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Mindfulness is a contemporary psychological concept which has been integrated into several formal interventions for psychological and physical health disorders including Mindfulness-based cognitive behaviour therapy (MBCT) and Mindfulness-based stress reduction (MBSR). A growing movement in research and clinical practice has led to the adaptation of mindfulness interventions aimed at improving the symptoms of those diagnosed with autism spectrum disorders (ASD) and improving the quality of life, well-being and parenting skills of parents and caregivers of children with ASD.

Rooted in Eastern Buddhist philosophy, mindfulness is primarily practised through guided meditation and trains enhanced awareness and attention to experiences, including emotions, bodily sensations and thoughts alongside fostering a non-judgemental attitude and increased self-compassion. Research has shown that interventions based on practising mindfulness can have benefits for mental and physical health problems in both clinical and healthy populations.

Mindfulness Interventions for Adults
Individuals diagnosed with Autism Spectrum Disorder (ASD) are at high risk of having other psychological problems alongside a diagnosis of ASD. Research has identified anxiety and depression as the most common and enduring throughout adulthood. Scientific studies suggest that mindfulness interventions can be effective in treating these psychological disorders in many differing groups of people. With this in mind, researchers have explored the effectiveness of mindfulness-based approaches in helping those with ASD.

MBT-AS

Mindfulness-based therapy for Autism Spectrum (MBT-AS) has been created based on the widely used Mindfulness-based cognitive behaviour therapy framework which is usually implemented in clinical practice for relapse prevention in those who have major depressive disorder. This intervention involves a mixture of group sessions, discussion, guided meditations, yoga, applying mindfulness to daily activities and home meditation practice. It has been modified for MBT-AS to accommodate the information processing deficits characteristic of ASD including:


 * Removing ambiguous phrases and metaphors as individuals with ASD have the tendency toward literal interpretation
 * Extending the course from 8 to 9 weeks and extending the length in some meditation practices to accommodate slower information processing
 * Extra support, planning materials and more structure to home practice to accommodate any issues with executive functioning
 * Discussion of applying mindfulness to specific situations which may be difficult for those with ASD such as repetitive thoughts and unexpected changes

Research
Two randomised-controlled trials implementing MBT-AS have shown a significant reduction in depression, anxiety and rumination, as well as an increase in positive mood in adults with ASD by the end of a 9 week course, one of these studies showed that these improvements were maintained one year after the intervention had ended.

A comparative study examined the differences between a course of Mindfulness-Based Therapy and Cognitive Behaviour Therapy (CBT). They found both to be equally effective in their ability to reduce symptoms of anxiety and depression, as well as having an impact on reducing autistic symptoms in adults with ASD. The mindfulness-based therapy was suggested to be preferred as a treatment for the symptoms of anxiety when the participants had low levels of irrational beliefs and higher positive mood prior to treatment.

A systematic review and narrative analysis from 2016 found that mindfulness training was effective at reducing anxiety and depression while at the same time increasing mood in adults with high-functioning ASD. However, it highlighted that there is a limited quantity of research in this area with some methodological limitations. The authors concluded that further study should be conducted to address these issues before considering this approach evidence-based practice to treat those with ASD.

Mindfulness Interventions for Children and Adolescents
In addition to impairments in emotional, cognitive and social functioning, some children and adolescents with ASD exhibit verbal and physically aggressive behaviours. These behaviours can impact the lives of the individual with ASD and also the parents and caregivers around them. Mindfulness interventions have been developed to help reduce these symptoms and increase behavioural self-management skills.

Mindfulness Meditations for Aggressive Behaviour

Several simple mindfulness-based meditation procedures have been trialled to help children and adolescents self-manage their aggressive behaviour   The youngsters were taught the meditations and then encouraged to practice independently on a daily basis.


 * Soles of The Feet Meditation: teaching children to shift attention from aggressive external situations to the soles of their feet, a neutral place in the body
 * Surfing the Urge Meditation: a meditation involving the use of breathing, to ‘ride out’ on the waves of their aggression and refrain from giving in to the urge to be aggressive
 * SOBER Breathing Space Meditation: training to notice a rise in anger and then how to implement the SOBER breathing meditation. SOBER is an acronym for Stop and be aware of physical and emotional changes, Breathe by bringing attention to breath, Expand awareness to the situation and possible responses, Respond mindfully. This meditation is most commonly used in addiction treatment, but the researchers suggest that it may be applicable to other high-risk situations as it provides a way of quickly regulating emotions and behaviour

Research
The results of a series of case studies implementing these strategies showed a significant reduction in aggressive behaviours. These positive effects were maintained at three-to-four year follow up for the ‘soles-of-the-feet’ meditation. The use of ‘surfing-the-urge’ was reported to have long-term positive effects and resulted in the discontinuation of adolescent’s psychotropic medication. The SOBER breathing space meditation produced reductions in aggressive behaviour which generalised to the school environment and resulted in the reduction in the use of physical restraint by parents. The authors highlight that the case studies are limited by sample size, with each study ranging from 3 to 6 participants, and propose that larger, higher-quality, studies would be beneficial to increase scientific understanding of the application of mindfulness in this context.

Mindful Parenting Interventions
Due to the complex impairments in behaviour, emotion and social interaction characteristic of ASD, parents of these children tend to experience higher levels of stress, distress and anxiety alongside difficulties in parenting. Researchers have explored the application of mindfulness-based interventions to improving psychological and physical well-being in parents of children with ASD.

In addition to reducing stress and anxiety, mindfulness-based interventions aim to foster awareness and self-compassion and provide skills to respond with more mastery and less reactivity to stressful situations. Adapted mindfulness interventions focus on mindful parenting to help bring these skills to child-care practices.

Common components of mindfulness-based parental programmes include:


 * Exploring breathing and bodily sensations
 * Fostering present-moment awareness, including awareness of automatic reactions to child behaviour
 * Cultivating increased acceptance and self-compassion to both oneself and parenting practices
 * Exploration of mental states and emotion
 * Learning to cope with stress and stressful situations specific to parenting
 * Some programmes integrate ASD specific examples, such as meditation on dealing with a frustrated child
 * Home practice including meditation and the application of mindfulness to challenging parenting situations

Research
Systematic review of research looking at mindfulness and well-being in the parents of those with autism is supportive of the of the use of mindfulness interventions in this context. However, it notes that the evidence-base is limited, and proposes that further research is required to expand scientific understanding. Since this review, further studies have been conducted and included within the summary of the research findings below.

Changes in Parental well-being

Multiple studies have found improvements in stress, distress and quality of life following mindfulness-based parenting interventions for those caring for children with ASD. One study found reduced levels of cortisol, the stress hormone, in parents of children with ASD when compared to those with typically developed children, following intervention. A comparative study found that mindfulness-based intervention was more effective at decreasing psychological distress than a support and information group in parents of children with ASD and other developmental disabilities. The results of this body of literature were not consistent across all outcomes measures and benefits to parent’s well-being and parenting skills varied across studies, as highlighted by systematic review.

Changes in Child Behaviours

Mindfulness interventions running parallel programmes for both youngster and parents have been found to reduce children’s problem behaviours, improve social responsiveness and communication, and increase parents well-being in some cases. The results of this preliminary research was not consistent across the participants studied and some benefits were not maintained following the end of the intervention.

Mindfulness-based parenting interventions have been paired with positive behaviour support resulting in a decrease in aggressive behaviours and non-compliance in children with ASD. Other research looking at a differently structured mindful parenting course, found that despite improvements in parental well-being, children’s problem behaviours did not change.

Changes in Parenting and Parenting beliefs

Mindful-parenting interventions have shown some changes to parenting and parenting beliefs. One study asked parents to self-report on various aspects of their behaviour and experience and found that a mindful-parenting intervention reduced their over-reactivity and stress about their competence as a parent. Another study found no decrease in over-reactivity but improvements in other parenting styles. Research presents conflicting evidence on improvements in parent-child interaction and social communication, some studies have found improvements and others do not.

Potential Mechanisms of Mindfulness
Though there is no definite theory for the mechanisms through which mindfulness may produce it's effects when used to treat those with ASD there are several suggestions put forth by researchers in the field.


 * Improvements of underlying neurocognitive deficits as mindfulness may enhance executive functioning through practising attention regulation
 * Improvements in social communication and interaction as mindfulness is also taught to be used in social situations, aiming to bring more awareness to interactions
 * Increased attention to emotions which may result in an increased understanding of one owns and other’s emotions, something which can be difficult for those with ASD
 * Improved coping abilities through a shift in attitude, increased self-compassion and the ability to observe connections between thoughts, feelings and physical sensations
 * Reduction in stress which may have trickle down effects on other areas of behaviour and well-being