The Effects of Mindfulness-Based Intervention on Children’s Attention Regulation

Abstract

Objective: This article describes results from a randomized clinical trial of a mindfulness-based intervention for parents and children, Mindful Family Stress Reduction, on a behavioral measure of attention in youths, the Attention Network Task (ANT). Method: Forty-one parent–child dyads were randomly assigned to either the mindfulness-based intervention condition or a wait-list control. School-age youths completed the ANT before and after the intervention. Results: Results demonstrate significant, medium-size (f² = −.16) intervention effects to the conflict monitoring subsystem of the ANT such that those in the intervention condition decreased in conflict monitoring more than those in the wait-list control. Youths in the intervention condition also showed improvements in their orienting subsystem scores, compared with controls. Conclusion: Mindfulness-based interventions for youths have potential utility to improve attentional self-regulation, and future research should consider incorporating measures of attention into interventions that use mindfulness training.

Keywords

children family Attention Network Test mindfulness randomized controlled trial Mindfulness-Based Stress Reduction

Middle childhood and early adolescence is a period of rapid change in physiology and brain development. In addition to its normative stressors and hardships, this period is characterized by high rates of psychopathology according to epidemiological research (Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2008). This period of development is also associated with the beginning of problem behaviors, such as drug use and risky sexual practices (Greenberg et al., 2003), which are predictive of later difficulties, such as high school dropout (Stoep, Weiss, Kuo, Cheney, & Cohen, 2003) and adult mental health problems.

Research increasingly suggests that understanding the role of attention regulation may provide a key to understanding the development of psychosocial problems in school-age youths. Given the complexity and magnitude of stimuli present in a youth’s life at any one point in time, being able to intentionally enhance the processing of certain information while simultaneously excluding other information (i.e., attention regulation) is central to effective self-regulation and psychosocial development (Eisenberg, Smith, Sadovsky, & Spinrad, 2004). Attention regulation moderates a child’s susceptibility to pathogenic parenting and negative peer environments (Belsky, Bakermans-Kranenburg, & van Izendoorn, 2007; Dishion & Patterson, 2006) and is implicated in numerous psychological disorders (Rothbart & Posner, 2006). It has also been suggested that attention regulation plays an important role in moderating the impact of problematic environments (i.e., stress and peer deviancy) on later development and adjustment (Dishion & Connell, 2006). Youths with strong ability to regulate attention are also less susceptible to deviant peer influences on problem behavior (Compas & Boyer, 2001; Dishion, Felver-Gant, Abdullaev, & Posner, 2010). Despite the importance of attention regulation in healthy psychological development, it is the target of few direct interventions.

Nonetheless, accruing theoretical developments and empirical evidence suggest that mindfulness-based interventions engender positive change by specifically teaching skills and practices that strengthen attentional regulatory processes (Semple, Lee, Rosa, & Miller, 2010; Shapiro, Carlson, Astin, & Freedman, 2006). Theoretically, the very constructs of mindfulness and attention regulation are inherently related, exemplified by the most widely used operational definition of mindfulness: “the self-regulation of attention [italics added] so that it is maintained on immediate experience . . . characterized by curiosity, openness, and acceptance” (Bishop et al., 2004, p. 232). Theorists also posit that mindfulness-based interventions operate indirectly by enhancing attention regulation (Shapiro et al., 2006), further suggesting the close relation of the constructs. Work by cognitive neuroscientists also demonstrates a connection between mindfulness-based interventions and attention regulation in that mindfulness practices affect attentional regulatory neural systems of conflict monitoring, selective attention, and sustaining attention (Lutz, Slagter, Dunne, & Davidson, 2008). A central feature of mindfulness-based interventions is that they teach individuals to disengage attention away from internal reactions (e.g., thoughts and feelings) that elicit distress and to instead explicitly train and self-regulate attention to experiences in the present moment, without elaborative cognitive appraisals or interpretations.

Because mindfulness and attention regulation are theoretically highly related (or perhaps nested) constructs, practices that promote mindfulness should also improve attention regulation. Research by Jha, Krompinger, and Baime (2007) offers tentative support for mindfulness-based intervention effects on aspects of attention. The effect of mindfulness training on attentional capabilities was examined using the Attention Network Task (ANT; Fan, McCandliss, Sommer, Raz, & Posner, 2002), a computerized task that assesses core features of attention (Posner & Petersen, 1990). Following 8 weeks of mindfulness training, adult participants had improved their ability to spatially direct their attention, as measured by the ANT orienting subsystem. Other research has demonstrated improvements by way of various measures of attention regulation in adults following brief (Wenk-Sormaz, 2005) and long-term (Valentine & Sweet, 1999) mindfulness training.

In a study that used the ANT to explore intervention effects of mindfulness interventions on attention regulation in youths, Saltzman and Goldin (2008) randomly assigned a nonclinical sample of parent–child dyads to either mindfulness intervention (n = 24) or wait-list control (n = 8) conditions. Children’s behavioral performance on the ANT was measured before and after the intervention group completed the eight-session intervention. Following completion of the mindfulness-based intervention, children in the intervention group had significantly greater behavioral performance on the ANT subsystem of conflict monitoring (i.e., prioritizing cognitive attentional resource allocation among competing stimuli), a common index of attention regulation.

Although emerging evidence supports the claim that mindfulness-based interventions enhance attention regulation, the aforementioned studies have been criticized for their methodologies (Jensen, Vangkilde, Frokjaer, & Hasselbach, 2012), and some evidence has been reported of null effects in research attempting to replicate findings (Anderson, Lau, Segal, & Bishop, 2007). More research is needed to understand the relation of mindfulness-based intervention and attention regulation, especially in youths whose attention regulation has important long-term implications.

In our study, we sought to explore the effects of a mindfulness-based intervention on attention regulation in school-age youths. Using data collected from a randomized wait-list control pilot trial of a recently developed mindfulness-based intervention for families (i.e., parent–child dyads), Mindful Family Stress Reduction (MFSR; Felver & Tipsord, 2011), this research analyzed youths’ behavioral performance on the ANT before and after intervention. We hypothesized that following mindfulness-based intervention, children would have improved performance on the conflict monitoring subsystems of the ANT relative to a wait-list control condition. Specifically, the subsystem of conflict monitoring would improve following intervention because this subsystem has demonstrated changes following mindfulness intervention in other studies with youths (Saltzman & Goldin, 2008), and because the construct of conflict monitoring is most similar to common definitions of attentional self-regulation in the literature (i.e., intentionally enhancing the processing of certain information while simultaneously excluding other information; Eisenberg et al., 2004). Other subsystems of attention (i.e., orienting and altering) were also expected to demonstrate improvements following intervention, in that mindfulness-based interventions are generally thought to affect attentional processes. Our research intended to add to the growing body of evidence implicating mindfulness-based intervention in improvements in attention regulation.

Method

Participants

This study analyzed data from the randomized, controlled trial of MFSR (Felver & Tipsord, 2011), a family-centered, mindfulness-based intervention adapted from Mindfulness-Based Stress Reduction (MBSR; Kabat-Zinn, 1990). The larger MFSR study was designed to explore general intervention effects (e.g., parent–child relationship, psychosocial well-being, and acceptability) of this intervention on a normative community sample, and the results from this work can be found elsewhere (see Felver, Tipsord, & Dishion, 2014); the results presented in this article focus entirely on behavioral effects relevant to child attentional processes in a laboratory task. Families (i.e., parents and children) were recruited from a medium-size city in the Pacific Northwest. Data were collected from the 47 children (57% female) who participated in the study. The mean age of children recruited for the study was 11 years and 1 month (SD = 12 months). The majority of families (98%) were reportedly of European American ethnicity. Yearly household income ranged from US$9,000 to US$250,000, with a median of US$46,500. Of the families, 77.1% represented two-parent households. Dyads were randomly assigned (balanced by child’s gender) to either the MFSR intervention condition (n = 24) or the wait-list control condition (n = 23).

Recruitment

Parent–child dyads were recruited for the study in one of two ways: either through direct phone calls to parents listed in the University of Oregon’s developmental database (a directory of youths and families potentially interested in participating in psychosocial research) or via flyers placed on community bulletin boards. Inclusion criteria for children included age between 9 and 12 years, ability to read and comprehend English, no history of psychological diagnosis (i.e., posttraumatic stress disorder, major depressive disorder, or any form of an anxiety disorder), and no history of epilepsy or seizures (exclusion criteria for electroencephalography [EEG] data collection conducted as part of the larger study).

Intervention

The mindfulness intervention, MFSR, was based on the most established mindfulness interventions to date (Kabat-Zinn, 1990; Lee, Semple, Rosa, & Miller, 2008) and was specifically adapted for families (i.e., parent–child dyads). More details about the MFSR and psychosocial intervention effects can be found elsewhere (Felver, 2012; Felver & Tipsord, 2011; Felver, Tipsord, & Dishion, 2014; May, Reinka, Tipsord, Felver, & Berkman, 2014). The MFSR intervention group met for 90 min one time per week for 8 consecutive weeks at a local community wellness center. The group consisted of a maximum of 24 parent–child dyads (i.e., 48 people), although the average attendance was generally less as a result of attrition and nonattendance (parents attended an average of 6.13 [SD = 1.70] classes; children 6.46 [SD = 1.59]). Each session followed a similar format, including both didactic and experiential mindfulness components based on the manualized MBSR curriculum. During the first 30 min of the class, the entire group met to practice, reviewed the previous week’s material, and reviewed the new topic for discussion that week. For the middle 30 min of the class, the parents and children split into separate groups in different rooms to practice sustained silent mindfulness activities (parent) and shorter child-friendly activities (child) relevant to the lesson topic of the week. After rejoining as a total group, the final 30 min of the class were used to summarize the lesson for the day, included a short practice or activity, and reviewed the home practice for the week. Formal mindfulness instruction (e.g., mindful breathing, basic yogic poses) and informal mindfulness instruction (e.g., mindful eating, mindful conversations) were taught every week. Each week participants were asked to practice at home the techniques learned during the session for approximately 15 to 20 min per day and record the number of minutes they spent practicing. Participant daily practice sheets were collected, reviewed, and recorded each week by the course instructors.

The MFSR class used the basic structure and curriculum of MBSR but was adapted to meet the needs of families (i.e., parent–child dyads). Each class included age-appropriate material and modifications in line with current research on child and family mindfulness intervention practices (Dumas, 2005; Duncan, Coatsworth, & Greenberg, 2009; Saltzman & Goldin, 2008; Thompson & Gauntlett-Gilbert, 2008). Table 1 presents a brief session outline of the MFSR curriculum. MFSR incorporated alternative sensory modalities in a way that is more akin to a game than to a static meditation exercise, to help children engage with the mindfulness activity (Thompson & Gauntlett-Gilbert, 2008). An example of such an activity is the “sound scavenger hunt,” during which children were asked to close their eyes, sit upright, and try to “find” (i.e., detect) as many novel sounds as possible inside and outside of the room for 5 min. After “searching” for sounds, a list was generated of all the noises that were noted by children. This activity taught children to maintain their attention on a single focus (i.e., hearing and not hearing other sensory modalities or cognitions) in a nonjudgmental and curious manner, thereby directly targeting both attention regulation and the qualitative aspect of acceptance inherent in mindfulness.

Table 1.

MFSR Intervention.

Lesson title	Activities and practices
Week 1: Autopilot and defining mindfulness	Concentrating on listening to sound
	Mindful stretching (yoga)
	Mindful eating
	Mindful abdominal breathing (sitting meditation)
	Mindfulness of somatic sensations (body scan)
Week 2: Wandering mind and barriers to practice	Sitting meditation, body scan
	Discussion of barriers to home practice
Week 3: Experiences with sitting meditation	Sitting meditation, discussion
	Yoga, discussion of yoga
Week 4: Acceptance and pleasant/unpleasant events	Sitting meditation, yoga, body scan
	Distress tolerance activity, discussion
Week 5: Stress and responding versus reacting	Sitting meditation, yoga, body scan
	Stress activity (walking in airport)
	Brief mindfulness exercise (3-min meditation)
Week 6: Thoughts are not facts, mindful communication	Imagery meditation
	Mindful communication exercise, discussion
	Sitting meditation
Week 7: Points of view, perspective taking	Perspective-taking activity, discussion
	Sitting meditation
	Point of view exercise, discussion
	Yoga
Week 8: Summary, continuing practice	Sitting meditation, yoga, body scan
	Writing letter to future self
	Discussion of continuing practice
	Wrap-up activity—MFSR graduation

Note. MFSR = Mindful Family Stress Reduction.

Fidelity of intervention administration was based on the manualized MFSR intervention and fidelity data were collected during all sessions; fidelity remained greater than 90% for all class sessions. The class was administered by the first and second authors, both of whom have received MBSR training and have extensive experience in mindfulness practice and intervention.

Measurement Procedures

Measurement occurred at two time points relative to the MFSR intervention group: preintervention (Time 1) and postintervention (Time 2). The wait-list control group completed assessments in the same time frame as did the intervention group (i.e., yoked temporal assessment between the two conditions). All assessments took place within 2 weeks before the beginning of the mindfulness intervention and within 2 weeks after completion of the intervention.

Each pre- and postintervention assessment session lasted approximately 2 hr, including assessment and measurement not related to the current research. Relevant to this study, during each session, parents and children completed questionnaires about themselves, and parents completed questionnaires about their child. While the parent was completing questionnaires, child participants had an EEG net applied and then completed a 5-min relaxation exercise (i.e., simply asked to close their eyes and relax) followed by cognitive laboratory tasks. Details about the complete list of laboratory tasks administered can be found elsewhere (Felver, 2012); this article describes only the behavioral results of the ANT. Following the lab tasks, children completed their self-report forms. Families were compensated US$40 for each assessment session, $20 for each mindfulness class attended, and an additional US$50 if they attended all eight classes.

Measurement of Attention Regulation

ANT

The ANT (Fan et al., 2002) is a computerized task used to assess subsystems of attention based on the tripartite model of attention postulated by Posner and Petersen (1990). The ANT subsystems include alerting (ability to maintain a state of vigilance or preparedness to environmental stimuli), orienting (directing and limiting attention to specific stimuli), and conflict monitoring (prioritizing cognitive attentional resource allocation among competing stimuli). A thorough discussion of how attention regulation is defined, operationalized, and measured is beyond the scope of this article. We chose to measure attention regulation by using the conflict monitoring subsystem of the ANT. It is worth noting that alerting and orienting subsystems are also likely implicated in the construct of attention regulation, and as such, these subsystems were measured as secondary outcomes and categorized as additional attention processes that may be affected by mindfulness-based intervention.

A more detailed description of the ANT can be found elsewhere (Fan et al., 2002). In brief, participants view a computer screen and indicate the direction of a target arrow by pressing a left or right response key. The target arrow was flanked by two distracting arrows to the left and right, which either pointed in the same direction (congruent condition, 50% of trials) or in the opposite direction (incongruent condition, 50% of trials). The arrows were presented in either the upper or lower halves of the screen (equiprobable) above or below the central fixation point. Trials were preceded by one of three cue conditions (equiprobable): no cue (central fixation cross remained constant until the target appeared), central cue (asterisk in the center of the screen provided temporal information about the target), and spatial cue (asterisk appeared in the target location and provided temporal and spatial information about the target).

The ANT was presented using E-Prime version 2.0 (Psychological Software Tools, Pittsburgh, PA). Participants gazed at the central fixation point and responded with either the left or the right index finger according to the direction of the target arrow points. Except for no-cue trials, all trials started with the presentation of the cue for 100 milliseconds (ms). The cue was followed by a 400 ms delay. The target stayed on the computer screen for 1,700 ms or until the participant made a response (whichever occurred first). The delay between trials varied from 400 to 1,600 ms; trial-type presentation was randomized. Following a short practice session with performance feedback, six blocks of 50 trials were presented to subjects; the total time to complete the ANT was approximately 20 min, including breaks and practice trials. Figure 1 details the visual presentation and timing of the ANT.

Figure 1.

Visual presentation and timing of the ANT.

Reaction times were measured in milliseconds between the presentation of a target stimulus and the time until correct response to the target. To measure alerting, orienting, and conflict monitoring subsystems, reaction time difference scores between the different cue and stimulus trial conditions were calculated. To calculate the conflict monitoring subsystem score, the reaction time to congruent trial responses were subtracted from the incongruent trial responses. To calculate the orienting subsystem of the ANT, the reaction time to spatial cue trials were subtracted from the center cue trials; the alerting subsystem was calculated by subtracting the reaction time to center cue trials from the no-cue trials. Behavioral indices on the ANT were calculated using raw reaction time for correct responses to a trial type, which was then standardized by an individual’s mean reaction time across all trials to control for individual variation in reaction time and motor speed. Accuracy for the ANT was generally high (>90%) across all trial types and was not incorporated into further analysis.

Results

Data Analysis

Participant retention

This study used an “intent to treat” analytic approach, whereby data were analyzed regardless of how many of the eight class sessions a subject attended. Forty-seven dyads (i.e., parent and child) had originally consented to participate in the MFSR intervention; data were collected for 46 children at preintervention (Time 1) and 41 children at postintervention (Time 2). One child participant did not complete the ANT at Time 1 because of discomfort with the EEG net; this family also did not participate in the intervention or in postintervention data collection. Two families in the intervention condition completed Time 1 assessment but subsequently dropped out of the study after the first three mindfulness classes and did not participate in data collection at Time 2. Two families assigned to the wait-list control condition did not return for the Time 2 assessment session. One child participant assigned to the wait-list control condition did not complete the ANT at Time 2 because of discomfort with the EEG net. Thus the final data set included 41 participants with data collected at Time 1 and Time 2, 22 in the MFSR intervention condition and 19 in the wait-list control group.

Preliminary analyses

Data were coded and analyzed using SPSS version 16.0 (SPSS, Chicago, IL). Independent sample t tests were used to determine whether Time 1 differences existed on a child participant’s ANT subsystem scores or age between groups; no statistically significant differences were found between intervention and wait-list control groups (ps > .05). Gender distributions did not differ between intervention and wait-list control groups, χ²(1, n = 41) = .046, p = .83.

A series of stepwise linear regression models was tested for each of the three ANT subsystems. Initial regression models included Time 1 ANT subsystem scores and the two covariates of age (mean centered in months) and gender (coded as −.5 and +.5 per centering recommendations by Kraemer & Blasey, 2004) in the first block and group assignment (coded as −.5 and +.5 per centering recommendations by Kraemer & Blasey, 2004) in the second block, and the interaction between age and intervention, and gender and intervention, in the third block. In every analysis conducted, there were no significant effects for age, gender, or their corresponding interaction terms (ps > .05), therefore, age and gender were dropped from the final models of all analyses reported in the following article subsections. The final regression models included the Time 1 ANT subsystem scores in the first block to control for preintervention effects and group assignment in the second block to test for intervention effects. Time 2 ANT subsystem scores were used as the dependent variable.

Overall models

Results for the final regression models are presented in Table 2. The overall models were statistically significant for conflict monitoring, F(2, 38) = 24.29, p < .001, and orienting, F(2, 38) = 5.25, p = .01, and marginally significant for alerting, F(2, 38) = 2.93, p = .06.

Table 2.

Stepwise Multiple Regression of MFSR Intervention on ANT Subsystems.

	Time 1 ANT effects			Intervention effects				Model statistics
ANT subsystem	β	t	p	β	t	p	f ²	R ²	df	F	p
Conflict monitoring	.63	5.72	<.01	−.27	−2.45	.01	−.16	.56	2,38	24.29	<.01
Orienting	.37	2.58	.01	−.26	−1.81	.07	−.09	.21	2,38	5.24	.01
Alerting	.31	1.96	.06	.29	1.89	.06	.10	.13	2,38	2.92	.06

Note. Subject response times reported in milliseconds standardized for average individual response time across all ANT trials.

MFSR = Mindful Family Stress Reduction; ANT = Attention Network Task.

Preintervention ANT scores

Time 1 ANT data were included in the final model to control for preintervention performance on the ANT (see Table 2). Preintervention performance was a significant predictor of postintervention performance for conflict monitoring (β = .63, p < .01) and orienting (β = .37, p = .01) and a marginally significant predictor for alerting (β = .31, p = .06).

Intervention effects

Intervention effects were analyzed while controlling for initial preintervention performance on the ANT (i.e., Time 1 ANT scores and group assignment were simultaneously entered as predictors). To further explore the results of these multiple regression analyses, effects sizes were calculated using Cohen’s f² statistic (Selya, Rose, Dierker, Hedeker, & Mermelstein, 2012) and interpreted using standard conventions (Cohen, 1988), whereby effect sizes of 0.02, 0.15, and 0.35 are considered small, medium, and large, respectively.

Intervention effects are reported in Table 2, and raw scores (i.e., not standardized by an individual’s mean reaction time) for both groups’ performance on all ANT subsystems at Time 1 and Time 2 are reported in Table 3. There was a significant intervention effect on conflict monitoring (β = −.27, p = .02). Both the MFSR and control groups showed decreases in conflict monitoring scores from Time 1 to Time 2, but the magnitude of the improvement was greater for children who received MFSR (see Figure 2). MFSR had a medium-size effect on conflict monitoring scores (f² = −.16). For orienting scores, there was a marginally significant effect of intervention (β = −.26, p = .08), which reflected a decrease in orienting scores from Time 1 to Time 2 for the MFSR group, compared with the stability in the control group (see Figure 3). MFSR had a small-size effect on orienting scores (f² = −.09). Finally, there was a marginally significant intervention effect on alerting scores (β = .30, p = .07), which reflected an increase in alerting scores from Time 1 to Time 2 in the MFSR group and a decrease in the control group (see Figure 4). MFSR had a small-size effect on alerting scores (f² = .10).

Table 3.

Mean and Standard Deviation Descriptive Statistics for ANT Subsystems (in ms) for MFSR Intervention and Control Groups at Time 1 and 2.

	MFSR intervention		Wait-list control
	Time 1	Time 2	Time 1	Time 2
ANT subsystem
Conflict monitoring	117 (53)	77 (42)	138 (51)	111 (44)
Orienting	53 (48)	29 (55)	55 (53)	52 (33)
Alerting	15 (36)	33 (41)	41 (48)	19 (41)

Note. ANT = Attention Network Task; MFSR = Mindful Family Stress

Figure 2.

ANT conflict monitoring scores in milliseconds for MFSR intervention and control groups at Times 1 and 2.

Figure 3.

ANT orienting scores in milliseconds for MFSR intervention and control groups at Times 1 and 2.

Figure 4.

ANT alerting scores in milliseconds for MFSR intervention and control groups at Time 1 and 2.

There were no intervention effects on overall reaction times (p > .50) or reaction times for individual trial types (i.e., congruent, incongruent, no-cue, central cue, or spatial cue; ps > .22).

Discussion

Results from this study confirmed the hypothesis that participation in a mindfulness-based intervention significantly improves children’s attention regulation as measured behaviorally in the ANT conflict monitoring subsystem and that the magnitude of this change can be considered a medium effect size. The ANT conflict monitoring condition measures an individual’s ability to self-regulate their attention to a targeted object in the presence of visual distraction. Much of the mindfulness-training curriculum emphasizes self-regulating one’s focus of attention on a selected somatic experience (e.g., the physical sensation of breathing) while not being distracted by other internal (e.g., cognitions) or external (e.g., sounds) stimuli. It could be that the practice of ignoring distracting stimuli in the environment strengthened this attentional subsystem in youths, which then generalized to better performance on the ANT.

The observed effect of MFSR on conflict monitoring could have important implications for promoting positive psychosocial development. Theoretically, a central feature of mindfulness-based interventions is that they teach individuals strategies to disengage attention away from internal reactions (e.g., thoughts and feelings) that elicit distress and to instead focus attention on present experience directly without elaborative cognitive appraisals or interpretations. Results of this study offer empirical evidence to support this theory. The implication of this finding is that this technology may directly benefit youths by promoting the capacity to regulate awareness away from distressing experience that could escalate into emotional and behavioral dysregulation and over time develop into dysfunctional patterns of behavior and psychopathology. Thus, by promoting attentional regulation specifically and overall self-regulatory capacity generally (because attention regulation is central to overall self-regulation; Eisenberg et al., 2004), mindfulness-based interventions, such as MFSR, could prevent the development of psychosocial dysfunction and disrupt pathological developmental pathways.

These results replicate mindfulness-based intervention effects on the ANT noted by Saltzman and Goldin (2008) in their study of children, but differ from results obtained by Jha and colleagues (2007), who did not find intervention effects on the conflict monitoring subsystem in their study of adults. Given that children in general have more difficulty with tasks that involve conflicting stimuli than do adults (Rueda, Posner, Rothbart, & Davis-Stober, 2004), it could be that for youths, this aspect of attention is more sensitive to change in response to intervention. Because attention regulation is critical to healthy psychosocial development and childhood represents the time frame during which these processes are susceptible to change, these findings suggest that mindfulness-based interventions can be considered effective for supporting the development of attention regulation.

Given the multiple calls for more research exploring intervention effects of mindfulness interventions in youths (Burke, 2009; Felver, Doerner, Jones, Kaye, & Merrell, 2013), future research should consider using conflict monitoring tasks to capture intervention effects on attention regulation following mindfulness intervention and may be used to help explore underlying mechanisms. Using the ANT conflict monitoring subsystem as a variable in mediational analysis could help elucidate the question of whether attention regulation is a key variable in producing salubrious intervention effects, as has been suggested in the literature (Shapiro et al., 2006). Future mindfulness-based intervention studies that specifically measure basic attentional processes in addition to important real-world outcomes (e.g., academic performance, prosocial behavior) could provide empirical support for the existing hypotheses postulating that attention regulation is the mechanistic operator underlying beneficial treatment effects.

In our study’s laboratory task, we implemented a brief relaxation induction whereby youths were asked to close their eyes and relax for 5 min before beginning laboratory tasks. Methodologically, it is worth noting that this step may have induced a state of mindfulness that then affected performance on the ANT; however, children in both conditions were given this instruction, so it does not account for differences between the groups. Future researchers may wish to implement similar procedures to induce a state effect, or compare relaxation/mindfulness-induction and no-induction conditions to determine whether relaxation has an effect on performance.

In addition to the significant improvement in ANT conflict monitoring, there were trend-level intervention effects on the attention subsystems of orienting and alerting. It should be noted that the intervention effects on the orienting and alerting subsystems were only marginally statistically significant and the overall regression model was not statistically significant for the alerting analysis; as such, these results should be cautiously interpreted.

Orienting scores decreased for those in the MFSR intervention group, meaning that after the intervention, participants were better able to use spatial information to help complete the task, similar to results obtained in adults following MBSR (Jha et al., 2007). A component of mindfulness-based interventions, and the MFSR intervention, involves bringing awareness and attention to internal and external experiences as they arise in the moment, referred to as open monitoring of experience. It could be that through the repeated practice of noticing, these experiences generalized to the orienting task of the ANT because subjects were essentially measured by how well they were able to incorporate, and arguably notice (although this was not an explicit instruction on the ANT), the information in their spatial field. MFSR and all mindfulness-based interventions based on the MBSR format use both focused attention practices (i.e., narrowing and maintaining attention on a target) and open monitoring practices (i.e., broadening attention to notice all aspects of one’s experience; Lutz et al., 2008). Thus, it is unclear whether the former, latter, or combination of practices affected the orienting scores. Future research should consider exploring what component practices directly affect specific aspects of attention, such as the ANT orienting subsystem, to advance our understanding of how mindfulness-based interventions affect specific attentional processes.

An unexpected finding was that alerting scores increased in the MFSR condition and decreased in the control condition, meaning that children in the treatment condition became less vigilant of target stimuli and children in the control condition became more vigilant. These findings were unusual given that they were the opposite of a priori hypothesis. Several methodological considerations and limitations may explain these results. Participants’ Time 1 responses in the MFSR condition were particularly fast, with an obtained mean of 15 ms. As a comparison, Johnson and colleagues (2008) reported a mean ANT alerting score of 66 ms in a normative sample of similar age. It could be that these obtained results were unusually fast and were potentially unduly influenced by our relatively small sample size, and that the observed increase in scores at posttreatment is simply the result of a regression to the mean. The seemingly improved control condition alerting scores could also be a simple regression to the mean. Furthermore, the overall model and Time 1 score predictors of Time 2 were found to be statistically insignificant for the alerting analyses only, which may also potentially indicate an additional error in the alerting scores. It could also be that there were unintended iatrogenic effects of MFSR on subjects’ attentional preparedness as measured by the alerting scores; however, this explanation would not account for the control group’s improvement in alerting and should therefore be considered unlikely. Taken as a whole, the marginally significant effect of MFSR on alerting reported in this study should be interpreted with caution.

Several other limitations of this study are worth noting. As with most other mindfulness interventions, the MFSR intervention used a group rather than an individual intervention approach. As such, individuals are inherently nested within a classroom, which is then nested within assignment to experimental condition. It could be that intervention effects observed resulted from this group nesting effect and not from the intervention per se. Future research should study individually administered interventions or should assign more groups to intervention and use appropriate statistical techniques (e.g., hierarchical linear modeling) to address this limitation. Furthermore, participants in the intervention condition in this experiment had repeated exposure to study personnel by virtue of their participation in weekly MFSR classes. As such, they could have been more motivated than the control condition to perform well at postassessment, which could explain the observed intervention effects. Future studies could consider using an active control condition and taking into account motivation and effort, which have been found to affect performance on attention tasks following mindfulness intervention (Jensen et al., 2012). This study was limited by the relatively small number of subjects, and although we do not believe the sample was unduly influenced by outliers in that none of the ANT data was above or below three standard deviations, it is possible that the obtained results could be sample specific, particularly in light of the unusual findings regarding the alerting subsystem. Future research that replicates these findings using larger sample sizes will address this limitation.

Mindfulness-based interventions hold great potential as an innovative and effective intervention approach. However, for mindfulness interventions to become more firmly established as an evidence-based psychosocial intervention, more research is needed to understand underlying mechanisms. Attention regulation, such as that measured by tasks of conflict monitoring, is theoretically and empirically shown to be affected by mindfulness training. Future research should continue to explore the relation between mindfulness and attention regulation to better understand the operational mechanisms of this intervention modality, information which can then be used to systematically develop interventions to meet the needs of today’s youths.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by National Institutes of Mental Health Grant T32MH20012 to Elizabeth A. Stormshak, PhD; Mind and Life Institute Valera Grant 2009-01-16 to Jessica Tipsord, PhD; and National Institute of Mental Health grant K01MH82 to Kristina Hiatt Racer, PhD.

Author Biographies

Joshua C. Felver, PhD, is a postdoctoral research fellow at the Alpert Medical School of Brown University and a clinical fellow in psychology at Bradley Hospital. His research focuses on the development and implementation targeted interventions to promote self-regulation in youth in community and school settings.

Jessica M. Tipsord, PhD, is a social psychologist who completed her doctorate and postdoctoral fellowship at the University of Oregon. Her research focuses on mindfulness and its effects on interpersonal relationships, empathy, and attention.

Maxwell J. Morris, BS, is a student in the Portland State University School of Social Work Master’s program and a mindfulness oriented counselor and milieu manager of an inpatient psychiatric unit in Eugene, Oregon. His research interests include the effects of mindfulness-based therapies on individuals and treatment providers.

Kristina Hiatt Racer, PhD, is a research scientist at the University of Oregon’s Prevention Science Institute. Her research interests include the role of attention in the regulation of emotion and behavior, and the etiology and treatment of externalizing disorders.

Thomas J. Dishion, PhD, is a child clinical psychologist who conducts research in developmental psychopathology and prevention science. He is currently the founding director of the Arizona State University REACH Institute and a professor in clinical psychology at Arizona State University.

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