Mindfulness in Children

Original Editor - Merinda Rodseth

Top Contributors - Gabriele Dara, Merinda Rodseth, Kim Jackson, Jess Bell, Robin Tacchetti, Tarina van der Stockt, Chelsea Mclene and Ewa Jaraczewska  

Introduction

Mindfulness originated from ancient eastern and Buddhist philosophy and dates back around 2500 years. 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).

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”
  

• “Intentionally directing attention to present moment experiences with an attitude of curiosity and acceptance”

• “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”

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

Mindfulness can be also explained according to a model developed by Shapiro and Carlson 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 practising mindfulness (the why?). “Intention is a direction, not a destination”. 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. 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”.
• 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. Siegel 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.

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).

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

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. Serious mental health disorders are widespread among children and of these, ADHD, anxiety, depression, behavioural and conduct problems are the most prevalent. 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”.

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. 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. 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. 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. 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. The benefits of MBI are well established in adults and include:

• 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. 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. Research on mindfulness in children and adolescents suggests benefits in both clinical and non-clinical populations and  include:

• 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. 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.

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. 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. Greater stress is associated with greater amygdala activation. A study done by Bauer et al. 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. 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.

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. 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. 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).

Mindfulness training in children is really about helping them find a space and place in their life where they can start learning to regulate. When a child functions in their “window of tolerance”, 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. 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.

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. Many of these MBI approaches are based on the principles of MBSR.

Some techniques incorporated in MBI include:

• 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

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.

The majority of research on mindfulness has focused on MBI programs, such as MBSR, which is an 8-week programme, but stand-alone mindfulness exercises (body scan, breathing meditation, sound scan, sitting meditation) have also been proven beneficial. 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. 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.

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.