Abstract
Objectives
The present study is aimed at investigating the effects and mechanisms of the Mindful Parenting Program (MPP) on the stress of Chinese parents of children with attention deficit hyperactivity disorder (ADHD).
Methods
A total of 113 Chinese parents of children with ADHD were randomly assigned to the MPP group (n = 58) or the treatment as usual (TAU) waitlist-control group (n = 55). The following parameters were assessed at baseline and posttreatment: parental stress, anxiety, and depressive symptoms, as well as general mindfulness, mindful parenting, and self-compassion. Each child’s ADHD symptoms and behavioral/emotional symptoms were also measured.
Results
The MPP group showed significantly greater amelioration of parental stress (F = 8.79, p = .004, effect size d =0.44) compared with that of the TAU waitlist-control group after eight weeks. The MPP group also showed greater improvements in parental general mindfulness (F = 11.40, p < .001, effect size d = 0.56) and self-compassion (F = 17.83, p < .001, effect size d = 0.62), but not mindful parenting (F = 2.32, p = 0.131), compared to those of the TAU group. Improvements in general mindfulness and parental self-compassion mediated the effect of the Mindful Parenting Program on parental stress at posttreatment, with effect sizes of 0.46 and 0.46, respectively. For the MPP completers, improvements in general parental mindfulness, parental self-compassion, and mindful parenting correlated with improvements in their children’s ADHD symptoms and behavioral symptoms. Correlation between the total practice times and outcome improvements was nonsignificant.
Conclusions
Our findings suggest that the Mindful Parenting Program may be effective for ameliorating parental stress among Chinese parents of children with ADHD.
Trial Registration
Clinical Trial Registration: https:// www.chictr.org.cn; ChiCTR1800019215
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs12671-021-01616-6/MediaObjects/12671_2021_1616_Fig1_HTML.png)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs12671-021-01616-6/MediaObjects/12671_2021_1616_Fig2_HTML.png)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs12671-021-01616-6/MediaObjects/12671_2021_1616_Fig3_HTML.png)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs12671-021-01616-6/MediaObjects/12671_2021_1616_Fig4_HTML.png)
Similar content being viewed by others
Data Availability
All data are available at the Research Manager (http://www.medresman.org.cn/).
References
Abidin, R. R. (1995). Parenting stress index: Professional manual (3rd ed.). Psychological Assessment Resources.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders: DSM-IV (4th ed.). American Psychiatric Publishing.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). American Psychiatric Publishing.
Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., Walsh, E., Duggan, D., & Williams, J. M. G. (2008). Construct validity of the Five Facet Mindfulness Questionnaire in meditating and nonmeditating samples. Assessment, 15(3), 329–342. https://doi.org/10.1177/1073191107313003.
Barkley, R. A. (1998). Attention-deficit hyperactivity disorder: A clinical workbook (2nd ed.). Guilford Press.
Barkley, R. A. (2018). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (4th ed.). Guilford Press.
Bedford, O. A. (2004). The individual experience of guilt and shame in Chinese culture. Culture & Psychology, 10(1), 29–52. https://doi.org/10.1177/1354067x04040929.
Behbahani, M., Zargar, F., Assarian, F., & Akbari, H. (2018). Effects of mindful parenting training on clinical symptoms in children with attention deficit hyperactivity disorder and parenting stress: randomized controlled trial. Iranian Journal of Medical Sciences, 43(6), 596–604. https://doi.org/10.30476/IJMS.2018.40582.
Bögels, S. M., & Restifo, K. (2014). Mindful parenting: A guide for mental health practitioners. Springer.
Bögels, S. M., Hellemans, J., van Deursen, S., Römer, M., & van der Meulen, R. (2014). Mindful parenting in mental health care: effects on parental and child psychopathology, parental stress, parenting, co-parenting, and marital functioning. Mindfulness, 5(5), 536–551. https://doi.org/10.1007/s12671-013-0209-7.
Breaux, R. P., & Harvey, E. A. (2019). A longitudinal study of the relation between family functioning and preschool ADHD symptoms. Journal of Clinical Child and Adolescent Psychology, 48(5), 749–764. https://doi.org/10.1080/15374416.2018.1437737.
Carmody, J., & Baer, R. A. (2009). How long does a mindfulness-based stress reduction program need to be? A review of class contact hours and effect sizes for psychological distress. Journal of Clinical Psychology, 65(6), 627–638. https://doi.org/10.1002/jclp.20555.
Chao, R. K. (1996). Chinese and European American mothers' beliefs about the role of parenting in children’s school success. Journal of Cross-Cultural Psychology, 27(4), 403–423. https://doi.org/10.1177/0022022196274002.
Chen, X., & French, D. C. (2008). Children’s social competence in cultural context. Annual Review of Psychology, 59, 591–616. https://doi.org/10.1146/annurev.psych.59.103006.093606.
Chen, J., Yan, L. S., & Zhou, L. H. (2011). Reliability and validity of Chinese version of self-compassion scale. Chinese Journal of Clinical Psychology, 19(6), 734–736.
Chen, W. L., Tsai, S. T., & Chou, F. H. (2015). Depression and related factors in mothers of school-aged children with attention-deficit hyperactivity disorder. The Journal of Nursing, 62(1), 39–49. https://doi.org/10.6224/JN.62.1.39.
Cheung, C. S. S., & Pomerantz, E. M. (2011). Parents’ involvement in children’s learning in the United States and China: implications for children’s academic and emotional adjustment. Child Development, 82(3), 932–950. https://doi.org/10.1111/j.1467-8624.2011.01582.x.
Corthorn, C. (2018). Benefits of mindfulness for parenting in mothers of preschoolers in Chile. Frontiers in Psychology, 9, 1443. https://doi.org/10.3389/fpsyg.2018.01443.
Crane, R. S., Eames, C., Kuyken, W., Hastings, R. P., Williams, J. M. G., Bartley, T., Evans, A., Silverton, S., Soulsby, J. G., & Surawy, C. (2013). Development and validation of the Mindfulness-Based Interventions–Teaching Assessment Criteria (MBI:TAC). Assessment, 20(6), 681–688. https://doi.org/10.1177/1073191113490790.
Crystal, D. S., Chen, C., Fuligni, A. J., Stevenson, H. W., Hsu, C. C., Ko, H. J., Kitamura, S., & Kimura, S. (1994). Psychological maladjustment and academic achievement: a cross-cultural study of Japanese, Chinese, and American high school students. Child Development, 65(3), 738–753. https://doi.org/10.2307/1131415.
Deng, Y. Q., Liu, X. H., Rodriguez, M. A., & **a, C. Y. (2011). The Five Facet Mindfulness Questionnaire: psychometric properties of the Chinese version. Mindfulness, 2(2), 123–128. https://doi.org/10.1007/s12671-011-0050-9.
Duncan, L. G. (2007). Assessment of mindful parenting among parents of early adolescents: development and validation of the Interpersonal Mindfulness in Parenting scale [Doctoral dissertation, Pennsylvania State University]. PennState Electronic Theses and Dissertations for Graduate School. https://etda.libraries.psu.edu/catalog/7740.
Duncan, L. G., Coatsworth, J. D., & Greenberg, M. T. (2009). A model of mindful parenting: implications for parent-child relationships and prevention research. Clinical Child and Family Psychology Review, 12(3), 255–270. https://doi.org/10.1007/s10567-009-0046-3.
Duncan, L. G., Coatsworth, J. D., Gayles, J. G., Geier, M. H., & Greenberg, M. T. (2015). Can mindful parenting be observed? Relations between observational ratings of mother-youth interactions and mothers' self-report of mindful parenting. Journal of Family Psychology, 29(2), 276–282. https://doi.org/10.1037/a0038857.
Eames, C., Crane, R., Gold, E., & Pratt, S. (2015). Mindfulness-based wellbeing for socio-economically disadvantaged parents: a pre-post pilot study. Journal of Children's Services, 10(1), 17–28. https://doi.org/10.1108/jcs-09-2014-0040.
Fabiano, G. A. (2007). Father participation in behavioral parent training for ADHD: review and recommendations for increasing inclusion and engagement. Journal of Family Psychology, 21(4), 683–693. https://doi.org/10.1037/0893-3200.21.4.683.
Ferraioli, S. J., & Harris, S. L. (2013). Comparative effects of mindfulness and skills-based parent training programs for parents of children with autism: feasibility and preliminary outcome data. Mindfulness, 4(2), 89–101. https://doi.org/10.1007/s12671-012-0099-0.
Finlay-Jones, A., **e, Q., Huang, X., Ma, X., & Guo, X. (2018). A pilot study of the 8-week mindful self-compassion training program in a Chinese community sample. Mindfulness, 9(3), 993–1002. https://doi.org/10.1007/s12671-017-0838-3.
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1997). User’s guide for the structured clinical interview for DSM-IV Axis I disorders: SCID-I clinician version. American Psychiatric Press.
Fischer, M. (1990). Parenting stress and the child with attention deficit hyperactivity disorder. Journal of Clinical Child Psychology, 19(4), 337–346. https://doi.org/10.1207/s15374424jccp1904_5.
Geurtzen, N., Scholte, R. H. J., Engels, R. C. M. E., Tak, Y. R., & van Zundert, R. M. P. (2015). Association between mindful parenting and adolescents' internalizing problems: nonjudgmental acceptance of parenting as core element. Journal of Child and Family Studies, 24(4), 1117–1128. https://doi.org/10.1007/s10826-014-9920-9.
Gilbert, P., & Procter, S. (2006). Compassionate mind training for people with high shame and self-criticism: overview and pilot study of a group therapy approach. Clinical Psychology & Psychotherapy, 13(6), 353–379. https://doi.org/10.1002/cpp.507.
Gouveia, M. J., Carona, C., Canavarro, M. C., & Moreira, H. (2016). Self-compassion and dispositional mindfulness are associated with parenting styles and parenting stress: the mediating role of mindful parenting. Mindfulness, 7(3), 700–712. https://doi.org/10.1007/s12671-016-0507-y.
Hamilton, M. (1959). The assessment of anxiety states by rating. British Journal of Medical Psychology, 32(1), 50–55. https://doi.org/10.1111/j.2044-8341.1959.tb00467.x.
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23(1), 56–62. https://doi.org/10.1136/jnnp.23.1.56.
Han, Z. R., Ahemaitijiang, N., Yan, J., Hu, X., Parent, J., Dale, C., DiMarzio, K., & Singh, N. N. (2019). Parent mindfulness, parenting, and child psychopathology in China. Mindfulness. https://doi.org/10.1007/s12671-019-01111-z.
Haydicky, J., Shecter, C., Wiener, J., & Ducharme, J. M. (2015). Evaluation of MBCT for adolescents with ADHD and their parents: impact on individual and family functioning. Journal of Child and Family Studies, 24(1), 76–94. https://doi.org/10.1007/s10826-013-9815-1.
Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. The Guilford Press.
Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 169–183. https://doi.org/10.1037/a0018555.
Hofstede, G., & Hofstede, G. J. (2004). Cultures and organizations: Software of the mind (2nd ed.). McGraw-Hill.
Johnston, C., Murray, C., Hinshaw, S. P., Pelham Jr., W. E., & Hoza, B. (2002). Responsiveness in interactions of mothers and sons with ADHD: Relations to maternal and child characteristics. Journal of Abnormal Child Psychology, 30(1), 77–88. https://doi.org/10.1023/a:1014235200174.
Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. Delta Trade Paperbacks.
Kabat-Zinn, M., & Kabat-Zinn, J. (1997). Everyday blessings: The inner work of mindful parenting. Hyperion.
Lee, P. C., Lin, K. C., Robson, D., Yang, H. J., Chen, V. C. H., & Niew, W. I. (2013). Parent–child interaction of mothers with depression and their children with ADHD. Research in Developmental Disabilities, 34(1), 656–668. https://doi.org/10.1016/j.ridd.2012.09.009.
Leung, K. K. W. (2014). Attitudes of Chinese people towards children with attention deficit hyperactivity disorder [Doctoral dissertation, Alliant International University]. ProQuest. https://search.proquest.com/openview/31b268af4ec70d39ad625333f5cd4c90/1?pq-origsite = gscholar&cbl = 18750&diss = y.
Leung, J. T. Y., & Shek, D. T. L. (2015). Parental beliefs and parental sacrifice of Chinese parents experiencing economic disadvantage in Hong Kong: Implications for social work. British Journal of Social Work, 45(4), 1119–1136. https://doi.org/10.1093/bjsw/bct190.
Liang, L., & Gao, X. (2016). Pre-service and in-service secondary school teachers' knowledge about Attention-deficit Hyperactivity Disorder (ADHD) and attitudes toward students with ADHD. International Journal of Disability, Development and Education, 63(3), 369–383. https://doi.org/10.1080/1034912x.2015.1123231.
Lippold, M. A., Duncan, L. G., Coatsworth, J. D., Nix, R. L., & Greenberg, M. T. (2015). Understanding how mindful parenting may be linked to mother-adolescent communication. Journal of Youth and Adolescence, 44(9), 1663–1673. https://doi.org/10.1007/s10964-015-0325-x.
Lo, H. H. M., Yeung, J. W. K., Duncan, L. G., Ma, Y., Siu, A. F. Y., Chan, S. K. C., Choi, C. W., Szeto, M. P., Chow, K. K. W., & Ng, S. M. (2018). Validating of the interpersonal mindfulness in parenting scale in Hong Kong Chinese. Mindfulness, 9(5), 1390–1401. https://doi.org/10.1007/s12671-017-0879-7.
Lo, H. H. M., Wong, S. W. L., Wong, J. Y. H., Yeung, J. W. K., Snel, E., & Wong, S. Y. S. (2020). The effects of family-based mindfulness intervention on ADHD symptomology in young children and their parents: a randomized control trial. Journal of Attention Disorders, 24(5), 667–680. https://doi.org/10.1177/1087054717743330.
Ma, J. L. C., & Lai, K. Y. C. (2014). Family engagement in children with mental health needs in a Chinese context: a dream or reality? Journal of Ethnic and Cultural Diversity in Social Work, 23(3–4), 173–189. https://doi.org/10.1080/15313204.2013.838815.
Ma, J. L. C., Lai, K. Y. C., & Lo, J. W. K. (2017). Perceived social support in Chinese parents of children with attention deficit hyperactivity disorder in a Chinese context: implications for social work practice. Social Work in Mental Health, 15(1), 28–46. https://doi.org/10.1080/15332985.2016.1159643.
Meppelink, R., de Bruin, E. I., Wanders-Mulder, F. H., Vennik, C. J., & Bögels, S. M. (2016). Mindful parenting training in child psychiatric settings: heightened parental mindfulness reduces parents’ and children’s psychopathology. Mindfulness, 7(3), 680–689. https://doi.org/10.1007/s12671-016-0504-1.
Miranda, A., Marco, R., & Grau, D. (2007). Parenting stress in families of children with attention-deficit/hyperactivity disorder: the impact of ADHD subtype and oppositional defiant disorder comorbidity. In T. E. Scruggs & M. A. Mastropieri (Eds.), International perspectives (pp. 139–162). Emerald Group Publishing.
Moreira, H., & Canavarro, M. C. (2018). Does the association between mindful parenting and adolescents’ dispositional mindfulness depend on the levels of anxiety and depression symptomatology in mothers? Journal of Adolescence, 68, 22–31. https://doi.org/10.1016/j.adolescence.2018.07.003.
Neff, K. D. (2003). The development and validation of a scale to measure self-compassion. Self and Identity, 2(3), 223–250. https://doi.org/10.1080/15298860309027.
Norvilitis, J. M., & Fang, P. (2005). Perceptions of ADHD in China and the United States: a preliminary study. Journal of Attention Disorders, 9(2), 413–424. https://doi.org/10.1177/1087054705281123.
Pappas, D. (2006). ADHD Rating Scale-IV: checklists, norms, and clinical interpretation. Journal of Psychoeducational Assessment, 24(2), 172–178. https://doi.org/10.1177/0734282905285792.
Parent, J., McKee, L. G., Rough, J. N., & Forehand, R. (2016). The association of parent mindfulness with parenting and youth psychopathology across three developmental stages. Journal of Abnormal Child Psychology, 44(1), 191–202. https://doi.org/10.1007/s10802-015-9978-x.
Pimentel, M. J., Vieira-Santos, S., Santos, V., & Vale, M. C. (2011). Mothers of children with attention deficit/hyperactivity disorder: relationship among parenting stress, parental practices and child behaviour. Attention Deficit and Hyperactivity Disorders, 3(1), 61–68. https://doi.org/10.1007/s12402-011-0053-3.
Sawyer Cohen, J. A., & Semple, R. J. (2010). Mindful parenting: a call for research. Journal of Child and Family Studies, 19(2), 145–151. https://doi.org/10.1007/s10826-009-9285-7.
Sengupta, S. M., Fortier, M. È., Thakur, G. A., Bhat, V., Grizenko, N., & Joober, R. (2015). Parental psychopathology in families of children with attention-deficit/hyperactivity disorder and exposed to maternal smoking during pregnancy. Journal of Child Psychology and Psychiatry, 56(2), 122–129. https://doi.org/10.1111/jcpp.12286.
Siu, A. F. Y., Ma, Y., & Chui, F. W. Y. (2016). Maternal mindfulness and child social behavior: the mediating role of the mother-child relationship. Mindfulness, 7(3), 577–583. https://doi.org/10.1007/s12671-016-0491-2.
Su, L., Geng, Y., Wang, H., Du, Y., Sun, L., Zhao, F., Fan, F., & National Cooperative Group. (2006). Norm of ADHD diagnostic scale-parent version in Chinese urban children. Chinese Journal of Practical Pediatrics, 21(11), 833–836. https://doi.org/10.3969/j.issn.1005-2224.2006.11.013.
Tang, H., & **n, R. (1993). Application of the Conners Children's Behavior Questionnaire (revised version). Shanghai Archives of Psychiatry, 5(4), 246–248.
Tang, Y., & Zhang, M. (1984). Hamilton Anxiety Scale (HAMA). Shanghai Archives of Psychiatry, 1984(2), 64–65.
Thapar, A., & Cooper, M. (2016). Attention deficit hyperactivity disorder. Lancet, 387(10024), 1240–1250. https://doi.org/10.1016/s0140-6736(15)00238-x.
Thomas, S. R., O'Brien, K. A., Clarke, T. L., Liu, Y., & Chronis-Tuscano, A. (2015). Maternal depression history moderates parenting responses to compliant and noncompliant behaviors of children with ADHD. Journal of Abnormal Child Psychology, 43(7), 1257–1269. https://doi.org/10.1007/s10802-014-9957-7.
Turpyn, C. C., & Chaplin, T. M. (2016). Mindful parenting and parents’ emotion expression: effects on adolescent risk behaviors. Mindfulness, 7(1), 246–254. https://doi.org/10.1007/s12671-015-0440-5.
van de Weijer-Bergsma, E., Formsma, A. R., de Bruin, E. I., & Bögels, S. M. (2012). The effectiveness of mindfulness training on behavioral problems and attentional functioning in adolescents with ADHD. Journal of Child and Family Studies, 21(5), 775–787. https://doi.org/10.1007/s10826-011-9531-7.
van der Oord, S., Bögels, S. M., & Peijnenburg, D. (2012). The effectiveness of mindfulness training for children with ADHD and mindful parenting for their parents. Journal of Child and Family Studies, 21(1), 139–147. https://doi.org/10.1007/s10826-011-9457-0.
Wang, Y. (2019). Attention deficit hyperactivity disorder. Peking University Medical Press.
Wang, Y., Liang, Y., Fan, L., Lin, K., **e, X., Pan, J., & Zhou, H. (2018). The indirect path from mindful parenting to emotional problems in adolescents: the role of maternal warmth and adolescents’ mindfulness. Frontiers in Psychology, 9, 546. https://doi.org/10.3389/fpsyg.2018.00546.
Yeh, C. H., Chen, M. L., Li, W., & Chuang, H. L. (2001). The Chinese version of the Parenting Stress Index: a psychometric study. Acta Paediatrica, 90(12), 1470–1477. https://doi.org/10.1111/j.1651-2227.2001.tb01615.x.
Zhang, D., Chan, S. K. C., Lo, H. H. M., Chan, C. Y. H., Chan, J. C. Y., Ting, K. T., Gao, T. T., Lai, K. Y. C., Bögels, S. M., & Wong, S. Y. S. (2017). Mindfulness-based intervention for Chinese children with ADHD and their parents: a pilot mixed-method study. Mindfulness, 8(4), 859–872. https://doi.org/10.1007/s12671-016-0660-3.
Zheng, Y., Zhao, J., Phillips, M., Liu, J., Cai, M., Sun, S., & Huang, M. (1988). Validity and reliability of the Chinese Hamilton Depression Rating Scale. British Journal of Psychiatry, 152(5), 660–664. https://doi.org/10.1192/bjp.152.5.660.
Zou, W., Anderson, N., Sorin, R., & Hajhashemi, K. (2013). A contextual understanding of mainland Chinese parent involvement in their children's primary school years' education. Journal of Asian Critical Education, 2, 54–68.
Acknowledgements
We thank LetPub (www.letpub.com) for its linguistic assistance during the preparation of this manuscript.
Funding
This study was funded by the National Science Foundation of China (81571340), the Capital’s Funds for Health Improvement and Research (CFH: 2020-2-4112), the National Key Technology R&D Program (2015BAI13B01), and the National Key Basic Research Program of China (973 program 2014CB846104).
Author information
Authors and Affiliations
Contributions
PL: executed the study, analyzed the data and wrote the paper. SQ: reviewed the literature, collaborated in study execution, and assisted the data analysis. HL and XS: collaborated with the design and writing of the study. QQ: designed the study and collaborated in study execution. All authors approved the final version of the manuscript for submission.
Corresponding author
Ethics declarations
Ethics Approval
The present study was conducted under the guidelines of the Declaration of Helsinki. This study was approved and overseen by the Institutional Review Board of Peking University Sixth Hospital
Consent to Participate
Written informed consent was obtained before participants who joined the study, and all participants signed consent on data publishing.
Conflict of Interest
We have no conflicts of interest to disclose.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
ESM 1
(XLSX 206 kb)
Rights and permissions
About this article
Cite this article
Liu, P., Qiu, S., Lo, H.H.M. et al. Applying the Mindful Parenting Program Among Chinese Parents of Children with ADHD: A Randomized Control Trial. Mindfulness 12, 1473–1489 (2021). https://doi.org/10.1007/s12671-021-01616-6
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12671-021-01616-6