The following article is a part of conference coverage from the National Association of Pediatric Nurse Practitioners (NAPNAP) 42nd National Conference on Pediatric Health Care, held virtually from March 24 to March 27, 2021. The team at the Clinical Advisor will be reporting on the latest news and research conducted by leading nurse practitioners in pediatrics. Check back for more from NAPNAP 2021.
Children and adolescents with ADHD who practiced brief mindfulness exercises using the Headspace app in combination with evidenced-based ADHD treatments showed significant improvements in overall symptoms at 4 months, according to a poster presented virtually by Stephanie M. Key, DNP, APRN, CPNP-PC, at the National Association of Pediatric Nurse Practitioners Annual Meeting (NAPNAP 2021).
“I enjoy working with patients with ADHD and wanted to look for other cost-effective, safe, efficacious options to be able to give parents and patients as tools for their toolbox to help with ADHD,” said Dr Key, who specializes in the care of children and adolescents with ADHD in a pediatric primary care office in Austin Texas.
“I had been reading a lot about mindfulness as an intervention for anxiety, depression, and other mental health disorders but found little research about mindfulness in the management of externalizing behaviors, which are common in patients with ADHD,” said Dr. Key, who is also clinical assistant professor and director of the PNP Program at the University of Texas at Austin School of Nursing.
This led her to initiate a pilot implementation of mindfulness exercises with every patient in her practice who was willing to try it. Her poster presentation focused on the first 17 children and adolescents with ADHD (aged 8 to 16 years) who agreed to participate. Fourteen of the patients (82%) were taking ADHD medications and 3 were not.
Implementation of the Mindfulness Mobile App
At the first visit, Dr Key showed patients how to download the Headspace mobile app and practiced the first free 5-minute mindfulness session on the app with patients and their family members. At regular follow-up office visits 2 and 4 months later, Dr. Key practiced the second and third mindfulness sessions on the app with all of the patients.
Patients were encouraged to use the app at home on a daily basis; however, adherence to the app at home varied considerably. Some patients reported using it once a week and others reported using it 7 days week, she said.
The primary outcome of this pilot implementation was change in scores on the Vanderbilt Parent Follow-Up form and Child and Adolescent Mindfulness Awareness (CAMM) from baseline to 4 months.
Improvements in Inattentiveness, Hyperactivity Found at 4 Months
Overall scores on the Vanderbilt Parent Follow-up form showed statistically significant improvement at 4 months compared with baseline (P =.001). A statistically significant improvement in inattentive symptoms was found on the Vanderbilt Parent Follow-up form (P =0.027) and a clinically significant (but not statistically significant) improvement in hyperactivity scores (P =.0592) was found at 4 months. Scores on CAMM also showed clinically significant (but not statistically significant) improvement. Statistical significance was difficult to achieve given the small sample size and short duration of the intervention, Dr Key noted.
The patients reported that practicing mindfulness helped them feel “calmer,” like they “can think before acting,” and “less stress with breathing exercises.”
Dr Key views the mindfulness sessions as therapeutic and easy to integrate into regular office visits. She is continuing to integrate the mindfulness sessions in daily practice in the hopes of transitioning to a pilot project in which she will evaluate pre- and postintervention data in a larger group over a longer period and compare outcomes with patients who do not participate in the mindfulness sessions.
“Many families are hesitant to give medication for [management of] ADHD, or patients continue to struggle with symptoms despite medication use. I see mindfulness exercises as an adjunct to management that can be used even into the adult years,” Dr Key noted.
“The use of a mobile mindfulness application is a low-cost and effective intervention to use during ADHD visits,” she concluded.
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Key SM. Mindfulness and the ADHD brain. Poster presented at: NAPNAP 2021; March 24-27, 2021. EP-PI28.