ADHD and Mindfulness

(This is a shorter post - the long, wonderful - amazing (honestly) - blog post that I published had disappeared. I am not ok with that but here we are. The moral of the story is to always, always write a draft in a google doc that WILL NOT DISAPPEAR. I’ll find the references and papers that SHOULD be at the bottom of the post later but for now, make sure you get the Cliff Notes version).

I sat listening to the beautiful tone of the tibetan singing bowl and had a split second of calm. Then I remembered where I was and that the class was ending. I jumped to what I was doing that evening and backwards to what I’d done this morning. Then I noticed that my foot was numb and my mind went to buying winter boots. Then to having sore feet from ballet in my childhood. Then to frustration with myself for not dancing and shame around my adult body. The bowl sounded again and I felt that I would never be calm, not for more than a split second at a time.

You can see why I would be sceptical that anyone with ADHD like mine would be able to practice mindfulness - or a mindful awareness practice (MAP) - that would actually reduce my stress, increase my dopamine and actually allow me to slowly increase the length of time I could direct my attention and manage my emotional reactions.

Then, I realised that I had no option. I’ve only been able to access medication for a year and now it’s out of stock - so I’m glad that I had already taken steps to learn and perfect a mindfulness practice that I’m sharing in my new RadiantMind group program in November this year.

The background of modern mindfulness

The background of mindfulness is a relatively new thing: it’s based on eastern meditation, so it’s definitely about being present in a single moment and ‘stilling’ the focus or attention of the mind more than a physical act like yoga. It’s a secular, non-religious practice that was developed for supporting patients with chronic pain who were not responding to standard medical treatment and who were having problems with mental health and wellbeing. 

It’s often referred to as MBSR - Mindfulness Based Stress Reduction - and there are now many places offering these programs.

There have been lots of studies using the official MBSR program - from cancer patients, carers for people with dementia, parents of children with additional needs, the list is pretty long. Even if the studies don’t follow up people long term, the data does show that the reduced stress, improved well being and emotional regulation are noticeable. Frankly, that sounds pretty good to most people with ADHD - especially in the middle of another medication crisis

Why not use standard MBSR mindfulness?

Most MBSR programs build up to 45 minute long sessions and ask learners to sit quietly and be still. There’s a LOT that is not neurodivergent friendly, so finding that some people had adapted it for ADHD was a relief. And - unsurprisingly - it worked for me.

What’s happening in our brains during Mindfulness practices?

What’s actually going on in our brains though? Since ADHD is a brain-based neurodevelopmental difference, what’s the action of the practices?

There are 3 possible changes that studies think may be happening - 

(1) increased resting-state cerebral blood flow, so that our brains get more oxygen

 (2) reduced inflammation (indirectly) as the connections in and around the default mode network are strengthened

 (3) a top-down control mechanism that likely reflects both a direct and an indirect neurovascular pathway - in other words, our minds are actively improving the physical state of our brains.

And by the way, if you want to have your mind blown on that topic, please read ‘The Mindful Body’ by Ellen J Langer.

So it could be more blood flow - it could be building up the connections around the DMN - or it could actually be that focusing positively, gently and kindly on our bodies and brains improves their physical state. Literally thinking ourselves into a better place… That’s pretty amazing, even if it’s just a little of each.

Which parts of the brain that ADHD affects are impacted by mindfulness?  

1. the anterior cingulate cortex (ACC)

2. Insula (working memory, decision making, state switching (shifting), socioemotional function, and interoception)

3. temporo-parietal junction 

4. fronto-limbic network, and 

5. default mode network structures (see below).

All of these areas work together - it’s impossible to say that one area does ONE job - and all together they are connected to  our executive functions, enhancing or self-regulation. 

The anterior cingulate cortex seems to be connected to the real core ADHD traits - inattention, impulsivity and hyperactivity. 

What does the ‘DMN’ do?

The Default Mode Network and Task Positive Network are explained really well in Dr Edward Hallowell’s ADHD 2.0 - but very briefly -

Our brains are always processing information from all around us and from our bodies, both consciously and subconsciously. The DMN activates when we’re not focused on a specific task - think of it like your car idling in neutral, the engine is running but you’re not in gear so it’s turning over.It seems that for many people with ADHD, the DMN is overactive compared to people without ADHD.

Instead of the ‘car’ staying in gear, our DMN decides to pop back into neutral half way through a task or even worse, at the same time as a task… it’s always wandering and It looks like we have both neural networks running at the same time, so instead of being able to focus on our work, our brains are running two tracks and one of them is all about wandering off and checking that something more interesting isn’t happening elsewhere.

So we think there is a physical change when people practice the MBSR or mindfulness based practice and we know that the areas of the brain that appear to be most affected are the ones that cause problems for ADHDers.

The challenge is always translating that into practice.

The goal is to turn our stressed, hyper vigilant, emotionally reactive and ‘out of control’ brains from wild bucking broncos into (more peaceful) trekking ponies - although the initial 8 weeks is just the start. Think of weight training - the ‘beginner gains’ are a great boost at the beginning - and help you recognise the benefits of continuing with short, daily sessions and adding tools that you can go back to when the inevitable frustrations, mistakes, disasters pop up..

Want to learn more?

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Katherine

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Further reading:

​​Pommy J, Smart CM, Bryant AM, Wang Y. Three potential neurovascular pathways driving the benefits of mindfulness meditation for older adults. Front Aging Neurosci. 2023 Jun 29;15:1207012. doi: 10.3389/fnagi.2023.1207012. PMID: 37455940; PMCID: PMC10340530.

Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003 Apr;84(4):822-48. doi: 10.1037/0022-3514.84.4.822. PMID: 12703651.

Bazzano, A., Wolfe, C., Zylowska, L. et al. Mindfulness Based Stress Reduction (MBSR) for Parents and Caregivers of Individuals with Developmental Disabilities: A Community-Based Approach. J Child Fam Stud 24, 298–308 (2015). https://doi.org/10.1007/s10826-013-9836-9

Nyklícek I, Kuijpers KF. Effects of mindfulness-based stress reduction intervention on psychological well-being and quality of life: is increased mindfulness indeed the mechanism? Ann Behav Med. 2008 Jun;35(3):331-40. doi: 10.1007/s12160-008-9030-2. Epub 2008 Jun 6. PMID: 18535870; PMCID: PMC2517090.

Deshmukh, P., Patel, D. Mindfulness and ADHD (Attention Deficit Hyperactivity Disorder) in Adolescents. Curr Dev Disord Rep 7, 93–99 (2020). https://doi.org/10.1007/s40474-020-00197-8

Kabat-Zinn J, Lipworth L, Burney R. The clinical use of mindfulness meditation for the self-regulation of chronic pain. J Behav Med. 1985 Jun;8(2):163-90. doi: 10.1007/BF00845519. PMID: 3897551.

Hölzel BK, Lazar SW, Gard T, Schuman-Olivier Z, Vago DR, Ott U. How Does Mindfulness Meditation Work? Proposing Mechanisms of Action From a Conceptual and Neural Perspective. Perspect Psychol Sci. 2011 Nov;6(6):537-59. doi: 10.1177/1745691611419671. PMID: 26168376.

Mitchell JT, Zylowska L, Kollins SH. Mindfulness Meditation Training for Attention-Deficit/Hyperactivity Disorder in Adulthood: Current Empirical Support, Treatment Overview, and Future Directions. Cogn Behav Pract. 2015 May;22(2):172-191. doi: 10.1016/j.cbpra.2014.10.002. PMID: 25908900; PMCID: PMC4403871.

Janssen LK, Duif I, Speckens AEM, van Loon I, Wegman J, de Vries JHM, Cools R, Aarts E. The effects of an 8-week mindful eating intervention on anticipatory reward responses in striatum and midbrain. Front Nutr. 2023 Aug 11;10:1115727. doi: 10.3389/fnut.2023.1115727. PMID: 37637944; PMCID: PMC10457123.

Jendryka, M.M., Lewin, U., van der Veen, B. et al. Control of sustained attention and impulsivity by Gq-protein signalling in parvalbumin interneurons of the anterior cingulate cortex. Transl Psychiatry 13, 243 (2023). https://doi.org/10.1038/s41398-023-02541-z

Zhao Qihua, Li Hui, Yu Xiaoyan, Huang Fang, Wang Yanfei, Liu Lu, Cao Qingjiu, Qian Qiujin, Zang Yufeng, Sun Li, Wang Yufeng. Abnormal Resting-State Functional Connectivity of Insular Subregions and Disrupted Correlation with Working Memory in Adults with Attention Deficit/Hyperactivity Disorder, Frontiers in Psychiatry, VOl.8, 2017, https://www.frontiersin.org/articles/10.3389/fpsyt.2017.00200   

Santonastaso O, Zaccari V, Crescentini C, Fabbro F, Capurso V, Vicari S, Menghini D. Clinical Application of Mindfulness-Oriented Meditation: A Preliminary Study in Children with ADHD. Int J Environ Res Public Health. 2020 Sep 22;17(18):6916. doi: 10.3390/ijerph17186916. PMID: 32971803; PMCID: PMC7557753.

Vetter NC, Buse J, Backhausen LL, Rubia K, Smolka MN, Roessner V. Anterior insula hyperactivation in ADHD when faced with distracting negative stimuli. Hum Brain Mapp. 2018 Jul;39(7):2972-2986. doi: 10.1002/hbm.24053. Epub 2018 Mar 23. PMID: 29569801; PMCID: PMC6866282.