on the present moment without judgment (Kabat-Zinn, 1994). Recent research
suggests that a mindfulness intervention can be successful to decrease anxiety, increase academic
functioning and decrease attention and behaviour problems in children (Flook et al., 2010;
Kendall, 1994; Semple, Lee, Rosa & Miller, 2010; Semple, Reid & Miller, 2005; Singh et al.,
2010; Smalley et al., 2009). For example, Flook et al. (2010) implemented a mindfulness
MINDFULNESS INTERVENTION FOR ANXIETYAND ADHD 4
awareness program call the Inner Kids Program with second- and third-grade children ages 7-9
years. The efficacy of the mindfulness intervention was assessed within a randomized
experimental design with a control group. Results showed that mindfulness awareness training
showed improvements in the children’s behaviour regulation, metacognition, and overall global
executive control.
The proposed research aims to further examine the potential of a mindfulness-based
intervention for decreasing anxiety and problem behaviours, increasing on task behaviour, and
increasing task accuracy in a school setting with children who experience anxiety and
characteristics of ADHD. This study will replicate and expand on the findings of Flook et al.
(2010) and Semple et al. (2005) by using the Inner Kids Program with older students (aged 9-12)
who have been diagnosed with Generalized Anxiety Disorder and ADHD in a school setting.
Few studies to date have focused on a teacher-led mindfulness intervention with children who
are diagnosed with both GAD and ADHD. It is hypothesized that through teacher-led
mindfulness interventions, children will experience fewer symptoms of anxiety, engage in more
on task, pro-social behaviour and social validity will be high.
Methods
Research Question
This study aims to address the research question: Is there a functional relation between a
mindfulness based intervention and a decrease in anxiety and Attention-Deficit/Hyperactivity
Disorder (ADHD) problem related behaviours and an increase in engaged time in learning
activities and in task accuracy in a school setting with children who experience anxiety and
characteristics of ADHD?
MINDFULNESS INTERVENTION FOR ANXIETYAND ADHD 5
Participants
Four students, between the ages of 9 and 12, from four different schools will participate
in the study. All students will be diagnosed with ADHD and/or generalized anxiety disorder. The
students participating in this study will show visible symptoms of ADHD or generalized anxiety
disorder such as off-task, problem behaviour and low task accuracy. All students will be enrolled
in schools located in the Lower Mainland and must not have any history of participating in
mindful awareness practice. Students participating in this study must not be starting any new
medications nor will they be starting any medications during the course of the study.
Participants will be recruited for this study in the following way. The district
superintendent will be contacted first to receive permission to conduct a research study in the
school district. After receiving permission to conduct the proposed study, integration support
teachers within the school district will be contacted and asked to recommend students from their
caseloads that have a current diagnosis of ADHD or generalized anxiety disorder. A letter will
be sent out to teachers and parents of the recommended students outlining the research study to
determine if there is interest in participating. Among those teachers and parents who express an
interest in participating in the study, an informed consent form for initial screening will be given
to the teachers and parents of the recommended students. The initial screening process will
include a classroom observation of the potential participants during academic learning activities
to confirm the possibility of baseline. Some students who are not participants may be captured
on videotape during the observation. Therefore, permission to videotape will be obtained from
parents of all students in the classroom. Parents will be informed that the videotape will be used
in a locked lab, their child may be in the background of the video, and researchers will only take
data on the child who is a potential participant for the study. A study participation consent will
MINDFULNESS INTERVENTION FOR ANXIETYAND ADHD 6
be sent home to parents of students who meet the criteria for being a participant in the study.
After receiving study participation consent from parents, students will then be contacted to
request their informed assent to participate in the study. Once informed assent is given, students
will be accepted as participants for the proposed study.
Setting
Intervention will take place in the morning at 9:00am in the natural classroom. The
duration of intervention ranges from 5-15 minutes depending on the level of students. There will
be 24 - 30 students in the natural classroom. Observation sessions will also take place in the
natural classroom either between recess and lunch (10:30 am -12:00 pm) or after lunch (12:30
pm - 2:30 pm) and will last for an hour. During observation sessions, classroom activities will
include math, science, social studies, and language arts lessons. These lessons will include pen
and paper work, hands-on activities, and/or group work. Intervention and observation sessions
will be videotaped and they will be coded in a research lab.
Measurement
Dependent Variables. Research suggests that a mindfulness intervention can be
successful to decrease anxiety, increase academic functioning and decrease attention and
behaviour problems in children who experience symptoms related to anxiety and ADHD (Flook
et al., 2010; Kendall, 1994; Semple et al., 2010; Semple et al., 2005; Singh et al., 2010; Smalley
et al., 2009). Therefore, the dependent variables chosen for this study will be engaged time,
problem behaviour related to anxiety and ADHD, and task accuracy. Each are defined below:
Engaged time. Engaged time refers to students’ active participation in classroom learning
activities. Some examples include: Maintaining focus during instructional time; completing
MINDFULNESS INTERVENTION FOR ANXIETYAND ADHD 7
given assignments; participating in class discussions; following instructions, rules and routines;
and working independently and in groups.
Problem behaviour. Behaviour that interferes with student learning and social-emotional
health will be defined as problem behaviour. Problem behaviour will include observable
behaviours such as non-compliance, defiance, leaving seat, putting head down on desk,
interrupting others, and self-injurious behaviour.
Task accuracy. Task accuracy will be defined as whether an assignment was completed
as requested and includes accurate responses based on the information provided during
instructional time by the classroom teacher. Examples of task accuracy include providing correct
answers to math, science or social studies questions; and writing a story that has a plot and well-
developed characters.
Social validity. Social validity refers to “the estimation of the importance, effectiveness,
and/or satisfaction various people experience in relation to a particular intervention” (Kennedy,
2005, p. 219). Examples of social validity include the students show improvement in classroom
behaviours and academic performance, the teachers can easily implement and sustain the
intervention over time, and the students enjoy participating in mindful awareness activities and
are able to independently use mindfulness to regulate behaviour.
Implementation fidelity. Implementation fidelity refers to whether or not the
intervention is being implemented as intended. In this study, implementation fidelity will be
defined as teachers following the Inner Kids curriculum lesson plans and delivering the lessons
on the prescribed schedule.
Measurement Procedures. Learning activities will occur in the natural classroom
setting. Both intervention and observation sessions will be videotaped. Child behaviour and
MINDFULNESS INTERVENTION FOR ANXIETYAND ADHD 8
participation in learning activities in the classroom will be coded in a research lab following each
observation session. Measures of engaged time and problem behaviour will be collected using a
partial interval recording system. The intervals will be divided into 15 s intervals. Observers
will observe the videotape and record intervals of the occurrence and non-occurrence of students
being engaged in learning and of being engaged in problem behaviour. Written assignment
samples will be collected for measuring task accuracy.
Engaged time. Some examples of the occurrence of engaged time include listening to
the teacher, participating in class discussions, following instructions, working independently, and
working in small groups for 10 out of 15 s without problem behaviour. Conversely, if the
student is not doing any of above-mentioned behaviours during the interval, it is considered to be
a non-occurrence of engaged time. Engaged time will be measured as percentage of intervals of
engaged time. The formula for calculating the percentage will be number of intervals scored as
occurrences of engaged time (E) divided by the total possible intervals (T) multiplied by 100%,
(E/T)100%.
Problem behaviour. The occurrence of problem behaviours include non-compliance,
defiance, leaving seat, putting head down on desk, interrupting others, engaging others in off-
topic conversation and self-injurious such as scratching skin until it bleeds. If the child does not
demonstrate the above behaviours during the 15 s interval, it is considered to be a non-
occurrence of problem behaviour. Problem behaviour will be measured as percentage of
intervals of problem behaviour. The formula for calculating the percentage will be number of
intervals scored as occurrences of problem behaviour (P) divided by the total number of intervals
(T) multiplied by 100%, (P/T)100%.
MINDFULNESS INTERVENTION FOR ANXIETYAND ADHD 9
Task accuracy. Work samples from the observation session will be collected and marked
according to a pre-determined rubric provided by the teacher to give a percentage of task
accuracy. If a response matches the criteria of the given rubric it is considered to be correct (i.e.,
an occurrence of task accuracy), if the response does not match the criteria in the given rubric, it
is considered to be incorrect (i.e., a non-occurrence of task accuracy). The formula for
calculating percentage of task accuracy will be number of correct answers (C) divided by the
total number of questions (T) multiplied by 100%, (C/T)100%.
Social validity. To address issues of social validity, teachers will be asked to answer
questions on a Likert-type scale, 1 meaning disagree and 5 meaning agree, about the MAPs
intervention goals, strategies, and outcomes. The teachers will complete the questionnaire at the
end of the 8 – week intervention phase and again during the maintenance and follow-up phase.
The formula for calculating social validity will be the total number of teacher agreement scores
(A) divided by the total number of possible scores (T) multiplied by 100%, (A/T)100%.
Implementation fidelity. Teachers will complete an implementation fidelity checklist
after each intervention session. The formula for calculating implementation fidelity will be the
number of strategies implemented by the teachers (I) divided by the total number of strategies
(T) multiplied by 100%, (I/T)100%. The intervention sessions will be videotaped so that
researchers will be able to provide feedback and further training if required. In addition, the
videotaped intervention sessions will be used to measure inter-observer agreement.
Observer training. To determine appropriate coding criteria, the researchers will watch
and code three videotaped sessions together and mark the corresponding assignment samples
using the marking rubric provided by the teacher. Examples and non-examples of engaged time
and problem behaviour will be determined in each video, and the examples and non-examples of
MINDFULNESS INTERVENTION FOR ANXIETYAND ADHD 10
accurate responses will be determined for each writing sample. Two research assistants will be
trained to 90% accuracy to serve as data collectors. Each assistant will be provided a written
manual, receive direct instruction, and complete three consecutive pilot observations and
marking work samples with one of the main researchers. A debriefing will follow each pilot
observation and marking session. Retraining will occur periodically during the study to control
for observer drift.
Inter-observer agreement procedures. Sequential coding of probe observational
sessions, which will be chosen at random, will be used. This means one research assistant and
one of the researchers will independently observe and code the same video. The observing and
coding of videos will take place on the same day that the probe observation session takes place.
Each of the following variables will be measured for agreement: (a) percentage of intervals for
engaged time, (b) percentage of interval for problem behaviour, and (c) task accuracy. For task
accuracy, one research assistant and one researcher will independently mark the subjective work
samples from the observation session and mark it according to the rubric provided by the teacher.
The researchers will then compare the percentages. For problem behaviour and for engaged
time, the research assistant and one researcher will independently mark the occurrence and non-
occurrence of problem behaviour and of engaged time. To ensure independence, the observers
will score these variables at the same starting point in the observation but at different times.
Inter-observer agreement for problem behaviour and for engaged time will be measured using
Cohen’s Kappa. The formula for Cohen’s Kappa is as follows: 2(ad - bc)/(n1f2 + n2f1).
MINDFULNESS INTERVENTION FOR ANXIETYAND ADHD 11
Observer 1
Agree Disagree
Observer
2
Agree a b f1
Disagree c d f2
n1 n2
Inter-observer agreement will be recorded for 33% of the observational sessions, which will be
evenly distributed across each phase. Inter-observer agreement for task accuracy will be
measured using a reliability percentage. The formula for reliability percentage is as follows: (L%
/ H%)100 = R%. Where L is equal to the lower percentage given by a data collector and H is
equal to the higher percentage give by a data collector and R equals the reliability percentage.
Reliability agreement will be used when the data collectors are required to use some subjectivity
when marking assignments (e.g. story writing and art projects).
Research Design
A concurrent multiple baseline design across students will be used to assess the effects of
the Inner Kids mindfulness awareness training program on students’ engaged time during
learning activities, problem behaviour, and task accuracy. One reason for choosing a multiple
baseline is that the independent variable (i.e., mindful awareness training) is non-reversible; it
involves the learning of a new skill. Having a concurrent baseline allows the researchers to
simultaneously evaluate the dependent variables (i.e., engaged time, problem behaviour, and task
accuracy) across participants. Four baselines will be used to prevent threats to internal validity
such as attrition and weak/no effect. Each participant will be randomly assigned to the baselines.
The design will have three phases: baseline, treatment, and follow-up. A multiple probe
MINDFULNESS INTERVENTION FOR ANXIETYAND ADHD 12
measurement procedure will be used to reduce effects of reactivity to continuous measurement
(Horner & Baer, 1978).
Research Procedures
Preparation. After participants have been recruited and consent has been received from
parents, schools, and students, classrooms will be equipped with video recording devices placed
in discreet, non-obtrusive locations to record student behaviour in the classroom across baseline,
intervention, and follow-up phases.
Prior to baseline measurement, a number of academic classroom learning activities will
be video taped for analysis of dependent measures. The pilot observation will be conducted for
the purpose of testing out the equipment, reducing reactivity, and for having data to train
observers.
Baseline. Observation sessions at baseline will be recorded and the video recordings will
be coded in a research lab. Data will be collected on the percentage of intervals of problem
behaviour related to ADHD and generalized anxiety disorder, the percentage of intervals of
engaged time in the classroom, and percentage of task accuracy. Teachers will give researchers a
marking rubric so data collectors will be able to collect data on task accuracy in the research lab.
Data will be collected in the first baseline until a stable level of behaviour is established. A
minimum of 3 data points will be gathered for each participant, with additional observation
sessions as necessary to establish the stability of baseline data. There will be a staggered start
time of intervention across the first three participants. The last two participants will start
intervention simultaneously unless there is participant attrition or a stable baseline was not
established.
MINDFULNESS INTERVENTION FOR ANXIETYAND ADHD 13
Intervention. Teachers will be trained in the Mindful Awareness Practice (MAP)
intervention (Flook et al., 2010) and will also be trained on how to correctly complete an
implementation fidelity checklist. Teachers will implement the MAPs training in the natural
classroom. The MAPs training that will be used in this study was developed by Susan Kaiser-
Greenland, who modeled her curriculum after classical mindfulness training for adults and
modified the training to be suitable for children (Flook et al., 2010). Intervention will be
delivered twice a week over 8 weeks for a total of 16 sessions.
The MAPs training will include exercises and games that promote different learning
objectives: (a) sensory awareness, attention regulation and awareness of thoughts and feelings;
(b) awareness of others (being aware of other people’s thoughts and feelings and being aware of
body placement in relation to other people); and (c) awareness of the environment (being aware
of relationships between people, places and things) (Flook et al., 2010). Each intervention
session will involve three standard sequences. The first sequence includes meditation for
approximately 3 minutes; the second sequence contains activities and games that promote each
week’s learning objective; and the third sequence includes a body scan meditation while lying
down for approximately 5 minutes. The duration of the first and third sequences, which are
reflective activities, will gradually increase over the 8-week intervention period while the second
sequence, which is more goal directed, will become shorter in duration (Flook et al., 2010).
Maintenance and Follow-up. Teachers will continue with MAPs training for students
after the intervention phase by engaging students in a daily 5-minute MAPs session. Follow-up
measures across all dependent variables will be gathered once per month for six months
following the intervention phase.
MINDFULNESS INTERVENTION FOR ANXIETYAND ADHD 14
Anticipated Results
The anticipated results for baseline, intervention, and follow-up phases for engaged time
are presented in figure 1, for problem behaviour are presented in figure 2, and for task accuracy
are presented in figure 3.
Baseline
It is anticipated that the percentage of intervals with engaged time will be low (ranging
between zero and 30%), the percentage of intervals with problem behaviour will be high
(ranging from 50% to 90%), and the percentage of task accuracy will be low (ranging from zero
to 50%). This prediction is based on evidence that students with ADHD and GAD have poor
executive functioning, which is associated with cognitive deficits, poor socio-emotional health,
and poor academic functioning (Flook et al., 2010). In addition, students with these diagnoses
typically experience difficulties concentrating and engage in maladaptive behaviours (DSM-IV,
2000).
Intervention
It is anticipated that the percentage of intervals with engaged time will increase gradually
during intervention to 70-85%, the percentage of intervals with problem behaviour will decrease
gradually to 0-15%, and the percentage of task accuracy will increase gradually to 70-90%. This
optimistic gradual increase is based on the idea that proficiency in mindfulness is cultivated
through repetition and continuous practice (Flook et al., 2010) . It is also based on scientific
research that mindful awareness training has a strong effect on children who have executive
function difficulties and that adolescents who participated in mindfulness training demonstrated
reduced attention and behaviour problems and improved executive functioning (van de Weijer-
Bergsma et al., (2011). It is anticipated that social validity results will be positive, 85-95%, as
MINDFULNESS INTERVENTION FOR ANXIETYAND ADHD 15
mindful awareness practices are easy to implement in natural settings (i.e., the classroom), they
are cost effective, and the outcomes for students (increased engaged time, reduced problem
behaviour, and increased task accuracy) are positive.
Follow-up
It is anticipated that there will be a stable or slight increase in percentage of intervals with
engaged time, a stable or slight decrease percentage of intervals with problem behaviour, and a
stable or slight increase percentage of task accuracy over time. This prediction is based on the
assumption that teachers will continue with MAPs training for students after the intervention
phase and that the students will continue to participate in a daily 5-minute MAPs session. Flook
et al. (2010) reported finding that improvements in children’s behavioural regulation increased
with practice and generalized across settings. Therefore, we anticipate that with regular practice
students will maintain improvements and generalize across settings. An area for further research
may involve longitudinal studies on the effects of mindfulness training and if children are able to
maintain positive effects into adulthood.
MINDFULNESS INTERVENTION FOR ANXIETYAND ADHD 16
Figure 1. Percentage of intervals of engaged time for 4 participants before, during, and after
mindfulness training using the Inner Kids Program developed by Susan Kaiser-Greenland.
MINDFULNESS INTERVENTION FOR ANXIETYAND ADHD 17
Figure 2. Percentage of intervals of problem behaviour for 4 participants before, during, and
after mindfulness training using the Inner Kids Program developed by Susan Kaiser-Greenland.
MINDFULNESS INTERVENTION FOR ANXIETYAND ADHD 18
Figure 3. Percentage of task accuracy for 4 participants before, during, and after mindfulness
training using the Inner Kids Program developed by Susan Kaiser-Greenland.
MINDFULNESS INTERVENTION FOR ANXIETYAND ADHD 19
References
Achenbach, T. M. (1991). Manual for the Child Behavior Checklist: Ages 4-18 and 1991 profile.
University of Vermont, Department of Psychiatry, Burlington, VT.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental
disorders: DSM-IV-TR. Washington, DC: Author.
Biederman, J., Monuteaux, M. C., Doyle, A. E., Seidman, L. j., Wilens, T. E., Ferrero, F., et al.
(2004). Impact of executive function deficits and attention-deficit/hyperactivity disorder
(ADHD) on academic outcomes in children. Journal of Consulting and Clinical
Psychology, 75(5), 757-766.
Barkley, R. A. (2004). Adolescents with attention-deficit/hyperactivity disorder: An overview of
empirically. Journal of Psychiatric Practice, 20, 39–56.
Blair, C. (2002). School readiness. Integrating cognition and emotion in a neurobilological
conceptualization of children’s functioning at school entry. American Psychologist,
57(2), 111-127.
Chambles, D. L., & Ollendick, T. H. (2001). Empirically supported psychosocial interventions:
Controversies and evidence. Annual Reviews of Psychology, 52, 685–716.
Chronis, A. M., Chacko, A., Fabiano, G. A., Wymbs, B. T., & Pelham, W. E. (2004).
Enhancements to the Behavioral Parent Training paradigm for families of children with
ADHD: and future directions. Clinical Child and Family Psychology Review, 7, 1–27.
Flannery-Schroeder, E. C, & Kendall, P. C. (2000). Group and individual cognitive-behavioral
treatments for youth with anxiety disorders: A randomized clinical trial. Cognitive Therapy
and Research, 24, 251-2.
MINDFULNESS INTERVENTION FOR ANXIETYAND ADHD 20
Flook, L., Smalley, S., Kitil, M., Galla, B., Kaiser-Greenland, S., Locke, J., et al. (2010). Effects
of mindful awareness practices on executive functions in elementary school children.
Journal of Applied School Psychology, 26, 70-95.
James, A., Lai, F. H., & Dahl, C. (2004). Attention deficit hyperactivity disorder and suicide: A
review of possible associations. Acta Psychiatrica Scandinavia, 110, 408–415.
Hayward, C, Varady, S., Albano, A. M., Thicnemann, M., Henderson, L., & Schatzberg, A. P.
(2000). Cognitive-behavioral group therapy for social phobia in female adolescents:
Results of a pilot study. Journal of the American Academy of Child and Adolescent
Psychiatry. 39, 721-726.
Horner, D.R., & Baer, D.M. (1978). Multiple probe technique: A variation of the multiple
baseline. Journal of Applied Behavior Analysis, 11, 189-196.
Kabat-Zinn, J. (1994). Mindfulness meditation for everyday life. New York: Hyperion.
Kendall, P. C. (1994). Treating anxiety disorders in children: Results of a randomized clinical
trial. Journal of Consulting and Clinical Psychology, 62, 100-110.
Kendall, P. C, Flannery-Schroeder, E., Panichclli-Mindel, S. M., Southam-Gerow, M., Henin,
A., & Warman, M. (1997). Therapy for youths with anxiety disorders: A second
randomized clinical trial. Journal of Consulting and Clinical Psychology, 65, 366-380.
Kendall, P. C, & Southam-Gerow, M. A. (1996). Long-term follow-up of a cognitive-behavioral
therapy for anxiety-disordered youth. Journal of Consulting and Clinical Psychology, 64,
724-73.
Kennedy, C. H. (2005). Single case designs for educational research. Boston: Allyn & Bacon.
Last, C. G., Hansen, C, & Franco, N. (1998). Cognitive-behavioral treatment of school phobia.
Journal of the American Academy of Child and Adolescent Psychiatry, 37, 404-411.
MINDFULNESS INTERVENTION FOR ANXIETYAND ADHD 21
Madaan, V., Daughton, J., Lubberstedt, B., Mattai, A., Vaughan, B. S., & Kratochvil, C. J.
(2008). Assessing the efficacy of treatment for ADHD: Overview of methodological
Issues. CNS Drugs, 22(4), 275.
March, I. S. (1997). Multidimensional Anxiety Scale for Children: Technical manual. Toronto,
Ontario: Multi-Health Systems, Inc.
Pelham, W. E., & Fabiano, G. A. (2008). Evidence-based psychosocial treatments for Attention-
Deficit/Hyperactivity Disorder. Journal of Clinical Child & Adolescent Psychology, 37,
184–214.
Schachter, H. M., Pham, B., King, J., Langford, S., & Moher, D. (2001). How efficacious and
safe is short-acting methylphenidate for the treatment of attention-deficit hyperactivity
disorder in children and adolescents? A meta-analysis. Canadian Medical Association
Journal, 165, 1475–1488.
Sciberras, E., Efron, D. & Iser, A. (2011). The Child’s Experience of ADHD. Journal of
attention disorders, 15(4), 321-327.
Semple, R., Lee, J., Rosa, D., & Miller, L. (2010). A randomized trial of mindfulness-
based cognitive therapy for children: promoting mindful attention to enhance social-
emotional resiliency in children. Journal of Child and Family Studies, 19(2), 218-229.
Semple, R.J., Reid, E.F.G.,& Miller, L. (2005). Treating anxiety with mindfulness: An
open trial of mindfulness training for anxious children. Journal of Cognitive
Psychotherapy, 19, 379-392.
Singh, N.N., Singh, A.N., Lancioni, G.E., Singh, J., Winton, A.S.W., & Adkins, A.D.
(2010). Mindfulness training for parents and their children with ADHD increases the
children’s compliance. Journal of Child and Family Studies 19(2), 157-166.
MINDFULNESS INTERVENTION FOR ANXIETYAND ADHD 22
Smalley, S.L., Loo, S.K., Hale, T.S., Shrestha, A., McGough, J., Flook, L., & Reise, S.
(2009). Mindfulness and attention deficit hyperactivity disorder. Journal of Clinical
Psychology 65(10), 1087-1098.
Sonuga-Barke, E. J. S., Daley, D., & Thompson, M. (2002). Does maternal ADHD reduce the
effectiveness of parent training for preschool children’s ADHD? Journal of the American
Academy of Child and Adolescent Psychiatry, 41, 696–702.
Van de Weijer-Bergsma, E., Formsma, A. R., de Bruin, E. I. & Bogels, S. M (2011). The
effectiveness of mindfulness training on behavioral problems and attentional functioning
in adolescents with ADHD. Journal of Child Family Studies. DOI 10.1007/s10826-011-
9531-7.
Van den Hoofdakker, B. J., Nauta, M. H., Van den Veen-Mulders, L. J., Sytema, S.,
Emmelkamp, P. M. G., Minderaa, R. B., et al. (2010). Behavioral parent training as an
adjunct to routine care in children with Attention-Deficit/Hyperactivity Disorder:
Moderators of treatment response. Journal of Pediatric Psychology, 35, 317–326.
Van der Oord, S., Bo¨ gels, S. M., & Peijnenburg, D. (2011). The effectiveness of mindfulness
training for children with ADHD and mindful parenting for their parents. Journal of Child
and Family Studies, 21(1), 139-147. doi:10.1007/s10826-011-9457-0.
MINDFULNESS INTERVENTION FOR ANXIETYAND ADHD 23
Appendix
Timeline
Weeks 1-4
- Complete literature search related to research topic area
- Obtain approval of thesis topic from supervisor and thesis
committee
- Write literature review
- Complete thesis proposal
- Submit ethical review application
Weeks 5-9 - Contact creators of Inner Kids mindfulness awareness training
program and inform them of our replication study
- Recruit graduate students to act as observers
- Discuss feedback from ethical review board with supervisor
- Revise and re-submit ethical review application if applicable
- Purchase video equipment
Weeks 10-14 - Recruit students and schools to participate in the study
o Contact district superintendent
o Contact integration support teachers
o Send letters to teachers of students who were
recommended by integration support teachers
- Obtain informed consent for initial screening of participants
- Send consent forms to the parents of students recommended for
the study
- Obtain permission from all parents of students in classroom to
videotape
- Create video samples that will be used for training on how to
code behaviour
- Train observers on how to code engaged time, problem behaviour
(partial interval recording system of 15-second intervals) and task
accuracy (written assignment samples)
- Assess inter-observer agreement
- Randomly assign participants to baselines
- Set up video recording equipment in classrooms in discrete
locations
- Conduct pre-baseline observation sessions
- Meet with supervisor to discuss progress
Weeks 15-16 - Implement baseline phase for all four participants
- Meet with supervisor to discuss implementation progress
Weeks 17-27 - Train teachers on MAPs training and how to use implementation
checklist (minimum of two training visits)
- Implement first intervention phase (8 weeks)
- Meet with supervisor to discuss data and implementation progress
for first and second participants
- Implement second intervention phase (8 weeks)
- Continue to recruit participants if necessary
- Conduct follow-up with first baseline
- Meet with supervisor to discuss data and implementation progress
for first, second and third participants
- Implement third and fourth intervention phase (8 weeks)
MINDFULNESS INTERVENTION FOR ANXIETYAND ADHD 24
- Conduct follow-up with first and second baseline
- Meet with supervisor to discuss data and implementation progress
for first, second, third and fourth participants
Weeks 28-29 - Conduct follow-up with baseline groups
- Meet with supervisor to discuss data and implementation progress
Weeks 30-35 - Begin writing up results
- Continue with follow-ups with baseline groups for six months
- Meet with supervisor to discuss results
Weeks 35-36 - Defend thesis research
- Prepare draft of manuscript for publication
Weeks 36 - Share draft of manuscript with supervisor
Week 37 - Discuss feedback with supervisor and revise manuscript
Weeks 37-40 - Complete manuscript and submit for publication
o Write draft of article to submit for publication in a peer-
review journal
o Submit to supervisor for feedback
o Revise article based on feedback
o Send to publication
Implementation Checklist
Mindful Awareness Practice (MAP)
Date:_____________ Person Completing Checklist__________________________
Not in
Place
Fully in
Place
1. MAPs training was implemented in the natural classroom 1 2 3 4 5
2. Meditation exercises were completed as the first sequence of MAPs training 1 2 3 4 5
3. Goals and learning objectives were outlined, explained and practiced through
activities and games (second sequence of MAPs training)
1 2 3 4 5
4. Body scan meditation was completed as the last sequence of MAPs training 1 2 3 4 5
Problem behaviours during MAPs training Behaviour Occurred
1. Non-compliance 1 2 3 4 5 or more
2. Interrupting others 1 2 3 4 5 or more
3. Self injurious behaviour 1 2 3 4 5 or more
4. Leaving seat 1 2 3 4 5 or more
5. Putting head down on desk 1 2 3 4 5 or more
6. Defiance 1 2 3 4 5 or more
Social Validity Disagree Agree
1. The goals of MAPs are acceptable and important 1 2 3 4 5
2. The strategies are useful and effective 1 2 3 4 5
3. The strategies are difficult to use 1 2 3 4 5
4. Students are successful with MAPs training sessions 1 2 3 4 5
5. We believe the MAPs is successful 1 2 3 4 5
6. Students are engaged during MAPs training sessions 1 2 3 4 5
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