Mindfulness, Psychoeducation Effective Treatments for Working Memory in Adult ADHD

Mindfulness and psychoeducation interventions may be effective neuropsychotherapeutic approaches for regulating attention-deficit/hyperactivity disorder (ADHD)-related brain dysfunction in adults, especially regarding working memory, according to research published in Behaviour Research and Therapy.

Researchers stated that, “this is the first study that could show that mindfulness meditation influences brain regions associated with impaired working memory function and inattention in adults with ADHD.”

Impairments in working memory are a definitive trait of ADHD in adulthood, affecting patients’ daily lives, decision making, and information storing. Current research supports mindfulness as a means of supporting attention and emotion regulation in patients with ADHD, as well as enhancing quality of life by strengthening brain function in regions believed to be associated with these deficits (the prefrontal cortex, parietal brain areas, and basal ganglia).

Researchers compared the effects of mindfulness treatment (MAP) with the effect of an active control treatment, psychoeducation (PE), which has previously shown to be an effective means of reducing ADHD symptoms. Two weeks prior to the treatment, participants were self-rated and observer rated using the Conners Adult ADHD Rating Scales (CAARS) to measure symptom severity, and each person underwent structural and functional magnetic resonance imaging (fMRI). As the participants performed a one-back letter task, fMRIs were acquired to assess working memory. After 8 weeks of treatment, CAARS scores and fMRI tests were recorded.

The researchers found no significant difference between the MAP and PE group participants across any demographic variables, ADHD symptoms or subtypes, comorbidity, or medication. Before treatment, the MAP participants had 54.55% target-correct responses and those in the PE group had 50.85% target-correct responses. After treatment, the MAP group had 62.35% target-correct responses and the PE group had 57.45% target-correct responses.

MAP was not superior compared with PE in improving working memory function. Results indicated a significantly higher activation in the right parietal lobe for target-correct responses across groups. In the MAP group, there was a task-related significant increase in brain activation in the bilateral inferior parietal lobule after intervention and a higher neural activation in parts of the basal ganglia associated with self-rated inattention and memory problems. In the MAP group, a decrease in the score on the observer-rated CAARS scale in “hyperactivity/restlessness” was associated with stronger activation in the bilateral medial prefrontal cortex and the bilateral posterior cingulate cortex. However, both groups improved on task performance.

Limitations of the study included a short time frame, small sample size, use of exploratory analyses, and that the changes in neurobiologic activation among MAP group participants could show changes in brain function not yet affecting behavior. Additionally, the study did not include a control group without ADHD, although researchers recommend the inclusion of such a group in future studies.

The results of the study point to effective alternatives to psychopharmacologic treatments with methylphenidate for patients who experience nonresponse, contraindications, or adverse events, or for patients who prefer nonpsychopharmacologic treatments.

“Given the current findings, it can be hypothesized that, in the short term, PE and MAP are equally effective in improving working memory function in ADHD,” the researchers concluded.

Reference

Bachmann K, Lam AP, Sörös P, et al. Effects of mindfulness and psychoeducation on working memory in adult ADHD: a randomised, controlled fMRI study. Behav Res Ther. 2018;106:47-56.