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Review Article
Behavioral and Cognitive Impacts of Mindfulness-Based
Interventions on Adults with Attention-Deficit Hyperactivity
Disorder: A Systematic Review
Hélène Poissant ,
1
Adrianna Mendrek,
2
Nadine Talbot ,
3
Bassam Khoury,
4
and Jennifer Nolan
1
1
Universite du Quebec à Montréal, Education and Pedagogy Department, Montréal, Quebec, Canada H3C 3P8
2
Bishop’s University, Psychology Department, Sherbrooke, Quebec, Canada J1M 1Z7
3
Universite du Quebec à Trois-Rivières, Sciences Education Department, Trois-Rivières, Canada G9A 5H7
4
McGill University, Educational and Counselling Psychology, Montréal, Quebec, Canada H3A 1Y2
Correspondence should be addressed to Hélène Poissant; poissant.helene@uqam.ca
Received 10 August 2018; Revised 18 December 2018; Accepted 20 January 2019; Published 4 April 2019
Academic Editor: Jesus Pastor
Copyright © 2019 Hélène Poissant et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Mindfulness-based interventions (MBIs) are becoming increasingly popular as treatments for physical and psychological problems.
Recently, several studies have suggested that MBIs may also be effective in reducing symptoms of attention-deficit hyperactivity
disorder (ADHD). Most studies have examined the effectiveness in children, but there are now a sufficient number of individual
treatment trials to consider a systematic review in adults. Majority of existing systematic reviews and meta-analyses only
consider ADHD symptoms as an outcome, and most of them do not fully report potential biases of included studies, thus
limiting considerably their conclusions. This is an important facet because some studies could be found ineligible to be included
in future analysis due to their low quality. In this systematic review, we followed the PRISMA/PICO criteria and we thoroughly
assessed the risks of bias for each of the selected studies according to Cochrane guidelines. We searched the available literature
concerning MBIs in adult participants with ADHD using PsycINFO, PubMed, Scopus, and ERIC databases. In total, 13 studies
conducted with 753 adults (mean age of 35.1 years) were identified as eligible. Potential moderators such as participants’age,
ADHD subtypes, medication status, comorbidity, intervention length, mindfulness techniques, homework amount, and training
of therapists were carefully described. Aside from measuring the symptoms of ADHD, outcome measures were categorized into
executive/cognitive functioning, emotional disturbances, quality of life, mindfulness, and grade point average at school.
According to presented descriptive results, all the studies (100%) showed improvement of ADHD symptoms. In addition,
mindfulness meditation training improves some aspects of executive function and emotion dysregulation. Although these are
promising findings to support treatment efficacy of MBIs for ADHD, various biases such as absence of randomization and lack
of a control group may affect the actual clinical value and implications of the studies. Moreover, the relatively low quality of
selection and performance criteria in several studies, as well as relatively high attrition bias across studies, call for caution before
considering conducting further analysis.
1. Introduction
Mindfulness-based interventions (MBIs) have gained in pop-
ularity over the past decade. Clinical trials provide evidence
of their effectiveness in the treatment of depression, anxiety,
addictions, and other mental health problems. Most MBIs
involve three somatically focused meditative techniques
(body scan, sitting meditation, and mindful yoga) that are
thought to help participants cultivate nonjudgmental, mind-
ful awareness of present-moment experience. Recently, sev-
eral studies have suggested that MBIs may also be effective
in reducing symptoms of attention-deficit hyperactivity dis-
order (ADHD). Most studies have examined the effectiveness
in children. There are now a sufficient number of individual
Hindawi
Behavioural Neurology
Volume 2019, Article ID 5682050, 16 pages
https://doi.org/10.1155/2019/5682050
treatment trials to consider a systematic review in adults.
To our knowledge, only Cairncross and Miller [1] have
conducted a meta-analysis (six studies in children and four
in adults) on ADHD to measure the impact of MBIs on
symptoms of ADHD. The authors only considered publi-
cation bias in their study. The present systematic review
goes further by exploring in detail seven types of biases
according to Cochrane guidelines. This is an important
aspect of the present review because it allows identifying
studies with poor quality.
This systematic review examines if MBIs are effective
treatments of attention-deficit hyperactivity disorder (ADHD)
in adults. ADHD is characterized by marked behavioral
symptoms such as inattention and/or hyperactivity and act-
ing impulsively. The prevalence of the disorder is about
3-4% in adults, and it is higher in males than in females.
ADHD often exists simultaneously with other conditions,
such as anxiety, depression, and personality disorders. The
most common treatment of ADHD consists of administra-
tion of psychostimulant medications. However, the pharma-
cotherapy is not always effective and is associated with
various side effects. Thus, MBIs represent a much-welcomed
addition to available treatments or a stand-alone therapy.
Comprehension of the mechanisms mediating the effec-
tiveness of MBIs in ADHD at both the behavioral and neuro-
nal levels has greatly improved. Thus, three large neural
networks have been implicated both in ADHD and in mind-
fulness meditation: the default mode network, salience net-
work, and central executive network [2–7]. Because of
space constraints, we concentrate in the present review only
on the behavioral level, considering the effects of MBIs on
hyperactivity, emotion dysregulation, deficits in attention
and executive function (EF), and other problems. Most of
these dysfunctional behaviors seem to improve following
MBIs. The improvement of these behaviors in turn contrib-
utes to the general well-being of adults with ADHD.
However, due to the heterogeneous presentation of
ADHD, it is important to document the interindividual
differences of individuals with ADHD. These differences
between individuals with ADHD may affect the success of
MBIs in reducing symptoms. For example, there is more
evidence to suggest that MBIs are effective in reducing
inattention, so perhaps the intervention is more helpful for
individuals with ADHD with a predominantly inattentive
type [1]. Adults being more often characterized as inatten-
tive (instead of hyperactive) may react in a different man-
ner to MBIs compared to children. Other variables could
also affect whether MBTs are effective in improving func-
tioning in individuals with ADHD. For example, it is
unclear how factors such as the length of intervention,
mindfulness techniques, amount of homework, homework
compliance, and training of the therapist affect the out-
come of therapy [1]. These are important elements that
should be taken into account. Moreover, besides symptoms
of inattention and hyperactivity, other indicators of efficacy
of MBTs had been reported, namely, EFs, emotional distur-
bance, quality of life, and academic performance. We con-
sider these additional elements useful in supporting the
portrayal of ADHD.
The present systematic review attempts to provide more
evidence for the use of MBIs in adults with ADHD by
means of investigation into several variables and character-
istics that may moderate the effectiveness of MBIs. It is
important for us to report these elements so that the relation-
ship between these characteristics and intervention effective-
ness can be better understood. Moreover, incorporation of an
exhaustive analysis of biases with an assessment of the quality
of studies is presented here as an essential element of the
systematic review.
2. Methods
2.1. Eligibility Criteria. In order to conduct the systematic
review, we used the criteria from PRISMA-P [8]. These cri-
teria allow following a stepwise methodology in conducting
and reporting the outcomes of the systematic review. A data
sheet based on the PRISMA-P protocol was designed and
comprised information extracted from each selected study
based on (1) research design (including RCT, N-RCT, the
presence of a waiting list, pre-posttest, follow-up, and base-
line), (2) characteristics of participants (including number,
age, gender, diagnosis with subtype, comorbidity, and medi-
cation), (3) characteristics of the intervention (including
type, description, length, identity of therapists, and their
experience), and (4) characteristics of outcomes (ADHD
symptoms, executive functioning, emotional disturbance,
mindfulness, and quality of life).
We limited inclusion to peer-reviewed empirical published
studies that examined effects of meditation or mindfulness-
based interventions (MBIs) on symptoms of ADHD. All stud-
ies were published in English. We excluded books, reviews,
meta-analyses, qualitative, psychometric, or single-case stud-
ies, and duplicates.
2.2. Information Sources and Search. We consulted Psy-
cINFO, PubMed, Scopus, and ERIC databases from the first
available date until June 2018 (+reference lists of previous
reviews). By the end of the search, the selected studies cover
a period from 2002 to 2018. The search terms “ADHD
AND meditation OR mindfulness”and associative terms
(e.g., impulsivity, inattention, and hyperactivity) were con-
sidered for inclusion. Impact of MBIs was extended to
cognition, EF, and brain structure alterations. We included
randomized and nonrandomized control trials (RCT and
N-RCT, respectively), pre-posttest (within-group) studies,
clinical trials, prospective or follow-up studies, and single-
or double-blind studies. Studies were excluded if they (1)
were conducted with children, (2) did not include a mind-
fulness- or meditation-based treatment, (3) did not include
a group of ADHD or ADD or hyperactivity disorders, (4) did
not examine treatment effects, (5) did not report clinical
outcomes, and (6) described solely mindfulness or medita-
tion instructions. We included different forms of MBIs as
long as the intervention contained significant elements of
mindfulness. We also excluded “gray literature,”reports,
and unpublished studies. By the end of the selection pro-
cess, we included thirteen studies conducted with adults,
2 Behavioural Neurology
young adults, and college students. The full electronic pro-
cess search strategy for our databases is described below.
2.3. Risk of Bias in Individual Studies. We looked for risk of
bias in each individual study. Thus, we designed and adapted
a classification to report potential bias for each individual
study using the Cochrane Collaboration [9] recommenda-
tions. Biases included (1) “sequence generation”(e.g., Is the
allocation sequence acceptably generated? “YES”if explicitly
mentioned that the “patients were randomly allocated”), (2)
“allocation concealment”(e.g., Is the allocation acceptably
concealed? “YES”if participants and researcher could not
foresee assignment because of an explicit mention of a
method to conceal allocation), (3) “blinding of participants,
personnel, and outcome assessors”(e.g., Is knowledge of
the allocated treatment plenty prevented during the study?
“YES”in case of blinding or if the authors judged improba-
bly that the outcome measurement was influenced by no
blinding, and (4) “selective outcome reporting”(e.g., Are
partial outcome data adequately addressed? “YES”if explic-
itly mentioned that nonmissing outcome data or reasons for
missing outcome data had little impact on outcomes). The
authors’judgments involved answering specific questions
for each query and providing a detailed entry addressing
the sources of bias. In all cases, an answer “YES”indicates
a low risk of bias, an answer “NO”indicates a high risk of
bias, and an answer “unclear”indicates an uncertain risk of
bias (p. 196, [9]).
Selection bias comprises random “sequence generation”
(1) and “allocation concealment”(2) (p. 196, [9]). According
to the criteria proposed by the Cochrane Collaboration [10],
a study was rated low risk on random sequence generation if
the method used to allocate sequence produces equivalent
groups. If random sequence generation was not described
in sufficient detail but the study was described as random-
ized and the groups were equivalent, we rated the risk
unclear. The studies, which have not fulfilled either condi-
tion, were rated high risk. Regarding allocation concealment,
we rated a study low risk when its method to conceal the
allocation sequence could not be predicted in advance of
or during intervention. If allocation concealment was not
described with sufficient accuracy to allow an appreciation
of whether it could be foreseen but participants would not
necessarily identify the group to which they belong (i.e.,
treatment or control), the risk was rated unclear. The
remaining studies, which have not fulfilled either condition,
were rated high risk.
Performance bias and detection bias (3) reflect the blind-
ing of participants and personnel (e.g., facilitators or trainers)
and reflect the blinding of assessors to the condition. We
considered studies low risk if they described the blinding
of outcome assessors and used only self-report subjective
measures and/or objective measure (e.g., neuropsychological
measures). Unclear risk corresponded to self-report mea-
sures but nonblinding of assessors. For the nature of inter-
ventions in this study (MBIs), it is not habitual, nor always
advantageous, to blind personnel or participants. Therefore,
we expected studies to have an elevated risk for performance
and/or detection bias.
Attrition bias (4) is based on the recommendation by
Higgins et al. [10] to rate studies with above 20% attrition
of participants as high risk. An attrition rate lower than
20% where the groups (i.e., treatment and control) are equiv-
alent yields a low risk. Thus, studies were rated high risk if the
attrition rate was greater than 20% and the authors did not
use any analyses to compensate for the missing data. Studies
were rated unclear risk if the authors did not explicitly pro-
vide attrition rates or the computation of the attrition was
not possible using the provided data.
Reporting bias refers to reporting the outcome data par-
tially or omitting to report scales (or subscales) that may lead
to a bias. We decided to rate the study low risk if all the scales
and subscales were reported. We rated the study unclear risk
when subscales were not fully reported or it was unclear
whether omitting to report the subscales led to a bias.
Other biases included a researcher’s allegiance and fund-
ing source. These biases addressed the authors’role in the
study development or implementation, as well as acknowl-
edgement of any conflict of interest. Studies were rated high
risk when authors were actively involved in delivering inter-
ventions, evaluating participants, or conducting any other
aspects of the study. Studies were rated low risk when authors
were not involved in conducting the study. Studies were rated
unclear when the authors did not report their involvement
and information from the paper did not suggest their
involvement. Regarding funding, studies were rated high risk
when sources of funding can cause a conflict of interest, low
when the study was not funded or when the sources of fund-
ing were disclosed with a nonconflict of interest statement,
and unclear when the sources of funding were not reported.
Discussions about the judgment ratings were provided in
an iterative way until consensus about the ratings was
reached between judges (H.P., B.K., and A.M.). Prior to these
discussions, the rating coauthors familiarized themselves
with a series of articles and a document containing specific
instructions and examples of rating the studies from the
Cochrane Collaboration’s tools.
2.4. Summary Measures and Additional Analyses. The results
of the present systematic review are first presented in a narra-
tive manner. Tables 1 and 2 give an overview of a PICO
description of each individual study considering two separate
types of research design: within and between subjects (see
Tables 1 and 2, respectively). For the bias analysis, apprecia-
tion of the quality of each study was converted into numeric
variables with quality scores ranging from 0 (high risk) and 1
(unclear risk) to 2 (low risk) on each of the seven bias evalu-
ation measures (the maximum score of quality for each study
is 14).
3. Results
3.1. Study Selection. The final literature search resulted in 720
studies: PsycINFO (n= 225), PubMed (n= 460), Scopus
(n=23), and ERIC (n=12). An Endnote file was first cre-
ated, and abstracts of all articles were saved on an electronic
file for further examination. The search was conducted in two
consecutive sessions from October 2016 to January 2017 and
3Behavioural Neurology
later updated from April 2018 to July 2018 resulting in the
incorporation of two new articles (with the help of N.T.).
The first step consisted of the elimination of 178 duplicates
(+1 erratum). The final study selection was based on eligibil-
ity assessment from two independent reviewers (H.P. and
A.M.). Disagreements were resolved through discussions.
After reviewing the abstracts of the 542 remaining studies,
458 studies were classified as irrelevant (erratum, theoretical
paper, qualitative study, no ADHD group, program develop-
ment, case study, study protocol, no treatment, and no quan-
titative outcome). From the remaining 84 studies, 56 were
reviews or meta-analyses; therefore, they were eliminated
Table 1
(a) Characteristics of single-group studies: research design and participants
1st author
(date) Research design
Age
participant
(y/o)
N%
males
% ADHD
subtypes % medication status % comorbid disorders
Hesslinger
(2002) [14] Pre-post
19-44,
x=319,
s=90
15 62.2
C=75,
I=125,
H=125
37.5 (MPH),
12.5 (other)
37.5 (MDD/Sx),
25 (social phobia),
25 (insomnia)
Morgensterns
(2016) [42]
Baseline (T1),
posttreatment (T2),
3-month follow-up (T3)
19–63,
x=374,
s=104
98 31.6 C=866,
I=134
74.7 (atomoxetine+central
stimulants), 88.2
(psychoactive drugs)
71.1 (at least one
comorbid DSM-IV
diagnosis)
Zylowska
(2008) [11] Pre (T1) to post (T2) x=485,
s= 10.9 24 38 C=50,
I=42,H=8 63 83 (mood), 33 (AD),
33 (ODD), 92 (any)
(1) Statistics: n.r. = nonreported; y/o = years old; x= mean; s= standard deviation. (2) ADHD subtypes: ADHD = attention-deficit and hyperactivity disorders;
I = inattentive; H = hyperactive; C = combined. (3) Comorbid disorders: AD/Sx = anxiety disorder or symptoms; ODD = oppositional defiant disorder;
MDD/Sx = major depressive disorder or symptoms. (4) MPH = methylphenidate.
(b) Characteristics of single-group studies: intervention
1st author (date) Intervention Intervention length Therapist Informants
Hesslinger
(2002) [14]
ST-based DBT+mindfulness
components
2 h/week,
13 weeks = 26 hPsychotherapists trained in DBT Self, objective
Morgensterns
(2016) [42]
DBT (elements of acceptance,
mindfulness, functional behavioral
analysis, psychoeducation)
2 h/week,
14 weeks = 28 h
Two clinical psychologists who are trained
in CBT+DBT experienced from previous
study phases (T.H.) or had clinical supervision
from the experienced group leader
Self
Zylowska
(2008) [11] MAP+psychoeducation
2.5 h/week,
8weeks = 20 h+daily
at-home practice
Experienced mindfulness instructor
(D.W.)+ADHD researchers (L.Z. & S.S.) Self, objective
Intervention: CBT = cognitive behavioral therapy; DBT = dialectical behavior therapy; MAP = mindful awareness program; ST = skills training.
(c) Characteristics of single-group studies: measures of outcome
1st author
(date) ADHD symptoms Cognitive/executive
function
Emotional
disturbance
Quality
of life
Academic
performance Mindfulness
Hesslinger
(2002) [14] ADHD-CL, SCL-16
Fluency, Stroop,
DSS, KLT,
d2-Test, WMS-R
BDI n.r. n.r. n.r.
Morgensterns
(2016) [42]
CADHDSC_SRF: ADHD
symptoms (functional
impairment,
aggression irritability)
n.r. BDI, BAI, PSS
AAQ-9,
AAQoL,
KSQ
n.r. MAAS
Zylowska
(2008) [11]
ADHD Rating Scale IV
(adults), DSM-IV
ANT, TMT,
DST, VOC BAI, BDI n.r. n.r. n.r.
(1) ADHD symptoms: ADHD-CL = Attention-Deficit Hyperactivity Disorder Checklist; CADHDSC_SRF = Current ADHD Symptom Scale-Self-Report Form;
DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; SCL-16 = Symptom Check List. (2) Cognitive/executive function:
ANT = Attention Network Task; d2-Test = selective attention; DSS = Digit Symbol Subtest; DST = Digit Span Test (WAIS-R); KLT = Konzentrations-
Leistungs-Test; TMT = Trail Making Test; VOC=vocabulary subtest (WAIS-R); WMS-R = Wechsler Memory Scale-R (mental control, digit span, visual
memory span). (3) Emotional disturbance: BAI = Beck Anxiety Inventory; BDI = Beck Depression Inventory; PSS = Perceived Stress Scale. (4) Quality of
life: AAQ-9 = Adult Quality of Life Questionnaire; AAQoL = Adult ADHD Quality of Life Questionnaire; KSQ = Karolinska Sleep Questionnaire. (5)
Mindfulness: MAAS = Mindful Attention Awareness Scale.
4 Behavioural Neurology
Table 2
(a) Characteristics of between-group studies (age and percentages only for ADHD groups with treatment (Tx)): research design and participants
1st author (date) Research design Age (y/o)
Nof ADHD,
HC, Tx, and
WL/no/other
Tx
% males % ADHD
subtypes
% medication
status % comorbid disorders
Bachmann (2018) [13] RCT, pre/post 18-65, x=40,
s=1058 40, 0, 21, 19 38 C=81,I=19
None (3 months
before and during
the study)
14 (AD), 57 (Sx), 4 (OC), none
(Schizo, BD, SD, AU, SUI/SI,
ND, Somato)
Bueno (2015) [44] N-RCT, pre/post 18-45, x=312,
s=7543, 17, 29, 31 54.5 n.r. 69.7 (MPH) n.r.
Cole (2016) [40]
ADHD-treated vs. ADHD-WL
at baseline, post, 3-month and
6-month follow-up, end of treatment
x=366,
s=1002 62, 0, 49, 13 54 C=735,
I=225,H=5
61.22 (MPH),
24.49 (other) 46.94 (MDD, BD, AD, SD, BPD)
Edel (2017) [32] N-RCT, WL, pre-post x=338,
s=10191, 0, 39, 52 59 C=692,
I=308
43.6 (MPH),
38.5 (other)
25.6 (BPD), 30.8 (other PD),
17.9 (social anxiety), 10.3
(MDD/Sx), 5.1 (dysthymia),
2.6 (SD)
Fleming (2015) [35] RCT, baseline, post, 3-month follow-up x=212,
s=167 33, 0, 17, 16 58.8
C=59,
I=882+59
(4 (Sx))
29.4 (MPH), 41.2
(other), 29.4 (none) AD, MDD/Sx (% n.r.)
Gu (2018) [48]
RCT, ADHD-treated vs.
ADHD-WL pre-post,
3-month follow-up
19-24, x=202,
s=103 54, 0, 28, 26 57.1 C=63,I=
93 3
28.6 (MPH), 42.8
(other), 28.6 (none) n.r.
Hepark (2019) [45] RCT, WL 18-65, x=365,
s=10 103, 0, 55, 48 38
CAARS-INV:
I=52,H=5 8
CAARS-SR:
I=43,H=5 1
46 (MPH), 15
(other), 40 (none) n.r.
Janssen (2019) [50]
RCT, ADHD-MBCT+TAU vs.
ADHD-TAU, baseline, post,
3-month and 6-month follow-up
18+, x=397,
s=111120, 0, 60, 60 47 C=50,I=38,
H=8 60 38 (MDD/Sx), 2 (BD), 13 (AD),
70 (Somato), 2 (ED), 2 (dysthymia)
Mitchell (2017) [25] WL & treatment group, pre-post
18-50,
x=4055,
s=683
20, 0, 11, 9 45.5 C=273,
I=72754.5 (“stimulants”) 54.5
Schoenberg (2014) [12] RCT, WL, pre-post 19-53, x=395,
s=9550, 0, 26, 24 37.5 n.r. 38 (MPH), 24
(other), 38 (none) n.r.
(1) Statistics and design: n.r. = nonreported; y/o = years old; x= mean; s= standard deviation; HC = healthy control; N-RCT = nonrandomized control trial; RCT = randomized control trial; Tx = treatment;
WL = waiting list. (2) ADHD subtypes: ADHD = Attention-Deficit and Hyperactivity Disorders; I = inattentive; H = hyperactive; C = combined. (3) Comorbid disorders: AD/Sx = anxiety disorder or symptoms;
AU = autism; BD = bipolar disorder; BPD = borderline personality disorder; ED = eating disorder; MDD/Sx = major depressive disorder or symptoms; ND = neurological disorders; OC = obsessive compulsive
disorders. (4) PD = any personality disorder; Somato = somatoform disorder; SD = substance dependence; SUI\SI+suicidality: self-injurious behavior. MPH = methylphenidate.
5Behavioural Neurology
(b) Characteristics of between-group studies: intervention
1st author (date) Intervention Intervention length Therapist Informants
Bachmann (2018) [13] MAP or PE 2.5 h/week, 8 weeks = 20 h+daily
home practice n.r. Self, objective
Bueno (2015) [44] MAP or no intervention 2.5 h/week, 8 weeks = 20 h+daily
home practice Highly experienced practitioners Self, objective
Cole (2016) [40]
DBT (+elements of mindfulness)
or CBT modules
(impulsivity/hyperactivity, attention)
2 h individual psychotherapy+group/week,
12-month period = 96 h+homework
assignments
Nurses, psychologists, and psychiatrists,
trained in DBT+CBT Self
Edel (2017) [32] MBT (+mindfulness component of
DBT) or ST (DBT-oriented skills training) 2 h/week, 13 weeks = 26 hExperienced psychologist working with
ADHD+5 y experience in DBT/MBT Self, expert-rated scale
Fleming (2015) [35] DBT (+elements of mindfulness)
or skills handouts
1.5 h group/week, 8 weeks = 12 h+7
10 min individual coaching/week+90 min
group (1st week follow-up)
Group leader (A.P.F.), coleader (L.R.M.),
graduate students in clinical psychology
with DBT training & intervention,
psychologist with experience in ADHD
students
Self, objective
Gu (2018) [48] MBCT
1 h individual/week,
6weeks = 6 h+30 min
self-practice/day workbook psychoeducation
Group leader, psychiatrist specializing in
ADHD+8 y experience, MBCT trainers,
psychologist with experience in ADHD
students
Self, objective
Hepark (2019) [45] MBDT (+PE) 12-week meditation exercises built up
gradually+home practice 30 min/day
Psychiatrist specializing in ADHD (10 y),
mindfulness teacher (S.H.) & nurse
specialist, Association of
Mindfulness-Based Teachers, 150 h
education (MBSR)/MBCT
Self, investigator
Janssen (2019) [50] MBDT (+PE) 2.5 h group/week, 8 weeks = 20 h+6 h
silent day+home practice 30 min/day
Mindfulness teachers at different levels
of competence Self, objective
Mitchell (2017) [25] MAP 2.5 h/week, 8 weeks = 20 h+home practice Ph.D. clinical psychology Self, objective
Schoenberg (2014) [12] MBCT 3 h/week, 12 weeks = 36 h+30-45 min
self-practice/day
Psychiatrist specializing in ADHD
with 9 y training in MBCT Self, objective
Intervention: CBT = cognitive behavioral therapy; DBT = dialectical behavior therapy; MAP = mindful awareness program; MBT/MBCT = mindfulness-based training; PE = psychoeducation; ST = skills training.
(c) Characteristics of between-group studies: measure of outcome
1st author (date) ADHD symptoms Cognitive/executive function Emotional disturbance Quality of life Academic performance Mindfulness
Bachmann (2018) [13] CAARS-SR/OR n-back n.r. n.r. n.r. n.r.
Bueno (2015) [44] ASRS ANT, CPT-2 BDI, STAI-T, PANAS-X AAQoL n.r. n.r.
Cole (2016) [40] ASRS v1.1, BIS-11 n.r. BDI-II, BHS, STAXI WHOQoL-BREF, QFS n.r. KIMS
Edel (2017) [32] DSM-IV-(SR/OR) n.r. WRI GSES n.r. MAAS
Fleming (2015) [35] BAARS-IV, BADDS CPT-2 BAI, BDI-II AAQoL GPA FFMQ
Gu (2017) [48] CAARS-S:SV ANT BAI; BDI-II VAS GPA MAAS
6 Behavioural Neurology
Table 2: Continued.
1st author (date) ADHD symptoms Cognitive/executive function Emotional disturbance Quality of life Academic performance Mindfulness
Hepark (2019) [45] CAARS-INV, CAARS-SR BRIEF-ASR BDI-II-NL, STAI OQ 45.2 n.r. KIMS
Janssen (2019) [50] CAARS-INV:SV, CAARS-S: SV BRIEF-A n.r. OQ 45.2, MHC-SF n.r. FFMQ-SF, SCF-SF
Mitchell (2017) [25] Current ADHD Symptom Scale DEFS, BRIEF-A, ANT, CPT,
DST, TMT, WAIS-R DERS, DTS n.r. n.r. n.r.
Schoenberg (2014) [12] CAARS-S:SV CPT-X n.r. OQ 45.2 n.r. KIMS
(2) ADHD symptoms: ASRS (v1.1) = Adult ADHD Self-Report Scale; BAARS-IV = Barkley Adult ADHD Rating Scale-IV; BADDS = Brown ADD Rating Scales; BIS-11 = 11th version of the Barratt Impulsiveness
Scale; CAARS-S:SV = Conners’Adult ADHD Self-Rating Scale; CAARS-SV = Conners’Adult ADHD Rating Scales-Screening Version; CAARS-SR = self-report version of the Conners’Adult ADHD Rating Scale;
CAARS-INV = investigator rating version of the Conners’Adult ADHD Rating Scale; DSM-IV-(SR/OR) = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (self-rating/other-rating). (2)
Cognitive/executive function: ANT = Attention Network Task; BRIEF-A = Behavior Rating Inventory of Executive Functioning-Adult Version; BRIEF-ASR = Behavior Rating Inventory of Executive
Function-Adult Self-Report version; CPT-2 = the Conners’Continuous Performance Test-2nd edition; CPT-X = visual Continuous Performance Task; DEFS = Deficits in Executive Functioning Scale;
DST = Digit Span Test (WAIS-R); TMT = Trail Making Test; WAIS-R = Wechsler Adult Intelligence Scale-Revised. (3) Emotional disturbance: BAI = Beck Anxiety Inventory; BDI-II/BDI-II-NL = Beck
Depression Inventory (2nd edition); BHS = Beck Hopelessness Scale; DERS = Difficulties in Emotion Regulation Scale; PANAS-X = Affect Schedule-Expanded form; STAI = State-Trait Anxiety Inventory;
STAXI = State-Trait Anger Expression Inventory; WRI = Wender–Reimherr Interview. (4) Quality of life: AAQoL = Adult ADHD Quality of Life Questionnaire; GSES = Generalized Self-Efficacy Scale;
MHC-SF = Positive Mental Health Short Form; OQ 45.2 = Outcome Questionnaire; QFS = questionnaire of social functioning; VAS = Visual Analog Scale (personal health status); WHOQoL-BREF = World
Health Organization Quality of Life. (5) Mindfulness: MAAS = Mindful Attention Awareness Scale; FFMQ = Five Facet Mindfulness Questionnaire; KIMS = Kentucky Inventory of Mindfulness Skills;
SCF-SF = Self-Compassion Short Form. (6) Academic performance: GPA = Grade Point Average.
7Behavioural Neurology
(but we examined their reference lists). Among the 28
remaining empirical studies, 15 were conducted with chil-
dren, adolescents, and/or their parents; therefore, they were
excluded. Thirteen studies conducted with adults, young
adults, and college students corresponded to all the selection
criteria; therefore, they were included. A detailed illustration
of the study selection process is found in Figure 1. The sys-
tematic review of the thirteen studies selected is presented
qualitatively (narrative review).
3.2. Study Characteristics and Results of Individual Studies.
Each of the following study characteristics (e.g., study size,
PICOS, and follow-up period) and results of individual
study are presented in Tables 1 and 2. Outcomes in terms
of benefits are presented in a narrative manner for each
study in the form of a simple summary data for each
intervention group. For briefness, we choose not to list the
effect size (ES) for every outcome (e.g., all tests and subtests
and T1-T2-T3-T4, totalizing 470 ESs for all articles). Rather,
a summary of effect sizes (ESs) is given for each study with a
main focus on symptom outcomes and posttest (T2) or
follow-up. Most ESs were retrieved directly from the articles.
However, for Zylowska et al. [11], Schoenberg et al. [12], and
Bachmann et al. [13], the ESs were not provided by the
authors. Therefore, for consistency, we calculated the ESs
using Comprehensive Meta-Analysis (CMA) software. Since
Bachmann et al. [13] did not find evidence for a significant
main effect of type of treatment (MAP vs. the psychoeduca-
tion comparison group), we did not calculate any ES for this
study (see below).
In an early pilot study, Hesslinger et al. [14] evaluated a
training based on dialectical behavior therapy (DBT) to suit
the special needs of adult patients with ADHD. The overall
treatment goal was that patients would “control ADHD
rather than being controlled by ADHD.”Prior to and follow-
ing group therapy, symptoms were assessed using self-rating
scales of ADHD-CL (from DSM-IV), a short version of the
SCL-16 to assess nervousness, memory deficits, carelessness,
excitability, emotional outburst, self-reproach, difficulties
to start, inferiority complex, sleep disturbances, concentra-
tion deficits, feeling of tension, embarrassment, exertion,
restlessness, worthlessness, thinking something is wrong
with comprehension, and the BDI [15]) to assess depressive
symptoms (see the appendix for the complete names of tests).
In addition, neuropsychological testing was performed at
baseline and following treatment, including a verbal and
Literature search produced
720 papers:
PubMed: 460
PsycINFO : 225
Scopus : 23
ERIC : 12
178 papers are
duplicate
records and
removed
1 paper is
an erratum
542 papers are
recorded once
458 papers are
irrelevant
84 papers are
relevant
56 papers are
reviews or meta-
analyses
28 papers are
empirical
studies
15 papers are
with children
13 papers are
with adults and
young adults
and retained for
further meta-
analysis
Figure 1: Flow chart of the eligibility criteria.
8 Behavioural Neurology
letter fluency test, the Stroop test indicating mental speed and
inhibitory EFs, the digit symbol subtest to evaluate divided
attention, a test of continuous attention, the d2-Test measur-
ing selective attention, and tests measuring mental control,
digit span, and visual memory span indicating short-term
memory, working memory (WM), and general attentional
capacities [16]. The DBT treatment resulted in mild to
moderate improvements on all the measured symptoms
and even greater improvements in neurocognitive function
(ESs ranging from 0.99 to 2.22).
Subsequently, Zylowska et al. [11] enrolled adults and
adolescents with ADHD in the mindful awareness pro-
gram (MAP) [17, 18] adapted to meet the challenges of
ADHD symptoms, including a psychoeducational compo-
nent. Self-report scales of ADHD, depression, and anxiety
symptoms and several cognitive tests were administered to
participants during pre- and postintervention sessions.
ADHD symptoms were assessed via the ADHD Rating Scale
IV [19] that measures the severity of symptoms. Self-reports
of anxiety and depression were assessed using the BAI [20]
and BDI. Attention was assessed using the ANT [21] measur-
ing three aspects of attention: alerting (maintaining a vigilant
state of preparedness), orienting (selecting a stimulus among
multiple inputs), and conflict (prioritizing among competing
tasks). Authors also used the Stroop test and measure of
attentional conflict with the ANT [22]; the Trail Making Test
[23], which assesses set-shifting and inhibition; the Digit
Span Test, which measures WM; and the vocabulary subtest
(WAIS-R) [24]. Improvements were found in depression and
anxiety as well as improvements in ADHD self-reported
symptoms (ESs ranging from 0.50 to 0.93) and measures
of attentional conflict and set-shifting after the training
(ES = 0 93 and 0.43, respectively).
Later on, Mitchell et al. [25] tested the impact of MAP for
adults with ADHD on symptoms, EF, and emotion dysregu-
lation. Adults were stratified by ADHD medication status
and then randomized into a group-based mindfulness
treatment or waitlist group. The authors observed large
effect sizes in improvement of self-reported and clinician
ratings of ADHD symptoms (ESs ranging from 1.35 to
3.14) and EF (ESs ranging from 1.45 to 2.67) as well as
self-reported emotion regulation (ESs ranging from 1.27 to
1.63), for the treatment group relative to the waitlist group.
EF self-report scales included the DEFS [26] and the
BRIEF-A [27], which consists of nine scales: Inhibit, Shift,
Emotional Control, Self-Monitor, Initiate, WM, Plan/Orga-
nize, Task Monitor, and Organization of Materials. Emotion
dysregulation was assessed by the DERS [28] and the DTS
[29]. The DERS assesses how often emotionally dysregulated
behavior occurs. Additional EF tasks were also administered:
the ANT, the CPT [30] to measure response inhibition, the
Digit Span Test [31] to measure WM, and the Trail Making
Test to assess attentional set-shifting and inhibition.
Edel et al. [32] recruited adults with ADHD and nonran-
domly assigned them to mindfulness-based training (MBT,
including elements of DBT) or a skills training group (ST).
The WRI [33] and scales covering the inattention and hyper-
activity/impulsivity symptoms (DSM-IV, [34]) were used for
pre- and postassessment. The WRI is an expert-rated scale
comprising symptom domains such as attentional difficul-
ties, hyperactivity/restlessness, (hot) temper, affective lability,
emotional overreactivity, disorganization, and impulsivity.
General linear models with repeated measures revealed that
both programs resulted in a similar reduction of ADHD
symptoms. The effect sizes were in the small-to-medium
range (ESs ranging from 0.06 to 0.49). However, some degree
of decrease in ADHD symptoms (30%) was more prominent
for the MBT participants since 30.8% of them showed
improvement compared to 11.5% of the ST participants.
Fleming et al. [35] conducted an RCT evaluating DBT
training adapted for college students with ADHD random-
ized to receive either DBT or skills handouts. ADHD symp-
toms, EF, and related outcomes were assessed at baseline,
posttreatment, and 3-month follow-up. Authors used the
BAARS-IV (based on DSM-5 criteria) to assess ADHD
symptoms. Self-report of current symptoms was used as a
primary outcome measure. EF was assessed with the BADDS,
a self-report questionnaire [36] that yields scores on cate-
gories of EF: organization and prioritization, focused and
sustained attention, regulation of alertness and sustained
effort, affect modulation, and WM. Anxiety and depressive
symptoms were assessed with self-report measures of BAI
and BDI-II [36]. The CPT-2 [37] provides assessment of
sustained attention, inhibition, and response variability
[38, 39]. Overall, participants receiving DBT group skills
training showed greater treatment response rates (59-65%
vs. 19-25%) and higher clinical recovery rates (53-59% vs.
6-13%) on ADHD symptoms (ES = 0 84 at follow-up) and
EF (ES = 0 81 at follow-up).
In a similar approach, Cole et al. [40] addressed training
skills by means of cognitive behavioral therapy (CBT) or
DBT. They assessed the benefits of the program to reduce
residual symptoms. Patients with ADHD who were poor
responders to medication were enrolled in a one-year pro-
gram where they received individual therapy, associated with
group therapy with different modules that included mindful-
ness (along with emotion regulation, interpersonal effective-
ness and distress tolerance, impulsivity/hyperactivity, and
attention). Each subject was assessed at baseline, at 3 and 6
months, and at the end of the treatment for ADHD severity
with the ASRS v1.1, for depression with BDI-II, for hopeless-
ness with the BHS, for anger experience, expression, and con-
trol with STAXI [41], and for impulsivity with BIS-11. The
ADHD patients were compared with ADHD patients on a
waiting list. Overall, the treatment was associated with signif-
icant improvements in almost all dimensions. The most sig-
nificant changes were observed with large to moderate
effect sizes for depression (ES = −084) followed by ADHD
severity (ES = −063) and hopelessness (ES = −0 52).
Morgensterns et al. [42] also used DBT for adults with
ADHD in an outpatient psychiatric context. The treatment
uses elements such as acceptance, mindfulness, functional
behavioral analysis, and psychoeducation to target problems
common in ADHD. Self-rating scales were administered at
baseline before the first session (T1), posttreatment (T2),
and 3-month follow-up (T3). Self-rating of current ADHD
symptoms was measured by the Current ADHD Symptom
Scale-Self-Report Form [43] that contains three parts: (1)
9Behavioural Neurology
the symptoms for ADHD, (2) impairment in major life areas,
and (3) symptoms of irritability and aggressiveness. More-
over, participants completed self-rating questionnaires for
assessing symptoms of psychiatric comorbidity: the BDI
and the BAI. The main results indicated that approximately
80% of the participants attended at least two-thirds of the ses-
sions. ADHD symptoms (ES = 0 22) and functional impair-
ment (ES = 0 15) in everyday life were reduced. The results
were stable at 3-month follow-up. Variables such as age,
comorbidity, ADHD medication status, and IQ level did
not predict outcomes.
A study from Bueno et al. [44] addresses the impact of
MAP on affective problems and impaired attention. Adults
with ADHD and healthy controls underwent MAP sessions
while similar patients and controls did not undergo the inter-
vention. The authors evaluated MAP-induced changes in
mood and attention using several measures: (1) the ASRS
for symptom assessment, (2) the BDI for attitudes related
to depression, (3) the STAI to describe how people feel at
a particular moment, and (4) the PANAS-X to assess feel-
ings or moods. Combinations of these ratings yield to
“higher-order affective levels”(positive affect and negative
affect) and “lower-order affective levels”(fear, sadness, guilt,
etc.). Attention was evaluated using the ANT and the CPT-2,
before and after intervention. The authors found that MAP
enhanced sustained attention (ANT) and detectability on
the CPT-2 and improved the mood of patients and healthy
controls with overall medium effect sizes (g>05) to large
effect sizes (g>08). Because of mixed results regarding the
enhancement of attentional performance (not all attentional
measures were found significant), the authors call for more
studies that address the efficacy of mindfulness meditation
for ADHD in terms of its impact on EF.
In a recent study, Bachmann et al. [13] evaluated the
impact of MAP on neurocognitive performance in adults
with ADHD. The authors performed a RCT to investigate
WM with an n-back task during fMRI before and after an
8-week mindfulness intervention. ADHD symptoms were
assessed using the self- and observer-rated Conners Adult
ADHD Rating Scales (CAARS). The researchers found a
significant decrease in ADHD symptoms and significant
improvement in task performance in both the MAP and
the psychoeducation comparison group post- versus prein-
tervention but did not find evidence for a significant main
effect of treatment or a significant interaction effect on any
ADHD symptoms (self- and observer-rated) nor on task per-
formance (WM). Results also revealed significant increased
brain activation after MAP in the bilateral inferior parietal
lobule, right posterior insula, and right precuneus. A decrease
in self-rated “inattention/memory problems”after MAP
compared to baseline was associated with stronger activation
in parts of the left putamen, globus pallidus, and thalamus.
Hepark et al. [45] also looked at the efficacy of an
adaptation of mindfulness-based cognitive therapy (MBCT)
on core ADHD symptoms and EF. Adults with ADHD were
randomly allocated to MBCT or waitlist. Outcome measures
included investigator-rated ADHD symptoms, self-reported
ADHD symptoms, EF, depressive and anxiety symptoms,
and patient functioning. Symptoms (total ADHD, inattention,
and hyperactivity/impulsivity scores) were assessed by a
clinician with the CAARS-INV [46] as well as with the
self-report of the CAARS-SR [46]. EF was assessed using
the BRIEF. The BDI-II was used to assess the presence of
depression symptoms. The Dutch version of the STAI [47]
was administered. The findings indicate that MBCT resulted
in a significant reduction of ADHD symptoms as assessed
by the investigator or self-reported (Cohen’sd=078 and
0.64, respectively). Significant improvements in EF were
also found (Cohen’sd=093). However, no improvements
were observed for depressive and anxiety symptoms.
Schoenberg et al. [12] looked at the effects of MBCT on
neurophysiological correlates (event-related potentials (ERPs))
of performance monitoring in adults with ADHD. Half of
patients were randomly allocated to MBCT, and the other half
to a waitlist control. Inattention and hyperactivity-impulsivity
ADHD symptoms, psychological distress, and social function-
ing were assessed. Clinical scales (the CAARS-S:SV) were
administered pre- and post-MCBT (or waiting list (WL)). Par-
ticipants also completed a standard visual continuous perfor-
mance task (CPT-X). Examining results for CAARS-S:SV
indicated reduced inattention, hyperactivity/impulsivity,
and global ADHD index symptoms pre to post-MBCT (ESs
ranged between 0.49 and 0.93). As expected, the main effect
of treatment was evident for CPT-X repeated-measures
ANCOVAs comparing accuracy score data indicated that
the number of false alarms (FA) significantly decreased pre
to post in the MBCT group alongside a significant slowing
in reaction times.
Gu et al. [48] conducted a clinical trial to assess MBCT
efficacy in the treatment of ADHD in college students.
Undergraduates with ADHD between ages 19 and 24 were
randomized either to receive MBCT or to be put on a waitlist.
ADHD symptoms, neuropsychological performance, and
related outcomes were assessed pre- (T1) and posttreat-
ment (T2), as well as at the 3-month follow-up (T3). Clinical
assessment was conducted with the CAARS-S:SV to assess
the extent of ADHD symptoms. Anxiety and depressive
symptoms were measured with the BAI and the BDI-II. In
addition, academic performance was collected (participants’
GPA) using an official transcript. The authors tested the par-
ticipants’neuropsychological performance (MAAS) and
attentional networks with the ANT [49]. At follow-up, results
revealed that participants receiving MBCT showed greater
treatment response rates (57%-71% vs. 23%-31%) and symp-
tom reduction (ES = 1 26). Participants also experienced less
anxiety and depression (ES = 0 75 and 0.53, respectively)
than those on the waitlist. Moreover, MBCT participants
showed greater improvement on most neuropsychological
performance and attentional scores (ES for MAAS = 1 30,
ES for ANT subscales ranging from 0.19 to 1.19).
In a recent study, [50] investigated the efficacy of MBCT
+treatment as usual (TAU) versus TAU only in reducing core
symptoms in adults with ADHD. Participants were ran-
domly assigned to MBCT+TAU, an 8-weekly group therapy
including meditation exercises, psychoeducation, and group
discussions, or TAU only, including pharmacotherapy and/
or psychoeducation. Outcomes were ADHD symptoms
rated by blinded clinicians (CAARS-INV) and self-reported
10 Behavioural Neurology
(CAARS-S), EF, mindfulness skills, self-compassion, positive
mental health, and general functioning (see details in
Table 2(c)). Outcomes were assessed at baseline, posttreat-
ment (T1), and 3- and 6-month follow-up (T2 and T3, respec-
tively). In MBCT+TAU patients, a significant reduction of
clinician-rated ADHD symptoms (CAARS-INV) was found
at posttreatment (T1) (ES = 0 41) and was maintained at the
6-month follow-up. MBCT+TAU patients compared with
TAU patients also reported significant improvements in
self-reported ADHD symptoms (ES = 0 37, 0.71, and 0.79 at
T1, T2, and T3, respectively), mindfulness skills, self-com-
passion, and positive mental health up to the 6-month
follow-up. Patients in MBCT+TAU reported improvement
in executive functioning (EF) but only at the 6-month
follow-up. A significant group x time interaction showed that
EF further improved over time in MBCT+TAU compared
with TAU resulting in an effect size of d=049 at the
6-month follow-up. The authors concluded that MBCT
might be a valuable treatment option alongside TAU for
adult ADHD aimed at alleviating symptoms.
3.3. Synthesis of Studies. For convenience, we divided the
above studies (n=13) according to the two main research
designs: within-group (Tables 1(a)–1(c)) and between-
group (Tables 2(a)–2(c)). Three studies used a within-group
design (with two or more time points) while the remaining
studies used different between-group designs (N-RCT, RCT).
All studies, except one [44], did not include a healthy control
group. Follow-up evaluations varied from none to three or
six months.
3.3.1. Participants. The sum of participants with ADHD was
753 with a mean age of 35.1 years (18-65 y/o). About half of
participants were males (47.7%). The combined and inatten-
tive subtypes of ADHD were the most predominant. Most
participants were on medication, with psychostimulants like
methylphenidate (MPH) being the most frequently reported.
Comorbidity was present in all studies, with major depressive
disorders and mood disorders being frequently reported. A
summary of participants’characteristics is presented in
Tables 1(a) and 2(a).
3.3.2. Intervention. Our definition of MBI intervention
included mindfulness and/or meditation as a principal or a
partial component of the intervention. That included various
adaptations of (1) dialectical behavior therapy (DBT), (2)
mindful awareness program (MAP), and (3) mindfulness-
based/cognitive training (MBT/MBCT). The duration of
treatment varied considerably across studies (from six to
96 hours, mode value of 20 hours). The presence or absence
of homework also accounted for variability between studies.
Therapists included clinical psychologists, psychology gradu-
ate students, mindfulness instructors, practitioners, group
leaders, ADHD researchers, nurses, and psychiatrists. A
summary of intervention characteristics is presented in
Tables 1(b) and 2(b).
3.3.3. Outcomes. Besides the measures of ADHD symptoms
(inattention and hyperactivity), outcome measures can be
categorized into executive/cognitive functioning, emotional
disturbance, quality of life, mindfulness, and grade point
average at school.
(1) ADHD Symptoms. Prior to and following treatment,
researchers used different self-rating scales to assess symp-
toms of ADHD. Among the most frequently used self-
report scales were the following:
(1) The Conners’Adult ADHD Rating Scale
(CAARS-SR/CAARS-S:SV) from Conners et al. [46,
51] ([12, 13, 45, 48, 50], n=5)
(2) The Adult ADHD Self-Report Scale (ASRS v1.1)
from Kessler et al. (2005) ([40, 44], n=2)
(3) The Attention-Deficit Hyperactivity Disorder Check-
list (ADHD-CL) from DSM-IV (1994) ([14, 32],
n=2)
The complete list of scales is available in Tables 1(c)
and 2(c).
(2) Executive/Cognitive Functioning. As additional measures
of outcomes, the most frequently used tests for executive/-
cognitive functioning were as follows:
(a) Objective tasks
(1) Various versions of Attention Network Test
(ANT) [21, 22, 49] ([11, 25, 44, 48], n=4)
(2) Various versions of the Conners’Continuous
Performance Test (CPT/CPT-2/CPT-X) from
Conners [30, 37] ([12, 25, 35, 44], n=4)
(3) The TMT (n=2)
(4) The Stroop test indicating mental speed and
inhibitory EFs ([11, 14], n=2)
(5) The digit span, vocabulary, memory scale, and
digit symbol subtests from the Wechsler Adult
Intelligence Scale-Revised (WAIS-R) [24, 31]
([11, 14, 25], n=2)
(6) n-back ([13], n=1)
(b) Subjective questionnaire
(1) The Behavior Rating Inventory of Executive
Functioning-Adult Version (BRIEF-A) from
Roth et al. [27] ([25, 45, 50], n=3)
The complete list of outcome measures is available in
Tables 1(c) and 2(c).
(3) Emotion Disturbance. Self-reports of anxiety, depression,
and other emotional disturbances were often assessed using
the following:
(1) The Beck Depression Inventory (BDI/BDI-II/B-
DI-II-NL) from Beck et al. [15] ([11, 14, 35, 40, 42,
44, 45, 48], n=8)
11Behavioural Neurology
(2) The Beck Anxiety Inventory (BAI) from Beck et al.
[20] ([11, 35, 42, 48], n=4)
(3) The State-Trait Anxiety Inventory (STAI) from Van
der Ploeg [47] ([44, 45], n=2)
(4) The Outcome Questionnaire (OQ 45.2) from Lambert
et al. (1996) ([12, 45], n=2)
The complete list of outcome measures is available in
Tables 1(c) and 2(c).
(4) Mindfulness. Mindfulness was assessed using the follow-
ing self-report questionnaires:
(1) The Mindful Attention Awareness Scale (MAAS)
from Brown and Ryan (2003) ([32, 42, 48], n=3)
(2) The Kentucky Inventory of Mindfulness (KIMS)
from Baer et al. (2004) ([12, 40, 45], n=3)
At two occasions, authors used the Five Facet Mindful-
ness Questionnaire (FFMQ) from Baer et al. (2006) ([35,
50], n=2).
(5) Quality of Life and Others. Self-report questionnaires or
semistructured interviews (QFS) were used in most studies
to evaluate the level of functioning and quality of life:
(1) The ADHD Quality of Life Questionnaire (AAQoL)
from Brod et al. (2006) ([35, 42, 44], n=3)
Other less frequently used measures, such as OQ 45.2
(n=2), are listed in Tables 1(c) and 2(c).
3.4. Risk of Bias within and across Studies. After characteriz-
ing each study according to PICO, we then evaluated each
study (n=13) on the seven categories of bias established by
the Cochrane Collaboration. As alluded earlier, this analysis
of bias gives us a useful complement of information besides
the sole calculation of effect sizes. Slight differences in inter-
pretation of bias were discussed and solved between the
judges (HP, BK, and AM). Assessment of risk of bias was
rated high (red), uncertain (yellow), or low (green) for each
individual study and category (see Figure 2), then compiled
into percentages of studies that fall into high, uncertain, or
low risk on each category of bias (see Figure 3).
3.5. Selection Bias. Only three studies were rated low risk on
that criterion [12, 13, 50]. Four studies (31%) were rated
unclear risk because of insufficient data on sequence genera-
tion. The remaining six (46%) studies were rated high risk.
Regarding allocation concealment, the same three studies
were judged as low risk because the occultation of the alloca-
tion sequence could not be predicted. Only one study was
judged as unclear risk because participants would not neces-
sarily identify the group to which they belong (i.e., treatment
or control). The remaining nine (69%) studies did not fulfill
either conditions and were considered high risk.
3.6. Performance and Detection Bias. Not surprisingly, the
vast majority of studies (92%) in this review were rated high
risk for performance bias (blinding of participants and of
personnel). Only [50] satisfied this criterion according to
our interrater judgment. Detection bias reflects the blinding
of assessors to the treatment condition. Overall, eleven stud-
ies (85%) were judged as low risk of detection bias (blinding
of assessors), one study as high risk, and one as unclear risk as
it included self-report measures but nonblinded assessors.
3.7. Attrition Bias. According to the application of the 20%
cut-offcriteria, six studies (46%) in this review were consid-
ered low risk of attrition bias. Three studies (23%) were rated
high risk (attrition rate > 20%, high differential attrition, and
0 0.25 0.5 0.75 1
Other biases (research allegiance, funding, confounds)
Selective outcome reporti ng (reporting bias)
Incomplete outcome data (attrition bias)
Blinding of outcome assessment (detection bias)
Blinding of partici pants and personnel (performance bias)
Allocation concealment (selection bias)
Random sequence generation (selection bias)
Low risk
Unclear risk
High risk
Figure 2: Methodological quality graph: a review of the authors’judgements about each methodological quality item presented as percentages
across all included studies.
12 Behavioural Neurology
no imputation of missing data). The remaining three studies
had no sufficient description of attrition (or impossibility to
compute the attrition rate) and thus were judged as having
unclear risk.
3.8. Reporting Bias. Most of the studies (11/13) were rated
low risk since the outcome data were reported on all used
scales and subscales. Two other studies were rated unclear
risk as subscales were not fully reported.
3.9. Other Biases and Limitations. Overall, eight studies
(62%) were rated low risk, while the five remaining studies
were judged as unclear risk. More precisely, we could iden-
tify an author’s role in the study development and/or imple-
mentation (e.g., delivery of the intervention) in only three
(23%) out of the 13 studies. In four of the studies (31%),
the authors identified a funding source. Other studies were
not funded or did not report the funding source. Other lim-
itations that were reported by the authors of each paper were
included as an additional source of information (in narrative
form) but were not rated (see supplementary materials
(available here)).
After conversion of the high, uncertain, and low risk
scores into numeric variables (0, 1, and 2), we found stud-
ies’quality mean scores ranging between 0.71 and 2 (with
2 being the highest quality) for each study. According to
our interrater judgment of quality, Bachmann et al. [13]
and Janssen et al. [50] were the most robust and valid studies
with 1.57/2 and 2/2 overall quality scores, respectively.
In sum, the majority of studies (but [12, 13, 50]) were
considered high risk on selection biases (random sequence
generation, allocation concealment), and all but [50] had a
performance bias (blinding of participants and personnel).
See Figure 3 and supplementary materials.
4. Discussion
4.1. Summary of Evidence. In this systematic review, we
assessed cognitive and behavioral effects observed in 13
studies using MBIs to alleviate ADHD symptoms and to
improve executive function and emotion dysregulation
among adults with ADHD. All the studies (100%) showed
improvement of ADHD symptoms following an MBI.
Researchers have also found a significant improvement on
cognitive task performance in post- versus preintervention
or with treatment as usual (TAU). For most patients, reduc-
tion of ADHD symptoms was maintained at posttreatment
(3- to 6-month follow-up). In studies addressing other out-
comes, patients reported significant improvements in mind-
fulness skills, self-compassion, and positive mental health up
to the 6-month follow-up.
Random sequence generation
(selection bias)
Allocation concealment
(selection bias)
Blinding of participants and
personnel (performance bias)
Blinding of outcome assessment
(detection bias)
Incomplete outcome data
(attrition bias)
Selective outcome reporting
(reporting bias)
Other biases (research allegiance,
funding, confounds)
Mean /2
Bachmann et al. (2018) 2 2 021221.57
Bueno et al. (2015) 0 0 0 2 2 2 2 1.14
Cole et al. (2016) 0 0 0 2 2 1 2 1.00
Edel et al. (2017) 0 0 0 012 2 0.71
Fleming et al. (2015) 1 1 0 2 2 2 1 1.29
Gu et al. (2018) 1 0 0 2 2 2 2 1.29
Hepark et al. (2019) 1 0 0 212 2 1.14
Hesslinger et al. (2002) 0 0 0 2 1 2 1 0.86
Jansenn et al. (2019) 2 2 2 222 2 2.00
Mitchell et al. (2017) 1 0 0 1 2 2 1 1.00
Morgensterns et al. (2016) 0 0 0 202 1 0.71
Schoenberg et al. (2014) 2 2 0 2 0 1 2 1.29
Zylowska et al. (2008) 0 0 0 202 1 0.71
High risk
Unclear risk
Low risk
Figure 3: Methodological quality summary: a review of the authors’judgments about each methodological quality item for each
included study.
13Behavioural Neurology
However, we also found the quality of studies to be vari-
able with a tendency for more recent studies to have less
biases. Notably, [50] was given a perfect score according to
our application of the Cochrane Collaboration standards. A
vast majority of studies were judged as high risk on the per-
formance bias (blinding of participants and personnel), and
several had issues with the selection biases (random sequence
generation, allocation concealment). As mentioned earlier, it
is not habitual, nor always advantageous, to blind personnel
or participants in this type of intervention, so the elevated
risk for performance and/or detection bias may be inevitable.
Attrition bias was found to have high or unclear risk in more
than a half of the studies. The reason for dropout of partici-
pants was not always clearly specified in those studies, so it
is difficult to decide if it might be related to adverse effects
or to some discomfort with treatment or instead to some
incidental reasons.
Despite the above limitations, most studies (except
one) scored well on the detection bias, meaning that the
trainers were not involved in the assessment of the partici-
pants and therefore could not interfere with the outcomes.
Moreover, most studies (except for the two studies being
unclear) were found free of suggestion of selective reporting
(reporting bias).
In sum, most studies show that mindfulness training or
structured programs with mindfulness components appear
useful for patients who respond partially or not at all to drug
therapy. Indeed, group skills training may be efficacious,
acceptable, and feasible for treating ADHD among college
students and adult patients. Mindfulness meditation training
seems to improve ADHD behavioral symptoms (inattention,
hyperactivity, and impulsivity) and some facets of EF and
emotion dysregulation. Although these are promising find-
ings to support treatment efficacy of MBIs for ADHD, vari-
ous biases such as the absence of randomization and lack of
a control group may affect the importance of outcomes.
Other factors such as those documented in the present study
(see Tables 1 and 2) may also impact on the outcomes. For
example, the amount of home exercise, type of monitoring
of participants’progress, or absence from sessions may also
affect the outcomes.
5. Conclusions, Future Research,
and Limitations
The aim of this systematic review was to look for symp-
toms and additional indicators of improvement of ADHD
mediated through mindfulness interventions. Each study
measured many outcomes, namely, executive functions,
emotional disturbance, quality of life, and academic perfor-
mance. Some outcomes were considered to be important
(e.g., symptoms), while others were surrogate outcomes
(e.g., attention test). Despite its comprehensiveness, this
review was not without limitations, mostly because of hetero-
geneity of available studies. Although all studies included a
mindfulness-based intervention for ADHD, there was a sub-
stantial variability among them, e.g., difference in sample size
and duration of intervention. Future studies and potential
meta-analysis should consider these factors.
Appendix
Full Names of Most Frequently Used Outcome
Measures (See Also Tables 1(c)–2(c))
ADHD symptoms measures:
(1) ADHD-CL = Attention-Deficit Hyperactivity Disor-
der Checklist
(2) ASRS (v1.1) = Adult ADHD Self-Report Scale
(3) BAARS-IV = Barkley Adult ADHD Rating Scale–IV
(4) BADDS = Brown ADD Rating Scales
(5) BIS-11 = 11th version of the Barratt Impulsiveness
Scale
(6) CAARS-INV = investigator rating version of the
Conners’Adult ADHD Rating Scale; CAARS-S: SV =
Conners’Adult ADHD Self-rating Scale; CAARS-
SV = Conners’Adult ADHD Rating Scales–Screening
Version; CAARS- SR = self-report version of the
Conners’Adult ADHD Rating Scale
(7) CADHDSC_SRF = Current ADHD Symptom Scale-
Self-Report Form
(8) DSM-IV (SR/OR) = Diagnostic and Statistical Man-
ual of Mental Disorders, 4th Edition (Self-rating/
Other-rating)
(9) DSM-IV = Diagnost ic and Statistical Manual of Men-
tal Disorders, 4th Edition; SCL-16 = Symptom Check
List
Cognitive/EF measures:
(1) ANT = Attention Network Task
(2) BRIEF-A = Behavior Rating Inventory of Executive
Functioning-Adult Version
(3) BRIEF-ASR = Behavior Rating Inventory of Execu-
tive Function-Adult Self-Report version
(4) CPT-2 = The Conners’Continuous Performance
Test-2nd edition
(5) CPT-X = visu al Continuous Performance Task
(6) d2-Test = selectiv e attention
(7) DEFS = Deficits in Executive Functioning Scale
(8) DSS = Digit Symbol Subtest
(9) DST = Digit Span Test (WAIS-R)
(10) KLT = Konzen trations-Leistungs-Test
(11) TMT = Trail Making Test
(12) VOC = Vocabulary subtest (WAIS-R)
(13) WAIS-R = Wechsler Adult Intelligence Scale-Revised
(14) WMS-R = Wec hsler Memory Scale-R
14 Behavioural Neurology
Emotional disturbance measures:
(1) BAI = Beck Anxiety Inventory
(2) BDI = Beck Depression Inventory; BDI-II = Beck
Depression Inventory (2nd edition)
(3) BHS = Beck Hopelessness Scale
(4) DERS = Difficulties in Emotion Regulation Scale
(5) PANAS-X = Affect Schedule-Expanded form
(6) PSS = Perceived Stress Scale
(7) STAI = State-Trait Anxiety Inventory
(8) STAXI = State-Trait Anger Expression Inventory
(9) WRI = Wender–Reimherr Interview
Conflicts of Interest
The authors declare that there is no conflict of interest
regarding the publication of this paper.
Authors’Contributions
H.P. conducted the literature search, data analysis, and
data interpretation and wrote the manuscript. A.M. inter-
rated the selection of articles and of analysis of bias and cow-
rote the manuscript. N.T. conducted the literature search
(update), created the figures, and collected the data. B.K. con-
ducted the analysis of bias (interrating) and data interpreta-
tion reviewed the manuscript. J.N. conducted the literature
search (phase 1) and is responsible for the endnote creation.
Acknowledgments
The project was funded by the Fonds de recherche du
Québec-Société et culture (FRQSC).
Supplementary Materials
Full details of analysis of bias for each of individual studies
(n=13). (Supplementary Materials)
References
[1] M. Cairncross and C. J. Miller, “The effectiveness of
mindfulness-based therapies for ADHD: a meta-analytic
review,”Journal of Attention Disorders, pp. 1–17, 2016.
[2] S. Cortese, C. Kelly, C. Chabernaud et al., “Toward systems
neuroscience of ADHD: a meta-analysis of 55 fMRI studies,”
American Journal of Psychiatry, vol. 169, no. 10, pp. 1038–
1055, 2012.
[3] W. Francx, M. Oldehinkel, J. Oosterlaan et al., “The executive
control network and symptomatic improvement in attention--
deficit/hyperactivity disorder,”Cortex, vol. 73, pp. 62–72,
2015.
[4] E. B. Liddle, C. Hollis, M. J. Batty et al., “Task-related default
mode network modulation and inhibitory control in ADHD:
effects of motivation and methylphenidate,”Journal of Child
Psychology and Psychiatry, vol. 52, no. 7, pp. 761–771, 2011.
[5] H. McCarthy, N. Skokauskas, A. Mulligan et al., “Attention
network hypoconnectivity with default and affective network
hyperconnectivity in adults diagnosed with attention-defi-
cit/hyperactivity disorder in childhood,”JAMA Psychiatry,
vol. 70, no. 12, pp. 1329–1337, 2013.
[6] L. J. Norman, C. O. Carlisi, A. Christakou et al., “Shared and
disorder-specific task-positive and default mode network dys-
functions during sustained attention in paediatric attention--
deficit/hyperactivity disorder and obsessive/compulsive
disorder,”NeuroImage: Clinical, vol. 15, pp. 181–193, 2017.
[7] J. Sidlauskaite, E. Sonuga-Barke, H. Roeyers, and R. Wiersema,
“State-to-state switching in ADHD: default mode network
abnormalities,”International Journal of Psychophysiology,
vol. 108, p. 29, 2016.
[8] L. Shamseer, D. Moher, M. Clarke et al., “Preferred reporting
items for systematic review and meta-analysis protocols
(PRISMA-P) 2015: elaboration and explanation,”BMJ,
vol. 349, article g7647, 2015.
[9] J. P. Higgins and S. Green, “Guide to the contents of a
Cochrane protocol and review,”in Cochrane Handbook for
Systematic Reviews of Interventions: Cochrane Book Series,
pp. 51–79, Wiley-Blackwell, 2008.
[10] J. P. T. Higgins, D. G. Altman, P. C. Gotzsche et al., “The
Cochrane Collaboration’s tool for assessing risk of bias in ran-
domised trials,”BMJ, vol. 343, article d5928, 2011.
[11] L. Zylowska, D. L. Ackerman, M. H. Yang et al., “Mindfulness
meditation training in adults and adolescents with ADHD: A
feasibility study,”Journal of Attention Disorders, vol. 11,
no. 6, pp. 737–746, 2008.
[12] P. L. A. Schoenberg, S. Hepark, C. C. Kan, H. P. Barendregt,
J. K. Buitelaar, and A. E. M. Speckens, “Effects of mindfulness-
based cognitive therapy on neurophysiological correlates of
performance monitoring in adult attention-deficit/hyperac-
tivity disorder,”Neurophysiologie Clinique, vol. 125, no. 7,
pp. 1407–1416, 2014.
[13] K. Bachmann, A. P. Lam, P. Sörös et al., “Effects of mindful-
ness and psychoeducation on working memory in adult
ADHD: a randomised, controlled fMRI study,”Behaviour
Research and Therapy, vol. 106, pp. 47–56, 2018.
[14] B. Hesslinger, L. Tebartz van Elst, E. Nyberg et al., “Psycho-
therapy of attention deficit hyperactivity disorder in adults:
a pilot study using a structured skills training program,”
European Archives of Psychiatry and Clinical Neuroscience,
vol. 252, no. 4, pp. 177–184, 2002.
[15] A. T. Beck, R. A. Steer, and G. K. Brown, BDI-II Manual,
Psychological Corporation, San Antonio, TX, USA, 1996.
[16] D. Wechsler, WMS-R: Wechsler Memory Scale-Revised, Psy-
chological Corporation, 1987.
[17] J. Kabat-Zinn, Full Catastrophe Living: Using the Wisdom of
Your Body and Mind to Face Stress, Pain and Illness, Delacorte,
New York, NY, USA, 1990.
[18] Z. V. Segal, J. M. G. Williams, and J. D. Teasdale, Mindfulness-
Based Cognitive Therapy for Depression, Guilford Press, New
York, NY, USA, 2013.
[19] G. J. DuPaul, The ADHD Rating Scale: Normative Data, Reli-
ability, and Validity, Unpublished manuscript, University of
Massachusetts Medical Center, Worcester, UK, 1990.
[20] A. T. Beck, N. Epstein, G. Brown, and R. A. Steer, “An inven-
tory for measuring clinical anxiety: psychometric properties,”
Journal of Consulting and Clinical Psychology, vol. 56, no. 6,
pp. 893–897, 1988.
15Behavioural Neurology
[21] J. Fan and M. Posner, “Human attentional networks,”Psychia-
trische Praxis, vol. 31, pp. 210–214, 2004.
[22] C. J. Golden, Stroop Color and Word Test: A Manual for
Clinical and Experimental Use, Stoelting, Chicago, IL,
USA, 1978.
[23] R. M. Reitan, Manual for Administration of Neuropsychologi-
cal Test Batteries for Adults and Children, Neuropsychology
Laboratory, Tucson, AZ, USA, 1979.
[24] D. Wechsler, Wechsler Adult Intelligence Scale–Revised, The
Psychological Corporation, New York, NY, USA, 1981.
[25] J. T. Mitchell, E. M. McIntyre, J. S. English, M. F. Dennis,
J. C. Beckham, and S. H. Kollins, “A pilot trial of mindful-
ness meditation training for ADHD in adulthood: impact
on core symptoms, executive functioning, and emotion dys-
regulation,”Journal of Attention Disorders, vol. 21, no. 13,
pp. 1105–1120, 2017.
[26] R. A. Barkley, Barkley Adult ADHD Rating Scale-IV (BAAR-
S-IV), Guilford Press, 2011.
[27] R. M. Roth, P. K. Isquith, and G. A. Gioia, BRIEF-A: Behavior
Rating Inventory of Executive Functions-Adult Version, Psy-
chological Assessment Resources, Lutz, FL, USA, 2005.
[28] K. L. Gratz and L. Roemer, “Multidimensional assessment of
emotion regulation and dysregulation: development, factor
structure, and initial validation of the difficulties in emotion
regulation scale,”Journal of Psychopathology and Behavioral
Assessment, vol. 26, no. 1, pp. 41–54, 2004.
[29] J. S. Simons and R. M. Gaher, “The distress tolerance scale:
development and validation of a self-report measure,”Motiva-
tion and Emotion, vol. 29, no. 2, pp. 83–102, 2005.
[30] C. K. Conners, The Conners’Continuous Performance Test,
Multi-Health Systems, Toronto, ON, Canada, 1995.
[31] D. Wechsler, Wechsler Adult Intelligence Scale–Fourth Edition
(WAIS-IV), The Psychological Corporation, San Antonio, TX,
USA, 2008.
[32] M.-A. Edel, T. Hölter, K. Wassink, and G. Juckel, “A compar-
ison of mindfulness-based group training and skills group
training in adults with ADHD: an open study,”Journal of
Attention Disorders, vol. 21, no. 6, pp. 533–539, 2017.
[33] M. Rösler, W. Retz, P. Retz-Junginger et al., “ADHS-diagnose
bei erwachsenen,”Der Nervenarzt, vol. 79, no. 3, pp. 320–327,
2008.
[34] American Psychiatric Association, Diagnostic and Statistical
Manual of Mental Disorders, American Psychiatric Associa-
tion, Washington, DC, USA, 4th edition, 1994.
[35] A. P. Fleming, R. J. McMahon, L. R. Moran, A. P. Peterson, and
A. Dreessen, “Pilot randomized controlled trial of dialectical
behavior therapy group skills training for ADHD among col-
lege students,”Journal of Attention Disorders, vol. 19, no. 3,
pp. 260–271, 2015.
[36] T. E. Brown, Brown Attention Deficit Disorder Scales, The
Psychological Corporation, San Antonio, TX, USA, 1996.
[37] C. K. Conners, Conners’Continuous Performance Test II
(CPT-II): Computer Program for Windows Technical Guide
and Software Manual, Multi-Health Systems, North Tona-
wanda, NY, USA, 2000.
[38] K. R. Murphy, R. A. Barkley, and T. Bush, “Executive function-
ing and olfactory identification in young adults with attention
deficit-hyperactivity disorder,”Neuropsychology, vol. 15, no. 2,
pp. 211–220, 2001.
[39] J. T. Nigg, E. G. Willcutt, A. E. Doyle, and E. J. S. Sonuga-
Barke, “Causal heterogeneity in attention-deficit/hyperactivity
disorder: do we need neuropsychologically impaired sub-
types?,”Biological Psychiatry, vol. 57, no. 11, pp. 1224–1230,
2005.
[40] P. Cole, S. Weibel, R. Nicastro et al., “CBT/DBT skills training
for adults with attention deficit hyperactivity disorder
(ADHD),”Psychiatria Danubina, vol. 28, pp. 103–107, 2016.
[41] C. D. Spielberger, “State-Trait Anxiety Inventory,”in Corsini
Encyclopedia of Psychology, vol. 1, p. 1698, John Wiley & Sons,
Inc., 2010.
[42] E. Morgensterns, J. Alfredsson, and T. Hirvikoski, “Structured
skills training for adults with ADHD in an outpatient psychi-
atric context: an open feasibility trial,”ADHD Attention Deficit
and Hyperactivity Disorders, vol. 8, no. 2, pp. 101–111, 2016.
[43] R. A. Barkley and K. R. Murphy, Attention-Deficit Hyperactiv-
ity Disorder: A Clinical Workbook, Guilford Press, 1998.
[44] V. F. Bueno, E. H. Kozasa, M. A. da Silva, T. M. Alves, M. R.
Louzã, and S. Pompéia, “Mindfulness meditation improves
mood, quality of life, and attention in adults with attention
deficit hyperactivity disorder,”BioMed Research International,
vol. 2015, Article ID 962857, 14 pages, 2015.
[45] S. Hepark, L. Janssen, A. de Vries et al., “The efficacy of
adapted MBCT on core symptoms and executive functioning
in adults with ADHD: a preliminary randomized controlled
trial,”Journal of Attention Disorders, vol. 23, no. 4, pp. 351–
362, 2019.
[46] C. K. Conners, D. Erhardt, and E. Sparrow, CAARS Adult
ADHD Rating Scales-Technical Manual, Multi-Health Sys-
tems, Toronto, Ontario, Canada, 1999.
[47] H. M. Van der Ploeg, Handleiding bij de Zelf-Beoordelings
Vragenlijst [Manual for the State-Trait Anxiety Inventory],
Harcout Assessment B.V, Amsterdam, Netherlands, 2000.
[48] Y. Gu, G. Xu, and Y. Zhu, “A randomized controlled trial of
mindfulness-based cognitive therapy for college students with
ADHD,”Journal of Attention Disorders, vol. 22, no. 4, pp. 388–
399, 2018.
[49] J. Fan, B. D. McCandliss, T. Sommer, A. Raz, and M. I. Posner,
“Testing the efficiency and independence of attentional net-
works,”Journal of Cognitive Neuroscience, vol. 14, no. 3,
pp. 340–347, 2002.
[50] L. Janssen, C. C. Kan, P. J. Carpentier et al., “Mindfulness-
based cognitive therapy v. treatment as usual in adults with
ADHD: a multicentre, single-blind, randomised controlled
trial,”Psychological Medicine, vol. 49, no. 1, pp. 55–65, 2019.
[51] C. K. Conners, D. Erhardt, and E. Sparrow, Conners’Adult
ADHD Self-Rating Scale (CAARS-S:SV), Psychological Assess-
ments Australia, Jannali, NSW, Australia, 2008.
16 Behavioural Neurology
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