Sunday, April 9, 2017

Mindfulness in Special Education

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). 


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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Black, D. S., & Fernando, R. (2013). Mindfulness training and classroom behavior among lower income and ethnic minority elementary school children. Journal of Child and Family Studies 23, 1242-1246.
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Copyright © 2017 by Pam Steffensen-Korges and Ellen McCarty. All Rights Reserved.