Mindfulness and Managing ADHD
by Mark Bertin, MD
Mark Bertin, MD, aims to clarify what the science says about the biology
and management of ADHD and to introduce ways the practice of mindfulness
can help those facing its challenges. The first section of this feature
article is an excerpt from his new book, The Family ADHD
Solution (New York: Palgrave Macmillan, 2011). In the second
section, Dr. Bertin continues with a discussion exclusive to
"I felt like a complete failure as a parent. I
tried sticker charts and time outs and yelling and not yelling. And
still Charlie wouldn’t listen. I’d explain all the rules
before going to the playground, and I’d turn around and he’d
push someone again. It didn’t make any sense. I was sure I was
doing something completely wrong."
The myth of perfect
THERE IS NO PERFECT
STEP-BY-STEP GUIDE BOOK ON HOW TO RAISE A CHILD, so
instead we’re left on our own to sort through the conflicting
advice we encounter in the world. When a child has ADHD, the stakes for
parents are raised. Where one child might respond to a quick reprimand,
a child with ADHD turns around and throws sand again and again. Bumps in
the academic road persist and become mountains, exhausting in scale.
Instead of a single bad grade or a passing fight with a friend, children
with ADHD encounter chronic academic failure, or struggle to maintain
Unsurprisingly, parents of children with ADHD carry more anxiety and
a higher risk of depression. They report feeling burdened by the
decisions they face around behavioral, educational, and medical
decisions. Their marriages are strained—couples affected by ADHD
are more likely to end up divorced.
Extended families and people in the community may often seem
judgmental. They might assume a parent could control their child’s
behavior if only they tried harder, or made better choices. Stories on
television or in magazines raise doubts that biologically driven
behavioral problems like ADHD exist. The politics of child development
breed uncertainty in parents, leaving them adrift and taxing their sense
Dealing with ADHD, you may wonder why life has to be so complicated.
It may be immensely frustrating to observe your child repeating his
self-destructive behavior. You know, for sure, that if he could stop
standing so close to his peers, or stop knocking over their toys, he
would get along better. But the situation is equally frustrating for
your child. It’s not like he wandered up to the sand box thinking,
“How can I alienate everyone, all at once?” However
unskilled his approach may seem, he’s trying to find peace of
mind, just like you are.
Reading this, you might think to yourself, “I’ve been
doing it wrong.” Or you might find yourself comparing all the
advice that follows here to what you have done in the past. When you
started your family, you may have had a picture of what everything would
be like. You may have expected that your family members would act in a
certain way, or that by working hard you and your kids would succeed all
the time. Most of us recognize this inner voice that escalates our fear
that we’re not parenting “the right way.”
There may be times in life when “perfect” makes sense.
Driving somewhere, we want to take the right route, make the right
turns, and get there. But despite our best intentions, we will, at some
point, get absolutely and completely lost. How do we respond emotionally
when we make a wrong turn? How can we separate our emotions from the
fact that we messed up?
Most of life is not like driving, it’s like baseball. The best
hitters bat .300. Seven out of ten times they are out. They practice and
refine, strive to improve—but never get much above .300. How long
would a player last who eviscerated himself after each strikeout? Not
someone who was angry for a moment, or miserable after striking out with
the bases loaded, but who truly assaulted himself? How long would a
player last who, overwhelmed, stopped practicing at all? Welcome to
parenting—you can expect to bat 1.000, and neither can your
children. Perfection is not the goal.
Taking the first step
A broad approach to ADHD starts with a proactive plan to address the
most obvious ADHD symptoms, and then continues much further. It helps
children build self-esteem and healthy relationships with parents and
peers. It helps you manage your own stress because under stress, none of
us acts at our best. It helps you examine your actions and cultivate
skills that lead you and your children to be adaptable and resilient.
You cannot erase your child’s medical condition, but you can make
astute choices about what to do next, for your child and for your
Building your own strength and resilience as a parent benefits your
entire family. When you feel on more solid ground, problem solving
becomes more flexible. Destructive habits can be broken, and new options
become apparent. Your perspective, and your parenting skills, can
fundamentally change. With an all-consuming problem like your
child’s ADHD, these life skills become even more important.
Over recent decades mainstream Western culture and health care have
embraced the Eastern concept of “mindfulness” as a means of
developing these abilities, separating it from spirituality or religion.
Mindfulness is often described as living with full awareness of our
moment-to-moment experience, without excessive judgment and bias. It
comprises a skill set that helps us focus on life as it happens, instead
of becoming lost in distracting fantasies of the future, rumination
about the past, or emotional reactions that clutter our minds.
Practicing mindfulness, we often discover a sense of inner strength and
calm in the midst of storms that come and go in our lives.
We train ourselves to focus our attention where we want, away from
mental distraction and onto the situation at hand. This skill can be
developed through a type of meditation that is about little more than
focused attention—our mind becomes lost in thought, and we bring
it back. The art of mindfulness is noticing our mind wandering, and
guiding it back to real life and to a sense of balance, without giving
ourselves a hard time for having wandered off in the first place. We try
our best, our thoughts drift off, and we think, of course I got
distracted, that happens, and start over again, paying attention.
While our children come first in so many ways, it is important that we
take care of ourselves as well. Our physical and mental health benefits
them. When stressed, we easily fall into fixed, habitual ways of dealing
with stress, limiting ourselves and how we interact with people around
us, and perhaps not addressing problems as adeptly as we are capable. So
in the face of all the challenges of parenting a child with ADHD,
protecting whatever small nurturing moments you find for yourself helps
The long-term goals never change—we all want our children to
thrive and be independent and happy. In the short term, the most loving
and supportive approach is to take an objective, clear-sighted look at a
child’s skills and challenges right now, in this moment. From that
starting point, an entirely new way of living with ADHD may begin.
The text above is excerpted from The Family ADHD
Solution by Mark Bertin, MD. Copyright © 2011 by the author
and reprinted by permission of Palgrave Macmillan, a division of
Macmillan Publishers Ltd.
Mental habits and awareness
Beyond the complex challenges found in managing any chronic
medical disorder, ADHD places intense demands on parents. Preconceived
images of family life are redrawn. Our style of parenting, based on some
combination of life experience and reasoned choice, perhaps hasn’t
worked out quite as well as expected. School plans requiring effort and
negotiation suddenly need revision—again. A decision for or
against medication, inflamed by all the available information and
misinformation we encounter, must be handled with as much calm and
perspective as possible. Another carefully orchestrated play date ends
in tears. Compassionate, effective ADHD care requires of parents a
constant ability to adapt, to think flexibly, and to rally loads of
That tall order is amplified further by one common reality: If we pay
attention to where our thoughts go throughout the day, we’ll
almost always discover that wherever we are, whatever we’re doing,
we spend little time engaged in our moment-to-moment lives. Rushing from
one place to the next, we barely notice the steps we’re taking in
between, packing lunches and saying goodbye, distractedly greeting
people as we race through our chores, zipping through our email while we
think about dinner. Taking time to slow down, we decide to go for a
walk, but then spend most of this ‘quiet time’ fantasizing
about our next vacation, or rehashing something that went poorly at
work, rather than catching a break. At any particular moment we’re
likely to find ourselves lost in fantasies of the future, mulling over
our past, or ruminating over problems we perceive in our lives.
Our mental habits affect how we live and how we feel. Adrift in a fog of
thinking, planning, or worrying, we miss moments where we might simply
relax or just enjoy an easier moment with our kids. Five minutes at the
end of lunch could be a peaceful moment with a cup of tea, but instead
we dwell over how to juggle the afternoon to-do list. We often react
without reflecting, yelling even though in calmer times we’ve
vowed to try something different. Or, maybe we fall back on some other
ingrained habitual way of dealing with running behind, or children who
don’t listen quickly enough, or fears that some crisis looms in
Without effort these habits generally exist outside of our awareness,
even though they drive so much of our behavior. When angry, we shut
down. When our child doesn’t do her homework, we feel a need to
push her harder. Maybe under stress we eat or we drink or feel a
compulsion to exercise. We all have tendencies to behave a certain way
when exhausted or overwhelmed, or when life feels out of our control.
The practice of mindfulness addresses these habits, without asking much
more of us than just to pay attention. There isn’t any need to
believe in anything in particular, or to seek any religious or spiritual
goal. Mindfulness is an effort to see our lives more clearly.
Learning and practicing mindfulness
Living mindfully means paying attention to life, right
now, as we live it, while maintaining an open and honest perspective.
Through mindfulness, we develop tools that build self-reliance and inner
strength. Parents of children with ADHD are often stressed, struggling
with decisionmaking. They may feel self-judgment, a belief that they
aren’t cutting it as parents. They feel the judgment of those
around them, a sense others are commenting on their parenting skills or
treatment decisions. Why can’t you just get control of your son?
Practicing mindfulness doesn’t ‘fix’ ADHD, but it
uniquely supports parents and families under often staggering pressure
No matter if we practice mindfulness or not, our minds will keep working
and making thoughts and running around. That’s what minds do,
thankfully, as we negotiate all the choices and problems that arise.
Through mindfulness, however, we often discover new possibilities from
paying attention and recognizing that not every random idea or anxiety
that pops into our mind is real or worth a response. As frustrated as I
feel, yelling about her messy room hasn’t changed anything yet,
and may not be the best choice right now.
Meditation is often part of programs that teach mindfulness. This style
of meditation is accessible to anyone, as there’s no attempt to
reach any particular mental or spiritual state of mind. We practice
focusing our attention with patience, expecting that we’ll get
distracted over and over again. Like training from scratch for a
marathon we start with whatever our tendencies are and work from there.
On the busiest day, even in the midst of minutes or hours of scattered
thinking, pausing and returning to focus on a few breaths is meditation.
Meditation is a way of training our ability to focus our attention where
we want, away from distracting, anxiety-provoking thoughts, and all the
layers we mentally add on to situations that complicate our lives.
We can’t still our minds any more than we can force ourselves to
stop blinking. We would set ourselves up for frustration expecting
either. Likewise, we shouldn’t aim to completely eliminate stress.
Many of us have had the experience of sitting in a car with a driver who
has too little concern for safety, too little fear about hurling a
couple of tons of metal through city streets. A little stress keeps us
safe. But when we let it take over our lives, stress has distinct
psychological and medical consequences.
Likewise, we can’t force ourselves to relax any more than we can
force ourselves to sleep. All we can do is set up a mental state that
makes relaxation more likely to happen. I feel pressured to run around,
to keep moving, to buy into the fears I’m feeling without
reflection… and instead, I’m getting to pause for a few
moments and recharge. Even when life seems overwhelming and pausing
doesn’t lead to an instant feeling of relaxation, we practice
breaking the mental cycle of always wanting to problem solve or do
something every moment. Over time it becomes easier, and less stress
Decades of research have proven that mindfulness augments psychological
and physical health. Practicing mindfulness for around half an hour a
day for only several weeks (or less in several studies) has been
demonstrated to physically change the brain, to lower levels of stress
hormones, and to increase our immune response. Positive genetic changes
may even occur because of stress reduction.
Mindfulness isn’t a miracle cure, or a magic pill. Stress cannot
be eliminated, but it can be managed. Problems will still exist.
We’ll find things in life, people, jobs, and various situations
that we like, and others we dislike. And still, building our own
capacity to maintain a sense of balance, taking care of ourselves so we
have the resources to pause and make clear decisions, over and over
again, as often as needed, fundamentally changes how we live, and how
our families grow.
ADHD is a real medical condition that has countless consequences for
individuals and families alike. Mindfulness cannot cure ADHD, but it can
build the strength for parents to define a new plan at home and stick to
it. To weather storms as they arise, like disappointing report cards or
social mishaps with their kids, or maybe another snide remark from a
neighbor or relative. Mindfulness fosters clarity while wading through
choices about school, about behavioral plans, and about medication. Life
still happens, with ups and downs and everything in between, but perhaps
with more joy and ease along the way.
MINDFULNESS AND ADULT ADHD
Adults with ADHD often ask if mindfulness and mindfulness mediation will
work for them. They might imagine that to benefit they must aim
to still their thoughts completely or to sit motionless for hours on
end. Neither is true; mindfulness is meant for anyone. The goal
isn’t to wrestle a busy mind into submission or to remain
perfectly unmoving for half an hour. Rather, the goal is to pay
attention to our experience in a way that allows us to see our own
habits and tendencies more clearly.
Adults with ADHD may become less reactive and less stressed through the
practice of mindfulness, as could anyone. Starting from wherever they
are, they can develop an ability to attend to both their external and
internal experience. Psychiatrist Lydia Zylowska and others have
published research showing benefits for attention and executive function
specifically with adult ADHD.
ADHD increases stress, anxiety, and strains relationships. Mindfulness
has been shown to decrease stress and anxiety and to promote healthy
relationships. Adults with ADHD have as much to gain as anyone through
trying it out.
BRING MINDFULNESS INTO YOUR LIFE
Here's a simple place to start bringing mindfulness into your
Three times a day for several weeks, pause and pay
Pick easy times to remember, such as when you are
about to leave the house, or when the kids get on the bus, or before
each meal. Or, practice taking a brief break when the day starts feeling
overwhelming or tense.
Take a minute to focus on several breaths.
Pay attention to the sensation of breathing, the
physical movement of air passing through your nose or mouth, the rising
and falling of your chest or belly, or whatever else is most
Notice whatever you think and feel
at that moment without, for one minute, doing anything more than
observing: I am rushed and my feet hurt. I am quiet and at peace now,
but worried about tonight.
Count five or ten breaths, if you
like. If you need you can take care of something when you're done; right
now, just give your mind a moment to settle. Then, gathering your
resources, deliberately choose what you will do next.
Mark Bertin, MD, is a pioneering developmental pediatrician in
private practice in Pleasantville, New York and assistant professor of
pediatrics at New York Medical College. He trains physicians, teachers,
and psychologists in ADHD care and leads stress-reduction classes for
parents. From 2003 to 2010, he was director of developmental pediatrics
at the Westchester Institute for Human Development.
Opening section of this article, as indicated, is excerpted from
The Family ADHD Solution by Mark Bertin, MD. Copyright ©
2011 by the author and reprinted by permission of Palgrave Macmillan, a
division of Macmillan Publishers Ltd.
This article appeared in the June 2011 issue of Attention
magazine. Copyright © by CHADD, Children and Adults with
Attention Deficit Hyperactivity Disorder. All rights reserved.
PHOTO CREDIT: PARKERDEEN/ISTOCK