Mindfulness in Children

Original Editor - Merinda Rodseth

Top Contributors - Gabriele Dara, Merinda Rodseth, Tarina van der Stockt and Jess Bell  

Introduction

Mindful or mind ful.jpg

Mindfulness originated from ancient eastern and Buddhist philosophy and dates back around 2500 years.[1][2][3] The concept of mindfulness was introduced to the western world around 40 years ago and was untangled from its cultural, religious and ideological factors associated with Buddhism to give birth to the first formalised mindfulness-based intervention (MBI), called Mindfulness-Based Stress Reduction (MBSR). [2][1]

Mindfulness can be defined as:

  • “The awareness that emerges through paying attention on purpose, in the present moment, and non-judgmentally to the unfolding of experience moment by moment” [2]
  • “Intentionally directing attention to present moment experiences with an attitude of curiosity and acceptance” [1]
  • “Mindful awareness is fundamentally a way of being - a way of inhabiting our bodies, our minds, our moment-to-moment experience… it is a way of relating to all experience - positive, negative, and neutral - in an open, receptive way...it simply knows and accepts what is here now” [4]

It guides individuals to focus their attention on the present moment through the use of attentional strategies such as breathing or the body scan.[5] Maintaining a mindful perspective has been shown to develop flexible and adaptive behaviours.[5] Mindfulness is a way of being that involves ongoing effort to develop and refine.[2]

Mindfulness can be also explained according to a model developed by Shapiro and Carlson[4] with it being composed of three core elements: intention, attention and attitude. These elements are not separate processes/stages but interwoven parts of a single process, continuously feeding back into each other.

  • Intention - knowing the reason for practicing mindfulness (the why?). “Intention is a direction, not a destination”.[4] Our intentions (personal visions) set the stage for what is possible and what is dynamic and evolving. With the practice of mindfulness, these often shift from self-regulation to self-exploration and finally to self-liberation and selfless service.[4] Our intentions are also an expression of what we value. Mindful practice makes us aware of our values and whether they are wholesome and a true expression of what we really value.
  • Attention - “observing the operations of one’s moment-to-moment internal and external experience”.[4]
  • Attitude - The qualities/attitudes we bring to the act of paying attention is crucial. Mindfulness can be translated as “heart-mindfulness”, emphasising the importance of including “heart” qualities in the attentional practice of mindfulness.[4] Siegel[6] describes these qualities as COAL - curiosity, openness, acceptance and love. The attitudes with which we engage in mindfulness should include gentleness, patience, compassion, curiosity, openness (beginner’s mind - seeing things as for the first time) and acceptance while being non-judging and nonreactive.[4]

Mindfulness has been suggested to include 3 components that interact closely to enhance self-regulation - enhanced attention control, improved emotion regulation and altered self-awareness (Figure 1).[7]

Components of Mindfulness.jpeg

Figure 1: Components of Mindfulness. Adapted from Tang et al.[7]

Why do Children Need Mindfulness?

Children are growing up in a rapidly changing world which brings its own set of challenges. Children and youth are experiencing high levels of stress and social pressure both in and outside of school which impacts their cognition and mental health.[3] Serious mental health disorders are widespread among children and of these, ADHD, anxiety, depression, behavioural and conduct problems are the most prevalent.[3] Research is showing that “academic achievement, social and emotional competence and physical and mental health are fundamentally and multiply interrelated. The best and most efficient way to foster any of them is to foster all of them”.[3]

Children and youth are also exposed to a variety of stressors and traumas early in life. This is not limited to lower economic income and minority groups where poverty, limited education and economic opportunities, drugs and violence surround them, but also in higher-income populations where they are continuously bombarded with the pressure to perform, excel and be successful.[8] The recurrent and chronic nature of these stressors leave many children in a “state of toxic stress”, continuously overwhelmed and unable to manage or cope with the stress.[8]  Many adult diseases have their origin in childhood exposure to stress and trauma and early intervention among children and youth has the capacity to mitigate the negative effects of these.[8] MBI could be ideal for addressing many of these issues.

Mindfulness can also be regarded as the foundation and basic pre-condition for education. Children have to learn to stop their minds from wandering and to regulate their attention and emotions, to manage their feelings of frustration, and motivate themselves.[3] These exact qualities are enhanced by mindfulness practice.

Benefits of the Mindfulness Approach

Mindfulness-Based Interventions (MBI) are showing promising results in supporting mental health needs even in the absence of psychological disorders and have become a more popular, cost-effective method to provide support.[1][5] The benefits of MBI are well established in adults and include:[9][10][11]

  • Decreased anxiety and depression
  • Relief from stress and psychological distress
  • Increased coping abilities
  • Alleviation of pain
  • Decreased negative affect

Considering the diverse uses and benefits of MBI in adults, clinicians and researchers are endeavouring to adapt MBI for use in children and adolescents as well.[3] Research is still in its infancy and evidence for the use of MBI in children and adolescents is still trailing the great enthusiasm for it.[1] Research on mindfulness in children and adolescents suggests benefits in both clinical and non-clinical populations[3][9] and  include:[1][3][5][8][10][11][12][13]

  • Improved academic performance
  • Improved focus and attention
  • Decreased stress and anxiety
  • Improved emotional regulation and executive functioning - especially visible in children with ADHD
  • Reduction in symptoms of depression
  • Decrease in negative behaviours
  • Improved social skills
  • Improved self-esteem
  • Increased compassion
  • Improved sleep habits
  • Improved coping skills
  • Reduction in post-traumatic symptoms

Geronimi et al[11] propose that “children who are mindful are also less likely to experience difficulties with inhibition, working memory and shifting (flexibility and open-mindedness)”. These skills make up the core executive functions of our cognitive processes.[11]

Cognitive Changes Associated with Mindfulness

Several changes in brain activation have been documented with the practice of mindfulness, allowing us to also “see” the benefits of MBI.[7][12] However, the study designs vary greatly with the use of different MBI and, therefore, the locations of the reported effects are diverse and spread over multiple regions of the brain.[7]

The brain regions most consistently altered with MBI are discussed in Table 1:[7][14][15][16]

Region of the brain Effect with MBI Function of the region
Insula and sensory cortices Increased activation Body awareness (interoception)

Emotional processing

Self-awareness

Interpersonal experience

*MBI like body scan affects this part and helps re-establishing body-mind connection after intense trauma that resulted in disconnection between body and mind

Anterior cingulate cortex (ACC) Increased activation Higher-order cognitive processes

Attention and attention regulation

Self and emotional regulation

Cognitive distancing - associated with non-judgemental acceptance

*MBI: Breath awareness

Prefrontal cortex Increased activation Higher-order cognitive processes

Attention and attention regulation

Emotion regulation

Meta-awareness and reappraisal

Reasoning and decision making

Functional connectivity with the salience network

Downregulation of amygdala responses

Hippocampus Increased activation

Increased volume

Memory processes
Amygdala Decreased activation

Decrease in volume/size

Fight-or-flight reaction

Fear response

Stress response

Adds emotional value to sensory input - emotional processing

Table 1: Neuroplastic changes associated with mindfulness

Greater stress is associated with greater amygdala activation. In a study done by Bauer et al[12] they found that students who received MBI reported lower stress, associated with reduced amygdala activation, in response to viewing fearful facial expressions. Down-regulation of the amygdala is what underscores the reduction in stress seen with MBSR.[15] Mindfulness is therefore not simply about paying attention. The way in which we use this focus of the mind ultimately changes the function and the structure of the brain.[6]

[17]

Mindfulness-Based Interventions

“Children need a fully attentive and attuned adult who is able to respond to the child in a way that the child feels understood, accepted, celebrated and received”. Dr Gabor Mate.

Children develop in the footsteps of adults with their nervous system attuned to their environment, to the adults around them, specifically their early attachments, their caregivers, their teachers, therapists and the people that they look up to.[18] If a child grows up in an environment where the adults around them do not feel safe, regulated, attuned and attentive, they will start to learn through a variety of mechanisms how to manage and regulate themselves in the world.[18] Working with children therefore starts with you as the therapist and your own attention, your ability to anchor in the present moment and the way you relate to those around you. MBIs are highly contextual and when you work with the child, you work with their context - their history and the multiple groups and structures that they belong to (social class, culture, teachers, family group, friendship group).[19]

Mindfulness training in children is really about helping them find a space and place in their life where they can start learning to regulate.[18] When a child functions in their “window of tolerance” [20], they are able to manage and regulate themselves and deal with their stress. It’s when they move out of this window that they become either hyper-aroused (sympathetic nervous system fight-or-flight response) or shut down/freeze (parasympathetic response). Mindfulness is a tool to teach children to notice when they move out of their window of tolerance and be able to regulate themselves back into that window.[18] The skill of “noticing” (being aware) might initially only incorporate the simple awareness of how they feel in their body before they are able to express a certain emotion or become aware of specific thoughts. This forms part of the triangle of awareness. When children are able to recognise that something is happening in them, they can learn to label it, which aids in diffusing their experience and the situation as a whole.[18]

Figure 2. Triangle of Awareness

Mindfulness is a skill akin to ball catching that can be augmented through training and a wide variety of MBI have been developed in order to enhance this skill.[1] Many of these MBI approaches are based on the principles of MBSR.[1]

Some techniques incorporated in MBI include: [5][13][21]

  • Breathing meditation - “notice and concentrate on the sensations involved in breath”
  • Body scan - “focus on each part of the body in a sequential way - from toes to head”
  • Sitting meditation
  • Mindful yoga
[22]

A useful approach to introducing mindfulness to children follows the model of DNA-V which was developed by Hayes and Ciarrochi [23]. DNA-V encompasses 3 skills or functional classes of behaviour, all existing in the service of building values and vitality (the V).

  • Discoverer - the trial and error behaviour that broadens and builds skills, resources and social networks. The discoverer engages with the world and learns through trial and error how to interact and manipulate it.[19] Trial-and-error naturally involves risk and it is important for young people to discover which risk-taking behaviour helps them build value and vitality. High discoverer skills are associated with adaptive openness to experiences and curiosity.[19]
  • Noticer - the attending behaviour that increases awareness of inner and outer experience. The five important functions of the noticer are to:[19]
    • Help us tune into our body, detect sensations and identify and label emotions
    • Map the effect of actions on others
    • Tune into the world and what it has to offer
    • Provide a way to reconnect with the physical realm when we are stuck inside thinking (e.g. listening to our advisor)
    • Help us be non-reactive to the inner experience and regulate our behaviour when experiencing difficult emotions
  • Advisor - the “inner voice” or GPS system that guides us and limits our need for trial and error experience for every event in life. Our beliefs, judgements, evaluations, ability to make sense of ourselves, others and life are included in it. The advisor can be helpful (and hence worth listening to), but it can also be judgmental and unhelpful, in which case shifting to another behaviour to find a more helpful way forward is more beneficial.[19]

DNA behaviour is strongly influenced by context. The aim of the skills taught in the DNA-V model is to build psychological flexibility - “the ability to contact the present moment more fully as a conscious human being, and to change or persist in behaviour when doing so serves valued ends”.[23] DNA-V aims to teach children to know what is happening inside of them and to live more fully in the moment by moving flexibly between the three skills of the model.[23] It develops behaviours that help children flexibly adapt to their environment in a way that is consistent with their values and that helps them reach their full potential.[19] The Discoverer, Noticer and Advisor provide the means to engage in valued action, in support of the values that are central to the model. Values refer to the “compass that guides people through storms and confusing times of life and towards the things they most care about.”[23] They are “the qualities of action that are chosen because they are personally important and meaningful”[23], such as connecting with others, giving to others, being physically active, challenging oneself and learning, etc.[19]

[24]

Mindfulness, therefore, starts with Noticing - the environment, the concrete sensations experienced in the body and then internal monitoring - noticing an emotion and subsequently noticing thoughts. As children notice their thoughts, they should be taught to consider them simply as bubbles moving through them, with no need to stop or block them, but to view them as if simply an observer. And if they get stuck in the “thought-bubbles”, they can simply move back to noticing something that will anchor them to the present moment (e.g. feeling of their feet on the floor or their breath) and hence transition back into Breathing meditation or Body Scan.[18]

The majority of research on mindfulness has focused on MBI programs, such as MBSR, which is an 8-week program, but stand-alone mindfulness exercises (body scan, breathing meditation, sound scan, sitting meditation) have also been proven beneficial.[21] Furthermore, technological advances have also been made to enhance mindfulness. Mobile applications have been developed to make mindfulness practices available to the general public and children are especially open to the use of technology.[5] Mindfulness-based apps that are well-rated include Mindfulness with Petit BamBou, Headspace: Meditation and Mindfulness, Breethe - Guided Meditation and Mindfulness, Stop, Breath & Think Kids, Smiling Mind and Calm.[5]

Conclusion

Mindfulness practice for use in children and youth is still in its infancy, but already showing promising benefits that will help children to grow and flourish as they learn how to better regulate themselves and their emotions while navigating the stressors of life. Teaching them to notice sensations, emotions and thoughts in their bodies, label it and then allow it to diffuse with acceptance, gives them the skills to manage difficult situations in life without being overwhelmed by them. Better regulation of themselves and their emotions opens the door for learning to occur more freely and with fewer obstacles, promising a brighter future.


References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Dunning, D.L., Griffiths, K., Kuyken, W., Crane, C., Foulkes, L., Parker, J. and Dalgleish, T., 2019. Research Review: The effects of mindfulness‐based interventions on cognition and mental health in children and adolescents–a meta‐analysis of randomized controlled trials. Journal of Child Psychology and Psychiatry, 60(3), pp.244-258. DOI:10.1111/jcpp.12980
  2. 2.0 2.1 2.2 2.3 Kabat‐Zinn J. Mindfulness‐based interventions in context: past, present, and future. Clinical psychology: Science and practice. 2003 Jun;10(2):144-56. DOI:10.1093/clipsy/bpg016
  3. 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Zenner C, Herrnleben-Kurz S, Walach H. Mindfulness-based interventions in schools—a systematic review and meta-analysis. Frontiers in psychology. 2014 Jun 30;5:603. DOI:10.3389/fpsyg.2014.00603
  4. 4.0 4.1 4.2 4.3 4.4 4.5 4.6 Shapiro SL, Carlson LE. The art and science of mindfulness: Integrating mindfulness into psychology and the helping professions. 2nd ed. Washington, DC: American Psychological Association; 2017.
  5. 5.0 5.1 5.2 5.3 5.4 5.5 5.6 Nunes A, Castro SL, Limpo T. A review of mindfulness-based apps for children. Mindfulness. 2020 Sep;11(9):2089-101. DOI:10.1007/s12671-020-01410-w
  6. 6.0 6.1 Siegel DJ. Mindfulness training and neural integration: Differentiation of distinct streams of awareness and the cultivation of well-being. Social cognitive and affective neuroscience. 2007 Dec 1;2(4):259-63. DOI:10.1093/scan/nsm034
  7. 7.0 7.1 7.2 7.3 7.4 Tang YY, Hölzel BK, Posner MI. The neuroscience of mindfulness meditation. Nature Reviews Neuroscience. 2015 Apr;16(4):213-25. DOI:10.1038/nrn3916
  8. 8.0 8.1 8.2 8.3 Sibinga EM, Webb L, Ghazarian SR, Ellen JM. School-based mindfulness instruction: an RCT. Pediatrics. 2016 Jan 1;137(1). DOI: 10.1542/peds.2015-2532
  9. 9.0 9.1 Spinelli C, Wisener M, Khoury B. Mindfulness training for healthcare professionals and trainees: A meta-analysis of randomized controlled trials. Journal of Psychosomatic Research. 2019 May 1;120:29-38. DOI:10.1016/j.jpsychores.2019.03.003  
  10. 10.0 10.1 Marusak HA, Elrahal F, Peters CA, Kundu P, Lombardo MV, Calhoun VD, Goldberg EK, Cohen C, Taub JW, Rabinak CA. Mindfulness and dynamic functional neural connectivity in children and adolescents. Behavioural brain research. 2018 Jan 15;336:211-8. DOI:10.1016/j.bbr.2017.09.010
  11. 11.0 11.1 11.2 11.3 Geronimi EM, Arellano B, Woodruff-Borden J. Relating mindfulness and executive function in children. Clinical child psychology and psychiatry. 2020 Apr;25(2):435-45. DOI:10.1177/135910451983373
  12. 12.0 12.1 12.2 Bauer CC, Caballero C, Scherer E, West MR, Mrazek MD, Phillips DT, Whitfield-Gabrieli S, Gabrieli JD. Mindfulness training reduces stress and amygdala reactivity to fearful faces in middle-school children. Behavioral Neuroscience. 2019 Dec;133(6):569. DOI:10.1037/bne0000337
  13. 13.0 13.1 Evans S, Ling M, Hill B, Rinehart N, Austin D, Sciberras E. Systematic review of meditation-based interventions for children with ADHD. European Child & Adolescent Psychiatry. 2018 Jan 1;27(1):9-27. DOI:10.1007/s00787-017-1008-9
  14. Young KS, van der Velden AM, Craske MG, Pallesen KJ, Fjorback L, Roepstorff A, Parsons CE. The impact of mindfulness-based interventions on brain activity: A systematic review of functional magnetic resonance imaging studies. Neuroscience & Biobehavioral Reviews. 2018 Jan 1;84:424-33. DOI: 10.1016/j.neubiorev.2017.08.003
  15. 15.0 15.1 Gotink RA, Meijboom R, Vernooij MW, Smits M, Hunink MM. 8-week mindfulness based stress reduction induces brain changes similar to traditional long-term meditation practice–a systematic review. Brain and cognition. 2016 Oct 1;108:32-41. DOI:10.1016/j.bandc.2016.07.001
  16. Zimmerman B, Finnegan M, Paul S, Schmidt S, Tai Y, Roth K, Chen Y, Husain FT. Functional brain changes during mindfulness-based cognitive therapy associated with tinnitus severity. Frontiers in neuroscience. 2019 Jul 24;13:747. DOI:10.3389/fnins.2019.00747
  17. Smiling Mind. Mind the Bump – Mindfulness and how the brain works. Publised 3 Feb 2015. Available from: https://www.youtube.com/watch?v=aNCB1MZDgQA [last accessed 26 Feb 2021]
  18. 18.0 18.1 18.2 18.3 18.4 18.5 Prowse, T. Introduction to Mindfulness for Children. Physioplus course. 2021
  19. 19.0 19.1 19.2 19.3 19.4 19.5 19.6 Ciarrochi J, Atkins PW, Hayes LL, Sahdra BK, Parker P. Contextual positive psychology: Policy recommendations for implementing positive psychology into schools. Frontiers in psychology. 2016 Oct 10;7:1561. DOI:10.3389/fpsyg.2016.01561
  20. Siegel DJ. The developing mind: Toward a neurobiology of interpersonal experience. 2nd ed. New York: Guilford Press; 2012
  21. 21.0 21.1 Blanck P, Perleth S, Heidenreich T, Kröger P, Ditzen B, Bents H, Mander J. Effects of mindfulness exercises as stand-alone intervention on symptoms of anxiety and depression: Systematic review and meta-analysis. Behaviour Research and Therapy. 2018 Mar 1; 102:25-35. DOI:10.1016/j.brat.2017.12.002
  22. Psych Hub. How to Practice Mindfulness. Published 23 June 2020. Available from: https://www.youtube.com/watch?v=bLpChrgS0AY [last accessed 26 Feb 2021]
  23. 23.0 23.1 23.2 23.3 23.4 Hayes LL, Ciarrochi JV. The thriving adolescent: Using acceptance and commitment therapy and positive psychology to help teens manage emotions, achieve goals, and build connection. California: New Harbinger Publications; 2015.
  24. Jesse Fankushen. DNA V model The Thriving Adolescent L Hayes & J Ciarrochi 2015 HD. Published 8 Aug 2016. Available from: https://www.youtube.com/watch?v=EoXn2AOR3kI [last accessed 26 Feb 2021]
  25. ABC ME. What is Mindfulness? The Mindfulness Toolkit. Published 8 July 2018. Available from: https://www.youtube.com/watch?v=kO5I0p3IuiQ [last accessed 26 Feb 2021]
  26. Sarasota County Schools Education Channel. What is Mindfulness? Published 10 Aug 2020. Available from: https://www.youtube.com/watch?v=5ZzFqAPRcLI [last accessed 26 Feb 2021]
  27. KeltyMentalHealth. Mindfulness: Youth Voices. Published 14 March 2013. https://www.youtube.com/watch?v=kk7IBwuhXWM [last accessed 18 Feb 2021]