Document Type : Research Article (s)


1 Research Center for Psychiatry and Behavioral Sciences, Shiraz University of Medical Sciences, Shiraz, IR Iran

2 Department of Clinical Psychology, Faculty of Education and Psychology, Shiraz University, Shiraz, IR Iran

3 School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran


Background: Children with attention deficit hyperactivity disorder (ADHD) run a high risk of behavioral problems. Their parents are also at risk of mental health and reduced quality of life. The present study aimed to investigate the effect of group mindfulness-based stress reduction on the parents of ADHD children and their mental health, quality of life, and behavioral problems.
Methods: We conducted this single-blind randomized controlled clinical trial on 76 mothers with ADHD children aged 8-16 years referred to the clinics affiliated to Shiraz University of Medical Sciences. We randomly divided the patients into intervention and control groups. Group therapy included eight 45-minute sessions in two months and a three-month follow-up. The employed instruments were Strengths and Difficulties Questionnaire-parent form (SDQ-P), General Health Questionnaire-28 (GHQ-28), and Health related quality of life-short form-36 (HRQOL-SF-36). We analyzed all data by SPSS, and P values less than 0.05 were statistically significant.
Results: After the intervention, the overall mean score for GHQ-28 (p <0.01) and dimensions of HRQOL-SF-36 (p <0.01), physical (p <0.001), and mental health significantly increased (p <0.01) and SDQ-P decreased (p <0.01) in the intervention group compared to the control group.
Conclusion: Group mindfulness-based stress reduction was effective on mental health and quality of life in the parents of children with ADHD and could decrease child behavioral problems.


1. Biondic D, Wiener J, Martinussen R. Parental psychopathology and parenting stress in parents of adolescents with attention-deficit hyperactivity disorder. J Child Fam Stud. 2019; 28: 2107-19. doi: 10.1007/s10826-019-01430-8. ## 2. Molly Cairncross, Carlin J Miller. The Effectiveness of Mindfulness-Based Therapies for ADHD: A Meta-Analytic Review. J Atten Disord. 2020; 24(5): 627-43. doi: 10.1177/1087054715625301. [PubMed: 26838555]. ## 3. Fairchild G, Hawes DJ, Frick PJ, Copeland WE, Odgers CL, Barbara F, et al. Conduct disorder. Nature Reviews Disease Primers. 2019; 5(1): 43. doi: 10.1038/s41572-019-0095-y. ## 4. Antonella Gagliano , Marco Lamberti , Rosamaria Siracusano , Massimo Ciuffo , Maria Boncoddo , Roberta Maggio, et al . A Comparison between children with ADHD and children with epilepsy in self-esteem and parental stress level. Clin Pract Epidemiol Ment Health. 2014; 10: 176-83. doi: 10.2174/1745017901410010176. [PubMed:25614755]; [PubMed Central: PMC4296476]. ## 5. Adrienne J Means-Christensen 1 , Douglas K Snyder, Charles Negy. Assessing nontraditional couples: validity of the marital satisfaction inventory-revised with gay, lesbian, and cohabiting heterosexual couples. J Marital Fam Ther. 2003; 29(1): 69-83. doi:10.1111/j.1752-0606.2003.tb00384.x. [PubMed:12616800]. ## 6. Meftagh SD, Mohammadi N, Ghanizadeh A, Rahimi C, Najimi A. Comparison the effectiveness of different treatment methods in childrens attention deficit-hyperactivity disorders. J of Isfahan Medical School. 2011; 29(148): 965-76. ## 7. Pahlavanzadeh S, Mousavi S, Maghsoudi J. Exploring the Needs of Family Caregivers of Children with Attention Deficit Hyperactivity Disorder: A Qualitative Study. Iran J Nurs Midwifery Res. 2018; 23(2):149-54. doi: 10.4103/ijnmr.IJNMR_16_17. [PubMed: PMC5881233]; [PubMed Central: 29628964]. ## 8. Britt Laugesen, Mette Groenkjaer. Parenting experiences of living with a child with attention deficit hyperactivity disorder: a systematic review of qualitative evidence. JBI Database System Rev Implement Rep. 2015; 13(11):169-234. doi: 10.11124/jbisrir-2015-2449. ## 9. Clara S C Lee, Man-Ting Ma, Hin-Yui Ho, Ka-Kei Tsang, Yi-Yi Zheng, Zou-Yi Wu. The effectiveness of mindfulness-based intervention in attention on individuals with ADHD: a systematic review. Hong Kong J Occup Ther. 2017; 30(1): 33-41. doi: org/10.1016/j.hkjot.2017.05.001. [PubMed: 30186078]; [PubMed Central: PMC6092011]. ## 10. Stefan G Hofmann, Alice T Sawyer, Ashley A Witt, Diana Oh. The effect of mindfulness- based therapy on anxiety and depression: a meta-analytic review. J Consult Clin Psychol. 2010; 78(2): 169-83. doi: 10.1037/a0018555. [PubMed: 20350028]; [PubMed Central: PMC2848393]. ## 11. Janssen M, HeerkensY, Kuijer W, van der Heijden B, Engels J. Effects of mindfulness based stress reduction on employees’ mental health: a systematic review. PLoS ONE. 2018; 13(1): e0191332. doi:10.1371/journal. pone.0191332. ## 12. Cullen M. Mindfulness-based interventions: an emerging phenomenon. Mindfulness. Nature Research Journal. 2011; (3): 186-93. doi:10.1007/s12671-011-0058-1. ## 13. Bohlmeijer E, Prenger R, Taal E, Cuijpers P. The effects of mindfulness-based stress reduction therapy on mental health of adults with a chronic medical disease: a meta-analysis. J Psychosom Res. 2010; 68(6): 539-44. doi:10.1016/j.jpsychores.2009.10.005. ## 14. Marie Crowe, Jennifer Jordan, Beverley Burrell, Virginia Jones, Deborah Gillon, Shirley Harris. Mindfulness-based stress reduction for long-term physical conditions: a systematic review. Aust N Z J Psychiatry. 2016; 50(1): 21-32. doi: 10.1177/0004867415607984. [PubMed: 26419491]. ## 15. Marcelo M.P. Demarzo, Jesús Montero-Marin, Pim Cuijpers, Edurne Zabaleta-del-Olmo, Kamal R. Mahtani, Akke Vellinga, et al. The efficacy of mindfulness-based interventions in primary care: a meta-analytic review. Ann Fam Med. 2015; 13(6): 57382. doi:10.1370/afm.1863. [PubMed: 26553897]; [PubMed Central: PMC4639383]. ## 16. Guichen Li, Hua Yuan, Wei Zhang. The effects of mindfulness-based stress reduction for family caregivers: Systematic review. Arch Psychiatr Nurs. 2016; 30(2): 292-9. doi:10.1016/j.apnu.2015.08.014. [PubMed: 26992885]. ## 17. Farhan Noordali, Jennifer Cumming, Janice L Thompson. Effectiveness of mindfulness-based interventions on physiological and psychological complications in adults with diabetes: a systematic review. J Health Psychol. 2015; 22(8): 965-83. doi:10.1177/1359105315620293. [PubMed: 26721631]. ## 18. Parswani MJ, Sharma MP, Iyengar SS. Mindfulness-based stress reduction program in coronary heart disease: a randomized control trial. Int J Yoga. 2013;6(2):11. 10.4103/0973-6131.113405. [PubMed: 23930029]; [PubMed Central: PMC3734636]. ## 19. Nor Zuraida Zainal, Sara Booth, Felicia A Huppert. The efficacy of mindfulness-based stress reduction on mental health of breast cancer patients: A meta-analysis. Psychooncology. 2013; 22: 1457-65. doi: 10.1002/pon.3171. [PubMed: 22961994]. ## 20. Khoury B, Sharma M, Rush SE, Fournier C. Mindfulness-based stress reduction for healthy individuals: A meta-analysis. J Psychosom Res. 2015; 78(6): 519-528. doi:10.1016/j.jpsychores.2015.03.009. [PubMed: 25818837]. ## 21. Jasem ZA, Delport SM. Mothers’ perspectives on the play of their children with attention deficit hyperactivity disorder. Occupational Therapy International. 2019; 1-10. doi: 10.1155/2019/6950605. ## 22. Charlotte Reedtz, Camilla Lauritzen, Ylva V Stover, Janita L Freili , Kamilla Rognmo. Identification of children of parents with mental illness: a necessity to provide relevant support. Front Psychiatry. 2019;8(9):728. doi: 10.3389/fpsyt.2018.00728. [PubMed: 30670987]; [PubMed Central: PMC6333019]. ## 23. Tercelli I, Nuno F. A systematic review of mindfulness based interventions for children and young people with ADHD and their parents. Global Psychiatry. 2019; 2(1): 1-17. doi: 10.2478/gp-2019-0007. ## 24. Cachia R, Anderson L, Moore A. Mindfulness, stress and well-being in parents of children with autism spectrum disorder: A Systematic Review. Journal of Child and Family Studies. 2016; 25 (1): 1-14. doi: 10.1007/s10826-015-0193-8. ## 25. Siebelink NM, Bögels SM, Boerboom LM, de Waal N, Buitelaar JK, Speckens AE, Greven CU. Mindfulness for children with ADHD and Mindful Parenting (MindChamp): Protocol of a randomised controlled trial comparing a family mindfulness-based intervention as an add-on to care-as-usual with care-as-usual only. BMC Psychiatry. 2018; 18(1): 237. doi: 10.1186/s12888-018-1811-y. [PubMed: 30045714]; [PubMed Central: PMC6060473]. ## 26. Stanley Kam Chung Chan, Dexing Zhang, Susan M Bögels, Christian Shaunlyn Chan, Kelly Yee Ching Lai, Herman Hay Ming Lo, et al . Effects of a mindfulness-based intervention (MYmind) for children with ADHD and their parents: protocol for a randomised controlled trial. BMJ Open. 2018; 8(11): e022514. doi: 10.1136/bmjopen-2018-022514. [PubMed: 30420347]; [PubMed Central: PMC6252633]. ## 27. Benito León-Del-Barco, Santiago Mendo-Lázaro, María I Polo-Del-Río, Víctor M López-Ramos. Parental psychological control and emotional and behavioral disorders among spanish adolescents. Int J Environ Res Public Health. 2019; 16(3): 507. doi:10.3390/ijerph16030507. [PubMed: 30759723]; [PubMed Central: PMC6388244]. ## 28. Haydicky J. Evaluating a mindfulness-based intervention for adolescents with ADHD and their parents: a mixed methods approach (doctoral dissertation). Retrieved from ProQuest Dissertations and Theses. 2014. ## 29. van der Oord S, Bogels SM & Peijnenburg D. The effectiveness of mindfulness training for children with ADHD and mindful parenting for their parents. J Child Fam Stud. 2012; 21(1): 139-47. doi: 10.1007/s10826-011-9457-0. [PubMed: 22347788]; [PubMed Central: PMC3267931]. ## 30. Singh NN, Singh AN, Lancioni GE, Singh J, Winton AS, Adkins AD. Mindfulness training for parents and their children with ADHD increases the children’s compliance. Journal of Child and Family Studies. 2010; 19(2): 157-66. doi: 10.1007/s10826-009-9272-z. ## 31. Nikhat Hoosen, Eugene Lee Davids, Petrus J de Vries, Maylene Shung-King. The strengths and difficulties questionnaire (SDQ) in africa: a scoping review of its application and validation. Child Adolesc Psychiatry Ment Health. 2018;12:6. doi:10.1186/s13034-017-0212-1. [PubMed: 29344084]; [PubMed Central: PMC5765647]. ## 32. Goodman A, Goodman R. Population mean scroes predict child mental disorder rates: validating SDQ prevalence estimators in Britian. J Child Psychol Psychiatry. 2011; 52: 100-108. doi: 10.1111/j.1469-7610.2010.02278.x. [PubMed: 20722879]. ## 33. Paula Kersten, Alain C Vandal, Hinemoa Elder, Kathryn M McPherson. Strengths and difficulties questionnaire: internal validity and reliability for new zealand preschoolers. BMJ Open. 2018; 8: e021551. doi: 10.1136/bmjopen-2018-021551. [PubMed: 29680813]; [PubMed Central: PMC5914702]. ## 34. Mieloo C, Raat H, van Oort F, Bevaart F, Vogel I, Donker M, Jansen W. Validity and reliability of the strengths and difficulties questionnaire in 5-6 year olds: differences by gender or by parental education? PLoS One. 2012; 7(5):e36805. doi: 10.1371/journal.pone.0036805. [PubMed: 22629332]; [PubMed Central: PMC3356337]. ## 35. Nik-Azin A, Naeinian M R, Shairi M R. Validity and reliability of health related quality of life questionnaire “KIDSCREEN-27” in a sample of iranian students. IJPCP. 2013; 18 (4): 310-21. ## 36. Mösko M, Dingoyan D, Penka S, Vardar A, Schulz H, Koch U, Heinz A, Kluge U. Prevalence of mental disorders and health service utilization among individuals with turkish migration backgrounds in germany: a study protocol for an epidemiological investigation. Open Journal of Psychiatry. 2016; 6: 237-52. doi: 10.4236/ojpsych.2016.63029. ## 37. Sakakibara BM, Miller WC, Orenczuk SG, Wolfe DL, SCIRE Research Team. A systematic review of depression and anxiety measures used with individuals with spinal cord injury. Spinal cord. 2009; 47(12): 841-51. ## 38. Nazifi M, Mokarami H, Akbaritabar A, Faraji Kujerdi M, Tabrizi R, Rahi A. Reliability, validity and factor structure of the persian translation of general health questionnire (GHQ-28) in hospitals of kerman university of medical sciences. Journal of Fasa University of Medical Sciences. 2013; 3(4): 336-42. ## 39. Sinha R, van den Heuvel WJ, Arokiasamy P. Validity and reliability of MOS short form health survey (SF-36) for use in India. Indian J Community Med. 2013; 38: 22-6. doi: 10.4103/0970-0218.106623.[PubMed: 23559699]; [PubMed Central: PMC3612292]. ## 40. Montazeri A, Goshtasebi A, Vahdaninia M, Gandek B. The Short Form Health Survey (SF-36): translation and validation study of the Iranian version. Qual Life Res. 2005; 14(3): 875-82. doi: 10.1007/s11136-004-1014-5. [PubMed: 16022079]. ## 41. Sochos A, Yahya F. Attachment style and relationship difficulties in parents of children with ADHD. Journal of Child and Family Studies. 2015; 24. doi: 10.1007/s10826-015-0179-6. ## 42. Carol K Whalen, Candice L Odgers, Preston L Reed, Barbara Henker. Dissecting daily distress in parents of children with ADHD: an electronic diary study. J Fam Psychol. 2011; 25(3): 402. [PubMed: 21517172]. ## 43. Parmentier FBR, García-Toro M, García-Campayo J, Yañez AM, Andrés P, Gili M. Mindfulness and symptoms of depression and anxiety in the general population: the mediating roles of worry, rumination, reappraisal and suppression. Front Psychol. 2019; 8(10): 506. doi: 10.3389/fpsyg.2019.00506. [PubMed: 30906276]; [PubMed Central: PMC6418017]. ## 44. Irving JA, Dobkin PL, Park J. Cultivating mindfulness in health care professionals: a review of empirical studies of mindfulness-based stress reduction (MBSR). Complement Ther Clin Pract. 2009; 15(2): 61-6. doi: 10.1016/j.ctcp.2009.01.002. [PubMed: 19341981]. ## 45. Anderson SB, Guthery AM. Mindfulness‐ based psychoeducation for parents of children with attention‐ deficit/hyperactivity disorder: an applied clinical project. J Child Adolesc Psychiatr Nurs. 2015; 28(1): 43-9. doi: 10.1111/jcap.12103. [PubMed: 25721214]. ## 46. Jalali D, Abdolazimi M, Alaei Z, Solati K. Effectiveness of mindfulness-based stress reduction program on quality of life in cardiovascular disease patients. IJC Heart & Vasculature. 2019; 23. doi: 10.1016/j.ijcha.2019.100356. [PubMed: 31011624]; [PubMed Central: PMC6465573]. ## 47. Margari F, Craig F, Petruzzelli MG, Lamanna A, Matera E, Margari L. Parents psychopathology of children with Attention Deficit Hyperactivity Disorder. Research in Developmental Disabilities. 2013; 34(3): 1036-43. doi:10.1016/j.ridd.2012.12.001. [PubMed: 23291521]. ##