Subtle Motor Signs as a Biomarker for Mindful Movement Intervention in Children with Attention-Deficit/Hyperactivity Disorder.

OBJECTIVE: Previous studies of Tai Chi or mindfulness-based interventions in attention-deficit/hyperactivity disorder (ADHD) have relied on self- or parent-reported outcome measures; however, there is a critical need for the validation of objective biomarkers of treatment. Therefore, we implemented a mindful movement intervention for children with ADHD, hypothesizing that an ADHD-relevant motor control measure could serve as a predictive biomarker of treatment-related improvement. METHODS: Thirty-four participants were included, 8 to 12 year olds diagnosed with DSM-5 ADHD. Participants engaged in the mindful movement treatment, an 8-week program with 2 classes a week for 60 minutes. At pre- and post-treatment, ADHD symptoms and associated impairment and motor control via the Physical and Neurological Examination for Subtle Signs (PANESS) were assessed. RESULTS: The results showed a significant reduction for PANESS Gaits and Station (p ≤ 0.001), total overflow (p = 0.009), and total score (p = 0.001) after treatment, with the largest effect for Gaits and Stations. The results also showed a significant reduction in symptoms of inattention (p ≤ 0.001), hyperactivity/impulsivity (p ≤ 0.001), oppositional defiant disorder (p = 0.001), and executive dysfunction (p ≤ 0.001). There were significant positive correlations between change in PANESS Gaits and Stations and change in both inattentive (p = 0.02) and hyperactive/impulsive symptoms (p = 0.02). There was also a significant positive correlation between change in the PANESS total score and change in inattentive (p = 0.007) and hyperactive/impulsive symptoms (p = 0.042). The change in the PANESS total score (ß = 0.295, p = 0.002) predicted post-treatment ADHD severity above the change in inattentive or hyperactive/impulsive symptoms. CONCLUSION: The results suggest the effectiveness of a mindful movement treatment on ADHD symptoms and suggest the PANESS as a candidate motor biomarker for future mindful movement trials. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02234557, https://clinicaltrials.gov/ct2/show/NCT02234557.

Evaluating In-Car Movements in the Design of Mindful Commute Interventions: Exploratory Study.

BACKGROUND: The daily commute could be a right moment to teach drivers to use movement or breath towards improving their mental health. Long commutes, the relevance of transitioning from home to work, and vice versa and the privacy of commuting by car make the commute an ideal scenario and time to perform mindful exercises safely. Whereas driving safety is paramount, mindful exercises might help commuters decrease their daily stress while staying alert. Increasing vehicle automation may present new opportunities but also new challenges. OBJECTIVE: This study aimed to explore the design space for movement-based mindful interventions for commuters. We used qualitative analysis of simulated driving experiences in combination with simple movements to obtain key design insights. METHODS: We performed a semistructured viability assessment in 2 parts. First, a think-aloud technique was used to obtain information about a driving task. Drivers (N=12) were given simple instructions to complete movements (configural or breath-based) while engaged in either simple (highway) or complex (city) simulated urban driving tasks using autonomous and manual driving modes. Then, we performed a matching exercise where participants could experience vibrotactile patterns from the back of the car seat and map them to the prior movements. RESULTS: We report a summary of individual perceptions concerning different movements and vibrotactile patterns. Beside describing situations within a drive when it may be more likely to perform movement-based interventions, we also describe movements that may interfere with driving and those that may complement it well. Furthermore, we identify movements that could be conducive to a more relaxing commute and describe vibrotactile patterns that could guide such movements and exercises. We discuss implications for design such as the influence of driving modality on the adoption of movement, need for personal customization, the influence that social perception has on participants, and the potential role of prior awareness of mindful techniques in the adoption of new movement-based interventions. CONCLUSIONS: This exploratory study provides insights into which types of movements could be better suited to design mindful interventions to reduce stress for commuters, when to encourage such movements, and how best to guide them using noninvasive haptic stimuli embedded in the car seat.

Mindful movement and skilled attention.

Bodily movement has long been employed as a foundation for cultivating mental skills such as attention, self-control or mindfulness, with recent studies documenting the positive impacts of mindful movement training, such as yoga and tai chi. A parallel "mind-body connection" has also been observed in many developmental disorders. We elaborate a spectrum of mindfulness by considering ADHD, in which deficient motor control correlates with impaired (disinhibited) behavioral control contributing to defining features of excessive distractibility and impulsivity. These data provide evidence for an important axis of variation for wellbeing, in which skillful cognitive control covaries with a capacity for skillful movement. We review empirical and theoretical literature on attention, cognitive control, mind wandering, mindfulness and skill learning, endorsing a model of skilled attention in which motor plans, attention, and executive goals are seen as mutually co-defining aspects of skilled behavior that are linked by reciprocal inhibitory and excitatory connections. Thus, any movement training should engage "higher-order" inhibition and selection and develop a repertoire of rehearsed procedures that coordinate goals, attention and motor plans. However, we propose that mindful movement practice may improve the functional quality of rehearsed procedures, cultivating a transferrable skill of attention. We adopt Langer's spectrum of mindful learning that spans from "mindlessness" to engagement with the details of the present task and contrast this with the mental attitudes cultivated in standard mindfulness meditation. We particularly follow Feldenkrais' suggestion that mindful learning of skills for organizing the body in movement might transfer to other forms of mental activity. The results of mindful movement training should be observed in multiple complementary measures, and may have tremendous potential benefit for individuals with ADHD and other populations.