Mindfulness as an Intervention for Anxiety and Attention ......MINDFULNESS INTERVENTION FOR ANXIETYAND ADHD 5 Participants Four students, between the ages of 9 and 12, from four different

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 &


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


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?


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


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


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


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%.


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


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).


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


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.


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.


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


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.


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.


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.


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.


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.


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.


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.


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.


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


for first, second and third participants

- Implement third and fourth intervention phase (8 weeks)


- Conduct follow-up with first and second baseline


for first, second, third and fourth participants

Weeks 28-29 - Conduct follow-up with baseline groups


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

Documents

Mindfulness as an Intervention for Anxiety and Attention ......MINDFULNESS INTERVENTION FOR ANXIETYAND ADHD 5 Participants Four students, between the ages of 9 and 12, from four different