Content uploaded by Flavia I. Spiroiu
Author content
All content in this area was uploaded by Flavia I. Spiroiu on Feb 03, 2015
Content may be subject to copyright.
ORIGINAL PAPER
Using Integra Mindfulness Martial Arts to Address Self-
regulation Challenges in Youth with Learning Disabilities:
A Qualitative Exploration
Karen Milligan •Paul Badali •Flavia Spiroiu
Springer Science+Business Media New York 2013
Abstract Youth with learning disabilities (LDs) have
information processing challenges that place them at
increased risk for emotion dysregulation and often rely on
coping strategies that emphasize avoidance of challenging
emotions, experiences or tasks. Integra mindfulness martial
arts (MMA) was developed to address and help participants
cope with these challenges and increase self-awareness and
present-focus. The present exploratory qualitative study
includes results from a post-treatment questionnaire com-
pleted by 29 youth aged 12–17 and 17 parents, and in-depth
interviews with 7 youth who participated in MMA and 5
parents. (1) Youth goals for MMA; (2) perceptions of
program components and delivery; (3) outcomes associated
with participation; and (4) challenging/negative aspects of
the program were explored. Thematic analysis of inter-
views suggested that the development of mastery and pride
was a common motivating factor for entering treatment.
The mindfulness component of MMA was identified as
helpful in promoting a sense of calm, tolerance and
acceptance of distress, and self-understanding in youth.
This research provides preliminary support for the Integra
MMA program from the perspective of participants. Future
research directions and clinical implications for treatment
of youth with LDs are discussed.
Keywords Learning disabilities Youth Mental
health Treatment Mindfulness
Introduction
Learning disabilities (LDs) affect approximately 5 % of the
public school population, which translates to over 2.7
million public school students in the United States (Corti-
ella 2009). LDs are neurobiological disorders that impact
on information processing and more specifically the
acquisition, organization, retention, understanding, and
application of verbal and visual information (LDAC 2002).
Youth with LDs differ from youth with intellectual dis-
abilities in that they have average to above average levels
of cognitive ability. However, the presence of information
processing challenges in areas such as expressive and
receptive language, visual-spatial processing, executive
functions, processing speed, memory and attention impact
on their ability to succeed academically, with youth
exhibiting significantly lower levels of academic ability.
These disorders cannot be accounted for by the presence of
hearing and/or vision problems, socio-economic factors,
cultural or linguistic differences, lack of motivation or
ineffective teaching, although these factors may further
complicate the challenges faced by individuals with LDs
(LDAC 2002).
While LDs are most commonly recognized for their
impact on academic achievement, difficulties frequently
extend beyond the classroom (Tannock 2013). Mayes and
Calhoun (2006), using a sample of 949 children (aged
6–16), found that rates of psychological disorders in chil-
dren with LDs ranged from 18 to 76 %. Among the highest
comorbid disorders was attention deficit hyperactivity
disorder (ADHD), with a co-occurrence rate of 71 %. Low
academic self-concept (Chapman 1988) and problems with
social competence (Kavale and Forness 1996) frequently
co-occur with LDs. Approximately 50 % of youth with
LDs are rejected, neglected, or victimized by peers
K. Milligan (&)F. Spiroiu
Department of Psychology, Ryerson University, 350 Victoria St.,
Toronto M5B 2K3, Canada
e-mail: karen.milligan@psych.ryerson.ca
P. Badali
Integra, Toronto, Canada
e-mail: pbadali@integra.on.ca
123
J Child Fam Stud
DOI 10.1007/s10826-013-9868-1
(Baumeister, Storch and Geffken 2008; Mishna 2003), and
many have impoverished and unstable friendships (Wiener
and Schneider 2002; Wiener and Sunohara 1998).
The high rate of comorbidity between LDs and psy-
chological disorders is due, in part, to information pro-
cessing weaknesses that are common to both (Barkley
2002; Bauminger et al. 2005). For example, weakness in
executive functions (e.g., inhibition, cognitive flexibility,
working memory, organization, and planning) commonly
present in youth with LDs and ADHD (Mattison and
Mayes 2012; Pennington and Ozonoff 1996), Asperger’s
Syndrome (Zingerevich and Patricia 2009), and behavior
disorders (Morgan and Lilienfeld 2000).
Providing effective mental health treatment for youth
with LDs is often complicated by two factors: (1) infor-
mation processing weaknesses present in the youth’s cog-
nitive profile and (2) patterns of avoiding challenges as a
result of the experience of difficulty and failure. Few
treatments have been adapted for youth with LDs or other
information processing difficulties (e.g., Moree and Davis
2010). Core processes involved in therapy, such as
reflecting on or talking about their experiences, setting
goals and developing problem-solving plans, remembering
and utilizing coping strategies, and generalizing informa-
tion, insights, or strategies to new settings can be impacted
by information processing weaknesses (Cosden et al.
2009). This includes, but is not limited to, challenges in
executive functions (e.g., planning and organizing), mem-
ory, attention, language and communication abilities, and
the speed at which youth process information. As such,
many traditional evidence-based therapies, such as cogni-
tive behaviour therapy or problem-solving skills training
need to be adapted to meet learning profiles in order to be
optimally effective.
The lived experiences of youth with LDs also can
complicate treatment, particularly in terms of their
approach to emotion regulation. Many youth with LDs may
experience feelings of low self-esteem, anxiety or depres-
sion, failure, shame, and self-doubt associated with the
school challenges they have experienced (Arthur 2003;
Mishna and Muskat 2004). To cope with strong emotions,
many youth with LDs avoid interactions, activities,
thoughts, and emotions associated with failure or distress
either by withdrawing from the stressful situation or
engaging in problem behaviors that enable them to avoid or
at least distract them from the experience of distress
(Ducharme and Harris 2005). This is consistent with the
process of experiential avoidance (Chawla and Ostafin
2007; Hayes et al. 1996). The paradox of experiential
avoidance is that attempting to hide or inhibit unpleasant
thoughts, feelings and body sensations, while somewhat
effective in the short-term, serves to increase the frequency
and distress of these same experiences over time (Kashdan
et al. 2006; Chawla and Ostafin 2007). Youth with LDs and
self-regulation challenges therefore require treatments that
will help them stay present with challenges so that they can
learn and internalize new ways of coping.
The objective of the present study was to assess the
effectiveness of a treatment program designed to address
self-regulation challenges in youth with LDs. Integra
mindfulness martial arts (MMA; Badali and Integra
Foundation 2011) is an evidence-informed manualized
treatment designed for youth 12–18 with LDs and self-
regulation difficulties (e.g., anxiety, behavior problems,
ADHD). MMA integrates mindfulness, cognitive therapy,
and behavior modification and activation into a martial arts
training program. To date, MMA has been shown to
improve parent-rated externalizing behavior, oppositional
defiant problems, and conduct problems in boys 12–15
with LDs, compared to a waitlist control. Those presenting
with anxiety showed decreases in anxiety that approached
significance compared to a waitlist control (Haydicky et al.
2012). The present study extends this research by qualita-
tively exploring the experience of youth in MMA from the
perspective of the youth and parents.
Method
Participants
The present study was undertaken as part of a larger
evaluation of MMA (Milligan and Badali 2010). All youth
had been diagnosed by a psychologist as having a LD
(defined as average cognitive ability with significantly
lower academic achievement and information processing
weaknesses in at least one area) and were presenting for
treatment to address self-regulation challenges (e.g., anxi-
ety, behavior problems, ADHD). 13/16 Beginners and
16/25 Advanced MMA participants completed an anony-
mous feedback survey at the last session of MMA. Seven
youth (6 boys, 1 girl) aged 12–17 (M=14 years) and 5
parents also completed individual interviews about their
experience. Interviews with the beginner MMA program
participants included the following participants (names
have been changed to preserve anonymity): (1) Trevor, a
16-year-old boy with challenges with anger management,
compliance, and sibling conflict; (2) Jack, a 14-year-old
boy with ADHD and challenges with anger management
that impacts on his relationship with parents and school; (3)
Fred, a 12-year-old boy with Generalized Anxiety Disorder
and Separation Anxiety Disorder and a history of being
bullied; (4) Erin, a 13-year-old girl with anxiety and
ADHD with significant challenges with social competence
and a significant history of peer rejection; and (5) Cole, a
12-year-old boy with ADHD, with impulsivity impacting
J Child Fam Stud
123
on his peer relations. Interviews with the advanced MMA
participants included (1) Anthony, a 17-year-old boy with
behavior problems symptomatology, ADHD, and difficul-
ties with social interactions and (2) Thomas, a 14-year-old
boy with emotion regulation challenges (easily becomes
sad/anxious), difficulty reading social cues, and social
withdrawal. Parents of Trevor, Jack, Fred, Cole, and Erin
(N =5) also completed an individual interview. This
sample is representative of the MMA population in terms
of age, gender, and presenting challenges of youth engaged
in MMA.
MMA Program Overview
MMA consists of 20 weekly sessions (1.5 h in length).
Each group includes 8–10 youth. There are two levels of
the MMA program. The beginner level of MMA is for
youth entering MMA for the first time. The advanced level
of MMA is for youth who have completed beginner MMA
and provides a chance for further practice and deepening of
skills.
MMA integrates mindfulness, cognitive therapy, and
behavior modification and activation into a martial arts
training program. Mindfulness techniques serve to enhance
awareness of the present moment and to increase non-
judgmental observation. From this present-focus, youth
learn that they can choose how they react to challenges
rather than reacting in an automatic or reflexive manner
(Chawla and Ostafin 2007; Kabat-Zinn 2003). Mindful-
ness-based treatments have been shown to be beneficial for
a variety of adult psychological disorders, including anxi-
ety (for review see Hofmann et al. 2010), depression
(Hofmann et al. 2010; Ma and Teasdale 2004; Piet and
Hougaard 2011), borderline personality disorder (Linehan
et al. 2006) and chronic pain (e.g., Veehof et al. 2011).
Evidence for the benefits of mindfulness-based treatments
in youth are starting to accumulate. In youth, mindfulness
treatments have been found to decrease externalizing
behavior (Bogels et al. 2008; Singh et al. 2007a,2011a)
and anxiety (Semple et al. 2005,2010), and improve key
areas of executive functions, such as impulsivity, attention
and flexibility in children (Flook et al. 2010). While MMA
is the only known mindfulness program that has been
evaluated for youth with LDs and self-regulation chal-
lenges (Haydicky et al. 2012), mindfulness strategies have
been found to be effective for youth with information
processing challenges such as youth with ADHD (van de
Weijer-Bergsma et al. 2012; van der Oord et al. 2012) and
Autism Spectrum Disorder (Singh et al. 2007b,2011a,b).
MMA uses two formal mindfulness approaches: mind-
fulness meditation and the mindful moment. Mindfulness
meditation practices include sitting meditations (e.g., lov-
ing kindness meditation), body scan, and Kinhin/walking
meditation, which includes breath and body sensation
awareness. Throughout, youth are taught to increase their
awareness of thoughts and feelings and to practice accep-
tance and letting go. The mindful moment is an adaptation
of the 3 min breathing space developed by Segal et al.
(2002) for an adult population. Breathing spaces are ‘‘mini
meditations’’ in which a person takes the opportunity to
reflect on what is happening in the present moment in an
accepting manner that makes space for positive and nega-
tive information. During the mindful moment youth are
asked to (1) focus on their breath (saying the word ‘‘BE’’),
(2) open and soften, and (3) note their experience. The
mindful moment is a non-striving action; that is, actively
being present with one’s experience without having to do
anything with it. The self-awareness and present focus
associated with mindfulness practice sets the stage for
integration of cognitive strategies, such as mindful self-
talk.
Cognitive therapy techniques are integrated into MMA
to address negative self-talk or seeing negative events or
qualities as stable and unchanging. This is essential as
these thinking patterns have been shown to impact on
youth’s ability to positively respond to an academic or
social challenge that may in turn place them on a more
positive developmental trajectory (Yeager and Dweck
2012). Similarly, negative self-talk has been shown to
negatively moderate the impact of treatment on anxiety
(Kendall and Treadwell 2007). While cognitive restruc-
turing is commonly used in many evidence-based treat-
ments (e.g., Coping Cat for childhood anxiety, Kendall and
Hedtke 2006) to challenge patterns of negative thinking,
the experience of the developers of MMA has been that
many youth with LDs have difficulty with cognitive
restructuring and often need to not only learn how to
challenge their thinking but what specifically to think. As
such, mindful self-talk is used to decrease negative self-talk
and to enhance youths’ belief in their ability to change
situations. This belief has been coined a Growth Mindset
by Dweck (2006). Youth are presented with statements or
mantras (e.g., ‘‘it will change,’’ ‘‘BE,’’ ‘‘bend like a tree in
the wind’’) that they can say to themselves in times of
discomfort or challenge that will help them with accepting
challenges, staying present and regulating the associated
emotion. Self-talk mantras are posted on the wall of the
dojo to accommodate for memory weakness and youth are
cued to use them in the context of their meditation, yoga,
and martial arts practice.
Given the strong presence of experiential avoidance in
this population, behavior activation and modification
strategies are often required to motivate youth to fully
participate in treatment. These strategies, namely use of a
response-cost point system (Barkley 1997), also serve to
structure and encourage the use of skills outside of
J Child Fam Stud
123
sessions. Attendance, class behavior, and completion of
homework are awarded with points toward promotion to
yellow belt in martial arts. A cost (loss of points) is
implemented for negative behavior (e.g., acts of aggression
toward peer or family member).
Each of these therapeutic components are embedded
into martial arts and dynamic yoga practice. Yoga and
martial arts are viewed as complementary activities. Given
the physical challenge of dynamic yoga, it provides an
opportunity during posture performance (e.g., chair pose)
to practice staying present, accept challenge, and practice
self-talk. Martial arts similarly presents a challenge that
must be observed and accepted, but differs from yoga in
that the movements are fast and more dynamic and provide
an opportunity to practice skills in the context of interac-
tion with another (i.e., opponent). While MMA is the first
known treatment to integrate mindfulness treatment into
martial arts, other treatments have integrated mindfulness
with yoga training in children with self-regulation disor-
ders, such as ADHD (e.g., van der Oord et al. 2012).
Studies examining mindfulness interventions for at-risk
and traumatized youth suggest that yoga interventions have
a positive impact on self-regulation and problematic
responses to stress including rumination, intrusive
thoughts, and emotional arousal (Mendelson et al. 2010;
Spinazzola et al. 2011). In another study looking at yoga
interventions among populations of youth with emotional
and behavioral disorders, teachers reported improvements
in attention and adaptive skills and reductions in depres-
sive, behavioral and internalizing symptoms among stu-
dents (Steiner et al. 2013).
Each MMA session includes 5 phases: (1) brief sitting
meditation; (2) the skill (i.e., therapeutic lesson, such as
making room for challenging emotions, thoughts and sit-
uations); (3) the case (i.e., story presentation of the skill);
the application (i.e., applying the skill in meditation); (4)
yoga warm-up; and (5) martial arts training. During phases
4 and 5, ‘‘the skill’’ is embedded into the meditation, yoga
and martial arts elements of the session. Sessions are fol-
lowed by a brief meeting with the group leader, parent, and
youth during which weekly goals are developed to practice
and implement strategies learned in session at home and
school. Youth are provided with a CD that guides and
supports them in practicing meditation at home (e.g., lov-
ing kindness meditation, body scan). Home practice is
checked during each session and tracked. Youth receive
points towards their yellow martial arts belt for completion
of home practice. Table 1provides an example of a typical
MMA session and highlights the integration of therapy and
martial arts training. This example session is built around
the skill of ‘‘it will change.’’ Many students with LDs and
self-regulation challenges exhibit patterns of learned
helplessness when faced with stress (Hersh et al. 1996),
which may become more broadly attributed to all negative
life events being seen as stable and unchanging. This
attribution style can prevent youth from trying new things
and prevent them from tolerating any discomfort associ-
ated with stress. Tolerance of discomfort sets the stage for
the more advanced skill of accepting discomfort. The
introduction of ‘‘it will change’’ is quite freeing for youth
and allows them to test out tolerating discomfort even for a
short moment. The skill ‘‘it will change’’ is then practiced
within yoga and martial arts. These two activities provide
opportunity for engaging in activity that requires present
focus and managing challenge or being pushed to the edge
of one’s comfort level physically, while knowing that this
discomfort is temporary and can be tolerated.
Given the integration across a number of different skill
sets, MMA group leaders need to have training and expe-
rience in basic martial arts and yoga and advanced therapy
training in mindfulness and cognitive behavior therapy.
Two group leaders and the developer and supervisor of
MMA led the groups for the present study. There was a
range of experience and training. The supervisor was a
registered social worker and who had been practicing
Table 1 Sample MMA session: everything changes, nothing stays
the same
Session component component description
Brief BE meditation Sitting meditation
The skill Group discussion
Will this change? Linked to previous
lesson flight, fight, or freeze
Accepting things in the present moment
The case Chris’ Ticking Clock (story
demonstrating lesson linking to
common challenge faced by group)
The application The skill ‘‘it will change’’ is practice in
context of BE meditation; mindful
activity exercise
MMA yoga warm-up Practice applying skill ‘‘it will change’’ to
discomfort experienced in the flow
Mixed martial arts Practice flexibility in martial arts skills
and need to change and adapt to new
situations
Martial arts skills: jab, cross, push off
back leg; jab, cross, push on kick pads;
jab, cross with target and gloves
Teach group ‘‘sandwich feedback’’ and
practice in with training partner
Meeting with youth,
parent, and instructor
Check practice
Review healthy ways of being (note
where improvements can be made)
Help formulate goal or review goal (may
be related to flight, fight or freeze or
healthy ways of being)
J Child Fam Stud
123
martial arts for 39 years and mindfulness for 21 years. He
has a fourth degree black belt in Jiujitsu, and is a certified
as a yoga instructor. One group leader had 2 years of
experience in Brazillian JiuJitsu, 4 years of practice in
yoga and 5 years of practice in meditation and had a
masters-level registered social worker. The final group
leader was a masters-level drama therapist with 10 years of
mindfulness experience and 10 years of Aikido practice
(1st Kyu ranking). As part of the larger evaluation (Milli-
gan and Badali 2010), assessment of treatment fidelity was
undertaken to ensure treatment fidelity. Videotaped
observations suggested a high level of treatment fidelity in
terms of content and treatment delivery characteristics, and
when compared to treatment outcomes of participants,
there were no significant differences between group
leaders.
Procedure
Youth and parent feedback surveys and individual quali-
tative interviews with youth and parents were employed to
gain an understanding of the experience of youth in MMA.
The following areas were explored in the survey and
interview: (1) youth goals for MMA; (2) perceptions of
program components and delivery; (3) outcomes associated
with participation; and (4) challenging/negative aspects of
the program.
Anonymous feedback surveys were completed with
youth and parents at the last session of MMA. Youth were
asked to rate how much they liked specific components of
the class (e.g., martial arts, mindfulness practices, stories)
on a 5-point scale. They were also asked what their goal
was for MMA and how successful they thought they were.
Given that parents were most knowledgeable about MMA
components within the context of home practice and parent
meetings, they were asked to rate on a 5-point scale how
helpful specific components of the home practice (e.g.,
meditation, worksheets) and parent meetings were for their
child. They were also asked about what their child’s goal
was for the program and how successful they thought their
child was in achieving their goal. For parent and youth
surveys, frequency scores were calculated for ratings, while
narrative responses regarding goals were coded for com-
mon themes.
To gain a deeper understanding of the youth with MMA,
qualitative interviews were also conducted. A poster
inviting youth and their parents to participate in interviews
about their experience was posted in the waiting room area
outside of the therapy room 2 weeks prior to the end of
MMA. Agency staff who were not directly involved in the
delivery of the MMA program also provided names of
parents and youth who they thought would be able to
reflect on their experience in the MMA program and fully
participate in a verbal interview. Qualitative individual
interviews took place during the month following MMA.
Interviews were conducted by researchers who had grad-
uate training in clinical psychology employed at the agency
where MMA took place. The interview guide was devel-
oped by the research team and MMA supervisor to ensure
appropriateness of questions in terms of content and level
(e.g., did they provide enough clarity for youth with a
range of LDs to respond). One pilot interview was con-
ducted with a youth (Thomas), who had been involved in
the advanced program for 3 sessions prior to the start of the
larger evaluation. Similar to the feedback survey, the
interview was designed to be exploratory in nature and
covered four main areas: (1) goals for MMA; (2) percep-
tions of program components and delivery; (3) outcomes
associated with participation; and (4) challenging/negative
aspects of the program. Specific probes were provided in
each of these broad areas to support youth and parents in
reflecting on their experience. For example, probes inclu-
ded how MMA had helped the youth to solve problems
and/or handle stress and challenges, to become more aware
of thoughts and feelings, to manage difficult/upsetting
thoughts and feelings, and to handle change. Specific
application probes were also included to assess changes in
how youth manage interpersonal conflict, stress, anxiety,
and anger (e.g., Has MMA helped you handle stress or
challenges?). Parents and youth were also asked about what
aspects of the program could be improved upon. Interviews
were audiotaped and ranged from approximately 30 to
90 min in length. Interviews were transcribed verbatim.
An exploratory thematic analysis approach was utilized
to code transcripts. Responses to questions were summa-
rized in Excel separately for youth and parents to aid
identification of themes. Two independent researchers
individually read each of the transcripts, tabulated
responses, and took notes on key themes. These themes
were then discussed by the two researchers to ensure
common interpretation and identification of key themes.
This process allowed for investigator triangulation (i.e., the
use of two or more investigators to examine the same
phenomenon) in interpreting the data, thereby reducing the
risk of biased interpretation.
Results
Questionnaire Survey Findings
Why Do Youth Attend Mindfulness Martial Arts?
Beginner Survey results for the 13 youth taking MMA for
the first time revealed 3 main themes regarding why youth
decided to participate in MMA and what they hoped to
J Child Fam Stud
123
accomplish. Five youth stated that their main goal in MMA
was related to improving their wellbeing in terms of
emotions and behavior; 5 youth described goals related to
mastery in terms of improving martial arts, fitness level and
homework completion; and 3 reported improved relation-
ships either at home or school as their primary goal for
MMA. In terms of achieving their goals, 9 youth reported
that they were entirely successful, 3 youth reported that
they were somewhat successful, and 1 youth indicated that
he was unsuccessful.
Advanced For the 16 youth who had taken advanced
MMA 1–3 times (M=1.64) and were available to com-
plete the survey, goals were more likely to focus on
emotions and emotion regulation (e.g., 10/16, ‘‘to be
calm,’’ ‘‘to be present,’’ ‘‘better at fight, flight or freeze,’’
‘‘to better understand my emotions’’) and relationships (5/
16, ‘‘improve relationships,’’ ‘‘to practice healthy rela-
tionships’’). Only one youth stated a goal related to mastery
in martial arts (i.e., ‘‘green belt’’). All youth reported that
they were somewhat successful (6/13) to successful (7/13)
in achieving their goal.
Parents For the 17 parents who completed the survey,
their children’s goals fell in three main areas: emotional
and behavior regulation (6/17, ‘‘help my child’s temper
‘fuse’ to be longer,’’ ‘‘to be with negative feelings’’);
mastery in school and fitness (8/17, ‘‘to learn martial arts,’’
‘‘to get better at soccer,’’ ‘‘to improve in school’’); and
improved relationships (3/17, ‘‘healthy relationships’’).
Taken together, these results suggest that goals for
MMA typically relate to improving emotional and behav-
ioral well-being and relationships with others, and devel-
oping mastery. The majority of youth reported that they
were somewhat to very successful in meeting their goals.
Evaluation of MMA Components
Beginner Participants were asked to rate how much they
liked specific components of the class (e.g., martial arts,
mindfulness practices, stories) on a 5-point scale. Marital
arts and being part of a club were the highest rated com-
ponents, with 10/13 stating that they liked or loved this
component. Eight of 13 reported that they liked or loved
mindful self-talk and the meditation. In terms of treatment
delivery, 8/13 reported that they liked or loved the use of
stories, and 9/13 liked or loved the provision of a summary
each class and tips for the skill learned, the use of a points
system, and the inclusion of parents in brief meetings after
MMA. Components of MMA that were less appealing
included completing worksheets and wearing the gui, with
only 3/13 and 6/13 liking or loving these aspects,
respectively. The class schedule (time, number, and length
of classes) was rated as appropriate by 11/13 youth.
Advanced Similar to the beginner level, marital arts
training and being part of a club received the highest rat-
ings, with 12/15 and 15/15 stating that they liked or loved
these components, respectively. Ten of 15 reported that
they liked or loved meditation. In terms of program
delivery, 12/15 reported that they liked or loved the use of
stories. Worksheets on mindful moments/thought reports
continued to be the least liked or loved component (4/15).
The class schedule (time, number, and length of classes)
was rated as appropriate by all but one youth.
Parents When asked to rate various components of
MMA, based on their experience of parent meetings and
home practice, 10 of 15 parents reported that the medita-
tion practice was helpful and highlighted the usefulness of
the CD in practice. One parent reported that their child did
not do any home practice and 4/12 parents did not respond
to this question. All but one parent found the individual
meetings with the instructor helpful. The mindful self-talk
component was reported to be by one parent. When asked
what the least helpful aspect of home practice was, 3/12
parents listed the worksheets and 2/12 listed the meditation
because it was difficult to encourage and remind youth to
complete them. Four parents reported that it was all helpful
and 5 did not respond to this question.
Overall these results suggest that being part of a club is
important to youth and that they like the mindful self-talk
and meditation components of the program. Making the
lessons meaningful through the use of stories and linking
them to the youth’s goals and lived experience outside of
session by meeting with youth, parents and the group lea-
der was a well-liked component of MMA. The least liked
components by parents and youth pertained to home
practice (e.g., worksheets and meditation practice).
Qualitative Interview Findings
There were a number of common themes that emerged
across youth and parent interviews. Themes emerging from
each of the four areas are discussed in turn.
Youth Goals for Attending Mindfulness Martial Arts
There were two main themes that were discussed in terms
of youth-set goals for MMA: (1) Development of skill and
mastery in martial arts; and (2) improving emotional well-
being and peer relations.
Enhancing Sense of Mastery and Pride For 4 of 7 youth,
martial arts was a motivating factor for participation in MMA,
J Child Fam Stud
123
with youth identifying the common goal of obtaining a higher-
ranking belt and obtaining proficiency in martial arts skills.
Having an opportunity to engage and develop skills in an
activity that would provide them with a senseof mastery was a
common motivating factor for participation. For example,
Anthony reported, ‘‘My goal is to obtain a high level of ability
[in martial arts]. Be excellent.’’ Similarly, Cole noted that his
goal was ‘‘to get through the belts,’’ while Jack’s goal was ‘‘to
get my black belt. I guess to keep going higher and higher.’’
Consistent with the goal of skill and mastery development in
martial arts, 6 of 7 youth reported that they liked the martial
arts component of the program and having the opportunity to
be physically active and engage in something that was of high
interest to them.
Parents’ responses about goals for MMA echoed similar
themes about martial arts and experience of success and
mastery. Half of the parents reported that their child’s goal
was to learn martial arts skills, noting that this would instill
a sense of pride in their children and increase their child’s
self-confidence. Fred’s father commented, ‘‘He wanted to
find a way of feeling less sad, less anxious, and less bullied.
He thought it [martial arts] was cool and if he had martial
arts he’d feel more confident when people bullied him.’’
The theme of pride was also echoed by two youth. While
Erin had difficulty reflecting on and expressing her goal she
noted, ‘‘Well I’m proud, I’m proud of myself…. I earned
my yellow belt.’’ Similarly, Fred stated ‘‘I just wanted to
have a feeling of pride. I wanted to get a good feeling in me
to have accomplished something important [martial arts]
and I’ve been working hard.’’
Improve Emotional Well-Being and Peer Relations For
all of the youth who presented with anxiety and a history of
peer victimization, wanting to improve emotional well-
being and peer relations was reported as their goal for
participating in MMA. For example, Thomas noted that his
goal was ‘‘Not to be as much of a victim. Beforehand, I’d
be a victim and people would always pick on me just
because I would get really upset easily.’’ While Erin had
difficulty reflecting on and expressing her goal, at the end
of MMA she emphasized ‘‘that people respect me more’’
because of taking martial arts. Fred’s father reported that
his son was ‘‘interested in coming because he was really
unhappy, depressed about his life. He really felt sad and
anxious and he wanted a way of feeling less sad, less
anxious, and less bullied. They’re all interrelated together.’’
Key MMA Components and Associated Outcomes
Six of seven youth and 3/4 parents identified mindfulness
as the most important component of the program. Helpful
mindfulness strategies identified by youth included the
mindful moment and meditation (e.g., body scan, loving
kindness). Mindfulness was thought to result in four main
outcomes: (1) increasing calmness; (2) thinking before
acting; (3) increased self-understanding and communica-
tion; and (4) tolerating and accepting discomfort.
Increasing Calmness The most common outcome of MMA
identified by youth and parents was increasing calmness and
this was most commonly attributed to the mindful moment. A
calm state was reported to provide youth with a moment of
clarity to think about/reinterpret a challenging situation
before responding. Youth responses suggested that this
allowed them to focus on difficult schoolwork and to not lose
their temper or engage in arguments.
I’ve been getting a lot of homework lately and MMA
kind of calms you down so it’s easier just to like sit
down and do your work…I’ll be more calm so I’m
more focused on my work and that makes it easier to
do the work in the first place. (Jack)
Trevor indicated, ‘‘the mindful moment just calms me
down,’’ while Cole reported, ‘‘I have ADHD so I get hyper
and the mindfulness helps in keeping me calm. It has
helped me so I do not have to take as much medicine for
[ADHD].’’ The increased calmness and clarity achieved
through MMA was also reflected in Fred’s statement:
I do meditation and it helps me to focus so I don’t
miss anything in the lesson (at school).
Finally, Jack added that ‘‘it’s calmed me down more. Like
if I was like yelling at someone like maybe I’d just think
like the, to be, so the meditation.’’
Parents also reported an increase in calmness in their
children. Erin’s mother reported that when Erin is com-
plaining about homework she prompts her to take a
mindful moment and it calms her down. Trevor and Fred’s
parents noted that their children were calmer and better
able to deal with challenges.
We have four boys so there are a lot of different
personalities. Everybody wants to be heard and
there’s a lot going on so I find that meditation helps to
calm things down a little bit…Now he’s more apt to
back off and come back with more of a calmer atti-
tude and try and explain maybe what the frustration is
about and whatever is going on. (Trevor’s Mother)
He’s able to calm himself down. Before MMA he
would be in such a state of mind that there was no
reasoning and he wasn’t able to reason and look
objectively at anything. MMA has given him tools to
bring himself down and deal with it. (Fred’s Father)
Think Before Acting Three of 7 youth in the sample had
diagnoses of ADHD and challenges with impulse control.
J Child Fam Stud
123
Thinking before acting was highlighted as a key theme for
these youth. Two of the 3 youth and all parents of these
children reported an improvement in the ability to stop
and think before acting. For example, Anthony explained,
‘‘Meditation helps me be able to become very self-con-
scious of things around me, think about things and try to
resolve them without lashing out. I don’t lash out. I can
solve problems easier without yelling.’’ Trevor and his
mother also reported that he was more likely to stop and
think. Trevor commented:
Well, not believing everything that you’re thin-
king…don’t jump to conclusions. So, say, if someone
looks like they’re giving you a dirty look it may not
be towards you, it may be at someone else or they’re
not doing it on purpose.
Similarly, Trevor’s mother noted, ‘‘I think with him, it’s
just not the ‘fly off the handle’ thing all the time. So maybe
he’s learning how to take that step back a little bit and think
about it.’’ Jack’s mother also noted that he was less
impulsive and able to talk instead of behaving in a more
reflexive manner. She reported:
I think he is much less impulsive, he thinks before he
acts, or he seems to, and he just seems to be much more
in touch with emotions in general, whether it’s his or
maybe other people’s…There was an instance when
Jack got really mad, and we got mad at him, my hus-
band and I, and he got really mad at us, and I said to
Jack ‘Don’t yell at me, speak to me.’ And he stopped,
and this is what MMA teaches them, to stop, and he told
me exactly, he verbalized what he was feeling.
Improved Self-Understanding and Communication Youth
in the advanced program identified knowing themselves
better. Anthony explained, ‘‘Meditation helps with my
mind, to know more about myself.’’ Similarly, Thomas
recounted,
I find that I’ve grown more mature and understanding
than most kids of my age. I also find that I can accept
things a lot more easily now. I’ve also found that
whenever I’m angry and having an angry thought, I
can usually figure out why I’m angry usually.
While enhanced self-understanding was not identified by
beginner MMA youth, their parents noted that they had a
better understanding of their emotions and thoughts and
were able to express these more openly with parents. For
example, Trevor’s mother reported:
Just talking about it, I guess. Just sometimes
expressing himself a bit more, where he’s saying he’s
frustrated about something or that he’s not feeling
good about something, or it might be that he’s excited
about something or happy but it’s something that,
before, it might be a little bit more closed and not
really spoken about at all.
He verbalized what he was feeling; he’s never done
that in his life. He told me what I was doing that was
making him angry and he was able to tell me and he
was able to calm down and I attribute that to MMA.
(Jack’s mom)
Erin would trade insults with [a classmate] and this
would escalate to physical altercations. After MMA,
she was able to tell me about it. Together we would
come up with an action plan. Since Erin is telling me
sooner, we are able to prevent it from escalating.
(Erin’s mom)
Tolerating and Accepting Discomfort A common theme
in the transcripts of youth and parents was the idea of
acceptance of challenge and staying in the present moment
even when it is associated with discomfort. All youth
reported that they applied the mindful moment and ‘‘BE’’ in
their daily lives to help them stay present with challenges. In
addition to ‘‘BE,’’ youth also noted that self-talk mantras,
such as ‘‘everything changes’’ and ‘‘it will pass’’ helped them
stay present with their challenges and facilitated calmness
and acceptance. They reported that this allowed for a neutral/
accepting stance that prevented them from jumping to con-
clusions. For example, Fred commented:
So, you just have to be with…like, if you’re upset
you just BE with it. And as I said before, you realize
why you’re upset. You don’t need to change it or
anything. It’s just being with your upset and not
trying to change. Like saying, oh, I’m all happy and
stuff when you’re upset…that will cause stress…I
just sit back and look at the situation and see why,
like, what’s happening, why is this happening? And
then just kind of be with it, and after I get a good
sense of what it is I can try to change it, or make it so
we get along better.
Similarly, Thomas commented:
Well, let’s say you hear about something and you want
to touch or throw something. Your immediate idea
would be to throw something or punch something but
now it means you notice those thoughts and accept
them like, ‘Okay, I’m angry right now.’ I want to punch
something or hurt something. Okay, I’m angry and I go
‘okay, you’ve got to make room for it. You’ve got to
really accept it.’ It’s not about getting rid of the feel-
ings. It’s more accepting that they are there. You notice
them but you don’t really act on them.
J Child Fam Stud
123
Parents also noted increased acceptance in their chil-
dren, for example, Erin’s mother reported, ‘‘she is more
able to define what she is feeling and accept it because this
is so integrated into the MMA program.’’
Behavioural Outcomes In terms of outcomes associated
with MMA, both youth and parents also discussed out-
comes at more of a broad behavioral level. As can be seen
in many of the quotes above, youth engaged in fewer
arguments with others and were better able to persist with
homework. Similarly, parents identified a number of spe-
cific changes in their children during the course of MMA,
including improved relationships with peers, parents, and
siblings; fewer behavior problems at school; ability to
persist with challenges in schoolwork; standing up for
themselves with bullies; and being seen as more mature by
adults.
Program Delivery
There were a number of key themes that arose regarding
aspects of program delivery, including (1) integration of
therapy and martial arts training; (2) specific learning
profile accommodations; and (3) the therapeutic milieu.
Integrating Therapy into Martial Arts Training: Experi-
ential Learning Youth and parents discussed the appeal
of integrating therapy into marital arts training. Youth
highlighted the opportunity afforded by martial arts and
yoga to practice the mindful moment and mantras. For
example, Jack explained how martial arts and yoga help
him practice staying with discomfort:
Like say you’re in a really hard yoga or martial arts
position you can think something like ‘this will pass’
and you consciously let your mind know. Kind of get
more determined, just like keep doing it until it
passes.
Similarly, Erin described how she used her breath as an
anchor: ‘‘I wasn’t getting this kick right, and I was getting
mad because of the way I was kicking with bent knees, so I
was taking a deep breath and I just kept practicing.’’
Anthony explained how practicing within the context of
martial arts has taught him persistence: ‘‘I kept doing it. I
kept doing it until I got it. You can’t fail, right, if you keep
practicing. You don’t fail anything. You might look like an
idiot in the process but you’re not going to fail.’’
Parents echoed the opportunity to practice mindfulness
in the context of physical challenge and reported that it is
done in a ‘natural’ way that may encourage youth come to
therapy who might not otherwise. Cole’s mother stated:
What I see as the important thing is that it is inte-
grated but it’s not just meditation by itself, yoga by
itself, or exercising and knowing your limits. It’s not
just about learning the martial arts and feeling com-
petence. What’s important to me is that it’s all things
and it just comes across so naturally.
Parents’ comments also focused on increasing persistence
and staying present with challenges. For example, Fred’s
father reported:
I think for what I see it’s the whole perseverance, the
idea of if things get tough you still have to keep
plugging away at it. To me, that’s the one message
that comes across. So, it could be if they’re talking
about a move in the martial arts that you have to…it
might take a bit of practice or whatever, but also that
idea spills over into your whole life, especially of
course into school which is where they struggle with
their LDs.
Specific Learning Accommodations Youth made specific
comments about the method of delivery of MMA. Youth
discussed learning and practicing mindfulness strategies
that were simplified so that they could be more easily
learned, recalled, and employed by youth with different
learning profiles (e.g., ‘‘BE,’’ The mindful moment, or self-
talk statements such as ‘‘Thoughts are not facts’’). Youth
also commented on how meaningfully linking concepts to
stories, role plays, and their martial arts practice made the
ideas easier to remember. Both parents and youth noted
that change did not occur until approximately week 13/20
or that they were just starting to see changes at the end of
the beginner program. For example, Thomas stated, ‘‘I
think I started noticing it after parts of the beginner’s
course and then I started noticing it more when I was in the
advanced class.’’
Therapeutic Milieu Parents were more likely than youth
to comment on the therapeutic milieu. Parents noted that
MMA provides youth with LDs with a safe, comfortable,
and non-judgmental environment wherein they can relate
to and support each other, as well as gain a sense of
belonging. For example, Jack’s mother reported, ‘‘I like
that he’s taking it at a place that I think is safe.’’ Being with
other youth who struggle with similar challenges was
viewed by parents as a positive social experience, some-
thing that many youth were desiring and struggling to
obtain. For example, Fred’s father reported, ‘‘While they
are in that dojo…They’re with a gang of kids who are like
them, who have similar problems, and they empathize with
each other and they care for each other.’’
J Child Fam Stud
123
Negative Aspects of MMA
The negative aspects of MMA were conceptualized in
terms of feasibility factors and challenging components of
the program. There was no consistency in terms of feasi-
bility factors; however, driving distance, cost of the pro-
gram (subsidies were provided), time waiting for parent
meetings, and time of program were identified. For
example, one parent noted that it was challenging to get
youth to the session after school and that weekend sessions
would be easier. Two youth also found the meditation and
yoga components challenging (e.g., slow, physically chal-
lenging). Trevor reported, ‘‘The meditation was a little
more slow. Not that it was hard, it just kind of gets boring.’’
Jack further noted:
I didn’t like the meditation at times, like when I was
really kind of like anxious or like wanted to leave at
times, but that’s it really…Like sometimes it’s
stressful and I don’t want to be sitting there and, like,
but I have to because it’s part of the mediation.
Erin noted, ‘‘I didn’t like when I had to do yoga with [the]
Sensei. Because it hurt.’’ Two youth and one parent
reported that they liked everything about the program.
Discussion
The impetus for developing MMA was to address two main
limitations in treatments available for youth with LDs and
self-regulation disorders. Namely, (1) to increase engage-
ment and present focus on challenges and to decrease
patterns of avoiding challenges commonly seen in youth
with LDs and (2) to accommodate for common information
processing weaknesses in youth with LDs (e.g., memory,
executive functions). A number of key themes emerged
within and across questionnaire and interview findings that
provide a window into how MMA may support youth in
staying present with challenges and decreasing patterns of
experiential avoidance, as well as the types of accommo-
dations or program delivery characteristics that support
youth in achieving their goals.
The reported goals of youth in MMA suggest that youth
have a desire to better themselves and to develop mastery.
Youth interviews underscored the importance of engaging
in an activity that would enable them to develop skill and
mastery in an activity that was of high interest to them,
such as martial arts. In questionnaires, the idea of mastery
was extended to development of mastery not only in
martial arts but also in terms of school work and fitness.
Working towards mastery goals was associated with a
sense of pride for many youth. Pride accounts for a sig-
nificant amount of the variance in mastery motivation in
young children in the context of student–teacher relation-
ships and social competence (Berhenke et al. 2011). The
development of mastery and pride were key motivators of
youth engagement, which has been positively related to
treatment retention (Smith et al. 2008).
The theme of development of mastery is also consistent
with the educational literature on building resilience in
youth. The belief or mindset that change is possible and
negative situations are not fixed sets the stage for the
development of goals related to mastery (Dweck 2006).
The concept of mastery has also been applied within the
area of achievement motivation (Elliot and Church 1997),
demonstrating the importance of mastery and performance-
related goals. Similar to these findings, youth in MMA
displayed both mastery and performance related goals.
More specifically, youth’s desire to ‘become excellent’ at
martial arts is consistent with mastery goals, which focus
on the development of competence. Youth wishing to
achieve a higher belt level is consistent with performance-
oriented goals, or attaining a level of performance that will
be viewed positively by others.
Mastery, performance-related goals, and pride set a
strong foundation for treatment as they are associated with
an approach orientation in which one faces challenges and
they also are thought to promote positive feelings, such as
excitement and task focus that support mastery and skill
development. Based on parent and youth comments, posi-
tive feelings and the desire for mastery also promote
present focus and the youth’s choice about how to manage
challenges in their life. The development of mastery and a
sense of control over positive outcomes in adolescence are
also salient from a developmental perspective and have
been shown to be associated with later physical and psy-
chological health in adulthood (Conger et al. 2009).
In addition to the development of mastery, youth reported
goals related to improved relationships and emotional and
behavioural well-being. Many youth in MMA engaged in
patterns of fight, flight, or freeze when they were confronted
with challenges in areas such as schoolwork, relationships,
and emotional discomfort. Youth and parent surveys and
questionnaires suggest that mindfulness practices, such as
the mindful moment, support youth in decreasing patterns of
experiential avoidance or reflexive patterns of fight, flight, or
freeze. Youth and parents consistently reported youth being
calmer and, in the cases of youth with ADHD, improved
ability to stop and think before acting. This is consistent with
an exploratory qualitative study of a 6-week mindfulness
program for healthy adolescents and young adults aged
16–24 that highlighted the role of mindfulness in moving
individuals from distress and over-reactivity to a state of
inner calm (Monshat et al. 2013).
The importance of calmness for treatment and imple-
mentation of skills learned can be understood within the
J Child Fam Stud
123
broader construct of emotion regulation. Research has
suggested that youth with LDs are more likely to have
emotion regulation challenges (Bauminger and Kimhi-
Kind 2008). When youth experience emotion dysregula-
tion, cognitive processes that promote adaptive behavior
tend to be hijacked, thereby limiting effective problem-
solving. Implementation of strategies, such as the mindful
moment, that promote a sense of calm may set the stage for
being able to engage in cognitive and problem-solving
strategies to navigate life challenges.
Calmness, however, cannot always be achieved without
the acceptance of discomfort. Acceptance has been shown
to be more critical to psychological well-being than purely
attending to one’s experience (Coffey et al. 2010). Toler-
ance of distress, mainly displayed by beginners, was in the
form of ‘‘BE,’’ reflecting the intention of the youth to stay
present with the challenge or discomfort. This may reflect a
beginning stage or a move in the direction of readiness for
acceptance. Youth in the advanced program reported
making room for and accepting discomfort without judg-
ment. Further research addressing client (e.g., presenting
problems, age) and treatment characteristics (e.g., length of
treatment, treatment components) that support the devel-
opment of acceptance in mindfulness treatments for ado-
lescents is needed.
Within and across questionnaire and interviews findings,
there were a number of important themes regarding pro-
gram delivery that arose. First, the active integration of
therapy and martial arts training was considered important
to the success of MMA. While martial arts is a means of
engaging youth in therapy and increasing mastery moti-
vation and a sense of pride, it was clear from youth and
parent responses that the benefits of martial arts extend
beyond engagement. More specifically, youth benefited
from experiential learning opportunities in session to
actively apply skills learned to lived experiences of chal-
lenge. Mindfulness, dynamic yoga, and martial arts were
physically and cognitively challenging for youth. Embed-
ding these activities into therapy provides as a common
challenge exposure experience for the group and a chance
to practice skills and strategies learned. Youth and parents
reported that youth were able to apply and practice strat-
egies in session and outside of session in the context of real
life challenges. The concept of embedding is consistent
with literature that has shown that exposure is a key
component of successful therapy for children with anxiety
disorders (Davis and Ollendick 2005). Further, Grycz-
kowski et al. (2013) found that use of exposure early in
treatment can decrease length of treatment, suggesting that
concepts and skills may be better assimilated in the context
of applying skills to real life challenges. In a group context
in which there are a range of presenting problems, it can be
complicated to complete group exposures that are
meaningful to all members in the group. Martial arts and
dynamic yoga provide this common challenge that can then
be individualized and generalized in meetings with youth
and parents to meet specific goals.
Youth reported that accommodations for information
processing weaknesses (e.g., repeated practice, use of role
play, the mindful moment, self-talk mantras on wall, in-the
-moment teaching) appeared to support youth in learning
and using strategies in and outside of session. Question-
naire results highlighted that youth enjoyed the stories that
were intended to bring lessons to life in the context of
living with a LD and self-regulation disorders. Youth also
reported that they liked the tip sheets. These two accom-
modations target memory by making information mean-
ingful and providing concrete aids that make it easier to
remember and retrieve strategies when needed.
Parents and youth reports suggest that it takes time for
change to occur, with change not being evident until week
13/20. This highlights the need for longer treatment pro-
tocols for youth with LD. This is consistent with research
in the area of mindfulness for individuals with intellectual
disabilities, with treatments being longer (e.g., 6 months)
and more intensive (Chapman et al. 2013; Singh et al.
2007b).
Home practice and the use of worksheets (common to
many cognitive behavioral treatments) were viewed less
positively and considered to be less helpful than other
MMA components. This is an area that requires further
exploration. More specifically, future research could
explore the relation between home practice and outcomes.
The use of accommodations, such as reducing the need for
writing through the use of speech-to-text software or audio-
recordings, could also be explored in terms of their pro-
motion of engagement in home practice. Certainly, the use
of digital recordings of mindfulness exercises to lead youth
through mindfulness practice at home has been reported as
helpful.
The provision of a safe and supportive environment with
other youth who are experiencing similar challenges was
highlighted by parents as facilitating engagement and
staying present with challenge. This type of group setting
allowed youth to take the risks needed to learn new skills
and to try on new behaviors, skills, and ways of coping
with social and emotional challenges. While youth rarely
commented on the group setting and a sense of belonging
in interviews, they rated being part of a club highly when
explicitly asked to rate components of MMA on the
questionnaire. This is consistent with group therapy theory
(Yalom and Leszcz 2005) and previous LD treatment
research conducted by Mishna and Muskat (2004) sug-
gesting that the group milieu decreases stigma and provides
youth with LDs with a sense that they are not the only ones
experiencing challenges. This can, in turn, decrease the
J Child Fam Stud
123
sense of isolation that many youth with LDs experience.
Feelings of belongingness also promote the sense of calm
discussed above at a behavioural and neurological level.
Feelings of social isolation or a sense that one does not
belong can impair logical reasoning (Baumeister et al.
2002) and are associated with less activity in the prefrontal
cortex (Campbell et al. 2006), which is involved in emotion
regulation and may impact on self-regulation. In sum, the
group milieu appears to be important to youth and may
support further support engagement, a sense of belong-
ingness and treatment goals related to emotion regulation.
Given the exploratory nature of this study, there are a
number of limitations that need to be addressed in future
research. First, parents and youth self-selected to partici-
pate in this research study and as such the results may have
been biased. The results are based on a small sample of
parents and youth. While efforts were made to triangulate
data by using two sources of data (questionnaires and
interviews), a larger sample of youth, particularly including
female and advanced participants may shed more light on
key processes and outcomes, and youth characteristics that
may moderate these outcomes.
In addition to addressing these limitations, there are a
number of interesting questions that have arisen in the
context of this research that need to be addressed in future
research. First, given that this is a mixed sample of youth
with diverse self-regulation disorders and LDs, future
qualitative research with a larger number of youth with
LDs and specific self-regulation disorders (e.g., ADHD;
anxiety) may be helpful in further delineating the ways in
which MMA is helpful for specific comorbidities. Second,
findings suggest some similarities to the process model of
mindfulness proposed by Monshat et al. (2013). The cur-
rent research could be extended to examine if similar
phases seen in healthy youth exist for youth with LDs and
self-regulation disorders and, importantly, what character-
istics may moderate or mediate successful attainment of
these different stages. Gathering data from youth
throughout the 20-week treatment process would be helpful
in this regard. This could include a process examination of
the development of acceptance. Third, while youth and
parents commented that they liked parents being involved
at the end of each session, this component was not exten-
sively explored. Future research could explore this com-
ponent in more depth to better assess its impact on
generalization and parent–child relationship quality. The
inclusion of a parent component in which parents learn the
skills taught may also be a complementary component for
future development and study. Certainly, research on
mindful parenting treatments has shown improvements in
adolescent-parent relationships after participation in a
mindful parenting intervention. Parents who engage in
more mindful parenting are able to stay in the present
moment and select behaviors or strategies that help to
disrupt cycles of automatic negative responding (Coats-
worth et al. 2010). Fourth, process data such as attendance
and homework completion was not collected as part of this
study and may be an important moderator of treatment
outcomes. Finally, the feasibility of delivering the MMA
program outside of Integra and the necessary skill set of the
leader needs to be examined. The integration of therapy
into martial arts and yoga necessitates a combination of
skills that may not be highly prevalent in most therapeutic
settings. While our leaders had a range of skill levels in
martial arts, yoga and mindfulness, more specific infor-
mation is needed about the required skill level is needed.
Future research could also explore if bringing together two
leaders with this complement of skills is as effective as
having one leader who possesses skills across all areas.
In conclusion, MMA is a promising approach that
addresses two key limitations in available treatments for
youth with LDs: decreasing experiential avoidance and
adapting treatment to address processing strengths and
needs. This exploratory qualitative research represents an
important step in beginning to understand the processes
that underlie the changes youth with LDs make in MMA.
While this study has focused on one manualized treatment
program, it highlights the importance of addressing expe-
riential avoidance and information processing in youth
with LDs and self-regulation disorders more broadly. The
themes from parents and youth provide important insights
that may guide the further development or adaptation of
therapies and direct research for youth with LDs and self-
regulation challenges.
Acknowledgments Thank you to all of the MMA youth and parents
who participated in this study. We are also grateful to the MMA
leaders and Integra staff for their assistance with this project and to
funding provided by the Ontario Centre for Excellence in Child and
Youth Mental Health. Please contact P. Badali (pbadali@inte-
gra.on.ca) for more information about the MMA program.
References
Arthur, A. R. (2003). The emotional lives of people with learning
disability. British Journal of Learning Disabilities, 31(1), 25–30.
doi:10.1046/j.1468-3156.2003.00193.x.
Badali, P., & Integra Foundation. (2011). The integra mindfulness
martial arts program manual. Toronto: Program Manual
Developed for the Integra Foundation.
Barkley, R. A. (1997). Defiant children: A clinician’s manual for
assessment and parent training (2nd ed.). New York, NY:
Guilford Press.
Barkley, R. A. (2002). Major life activity and health outcomes
associated with attention-deficit/hyperactivity disorder. Journal
of Clinical Psychiatry, 63, 10–15.
Baumeister, A. L., Storch, E. A., & Geffken, G. R. (2008). Peer
victimization in children with learning disabilities. Child and
Adolescent Social Work Journal, 25(1), 11–23. doi:10.1007/
s10560-007-0109-6.
J Child Fam Stud
123
Baumeister, R. F., Twenge, J. M., & Nuss, C. K. (2002). Effects of
social exclusion on cognitive processes: Anticipated aloneness
reduces intelligent thought. Journal of Personality and Social
Psychology, 83(4), 817–827. doi:10.1037/0022-3514.83.4.817.
Bauminger, N., Edelsztein, H. S., & Morash, J. (2005). Social
information processing and emotional understanding in children
with LD. Journal of Learning Disabilities, 38(1), 45–60. doi:10.
1177/00222194050380010401.
Bauminger, N., & Kimhi-Kind, I. (2008). Social information
processing, security of attachment, and emotion regulation in
children with learning disabilities. Journal of Learning Disabil-
ities, 41(4), 315–332. doi:10.1177/0022219408316095.
Berhenke, A., Miller, A. L., Brown, E., Seifer, R., & Dickstein, S.
(2011). Observed emotional and behavioral indicators of moti-
vation predict school readiness in Head Start graduates. Early
childhood research quarterly, 26(4), 430–441. doi:10.1016/j.
ecresq.2011.04.001.
Bogels, S., Hoogstad, B., Van Dun, L., De Schutter, S., & Restifo, K.
(2008). Mindfulness training for adolescents with externalizing
disorders and their parents. Behavioral and Cognitive Psycho-
therapy, 36(2), 193–209. doi:10.1017/S1352465808004190.
Campbell, W. K., Krusemark, E. A., Dyckman, K. A., Brunell, A. B.,
McDowell, J. E., Twenge, J. M., et al. (2006). A magnetoen-
cephalography investigation of neural correlates for social
exclusion and self-control. Social Neuroscience, 1(2), 124–134.
doi:10.1080/17470910601035160.
Chapman, J. (1988). Learning disabled children’s self-concepts.
Review of Educational Research, 58(3), 347–371. doi:10.3102/
00346543058003347.
Chapman, M. J., Hare, D. J., Caton, S., Donalds, D., McInnis, E., &
Mitchell, D. (2013). The use of mindfulness with people with
intellectual disabilities: A systematic review and narrative
analysis. Mindfulness, doi:10.1007/s12671-013-0197-7.
Chawla, N., & Ostafin, B. (2007). Experiential avoidance as a
functional dimensional approach to psychopathology: An empir-
ical review. Journal of Clinical Psychology, 63(9), 871–890.
doi:10.1002/jclp.20400.
Coatsworth, J. D., Duncan, L. G., Greenberg, M. T., & Nix, R. L.
(2010). Changing parent’s mindfulness, child management skills
and relationship quality with their youth: Results from a
randomized pilot intervention trial. Journal of Child and Family
Studies, 19(2), 203–217. doi:10.1007/s10826-009-9304-8.
Coffey, K. A., Hartman, M., & Fredrickson, B. L. (2010). Decon-
structing mindfulness and constructing mental health: Under-
standing mindfulness and its mechanisms of action. Mindfulness,
1(4), 235–253. doi:10.1007/s12671-010-0033-2.
Conger, K., Williams, S., Little, W., Masyn, K., & Shebloski, B.
(2009). Development of mastery during adolescence: The role of
family problem solving. Journal of Health and Social Behavior,
50(1), 99–114. doi:10.1177/002214650905000107.
Cortiella, C. (2009). The state of learning disabilities 2009. New
York, NY: National Centre for Learning Disabilities. 2.
Cosden, M., Patz, S., & Smith, S. (2009). Do problems with
information processing affect the process of psychotherapy for
adults with learning disabilities or attention deficit/hyperactivity
disorder? Learning Disabilities Research and Practice, 24(4),
165–173. doi:10.1111/j.1540-5826.2009.00290.x.
Davis, T. E., & Ollendick, T. H. (2005). Empirically supported
treatments for specific phobia in children: Do efficacious
treatments address the components of a phobic response?
Clinical Psychology: Science and Practice, 12(2), 144–160.
doi:10.1093/clipsy/bpi018.
Ducharme, J. M., & Harris, K. E. (2005). Errorless embedding for
children with on-task and conduct difficulties: Rapport-based,
success-focused intervention in the classroom. Behavior Ther-
apy, 36(3), 213–222. doi:10.1016/S0005-7894(05)80070-X.
Dweck, C. S. (2006). Mindset: The new psychology of success
Random House. New York, NY.
Elliot, A. J., & Church, M. A. (1997). A hierarchical model of
approach and avoidance achievement motivation. Journal of
Personality and Social Psychology, 72(1), 218–232. doi:10.
1037/0022-3514.72.1.218.
Flook, L., Smalley, S., Kitil, M., Galla, B., Kaiser-Greenland, S.,
Locke, J., et al. (2010). Effects of mindful awareness practices
on executive functions in elementary school children. Journal of
Applied School Psychology, 26(1), 70–95. doi:10.1080/
15377900903379125.
Gryczkowski, M. R., Tiede, M. S., Dammann, J. E., Jacobsen, A. B.,
Hale, L. R., & Whiteside, S. P. H. (2013). The timing of
exposure in clinic-based treatment for childhood anxiety disor-
ders. Behavior Modification, 37(1), 113–127. doi:10.1177/
0145445512456546.
Haydicky, J., Wiener, J., Badali, P., Ducharme, J. M., & Milligan, K.
(2012). Evaluation of mindfulness-based intervention for ado-
lescents with learning disabilities and co-occurring ADHD and
anxiety. Mindfulness, 3(2), 151–164. doi:10.1007/s12671-012-
0089-2.
Hayes, S., Wilson, K., Gifford, E., Folette, V., & Kirk, S. (1996).
Experiential avoidance and behavioral disorders: A functional
dimensional approach to diagnosis and treatment. Journal of
Consulting and Clinical Psychology, 64(6), 1152–1168. doi:10.
1037/0022-006X.64.6.1152.
Hersh, C. A., Stone, B. J., & Ford, L. (1996). Learning disabilities and
learned helplessness: A heuristic approach. International Journal
of Neuroscience, 84(1–4), 103–113.
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. doi:10.1037/a0018555.
Kabat-Zinn, J. (2003). Mindfulness based interventions in context:
past, present, and future. Clinical Psychology: Science and
Practice, 10(2), 144–156. doi:10.1093/clipsy.bpg016.
Kavale, K. A., & Forness, S. R. (1996). Social skill deficits and
learning disabilities: A meta-analysis. Journal of learning
disabilities, 29(3), 226–237. doi:10.1177/002221949602900301.
Kashdan, T. B., Barrios, V., Forsyth, J. P., & Steger, M. F. (2006).
Experiential avoidance as a generalized psychological vulnera-
bility: Comparisons with coping and emotion regulation strate-
gies. Behaviour Research and Therapy, 9, 1301–1320. doi:10.
1016/j.brat.2005.10.003.
Kendall, P. C., & Hedtke, K. A. (2006). Cognitive behavioural
therapy for anxious children: Therapist manual (3rd Ed.).
Ardmore: Workbook Publishing.
Kendall, P. C., & Treadwell, K. R. H. (2007). The role of self-
statements as a mediator in treatment for youth with anxiety
disorders. Journal of Consulting and Clinical Psychology, 75(3),
380–389. doi:10.1037/0022-006X.75.3.380.
Learning Disabilities Association of Canada. (2002). Official defini-
tion of learning disabilities. Retrieved from: http://www.ldac-
acta.ca/en/learn-more/ld-defined.html.
Linehan, M., Comtois, K., Murray, A., Brown, M., Gallop, R., Heard,
H., et al. (2006). Two-year randomized controlled trial and
follow-up of dialectical behavior therapy vs Therapy by experts
for suicidal behaviors and borderline personality disorder.
Archives of General Psychiatry, 63(7), 757–766. doi:10.1001/
archpsyc.63.7.757.
Ma, S., & Teasdale, J. (2004). Mindfulness-based cognitive therapy
for depression: Replication and exploration of differential
relapse prevention effects. Journal of Consulting and Clinical
Psychology, 72(1), 31–40. doi:10.1037/0022-006X.72.1.31.
Mattison, R. E., & Mayes, S. D. (2012). Relationships between
learning disability, executive function, and psychopathology in
J Child Fam Stud
123
children with ADHD. Journal of Attention Disorders, 16(2),
138–146. doi:10.1177/1087054710380188.
Mayes, S. D., & Calhoun, S. L. (2006). Frequency of reading, math,
and writing disabilities in children with clinical disorders.
Learning and Individual Differences, 16(2), 145–157. doi:10.
1016/j.lindif.2005.07.004.
Mendelson, T., Greenberg, M. T., Dariotis, J. K., Gould, L. F.,
Rhoades, B. L., & Leaf, P. J. (2010). Feasibility and preliminary
outcomes of a school-based mindfulness intervention for urban
youth. Journal of Abnormal Child Psychology, 38(7), 985–994.
Milligan, K., & Badali, P. (2010). Mindfulness Martial Arts: An
innovative treatment for youth with learning disabilities and
mental health disorders. (Final report for the Ontario Centre of
Excellence in Child and Youth Mental Health). Retrieved from
http://www.excellenceforchildandyouth.ca/sites/default/files/gai_
attach/EIG-1155_Final_Outcomes_Report.pdf.
Mishna, F. (2003). Learning disabilities and bullying: Double
jeopardy. Journal of Learning Disabilities, 36(4), 336–348.
doi:10.1177/00222194030360040501.
Mishna, F., & Muskat, B. (2004). ‘‘I’m not the only one!’’ group
therapy with older children and adolescents who have learning
disabilities. International Journal of Group Psychotherapy,
54(4), 455–476. doi:10.1521/ijgp.54.4.455.42762.
Monshat, K., Khong, B., Hassed, C., Vella-Brodrick, D., Norrish, J.,
Burns, J., et al. (2013). ‘‘A conscious control over life and my
emotions:’’ Mindfulness practice and healthy young people. A
qualitative study. Journal of Adolescent Health, 52(5), 572–577.
doi:10.1016/j.jadohealth.2012.09.008.
Moree, B., & Davis, T. (2010). Cognitive-behavioral therapy for
anxiety in children diagnosed with autism spectrum disorders:
Modification trends. Research in Autism Spectrum Disorders,
4(3), 346–354. doi:10.1016/j.rasd.2009.10.015.
Morgan, A. B., & Lilienfeld, S. O. (2000). A meta-analytic review of
the relation between antisocial behavior and neuropsychological
measures of executive function. Clinical Psychology Review,
20(1), 113–136. doi:10.1016/S0272-7358(98)00096-8.
Pennington, B. F., & Ozonoff, S. (1996). Executive functions and
developmental psychopathology. Journal of Child Psychology
and Psychiatry, 37(1), 51–87. doi:10.1111/j.1469-7610.1996.
tb01380.x.
Piet, J., & Hougaard, E. (2011). The effect of mindfulness-based
cognitive therapy for prevention of relapse in recurrent major
depressive disorder: A systematic review and meta-analysis.
Clinical Psychology Review, 31(6), 1032–1040. doi:10.1016/j.
cpr.2011.05.002.
Segal, Z., Williams, J., & Teasdale, J. (2002). Mindfulness-based
cognitive therapy for depression- A new approach to preventing
relapse. New York: Guilford Press.
Semple, R. J., Lee, J., Rosa, D., & Miller, L. F. (2010). A randomized
trial of mindfulness-based cognitive therapy for children:
Promoting mindful attention to enhance social-emotional resil-
iency in children. Journal of Child and Family Studies, 19(2),
218–229. doi:10.1007/s10826-009-9301-y.
Semple, R., Reid, E., & Miller, L. (2005). Treating anxiety with
mindfulness: An open trial of mindfulness training for anxious
children. Journal of Cognitive Psychotherapy, 19(4), 379–392.
doi:10.1891/jcop.2005.19.4.379.
Singh, N. N., Lancioni, G. E., Manikam, R., Winton, A. S., Singh, A.
N., Singh, J., et al. (2011a). A mindfulness-based strategy for
self-management of aggressive behavior in adolescents with
autism. Research in Autism Spectrum Disorders, 5(3),
1153–1158. doi:10.1016/j.rasd.2010.12.012.
Singh, N. N., Lancioni, G. E., Singh Joy, S. D., Winton, A. S. W.,
Sabaawi, M., Wahler, R. G., et al. (2007a). Adolescents with
conduct disorder can be mindful of their aggressive behavior.
Journal of Emotional and Behavioral Disorders, 15(1), 56–63.
doi:10.1177/10634266070150010601.
Singh, N. N., Lancioni, G. E., Singh, A. D., Winton, A. S., Singh, A.
N., & Singh, J. (2011b). Adolescents with Asperger syndrome
can use a mindfulness-based strategy to control their aggressive
behavior. Research in Autism Spectrum Disorders, 5(3),
1103–1109. doi:10.1016/j.rasd.2010.12.006.
Singh, N. N., Lancioni, G. E., Winton, A. S. W., Adkins, A. D., Singh,
J., & Singh, A. N. (2007b). Mindfulness training assists
individuals with moderate mental retardation to maintain their
community placements. Behavior Modification, 31(6), 800–814.
doi:10.1177/0145445507300925.
Smith, B. D., Duffee, D. E., Steinke, C. M., Huang, Y., & Larkin, H.
(2008). Outcomes in residential treatment for youth: The role of
early engagement. Children and Youth Services Review, 30(12),
1425–1436. doi:10.1016/j.childyouth.2008.04.010.
Spinazzola, J., Rhodes, A. M., Emerson, D., Earle, E., & Monroe, K.
(2011). Application of yoga in residential treatment of trauma-
tized youth. Journal of the American Psychiatric Nurses
Association, 17(6), 431–444.
Steiner, N. J., Sidhu, T. K., Pop, P. G., Frenette, E. C., & Perrin, E. C.
(2013). Yoga in an urban school for children with emotional and
behavioral disorders: A feasibility study. Journal of Child and
Family Studies, 22(6), 815–826.
Tannock, R. (2013). Rethinking ADHD and LD in DSM-5: Proposed
changes in diagnostic criteria. Journal of Learning Disabilities,
46(1), 5–25. doi:10.1177/0022219412464341.
van de Weijer-Bergsma, E., Formsma, A. R., Bruin, E. I., & Bo
¨gels,
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. doi:10.1007/s10826-011-9531-7.
van der Oord, S., Bo
¨gels, 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. doi:10.1007/s10826-011-9457-0.
Veehof, M. M., Oskam, M., Schreurs, K. M. G., & Bohlmeijer, E. T.
(2011). Acceptance-based interventions for the treatment of
chronic pain: A systematic review and meta-analysis. Pain,
152(3), 533–542. doi:10.1016/j.pain.2010.11.002.
Wiener, J., & Schneider, B. (2002). A multisource exploration of
friendship patterns of children with and without learning
disabilities. Journal of Abnormal Child Psychology, 30(2),
127–141. doi:10.1023/A:1014701215315.
Wiener, J., & Sunohara, G. (1998). Parents’ perceptions of the quality
of friendship of their children with learning disabilities. Learning
Disabilities Research and Practice, 13(4), 242–257.
Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group
psychotherapy. New York, NY: Basic Books.
Yeager, D. S., & Dweck, C. S. (2012). Mindsets that promote
resilience: When students believe that personal characteristics
can be developed. Educational Psychologist, 47(4), 302–314.
doi:10.1080/00461520.2012.722805.
Zingerevich, C., & Patricia, D. L. (2009). The contribution of
executive functions to participation in school activities of
children with high functioning autism spectrum disorder.
Research in Autism Spectrum Disorders, 3(2), 429–437.
doi:10.1016/j.rasd.2008.09.002.
J Child Fam Stud
123
