Mental health exercises like mindfulness have been an effective tool used in hospitals, schools, and at home to promote the mental well-being of children. Even before the pandemic, these strategies have started to gain more attention in the past two decades. According to the American Psychological Association, mindfulness is defined as:
“[A]wareness of one’s internal states and surroundings. Mindfulness can help people avoid destructive or automatic habits and responses by learning to observe their thoughts, emotions, and other present-moment experiences without judging or reacting to them.”
It is important to note that although mindfulness can be used with meditation, it is different. Meditation aims to clear thoughts and focus on the body’s physical state, generally through breathing and physical exercises like yoga. With mindfulness, thoughts and emotions are not dismissed but indeed observed and focused upon at face value. It is a coping mechanism for mental distress and promotes mental well-being.
Utilizing mindfulness for children is a relatively new science that has only been studied extensively within the last twenty years. This article aims to review several studies researching the effectiveness of mindfulness on children’s mental health, focusing on the cognitive benefits that mindfulness can provide for those with attention deficit disorder (ADHD), emotional issues like depression and anxiety, and autism spectrum disorder (ASD). Lastly, this piece will suggest a new mindfulness strategy, the Chair of Joy (COJ), as a potential mindfulness exercise to increase mental well-being and joy in a child’s life.
Mindfulness and ADHD in Children:
ADHD is a popular topic of discussion regarding children’s mental health. Many think it is overdiagnosed and is just a phase, but ADHD can severely affect a child’s educational and emotional development if it is ignored. It can continue into adulthood and affect relationships and one’s career.
The criteria to diagnose ADHD, according to the Internal Classification of Diseases, is constantly showing inattention and/or hyperactivity/impulsivity over six months, usually starting before or around adolescence, and the symptoms cause issues with school, work, or relationships. Today, this mental health concern is generally treated with psychostimulants and some non-stimulants. These treatments are not always helpful, and not many longitudinal studies evaluate the effects of stimulants many years later. Still, many studies conclude that it is a safe and effective treatment for ADHD.
Is there an effective alternative, however? Mindfulness exercises may be one answer; the data is somewhat mixed. One study using mindfulness-based intervention (MBI) and a care-as-usual (CAU) control group found that mindfulness increased self-control in children. Still, after a six-week follow-up evaluation, this effect disappeared. This study and a review of several other studies showed that, although the impact of mindfulness on children’s ADHD symptoms was limited, it did help with parental stress related to parenting a child with ADHD [1, 2]. A meta-analysis by Siebelink et al. [3] showed that several studies had positive outcomes with MBIs. The general results were reduced impulsivity and increased impulse control and attention. Mindfulness directly addresses the cognitive issues related to ADHD by emphasizing the connection to thoughts and emotions present at that moment [4]. However, attention seems to be more greatly affected by MBIs than hyperactivity and impulsivity [5]. These studies show promise in effectively treating ADHD in children and their parents, but more long-term studies need to be conducted to establish if these results can be retained over long periods.
Mindfulness and Emotional Issues in Children:
Mindfulness exercises may be valuable for treating emotional issues like anxiety, depression, and behavioral problems. A superb meta-analysis by Dunning et al. [6] reviewed many studies that used random control trials (RCT) to evaluate the effect of MBIs on children and adolescents. Random control trials are essential for research because they reduce bias in the study and reveal more true results.
This meta-analysis reviewed active control groups, which included an active placebo group, and non-active control groups, such as a waitlist or no contact. Analyzing both groups revealed that MBIs significantly positively affect mindfulness, executive function, and attention, with a lesser but evident effect on anxiety, depression, and adverse behaviors. Analyzing active control group studies independently revealed a significance with mindfulness, depression, and anxiety but not with executive function or attention. Also, fewer negative behaviors were observed in a younger demographic [6].
Mindfulness for Bipolar Disorder:
Mindfulness may also be a valuable strategy for children at risk for more severe mental illnesses like bipolar disorder. Research points to mindfulness with cognitive behavioral therapy can reduce anxiety associated with bipolar disorder but not the main symptoms of depression and mania [7]. It may be more effective for youth displaying anxiety at risk for bipolar disorder and might also be helpful in other ways [8]. An fMRI study on 35 children ages 10-14 who underwent an eight-week MBI treatment reported having more mindfulness, mood stability, and reduced inhibition of negative thoughts. The two brain regions that showed increased resting state connectivity and are responsible for the self-reported outcomes are the dorsolateral prefrontal cortex (DLPFC) (responsible for executive functions like changing and rearranging tasks, filtering out interfering stimuli, strategizing, and specific aspects of working memory) and the posterior cingulate cortex (PCC) (responsible for self-reflection) [9-11]. This is in line with the primary purpose of mindfulness exercises, which is to focus on the present emotions and thoughts in a non-judgmental fashion.
Effects of Mindfulness on Children with Autism Spectrum Disorder (ASD):
Autism spectrum disorder (ASD) is a complex neurological disorder that can manifest in many ways and severities. According to the American Psychological Association, ASD is defined as having issues with communicating, socializing, and displaying a pattern of recurring and inhibiting actions, with symptoms generally appearing around pre-school. Many individuals with ASD are high functioning in other areas, such as creativity and memorization, but they are disconnected from the rest of society. More needs to be done to understand the complexities of this disorder and mitigate ASDs social and cognitive issues.
Mindfulness could be a helpful strategy for several symptoms associated with ASD, and it has been shown to help the parents of children with ASD as well. A study using the mindfulness program MyMind also used for ADHD, found that after the 9-week regimen of 1.5-hour sessions, the children with ASD had a significant reduction in socializing issues, and according to the parents, even after a year follow-up, displayed improvement in behavior outcomes, attention, and overall well-being. The parents had less stress concerning parenting a child with ASD, improved interaction with the child, and increased well-being [12]. In another study, the mindfulness strategy MyMind was not associated with increased attention [13]. This is unusual because this approach was primarily developed for individuals with ADHD, and the limitation may be due to the technique focusing on internal reflection at that moment.
The Chair of Joy to Promote the Mental Well-Being of Children:
Although mindfulness techniques such as MyMind have been moderately effective, there may be more efficient ways to approach the issues affecting mental well-being. These programs are intense and take a considerable amount of time and effort. Also, some of the intended effects are reduced over time, and the initial results depend on how the study is conducted, particularly the type of control being utilized. There needs to be a simpler approach. More children could be reached if there is an approach where mindfulness can be conducted autonomously and not take so much time. These strategies work for internal attention and do not have an external element to focus on besides breathing. The mindfulness strategies discussed aim to be attentive to the moment-to-moment thoughts and feelings of the individual. Still, a component missing in the exercise reduces its effect on decision-making and attention to external stimuli.
The Chair of Joy (COJ) mindfulness technique may be a practical alternative. Instead of focusing on reducing mental health issues, it emphasizes mental well-being. The simple strategy of sitting, breathing, thinking, and feeling can be used in most age groups and does not require special training. The COJ’s purpose is to create a joyful, comfortable, and safe space to think and feel in the moment. It maintains the basis of other mindfulness exercises with the added component of visualization. This is not restricted to one place. It could be a serene lake, a park, the beach, or a friend or family member’s house. Wherever one is most comfortable and can experience a sense of calm and joy is where their Chair of Joy should be.
Visualization, in concert with mindfulness, activates different brain structures. In particular, it activates the anterior cingulate cortex (involved with maintaining attention to stimuli), the ventromedial prefrontal cortex (involved in several cognitive processes like processing emotions, perception of self, and recognizing social cues), and the insula (which is the hub for emotional recognition and other aspects like empathy) [14-17]. Mindfulness exercises with a visualization component would be a more efficient means of promoting well-being and reducing negative mental states.
The COJ offers this added component. It would be interesting to see how effective this technique would be in a longitudinal study. Given the simplicity of the type of mindfulness the COJ provides, this could be a more feasible way to increase well-being and offer better support to mitigate the symptoms of ADHD and ASD. Notably, it may have superior effectiveness in improving attention, socialization, and cognition.
More must be done to increase children’s well-being and mental health, especially for those at risk for more adverse mental health issues. The COJ has untapped potential to help in this respect. It only takes a couple of minutes a day to exercise, and with practice, it could offer superior results to other mindfulness strategies that lack simplicity and visual components. Parents, teachers, and other caregivers can also benefit from this exercise. Still, future research needs to be done to verify its advantages for children and adults alike.