Recent research reveals that even when students with developmental disabilities are not able to practice mindfulness meditation, they still benefit behaviorally and emotionally when family members practice in the home. I reference this research during my family workshops and by request, am posting the full 11-page paper, Mindfulness as an Intervention Strategy, co-written with my colleague Pam Steffensen-Korges as part of my SJSU coursework (completed in 2016).
Abstract
Children
with developmental disabilities often suffer from unique stressors. The unremitting aspect of their disability,
possible lack of social acceptance and support, and the absence of acceptance
by their families can all contribute to chronic stress. Aggression and behavior problems that are
comorbid with many developmental disabilities can further impact feelings of
stress. Due to the fact that parental
stress also has a negative effect on child behavior and upon the parent-child
relationship, it is imperative that both parents and children receive help with
stress reduction. More than three
decades of research on the secular Mindfulness in Medicine movement, more
widely known as Mindfulness-Based Stress Reduction (MBSR) training, has
demonstrated that mindfulness can alleviate stress, anxiety, and depression in
many individuals (Felver, Doerner, Jones, Kaye, & Merrell, 2013). The
effect of mindfulness on the quality of parenting has been shown to lead to a
reduction in aggression and an increase in pro-social behaviors and compliance
by younger children with special needs. In 2007 the non-profit Mindful Schools
began a Mindfulness in Education curriculum that is now practiced in schools in
more than 42 countries. Mindful Schools defines mindfulness as simply paying
attention to anything in the present moment and its curriculum has yielded
dramatic increases in attention span, empathy and self care in urban youth
(Black & Fernando, 2013). Parallel research in the field of
neuroscience has revealed that mindfulness training is effective because it
actually changes the brain, increasing activity and gray matter in the
hippocampus and prefrontal cortext, centers of learning, sound judgment and
emotional regulation, while decreasing activity and gray matter in the
amygdala, the fight-or-flight center of the brain which can inhibit learning,
emotional regulation and attention span (Lutz, Slagter, Dunne, & Davidson,
2008; Hölzel, Carmody, Evans, Hoge, Dusek, Morgan, Lazar, 2010; Chiesa &
Serretti, 2010; Goldin & Gross, 2010; Hölzel, Carmody, Vangel, Congleton,
Yerramsetti, Gard, & Lazar, 2011; Desbordes, Negi, Pace, Wallace, Raison,
& Schwartz, 2012). While
research regarding mindfulness curricula specifically designed for special
education is still in its infancy, extensive studies on mindfulness to date
demonstrate that the practice can be a powerful tool in building a happier,
less stressful future for all children, including those with developmental
disabilities, and their parents.
A
Definition of Mindfulness
Core
Concepts
Mindfulness,
as a concept, begins with awareness and attention, and can be defined as
attending to the present moment and observing it without judgment (Brown &
Ryan, 2003). Being fully conscious of
the present moment, accepting both the moment and the emotions it arouses, and
acknowledging one’s feelings non-judgmentally are important facets of
mindfulness. Mindfulness allows the
practitioner to react to situations in a calmer and more peaceful way, less
dependent upon emotions, and more in harmony with the situation at hand
(Shapiro, Carlson, Astin, & Freeman, 2006).
Mindfulness has a component of radical acceptance, which means the
complete and total acceptance of things as they truly are, not as the individual
wishes them to be (Singh et al, 2010a). It is important to note that while
mindfulness shares similarities with cognitive-based therapies (CBT), it is
distinct in that CBT seeks to intentionally change thought patterns and related
emotional responses while mindfulness is designed to change a person’s
relationship to an observed experience without trying to control or revise
thoughts and emotions because trying to control thoughts and emotions can lead to greater distress (Metz et al., 2013). The
practice of mindfulness meditation has its roots in contemplative Buddhism but
can be used as a strictly secular application divorced from religious dogma
(Brown & Ryan, 2003). To be
effective, mindfulness skills must be practiced regularly over time, as it is a
way of experiencing the present moment that does not occur naturally.
Mindfulness as an
Intervention Strategy at Home
Children with developmental
disabilities comprise approximately 13% of the U.S. school age population, and
most of them receive some type of special education services (National Center
for Education Statistics, 2014).
Additionally, nearly 13% to 30% of these special needs children have
comorbid behavioral problems (Singh et al., 2007b). The needs of these children do not stop once
they leave the school grounds. They go
home at the end of their school day to parents who are quite often tired,
stressed, and incapable of reacting to behavioral problems with patience and
thoughtfulness. Responding with empathy
and compassion to behavioral situations and emotional needs necessitates a
level of attention, calmness, and flexibility that many parents of children
with special needs are unable to summon at the end of the day (Benn, Akiva,
& Arel, 2012).
Research has shown that parents of
children diagnosed with developmental disabilities are subjected to an elevated
level of chronic emotional strain and anxiety when compared to parents of
children who do not have developmental disabilities (Singh et al., 2007b). Additional research has found children’s
behavior problems, more so than their level of cognitive functioning, have a
substantial effect upon parental stress (Baker et al., 2003). Negative and maladaptive behaviors increase
parental stress, each component building upon the other. This suggests a transactional relationship between
parents and children (Neece, Green, & Baker, 2012). Both parent and child have a significant
influence upon each other’s behavior (Singh et al., 2007b).
An intervention that has been
particularly successful with individuals suffering from anxiety and stress is
mindfulness (Brown & Ryan, 2003).
Mindfulness, as a practice, also aids in supporting emotional health
(Shapiro, Carlson, Astin, & Freeman, 2006).
Training in mindfulness teaches parents to focus on one thing at a time
(Singh et al., 2006). It enables parents
to be in the precise moment where they currently reside, instead of focusing on
the past, when they are dealing with their child’s maladaptive behaviors. It can have a transformational effect upon
the lives of its practitioners and those they interact with (Singh et al.,
2010b). Mindfulness can be a valuable
tool in managing the stress of parents of children diagnosed with developmental
disabilities, and as a result, in reducing problem behaviors in their children
in the present, and can give children the tools they need to help themselves in
the future.
Mindfulness-Based Stress Reduction and
Mindfulness-Based Parent Training
Research on mindfulness intervention
strategies for parents has focused on Mindfulness-Based Stress Reduction (MBSR)
training and Mindfulness-Based Parent Training (MBPT) (Dumas, 2005). For over three decades, MBSR has been used to
treat anxiety, stress, and depression. MBSR has also been used to help patients
deal with chronic pain and illness. Participants are taught mindful breathing
techniques and body awareness, along with stretching. They are then taught how
to incorporate these skills into everyday life to help reduce stress, pain, and
depression (Felver et al., 2013). The effectiveness of MBSR has been established
as an evidence-based practice and MBSR instruction is offered by medical
centers all across the United States (Felver et al., 2013).
Mindfulness-Based Parent Training
(MBPT) is a program that has applications more directly related to
parenting. It teaches mindfulness within
the context of everyday events, training parents to view both their behavior
and their child’s behavior in an open-minded way (Dumas, 2005). This allows parents to observe the activation
of their negative emotions but not react to them, which allows them to develop
parenting objectives that are facilitated by specific behavioral plans (Dumas,
2005). MBPT uses a three-pronged
approach: facilitative listening, distancing, and motivated action plans. Facilitative listening consists of parents
sharing concerns and experiences with a clinician, and receiving nonjudgmental
acceptance in return. Distancing teaches
parents to separate themselves from practicing unhealthy patterns of negative feelings
and thoughts, and also to recognize that they are not their thoughts, that
their thoughts are just one part of who they are. Motivated action plans assist parents with
planning out how to reach their behavior goals with their children (Dumas, 2005).
Outcomes of Parental Mindfulness Training
Upon Children
It
appears that it is possible for parents to change the externalizing behavior of
their children with developmental disabilities simply by changing their own
behavior, however most behavioral interventions have focused purely upon
managing the child’s conduct and behavior.
Mindful parenting focuses on first changing parental behavior and, as a
result, the nature of interactions with the child, which in turn, influences
the child’s behavior (Singh et al., 2006).
Parents taught MBSR over a period of 8 weeks, beginning with the
concepts of mindfulness and mindfulness exercises and ending with group
discussions with other parents, not only experienced dramatic decreases in
stress and depression but they also reported meaningful improvement in their
general satisfaction with life.
Researchers found that mindfulness can aid parents in slowing down to
listen to their children and to be less reactive. This calm and serene reaction on behalf of
the parent has a definite positive influence upon the child (Neece, 2014).
Research conducted with mothers of children
diagnosed with autism found that maladaptive behaviors, such as aggression,
non-compliance, and self-injury, were significantly decreased when mothers were
practicing mindfulness (Singh et al., 2006).
In a Virginia-based study, these mothers were taught MBPT mindfulness
training from homecare providers over a period of 12 weeks, and both their
children’s behavior and their own parenting satisfaction levels were
measured. Researchers found a
considerable spill over effect from the mindfulness training. Not only did the externalizing behaviors of
their children decrease, the mothers had more positive feelings about their
parenting, their communication, and their relationship with their autistic
children. The focus of the mothers moved
from trying to control or change the behavior of their autistic children toward
a more accepting and non-judgmental attitude that in turn, actually changed the
behavior of the child (Singh et al., 2006).
In
a similar study, when mothers of children with autism were instructed in
mindfulness skills, not only did the previous self-injurious, noncompliant, and
aggressive behaviors of the autistic children decrease, their interactions with
other family members and siblings became more positive (Singh et al.,
2007b). After 12 weeks of mindfulness
training, mothers rated their satisfaction with parenting as more positive, and
their children’s maladaptive behaviors diminished or ceased altogether. The children were not taught any mindfulness
techniques, yet the negative interactions with their siblings declined and
their positive interactions increased.
The effects of mindfulness training are
even more salient when the child is taught the technique, either at the same
time as the parent or in subsequent trainings.
Non-compliance is often an issue with children who have been diagnosed
with ADHD (Singh et al., 2010b). Research
has revealed that mindfulness training for children with ADHD, without any
specific focus on self-management of ADHD, not only increased their compliance
to their mother’s requests, it also changed the quality of the interactions
between the child and their mothers. The
interactions were regarded in a much more positive light, and the children
stated that their mothers did not yell at them anymore and were much more calm
with them (Singh et al., 2010b). The
children reported feeling that their mothers listened to them without judgment
and, by the end of the study, both the children and the mothers had
significantly higher ratings of satisfaction in their communication with each
other.
Mindfulness
as an Intervention Strategy at School
Mindful Schools
The success of Mindfulness-Based
Interventions (MBIs) in medicine and in the home via MBSR motivated educators
to seek ways to bring mindfulness into the classroom. The first large-scale
mindfulness-based intervention in education was designed and implemented in
2007 by the Oakland-based non-profit Mindful Schools, which modeled its
curriculum after MBSR while making its lessons more simple and concrete, and
therefore more appropriate for K-6 elementary school children than the
adult-centric MBSR program. The initial Mindful Schools curriculum, implemented
in schools between 2007 and 2013, was comprised of 15 short lessons lasting an
average of 15-20 minutes (4 hours total) delivered at school sites by
experienced meditation practitioners over two-month periods. Table 2, extracted
from a UC Davis Department of Psychology study conducted in partnership with
Mindful Schools, summarizes each of the 15 lessons in its curriculum: Mindful
Bodies & Listening, Mindfulness of Breathing, Heartfulness (Kind Thoughts),
Body Awareness, Mindfulness of Breathing, Generosity, Mindfulness of Thought,
Caring on the Playground, Mindfulness of Emotions, Slow Motion, Gratitude,
Mindful Walking, Mindful Eating and Mindful Test Taking (Black & Fernando, 2013). A study conducted in 2011-12 in
East Bay elementary schools validated this curriculum, documenting significant
improvement among low-income urban students in all four target development
categories: mental, emotional, social and physical (Black & Fernando,
2013). Most notable was the increase in attention span by more than double and
improved empathy and self-care among violence-exposed youth (Black &
Fernando, 2013). As a result, Mindful Schools’ curriculum was used as the basis
for many other education-based MBIs such as the
Canadian in-schools program MindUp. (Schonert-Reichl, et al., 2015).
Meditation on the Soles of the Feet
Research has been conducted with
adolescents diagnosed with different developmental disabilities regarding the
effects of teaching a specific mindfulness program, Meditation on the Soles of
the Feet (SoF). SoF instruction is effective in teaching adolescents with
developmental and intellectual disabilities to manage their own aggression,
instead of relying on external cues. (Singh et al., 2011b). Adolescents were
taught to direct their attention to a neutral area of their body, the soles of
their feet, when they were in a situation that could trigger aggression. A
group of three adolescents with autism were
taught SoF during a 17 week period, after which the rates of aggression were
reported at half the previous rate. At a four-year follow up, there had been no
instances of aggression at all (Singh et al., 2011b).
A parallel study conducted with
three adolescents with autism who were taught SoF had similar results (Singh et
al., 2011a). After learning to self manage their aggression by changing their
focus to the soles of their feet, these adolescents were able to reduce
reported episodes of aggression to one episode a year over a period of three
years. SoF has also been proven to help adolescents with psychiatric disorders,
such as conduct disorder, to self manage their aggressive behavior (Singh et
al., 2007a). Self management is crucial as adolescents grow into adulthood,
move out into the community, and strive to become independent.
Mindfulness Training For General
Education Students
Low-income urban youth are subjected to
severe environmental challenges such as violence and substance abuse that can
cause chronic stress. Long-term childhood adversity can trigger neurobiological
changes in brain development, impairing cognitive and emotional regulation
which can cause rumination and depression and set students on a path of low
academic achievement and negative social outcomes (Mendelson et al., 2010). Urban schools that are most in need of
psychological supports for their students are least likely to have the funds to
provide that support. The low-cost and low-time investment of MBIs and their
proven effectiveness in creating healthy changes in brain development, therefore,
makes them ideal intervention strategies for education (Zenner,
Herrnleben-Kurz, & Walach, 2014; Schonert-Reichl et al., 2015). Most
critically, mindfulness training reduces the activity of the amygdala, the
brain center that regulates the fight-or-flight response that when chronically
active, reduces the ability to concentrate and limits centers of the brain that
control learning and sound judgment (Siegel, 2007). More recent chronic
academic stress among students in wealthier school districts is yielding
mental, physical, and academic problems akin to their low-income peers. Today
21% percent of all 13 to 18 year olds in the United States have been diagnosed
with a severe disorder, the most common being ADHD, conduct disorders, anxiety,
and depression (Zenner et al., 2014).
Mindful School identifies three major
areas of benefit regarding mindfulness training in education: cognitive
outcomes such as attention span and focus, social emotional skills like
emotional regulation, good behavior in schools, empathy, social skills and a
healthy perspective and finally a high level of well-being, created by reduced
test anxiety, reduced stress, reduced post traumatic stress disorder (PTSD)
symptoms and reduced depression. Mindfulness training’s effectiveness in
increasing student attention span also reduces the need for behavior management
in the classroom (Black & Fernando, 2013: Baijal, Jha, Kiyonaga, Singh,
& Srinivasan, 2011).
Additional benefits are felt across the
socio-economic spectrum and across all grade levels. A 12-week mindfulness
intervention in Baltimore elementary schools was found to reduce stress,
anxiety, emotional, and behavioral reactivity while improving self-awareness
and sleep among inner-city youth (Mendelson et al., 2010). In another Baltimore
study, 350 low-income 5th-8th grade students demonstrated significantly lower
levels of depression, negative emotion, self-hostility, and PTSD symptoms after
taking an 8-week MBSR program (Sibinga, Webb, Ghazarian, & Ellen, 2016).
Another MBSR-based program in Pennsylvania Learning to BREATHE found
statistically lower stress levels and higher levels of emotional regulation
among the 216 general education high school students who completed its 4.5-hour,
6-part program (Metz et al., 2013). One hundred 4th and 5th graders enrolled in
the Canadian mindfulness-based social and emotional learning (SEL) program
MindUp demonstrated improved cognitive control and stress-response physiology,
greater empathy, perspective, emotional control, optimism and peer acceptance
as well as decreased depression and peer aggression (Schonert-Reichl et al.,
2015).
Reflection
on Mindfulness
A
2014 review and meta-analysis summarizing the findings of 24 different mindfulness
studies found that mindfulness training is an effective intervention strategy
in schools but has a stronger effect when it is accompanied by extended
mindfulness practice at home (Zenner, Herrnleben-Kurz, & Walach, 2014).
When taught mindfulness techniques as an adolescent, students with
developmental disabilities are better equipped to control and manage their
behavior in adulthood. If their parents have been practicing mindfulness from
early on in their lives, there will be an even stronger foundation for
nonjudgmental acceptance, gratitude, and positive behaviors that are crucial
for happiness and a good quality of life as an adult with developmental
disabilities. Reducing negative behaviors is critical for full integration into
a community and for positive rapport with community services workers (Singh et
al., 2013). Providing mindfulness as a support for students and their families
can significantly increase self-regulation, optimism, and moral reasoning and
increased odds of becoming smarter, happier, and more caring citizens
(Schonert-Reichl et al., 2015; Zenner, Herrnleben-Kurz, & Walach,
2014).
The focus of mindfulness is the changing of
one’s thoughts and behavior. This depth of change requires dedication and
practice (Singh et al., 2004). Viewing
and experiencing behavior through a lens of neutrality, rather than labeling it
as good or bad, allows parents of children diagnosed with developmental
disabilities to practice a calm acceptance of the present moment (Singh et al.,
2006). The focus of radical acceptance
requires not only the initial mindfulness training, but also regular daily
practice. Just as an athlete must
practice to keep their skills and performance levels high, the practice of being
mindful requires commitment and devotion in order to be effective (Singh et
al., 2006).
In
other words, mindfulness works best when the practitioner uses it regularly and
purposefully. In order to reap the
benefits of mindfulness, parents and children with developmental disabilities need to make a conscious effort to
incorporate the practice into their daily lives (Singh et al., 2006). Mindfulness is not effective if the
practitioner decides not to make use of it or to only use it sparingly. Ongoing practice is the key to successful
change (Singh et al., 2010b).
When parents receive a diagnosis of a
developmental disability for their child, some form of mindfulness training
should be offered to them alongside of therapies prescribed for the child. Parents should be informed about the
effectiveness of mindfulness for the reduction of stress and anxiety and the
reciprocal relationship between parental stress and child behavior. Using mindfulness as a strategy would prevent
parents of developmentally disabled children from being so heavily afflicted by
stress from the beginning of the child’s diagnosis. This could conceivably stave off problem
behaviors by children that are a reaction to stress in the home, and form a
solid foundation for the self-management of aggressive behaviors for these
children later on in life.
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Copyright © 2017 by Pam Steffensen-Korges and Ellen McCarty. All Rights Reserved.
