By Marisa Markowtiz, LMSW, CASAC-T
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that develops in childhood and lasts into adulthood.
Approximately nine percent of children get diagnosed with ADHD, according to the latest CDC survey from 2019. Common features of ADHD include problems with executive functioning tasks, including working memory, self-monitoring, planning, prioritizing, task initiation, organization, impulse control, emotional control, and flexible thinking. Licensed mental health care professionals diagnose ADHD using the DSM-5.
ADHD is treated through behavior therapy and medications. Misdiagnosis of children who present with ADHD symptoms is a concern, and the best care needs to be taken to ensure that a diagnosis is accurate. Boys are at an elevated risk for over-diagnosis, and inattentive students, girls in particular, for under-diagnosis, according to developmental pediatrician Dr. Mark Bertin.
Long-term effects of ADHD can take a toll on a client’s personal life. One of the reasons for this is that the client experiences executive functioning impairment, which can lead to a chronic sense of feeling like they are letting people down. They may feel that they are failing, which erodes self-confidence. A common quote is that ADHD is “a disorder of not doing what you know.” Indeed, clients with ADHD know what the issues are, but handling their symptoms is a vicious cycle of dealing with them and learning how to cope with them.
Clients with ADHD are not treatment resistant. Bertin asserts that there is a misperception that clients with ADHD cannot be helped because they believe they are incapable of managing their emotions. Frustration around managing ADHD symptoms is a real concern for clients with ADHD. To mitigate these fears, Bertin recommends describing ADHD as a problem-solving disorder, which helps conceptualize ADHD in a way that is manageable, rather than scary or daunting.
Not all clients opt to take medication and look to lifestyle changes to help them manage ADHD symptoms. One such lifestyle approach, both for people who medicate and those who don’t, is mindfulness. Mindfulness has been shown to be an effective tool to help treat ADHD symptoms.
Mindfulness is a tool to help with ADHD
Mindfulness is the practice of observing thoughts without judgment. The goal of a mindfulness practice for ADHD, according to ADHD expert Dr. Lydia Zylowska, is to help clients to step away from a busy and anxious mind. Zylowska believes that the more a client works on regulating their attention and executive functioning skills, the better they become at managing their ADHD symptoms.
Studies indicate that mindfulness is an effective model for helping clients with ADHD. A study from Psychiatry International found possible benefits of mindfulness to help with self-compassion, quality of life, well being, depression, and anxiety. The findings suggest that mindfulness may improve ADHD symptoms, including executive functioning, problematic behaviors, and emotional dysregulation, despite some limitations with the study.
Mindfulness is a practice that encompasses a variety of mindfulness-based interventions. Mindfulness awareness practices (MAP), mindfulness based cognitive therapy (MBCT), and mindfulness-based stress reduction (MBSR) are evidenced-based practices meant to help ADHD symptoms. One study found these interventions to be complementary to other active treatments for ADHD, like behavioral interventions and medication.
Despite evidence that mindfulness is a strong tool to help clients with ADHD symptoms, not all clients benefit from mindfulness practices. Bertin explains that clients who intellectualize their problems may feel that it’s nearly impossible to overcome ADHD symptoms through mindfulness alone. Sarah McConkey, LCSW, specializes in ADHD and finds that mindfulness has been shown to be risky for survivors of sexual assault and other clients with complicated trauma histories. Zylowska believes that clients who are in a deep depression may find it difficult to focus on the present moment without depressive rumination.
Social workers use mindfulness for clients with ADHD
Cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) are evidence-based treatments that focus on cognition and the mind-body connection. Social workers who are helping clients with ADHD might use these approaches to help clients regulate emotions, improve interpersonal communication, and develop distress tolerance skills. These skills can be used without mindfulness training and are effective in targeting ADHD-related symptoms.
Bertin explains that social workers use elements of DBT that seem to be especially effective in helping clients with ADHD. Distress tolerance and emotion regulation are cornerstones of ADHD issues, which DBT skills target. Zylowska provides her clients with practical tools that can be used outside of therapy sessions. One such tool is the acronym STOP: stop, take a breath, observe, and proceed. This trick can be used in a non-clinical setting, or when a client is in a state of distress. Social workers can train clients with mindful walking with breath awareness, seated meditation, and through the practice of living one moment at a time.
Zylowska admits that mindfulness apps like Headspace or Calm can be helpful in helping clients in the moment. They serve as a “time out” to ground oneself. While helpful, Zylowska believes that the full scope of ADHD symptoms should be treated within the context of a trained clinician or coach.
Groups can also empower clients to find healing through community and can be a powerful way for social workers to help clients with ADHD. Groups provide social support, structure, and an opportunity for clients to discuss their concerns about ADHD symptoms without feelings of shame or embarrassment.
McConkey suggests that on an individual level, feeling frustrated or wanting to turn away is common for clients with ADHD. “Mindfulness, and the practice of simply remaining in the mindful headspace while tolerating the things that can make meditating difficult, are very effective at targeting the very same mental “muscle” that folks with ADHD have a little more trouble flexing to do what they want to do with their day.’” In other words, her work focuses on helping her clients lean into these uncomfortable experiences rather than shy away from them.
There is no “one size fits all” approach to treating ADHD, according to Zylowska. Social workers can familiarize themselves with evidence-based practices like CBT or DBT. It’s possible for social workers to help clients with ADHD without formal mindfulness training. There are good reasons to believe that mindfulness, when coupled with other evidence-based practices and medication, is a helpful tool in combating symptoms of ADHD.
Marisa Markowitz, LMSW, CASAC-T, studies the relationship between technology and its adverse effects on mental health, particularly for vulnerable populations.
Disclaimer: The National Association of Social Workers invites members to share their expertise and experiences through Member Voices. This blog was prepared by Marisa Markowitz in her personal capacity and does not necessarily reflect the view of the National Association of Social Workers.