Figure 1
PRISMA Flow Diagram (adapted from Moher et al., 2009)
Table 1
Summary overview of included papers
| Study / Research Design | Sample Characteristics | Treatment, duration and therapist characteristics | Informant Measures | Treatment key findings |
|---|---|---|---|---|
| Carboni (2012) | Children:4 males | • MBSR | Teacher and parent | • BOSS -On task behavior: increase in the percentage of intervals (between 60-62%) |
| Multiple baseline across participants’ design | (M age = 8) Medicated: N= 4 | • 30 to 45 minutes twice per week/ 10 treatment sessions | Measures: | • BRIEF (teachers): Improvement inhibition (RCI= -4.29, -5.71), and Monitor Scale (RCI=-3.40, -7.95, -7.39) |
| (pre-post test design) | (100%) | • BASC-2 | ||
| • Delivered by school Psychologist | • BRIEF | • BRIEF (parents): Improvement inhibition (RCI= -8.20, -2.98, -2.98, -7.46) | ||
| • BOSS | • BASC-2 Hyperactive behavior (teachers): decrease in Hyperactivity (RCI= -2.72, -7.27) | |||
| • BASC-2 Hyperactive behavior (parents) – decrease in Hyperactivity (RCI= -3.8, -5.5, -3.05) | ||||
| Carboni, Roach, Friedrick (2013) | Children:4 males | • MBSR | Teacher and parent Measures: | • BOSS - On task behavior: Increase of percentage of intervals |
| (M age = 8) | • 30 to 45 minutes twice per week/ at least 10 treatment sessions | • BASC-2 | • BASC-2 Hyperactive behavior (teachers): decrease in Hyperactivity (RCI= -2.72, -7.27) | |
| Multiple baseline across participants’ design (pre-post test design) | Medicated: N= 4 (100%) | • Delivered by school Psychologist | • BOSS | • BASC-2 Hyperactive behavior (parents): decrease in Hyperactivity (RCI= -3.8, -5.5, -3.05) |
| Haydicky, Shecter, | Children: | • MBCT | Child and parent | ADHD symptoms |
| Wiener & Ducharme | 5 females and | • 90 minutes’ sessions/8 | Attention – Hyperactivity (Conners 3rd) | |
| (2013) | 13 males (age | weeks | Measures: | • Parental report: no significant changes |
| range 13-18) | • Delivered by Doctoral | • Conners -3rd | • Self-report: no significant changes | |
| And | Medicated: N = 11 (61%) | students in Clinical Psychology | • RCADS | Externalizing symptoms (Conners 3rd) |
| Comorbidity: | • SIPA | • Parental report: decrease in Conduct Problems with a medium to large | ||
| Haydicky, (2014) | Learning | • FAD | effect size (p=0.04, d=0.7), | |
| disability = 4 | • AAQ | • Self-report: no significant change | ||
| Quasi-experimental single group (pre-test, | Depressive | • IM-P | Functional impairment (Conners 3rd) | |
| post-test and follow up) | disorder = 4 | • Parental report: decrease in peer relation problems with a large effect | ||
| Anxiety disorder | size (p=0.002, d=1.07). | |||
| = 1 | • Self-report: significant time effect in the repeated measures ANOVA in | |||
| Family relations (p=0.23) | ||||
| Parents: | Internalizing symptoms (RCARDS) | |||
| 17 mothers 6 | • Self report: no significant changes | |||
| fathers | • Significant reduction with a medium to large effect size at 6 week follow | |||
| up in: depression (p=0.032, d=0.64) anxiety (p.002, d=1.02) and total | ||||
| internalizing problems (p=0.002, d=1.01). | ||||
| Parental stress (SIPA) | ||||
| • Parental report: significant reduction in parenting stress with a large effect size at follow up compared to post-test (p=0.01, d=0.81) | ||||
| • Adolescent domain scales: significant reduction in isolation/withdrawal with a medium to large effect size between pre-post test (p=0.39, d=0.77), whereas a medium effect size was found (p=0.030, d=77) | ||||
| • Significant time effect in the repeated measures ANOVA on the failure to achieve domain (p=0.41) | ||||
| Family functioning (FAD) | ||||
| • Parental report: significant time effect in family functioning (p=0.43) | ||||
| • Self report: significant time effect in conflict intensity (p=0.21) | ||||
| Mindfulness (IM-P) and Acceptance (AAQ) | ||||
| • Parental report: significant time effect in mindful parenting (p=0.27), No changes in acceptance | ||||
| • Self report: a significant time effect in adolescent acceptance (p=0.43) | ||||
| Shecter (2013) | Children = 4 | • MBCT | Child and parent | ADHD symptoms |
| Multiple baseline across | females, 5 males | • 90 minutes / 8 weeks | Attention | |
| participants’ design | (age range | • Delivered by Doctoral | Measures: | • Parental report: reduction in adolescents’ inattention levels reported by |
| (pre-post test design) | 13-18) | students in Clinical | • DSQ | 64% of parents |
| Medicated: N=7 | Psychology | • CSQ | • Self-report: reduction of adolescents’ inattention levels reported in 44% | |
| Comorbidity: | self-reports | |||
| Learning | Hyperactivity | |||
| disability = 5 | ||||
| • Parental report: reduction in adolescents’ hyperactivity levels reported by | ||||
| Depression = 2 | 71% of parents | |||
| Anxiety disorder | • Self-report: reduction in adolescents’ hyperactivity levels reported by 44% | |||
| = 2 | of parents | |||
| Tic Disorder = 1 | Impulsivity | |||
| • Parental report: reduction in adolescents’ impulsivity, according to 64% | ||||
| Parents: | of parents | |||
| 10 mothers, 3 | • Self-report: reduction in impulsivity level, according to 33% of adolescents | |||
| fathers | Meditation practice | |||
| • Parental report: Increase in meditation practice compared to baseline | ||||
| reported by 92% of parents | ||||
| • Self-report: Increase in meditation practice by treatment completion | ||||
| reported by 89% of adolescents | ||||
| Stress | ||||
| • Parental report: improvements in the last half of treatment and/or across | ||||
| follow up reported by 85% of parents | ||||
| • Self report: decrease in stress by end of treatment and follow up reported | ||||
| by 8 out of 9 adolescents | ||||
| Distress due to family conflict | ||||
| • Parental report: improvement in distress from conflict with their | ||||
| adolescents reported by 71% of parents | ||||
| • Self-report: improvement in distress due to conflict with their parents | ||||
| reported by 78% adolescents | ||||
| Sidhu (2013) | Children: 34 | • SQP | Child and parent | ADHD symptoms |
| Pre-test and post-test | (age range 7-12) | • 45 minutes (2 times a | • Attention (CPRS-R): significant improvement in attention with a medium | |
| with control group | week for 4 weeks) | Measures: | effect size (p=0.40, ηp2= 0.147) | |
| design | • CPRS-R) | • Attention (BASC 2): significant improvement in attention with a large | ||
| • BASC - 2 | effect size (p=0.02, ηp2= 0.32) | |||
| • TOVA | Attention (TOVA) | |||
| • TOVA (Inattention): improvement in the inattention scores for MBI group | ||||
| (p=0.12, ηp2= 0.21) | ||||
| • TOVA (Reaction time): improvement in scores of response time for MBI for | ||||
| infrequent (p=0.001, ηp2 = 0.44) and frequent (p=0.001, ηp2 = .63) targets | ||||
| • TOVA (Omission errors): improvement in scores of omission errors for | ||||
| MBI group for infrequent (p=0.001, ηp2 = .59) and frequent (p=0.001, ηp2 | ||||
| = .54) targets | ||||
| Singh, Singh, Lancioni, | Children 2 males | • MBPBS | Child and parent | Compliance |
| Singh, Winton & | (12 years old) | • 12 sessions training for | Mean number of compliant responses after training increased by : 57.4% | |
| Adkins (2010) | Medicated: N=2 | each child followed by | Measures: | (Chris) and 322% (Will) |
| Multiple baseline across | parental training | • SSIMC | Mother’s requests | |
| participants’ design | Parents: 2 | • Delivered by Psychology | • SUHMC | Mean number of mother’s requests after training decreased :by 31.2% (Judy) |
| (pre-post test design) | mothers | PhD | 12.1 % (Denise)from parent training to child training, and by 43.8% from child | |
| • Informal Interviews | training to follow up | |||
| Child-parent relationship. | ||||
| Increase in satisfaction among parents regarding the interaction with the child, further increase in follow up. | ||||
| van de Weijer- | Children: 5 | • MBCT | Child and parent | ADHD symptoms |
| Bergsma, Formsma, de | males and 5 | Attention (YSR/CBCL/TRF) | ||
| Bruin & | females (age | 1.5hr sessions for 8 weeks | Measures: | • 8-week FU reduction reported by fathers (p=0.003, d=1.5) and adolescents |
| Bogels (2012) | range 11-15) | Child: | (p=0.017, d=0.9), | |
| Quasi-experimental | Medicated: N=1 | • Delivered by experienced | • YSR | Externalizing difficulties (YSR/CBCL/TRF) |
| (pre-post test design) | CBT therapists | • FFS | • Post-test reduction in externalizing problems (p=0.04, d= 0.2) reported by | |
| Parents: 19 | • SHS | fathers but not by adolescents | ||
| • ANT | • 8-week FU, the reduction reported by fathers was maintained (p=0.01, | |||
| d=0.3) | ||||
| Parents: | Internalizing problems (YSR/CBCL/TRF) | |||
| • CBCL | • Post-test reduction reported by fathers (p=0.03, d=0.4). | |||
| • BRIEF | • 8-week FUfollow-up, fathers reported a borderline significant reduction | |||
| • PSI | (p=0.07, d=0.5). | |||
| • PS | Executive Functioning (BRIEF) | |||
| Metacognition | ||||
| • 8-week FU, reduction in meta-cognitive problems (p=0.01, d=1.8) was | ||||
| reported by fathers. | ||||
| Behavioral Regulation (BRIEF) | ||||
| • 8-week FU improvement reported by fathers (p=0.03, d=0.6) | ||||
| Mindful Awareness and Attention (MAAS) | ||||
| • There were no changes stated by fathers, adolescents and mothers | ||||
| Parenting Stress (PSI) | ||||
| • reduction between pre-post test was reported by fathers (p=0.002, | ||||
| d=0.07), and maintained at 8-week follow-up (p=0.003, d=1.1) | ||||
| Parental Over-reactivity (PS) | ||||
| • There were no changes stated by fathers, adolescents and mothers | ||||
| Fatigue (FFS) and Feelings of Happiness (SHS) | ||||
| • There were no changes stated by fathers, adolescents and mothers | ||||
| Computerized Attention Tests (ANT) | ||||
| • Baseline speed: No significant improvement | ||||
| • Sustained Attention Dots: Significant reduction in reaction speed between | ||||
| pre-post test (p=0.00038, d=0.9) | ||||
| • Sustained Attention Auditory: No significant improvement on reaction speed or the number of misses. | ||||
| van der Oord, Bögels, & | Children: 13 | • MBCT and MBSR | Teachers and | ADHD symptoms |
| Peijnenburg (2012) | males and 5 | • 90 minutes sessions/ 8 | parent | Child- Attention (DBDRS) |
| Quasi-experimental | females (age | weeks | • Parental report: reduction in inattention with a large effect size (d=0.80), | |
| waitlist control (pre- | range 8-12) | • Delivered by CBT | Measures: | maintained at follow up (d=0.80) |
| post-follow up design) | Medicated: N=4 | Therapists | • DBDRS | • Teacher’s report: pre-post test reduction of inattention with small effect |
| Comorbidity: | • ARS | size (d=0.39) | ||
| ODD =3 | • MASS | Hyperactivity/impulsivity (DBDRS) | ||
| • PSI) | • Parental report: reduction of hyperactivity/impulsivity with a medium | |||
| Parents: 21 Mothers | • PS | effect size (d=56), which was maintained at follow up with a medium effect size (d=0.59) | ||
| Parent – ADHD symptoms (rated on the ARS) | ||||
| • Inattention: reduction with a small effect size (d=0.36), maintained at | ||||
| follow up (d=0.34) | ||||
| • Hyperactivity/ impulsivity: reduction with a small effect size (d=0.48), | ||||
| improved at follow up (d=0.50) | ||||
| Parent - Mindful awareness (MAAS) | ||||
| Significant more mindful awareness with small effect size (d=0.28), | ||||
| Parental stress (PSI) | ||||
| Showed a significant reduction with a medium effect size (d=0.57) | ||||
| Parental Over-reactivity (PS) | ||||
| Significant reduction with a large effect size (d=0.85) | ||||
| Worth (2013) | Children: 12 | • MAPs | Teachers and | ADHD symptoms |
| Feasibility study (pre- | males and 5 | • 1⁄2-hour session each | parents | Attention |
| post test design) | females (age | day / eight weeks | • Teacher report: decrease between pre-post Inattention score with | |
| range 11-15) | • Delivered by a school | Measures: | large effect size (p=0.001, r2=0.55) | |
| Medicated: N=12 | counselor | • Conners 3rd | Hyperactivity/Impulsivity: | |
| • SCWT | • No significant changes | |||
| • TMT | ADHD Index | |||
| • MASS | • Teacher report: increase from pre to post-test with a small effect size | |||
| (p=0.008, r2=0.13) | ||||
| Response-distractor inhibition (SCWT) | ||||
| • Significant reduction in Color- Word scores with a large effect size | ||||
| (p=0.001, r2= 0.81) | ||||
| Attentional shifting (TMT) | ||||
| • TMT-A (numbers only): reduction from pre to post-test with a large effect | ||||
| size (p=0.001, r2=0.76) | ||||
| • TMT-B (numbers and letters): reduction from pre to post-test with a large | ||||
| effect size (p=0.001, r2=0.72) | ||||
| Mindfulness (MAAS-A) | ||||
| Increase in mindfulness after training with large effect size (p=0.001, r2= 0.76) |
[i] Table note: MBSR – Mindfulness Based Stress Reduction (Saltzaman & Goldin, 2008); MBCT – Mindfulness Based Cognitive Therapy (Borgels et al., 2008); SQP - Still Quiet Place training (Saltzman, 2009); MBPBS - Mindfulness-Based Positive Behavior Supports (Singh et al. 2009); MAPs – Mindful Awareness Practices (Zylowska et al., 2008); BASC – 2 – Behavioural Assessment System for Children; BRIEF - Behaviour Rating Inventory of Executive Function; BOSS - Behavioral Observation of Students in Schools; RCADS - Revised Child Anxiety and Depression Scale – Youth and Parent Report; SIPA - Stress Index for Parents of Adolescents; FAD - Family Assessment Device; AAQ - Acceptance and Action Questionnaire; IM-P - Interpersonal Mindfulness in Parenting Scale; DSQ - Daily Symptoms Questionnaire; CSQ - Consumer-Satisfaction Questionnaire; CPRS-R - Conners’ Parent Rating Scale – Revised; TOVA - Test of Variables of Attention; SSIMC - Satisfaction with self in interaction with my child; SUHMC - Subjective units of happiness with my child; YSR - Youth Self Report; FFS - Flinders Fatigue Scale; SHS - Subjective Happiness Scale; ANT - Computerized Tests of Attention; CBCL - Child Behaviour Checklist; PSI - Parenting Stress Index; PS - Parenting Scale; DBDRS - Disruptive Behaviour Disorder Rating Scale; ARS - ADHD Rating Scale; MASS - Mindfulness Attention and Awareness Scale; SCWT - Stroop Colour and Word Test; TMT - Trial Making Test;
Table 2
Ratings of study quality
| Study | Research question and design | Participants/Sampling | Fidelity | Outcome Measures | Data analysis | Times of measurement follow-up | Attrition | Generalizability | Quality category |
|---|---|---|---|---|---|---|---|---|---|
| Carboni (2012) | Well covered | Well covered | Well covered | Well covered | Poorly addressed | Poorly addressed | Not applicable | Adequately addressed | Reasonable |
| Carboni, et al. (2013) | Adequately addressed | Well covered | Well covered | Well covered | Poorly addressed | Poorly addressed | Not applicable | Adequately addressed | Reasonable |
| Haydicky, et al. (2013) | Well covered | Well covered | Well covered | Well covered | Well covered | Well covered | Well covered | Adequately addressed | Excellent |
| Haydicky, (2014) | Well covered | Well covered | Well covered | Well covered | Well covered | Well covered | Well covered | Adequately addressed | Excellent |
| Shecter (2013) | Well covered | Well covered | Well covered | Poorly addressed | Poorly addressed | Adequately addressed | Poorly addressed | Adequately addressed | Reasonable |
| Sidhu (2013) | Well covered | Well covered | Adequately addressed | Well covered | Well covered | Poorly addressed | Well covered | Adequately addressed | Reasonable |
| Singh, et al. (2010) | Well covered | Poorly addressed | Poorly addressed | Poorly addressed | Poorly addressed | Poorly addressed | Not applicable | Adequately addressed | Limited |
| van de Weijer- Bergsma, et al. 2012) | Well covered | Adequately addressed | Well covered | Well covered | Well covered | Well covered | Poorly addressed | Adequately addressed | Very good |
| van der Oord, et al. (2012) | Well covered | Well covered | Adequately addressed | Well covered | Well covered | Well covered | Not addressed | Well covered | Very good |
| Worth (2013) | Well covered | Adequately addressed | Adequately addressed | Well covered | Well covered | Not addressed | Not addressed | Adequately addressed | Reasonable |