Mindfulness, ADHD, and Managing Emotions

Mark Bertin MD

 Attention Magazine December 2019

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A NEW STUDY* SHOWS BENEFIT TO CHILDREN WITH ADHD as young as seven years old when they practice mindfulness. Perhaps surprisingly, the study is not really about attention. Instead, the researchers measured improvements around behavior and emotion. That’s because neither ADHD nor mindfulness specifically have to do with focus. On a much grander level, both ADHD and mindfulness impact all of our lives.

It’s not uncommon to hear well-meaning mindfulness researchers suggest that since ADHD is an attention disorder then practicing focus through mindfulness should eliminate it. But ADHD isn’t an attention disorder. ADHD is a highly genetic medical disorder affecting an array of cognitive abilities related to a skill set called executive function.

Executive function is often referred to as our “brain manager.” It includes an array of mental skills used to navigate anything that requires self-regulation, organization, planning, and forethought. ADHD therefore can affect almost anything that needs to be managed: attention, behavior, time, projects, goals, sustaining routines, emotion, and more. Through these abilities, we oversee situations like our classroom learning, work, conversations, relationships, and even our physical health.

Mindfulness represents the other side of that same executive function-based coin. Better focus alone wouldn’t change our lives. We start with focus but also work on staying settled, observing our ever-changing experience, and on shifting various habits we uncover that affect how we live. The intention is to see life with clarity, and to develop traits that help us manage with resilience and skill whatever we experience day to day.

Mindfulness, ADHD, and emotion

Emotions are clearly a vital part of life, so we all must learn to manage them as best as we’re able. Executive function-based skills include the ability to notice our emotions without reacting right away. Otherwise, every time something excites or rattles us, we’ll mindlessly act on it.

ADHD therefore causes many people to have a quick temper, to frustrate easily, or to get overwhelmed and shut down too often. In fact, emotional dysregulation has been found in up to half of children with ADHD. It can be an overwhelming and complicating aspect of their lives. And yet, it’s not a choice to be less reactive, as is often implied (you know better, calm down), it’s a skill to address.

Some of the more proven benefits of mindfulness regard emotion, stress, and anxiety. With practice, we become better at noticing our feelings, whether pleasant or unpleasant or not much of either, before we decide what to do, or not do, about them. Though there’s value to staying settled when we’re able, when we practice mindfulness, we’re not always expecting to be calm. It’s more that without awareness, we easily get swept away by emotions, and then fall back on habits that exacerbate instead of improving our situation.

Mindfulness: It’s all about the effort

Meditation is an impossible task, and that’s why we practice. We feel distracted and restless and bored… and are also probably safe and well fed during the time we meditate. We notice all that discomfort, and practice sitting with it a few minutes. We notice when we get distracted, and without judging ourselves for having lost track of our intentions, come back again. Those are useful traits to cultivate in life.

We build a kind of awareness and patience in meditation. We observe, and whatever happens (I’m tired, my mind won’t stop, I’m angry), for a few breaths we let it be. It’s normal to feel restless, anxious or bored while meditating, and we work on being more patient and purposeful. If that were easy, with or without ADHD, we wouldn’t need so much practice.

It sometimes feels easier to rely on “informal” mindfulness, instead of pushing through the challenge of starting with meditation. We all benefit from a general aim of staying settled, accepting how things are, and seeing our lives accurately. That’s easier said than done, and kind of like taking the stairs at work instead of the elevator. It’s productive, but not the same as going to the gym. Aiming for mindfulness through therapy, coaching, and reading books is great—and not the same as mindfulness practice.

Meditation is challenging and so is remembering to meditate. And yet, meditation is the core of mindfulness practice and has been shown feasible and effective even when people have ADHD. The bottom line is that it takes ongoing effort and repetition to rewire new traits and habits. It’s easy to talk about change, and to know we want to change; the intention of mindfulness is to show us how to actually make changes happen for ourselves.

Mindfulness is also not a passive practice. It’s not that suddenly we’re fine with whatever is going on that annoys us. Quite often, after settling, we determine exactly what does seem best to do next—instead of what we habitually would have done. Or maybe, we allow ourselves to experience an emotion we would otherwise have aimed to avoid or repress. This is my reality in this moment, I’m actually quite distraught and embarrassed.

With time, we become better at navigating our emotions instead of falling back on old patterns like ignoring, avoiding, or compulsively fixing. Sometimes there is something to act on, and that becomes clear. Sometimes there’s nothing more available than compassion and finding space to experience our evolving feelings. And as shown in this new study, even with ADHD, and even in young children, these emotional benefits are available and accessible to all.

Emotional rescue: Using mindfulness to manage your inner world

At any age, mindfulness is about long-term effort more than short-term goals. It’s like planting seeds that blossom one day in the future. Don’t get stressed if you have a busy mind and restless body. Don’t get worried if your kids don’t want to practice at first, or resist. Come back to your own mindfulness over time, and related skills and traits will grow for you, and if you have one, your family.

When we work on mindful awareness, we notice our emotions more clearly and with less resistance. We recognize our mental habits and actively leave things alone for a moment instead: I’m in a bad mood, it’s not my fault or anyone else’s, and it will pass. Whatever our urge—to ignore emotion or to react to it—we can work on something new. If something useful and healthy can relieve an intense emotion, go for it. The rest of the time, observe, seek comfort when you can, and then define the next skillful step forward for yourself.

One commonly referenced mindfulness practice with emotions is summarized by the acronym RAIN (typically attributed to Tara Brach):

R = Recognize your emotions.
A more nuanced ability to describe emotions all on their own may change your experience. When you see nothing more than anger in life, that’s all there is. When you nuance that unsettled experience into fearful, embarrassed, and regretful, you understand your situation differently and may become better able to seek useful solutions moving forward.

A = Accept your emotions.
You cannot force yourself to feel any specific emotion; they come and go all on their own. Fighting with or refusing to acknowledge a bad mood often makes it worse. Notice what’s there, and for a few moments accept it as it is.

I = Investigate your emotions.
Turn with curiosity toward your emotional experience. Does it wax and wane? Does it cause a physical sensation in your body? Alter how you think and perceive the world? Is there a more accurate word to describe your emotion than you’d typically use?

N = Nonidentification.
You are not your emotions. Your knee hurts, not you, but so often we say, I am sad. You are you, and you happen to feel sad. The emotion will run its course, particularly when you remain less caught up in it.

Consider this

Pay attention to family messages about emotions. Do you accept and discuss emotions with your children, or tend toward denying or ignoring? Even saying It’s all okay can be a type of dismissal—It’s clearly not okay—can’t you see I’m hysterical here? Supply both comfort and empathy: I know that hurts. Come here, you’re going be all right. The same can apply to discipline: I see you’re angry, and you still cannot talk to me like that.

Mark Bertin, MD, is a developmental pediatrician and author of How Children Thrive, Mindful Parenting for ADHD, and The Family ADHD Solution, which integrate mindfulness into the rest of evidence-based pediatric care. He is a contributing author for the book Teaching Mindfulness Skills to Kids and Teens. Bertin is on faculty at New York Medical College and the Windward Teacher Training Institute, and on the advisory boards for the nonprofits Common Sense Media and Reach Out and Read. He is a regular contributor to Mindful magazine, and his blog is available through Mindful.org and PsychologyToday.com. For more information, visit his website at developmentaldoctor.com.
Parts of this article were adapted from a blog originally published on PsychologyToday.com and from Dr. Bertin’s book
How Children Thrive: The Practical Science of Raising Independent, Resilient, and Happy Kids (Sounds True, 2019).

*Huguet A, Izaguirre Eguren J, Miguel-Ruiz D, Vall Vallés X, Alda JA. Deficient Emotional Self-Regulation in Children with Attention Deficit Hyperactivity Disorder: Mindfulness as a Useful Treatment Modality. Journal of Developmental & Behavioral Pediatrics. July/August 2019, Volume 40, Issue 6, p 425–431. https://journals.lww.com/jrnldbp/Abstract/2019/08000/Deficient_Emotional_Self_Regulation_in_Children.3.aspx