Child and Adolescent Mental Health Volume 17, No. 4, 2012, pp. 195–208 doi:10.1111/j.1475-3588.2011.00643.

Review: The contribution of mindfulness-based

therapies for children and families and proposed
conceptual integration
Paul H. Harnett1 & Sharon Dawe2
1
School of Psychology, University of Queensland, St Lucia, Brisbane, Queensland 4072, Australia.
E-mail: p.harnett@psy.uq.edu.au
2
School of Psychology, Griffith University, Brisbane, Queensland, Australia

Background: Mindfulness is the development of a nonjudgmental accepting awareness of moment-by-

moment experience. Intentionally attending to oneÕs ongoing stream of sensations, thoughts, and emotions as
they arise has a number of benefits, including the ability to react with greater flexibility to events and sustain
attention. Thus the teaching of mindfulness-based skills to children and their carers is a potential means of
improving family relationships and helping children achieve more positive developmental outcomes through
increased ability to sustain attention and manage emotions. We provide a review of recent studies evaluating
mindfulness-based interventions targeting children, adolescents, and families in educational and clinical
settings. Method: Searches were conducted of several databases (including Medline, PsychINFO and Cochrane
Reviews) to identify studies that have evaluated mindfulness-based interventions targeting children, adolescents
or families published since 2009. Results: Twenty-four studies were identified. We conclude that mindfulness-
based interventions are an important addition to the repertoire of existing therapeutic techniques. However,
large-scale, methodologically rigorous studies are lacking. The interventions used in treatment evaluations vary
in both content and dose, the outcomes targeted have varied, and no studies have employed methodology to
investigate mechanisms of change. Conclusions: There is increasing evidence that mindfulness-based thera-
peutic techniques can have a positive impact on a range of outcome variables. A greater understanding of the
mechanisms of change is an important future direction of research. We argue that locating mindfulness-based
therapies targeting children and families within the broader child and family field has greater promise in
improving child and family functioning than viewing mindful parenting as an independent endeavor.

Key Practitioner Message:

• Mindfulness-based interventions hold promise for improving outcomes for children and adolescents
• The number of mindfulness-based interventions being developed and evaluated is increasing rapidly
• There is a need for greater methodological rigor in studies evaluating mindfulness-based therapies
targeting children and adolescents
• Understanding the mechanisms of change is important in the future development of mindfulness-based
family interventions
• Models of mindful parenting have been proposed to guide both research and the clinical application of
mindfulness-based family interventions

Keywords: Mindfulness; child development; parenting; intervention; mechanisms of change

Mindfulness has been described as a process of devel-
oping a nonjudgmental accepting awareness of
moment-by-moment experience (Bishop et al., 2004;
Kabat-Zinn, 2005). This involves intentionally attend-
ing to oneÕs ongoing stream of sensations, thoughts,
and emotions as they arise, without evaluating these
phenomena as good or bad, true or false, healthy or sick
(Baer, 2003). The practice of mindfulness is integral to
Eastern spiritual, philosophical traditions, most nota-
bly Buddhism from which much of the understanding
and practice of mindfulness within Western psycho-
therapies has derived (Kang & Whittingham, 2010).
When integrated into Western psychotherapies, mind-
ful awareness and an accepting attitude toward
moment-to-moment experience is taught as a way of
helping people tolerate psychological and physiological
distress. Insofar as mindfulness can also raise an
individualÕs awareness of positive experiences that
otherwise may not be attended to, mindfulness training
has been used as a means of enhancing emotional well
being and life satisfaction (Harnett et al., 2010).
The turn of the century has seen a growing interest in
mindfulness as evidenced by a comprehensive search of
the research literature with the term ÔmindfulnessÕ. In
1990, a search of 30 databases across multiple disci-
plines resulted in 27 hits, when all publication types

 2012 The Authors. Child and Adolescent Mental Health  2012 Association for Child and Adolescent Mental Health.
Published by Blackwell Publishing, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main St, Malden, MA 02148, USA
196 Paul H. Harnett & S. Dawe
(journal articles, book reviews, and dissertations) were
included. For the year 2010 the same search resulted in
1060 hits. Of particular interest for the current article
was the increase in the number of peer-reviewed arti-
cles on mindfulness focusing on children, adolescents
or families. Seven were found in 1990 compared to 55 in
2009 and 116 hits one year later (see Figure 1). With
this rapid escalation of interest in mindfulness, it is
timely to consider how the concept of mindfulness can
contribute to efforts to improve child and family func-
tioning.
In this article, we first provide a review of intervention
studies published since 2009. We then consider whe-
ther the teaching of mindfulness skills has the potential
to contribute to the treatment of child and family
functioning more broadly than has been attempted to
date. We do so by considering the potential role of
mindfulness in the light of an integrated theoretical
framework for working therapeutically with families.
Method
The review builds upon a preliminary review of 15 studies
on mindfulness-based approaches with children and ado-
lescents written by Burke (2009). Searches were conducted
in the following electronic data bases: PsychINFO, PSYar-
ticles, Medline, Web of Science, and the Cochrane Library.
Search terms included ÔÔmindfulnessÕÕ, ÔÔmeditationÕÕ
ÔÔMBCTÕÕ, ÔÔMBSRÕÕ, ÔÔchildrenÕÕ, ÔÔadolescentsÕÕ, ÔÔyoung peo-
pleÕÕ, ÔÔfamiliesÕÕ, and ÔÔschoolsÕÕ. Dissertation studies and
conference papers were excluded and only articles written
in English were considered. In examining the quality of the
research evidence we focused on the following: (i) research
design, including descriptive studies such as single-case
designs, nonrandomized designs, studies that had a wait
list control group and finally, as the design with the most
rigorous support, randomized controlled designs; (ii) the
extent to which the measures reflected the theoretical
foundation of the intervention; and (iii) the dose of treat-
ment and the extent to which the treatment was manual-
ized or had a published description that addressed
treatment fidelity (Mercer & Pignotti, 2007).
Results of the literature review
We identified 24 studies published since BurkeÕs review
(2009) targeting children and adolescents that had been
1200
all disciplines-peer reviewed
1000 all disciplines-all publication types
child & family all disciplines-peer reviewed
child & family all disciplines-all publication
800 types
Number of hits
600
400
200
0 in the early adolescent group showed deterioration rel-
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010
Year
Figure 1. Number of hits from database searches of the term
ÔmindfulnessÕ from 1990 to 2010
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Child Adolesc Ment Health 2012; 17(4): 195–208
conducted both in educational settings and with clinical
groups either in the home or in clinical settings. The
school-based studies tended to have a preventative fo-
cus and were generally delivered by teachers specifically
trained in mindfulness procedures. The interventions
evaluated in the school setting included programs for
the children themselves and programs aimed at
improving child outcomes by teaching mindfulness
skills to teachers, carers or parents (e.g., Coatsworth,
Duncan, Greenberg, & Nix, 2010; Duncan, Coatsworth,
& Greenberg, 2009b). Two studies focused on reducing
psychological distress of the teachers rather than chil-
dren (Franco, Manas, Cangas, Moreno, & Gallego, 2010;
Gold et al., 2010). A second group of studies used
mindfulness-based strategies within clinical settings
where children and young people were referred with an
existing psychological disorder or identified as high risk
for a stress-related physical disorder. While we have
grouped the review into school-based and clinical set-
tings, many of the techniques used to improve child
outcomes were common to both types of studies.
Mindfulness-based interventions delivered in
educational settings
Mindfulness-based interventions have been delivered in
educational settings with both pupils and teachers (see
Table 1). When considering those with a focus on
improving emotional well being in children, Joyce,
Etty-Leal, Zazryn, Hamilton, and Hassed (2010) report
pre- and post-group differences in children aged 10–
13 years on measures of behavior problems and
depression. The 10-week program delivered by teachers
lead to a significant reduction in self-reported behav-
ioral problems and depression scores at post-treat-
ment. However, the gains were mainly limited to
students showing clinically significant scores at pre-
intervention. Targeting older adolescents, Broderick
and Metz (2009) reported a study that involved a
curriculum-based program delivered over six lessons.
Using a non-randomized design with a small compari-
son group of younger school children, the authors
reported a decrease in negative affect and an increase in
feeling calm, relaxed, and self-accepting. Notably,
however, there were no changes in any of the other
measures including rumination, somatization and a
well-established measure of emotional regulation – a
key construct targeted in mindfulness interventions.
Mixed findings were also reported by Schonert-Reichl
and Lawlor (2010) in a study that included both a wait
list control and measures of treatment fidelity in a large
sample of fourth to seventh grade children. The mind-
fulness-based program, delivered by teachers, involved
10 lessons and three times daily practice of mindful-
ness meditation. Overall, there was a significant
increase in scores on self-report measures of optimism
(part of a larger scale focusing on resilience) and a trend
toward an increase in positive emotions. There was no
change in self-reported negative affect. An unusual
finding was that students in the preadolescent group
showed an improvement in self-concept, while students
ative to controls. Teacher reports showed an improve-
ment in social and emotional competence for children in
the intervention group, and a decrease in aggression
and oppositional behavior, although the lack of
 Table 1. Summary of mindfulness-based intervention studies in educational settings

Participant Study Research Control

Study N Type Age(years) Setting design Treatment group group DV Results

Studies targeting school students

Joyce et al., 2010 175 Year 5 and 10–13 years Classroom Pre test post-test 10 · 45 min sessions None Self-report: < in child behavior
6 primary (7.5 hr) based on MBSR child problems
school students behavior for high and low
problems; scorers; <
depression; in depression for high
scorers only; > in
prosocial
functioning for low
scorers only.
Broderick & 120 All students of 17.4 years Classroom 2 group pre test 6 · 30 min sessions (3 hr) Junior school Self-report: < in negative affect; > in
doi:10.1111/j.1475-3588.2011.00643.x

Metz, 2009 a senior post-test of the Learning to students affect; feeling calm/relaxed/
high BREATHE based on MBSR (n = 17) emotional self-accepting; No change
school class regulation; in emotional regulation,
rumination; rumination or
somatization somatization.
Schonert-Reichl & 246 4th–7th grade 11.4 years Classroom Quasi-experimental 10 · 40–50 min weekly Wait list Self-report: > in self-reported
Lawlor, 2010 students control group pre sessions (7.5 hr) optimism; optimism
test post-test :mindfulness, self- school and and positive affect for all
regulation, goal setting, general students; no change in
learned optimism; self-concept; negative affect; > in
plus 3 · 3 min daily positive self-reported general
mindfulness practice and negative self concept for pre
affect. adolescents only. > in
teacher report: teacher report of
social and attention, emotional
emotional regulation, social and
competence emotional competence; <
in teacher report of
aggression and
oppositional behavior.
Mendelson 97 Fourth and 9–10 years School 2 group RCT pre 12 · 45 min sessions (9 hr) No treatment Self-report: Good retention and
et al., 2010 fifth grade test post-test of mindfulness and yoga involuntary acceptability of program
students responses to students and
to stress; teachers; < in rumination,
depression; intrusive thoughts and
peer and emotional arousal; no
school change in positive or
relationships; negative affect,

 2012 The Authors. Child and Adolescent Mental Health  2012 Association for Child and Adolescent Mental Health.
affect depression,
or relationships with
peers and teachers;
trend toward
Mindfulness-based therapies for families

greater trust in friends.

197
 198

Table 1. Continued

Participant Study Research Control

Study N Type Age(years) Setting design Treatment group group DV Results

Liehr & Diaz, 2010 18 Minority 9.5 years School 2 group RCT pre 10 · 15 min sessions daily Health Self-report: < in depression in
children test post-test for 2 weeks (2.5 hr) of education depression; intervention
attention to breath, anxiety group only; < in
mindful movement anxiety in
and generosity. both intervention and
Paul H. Harnett & S. Dawe

control group.
Semple et al., 2010 25 Children 9–13 School RCT 12 · 90 min weekly sessions Waitlist Attention; < in attention
struggling (18 hr) MBCT for children anxiety; problems; <
academically behavior in anxiety, but
no group
differences; < in
behavior
problems, but
no group
differences.
Gregoski et al., 2011 166 Afro-American 15 years School and 3 group RCT pre 12 · weekly (10 min Heath Physiological: BAM group showed
adolescents home test post-test weekdays, 20 mins education; ambulatory greatest improvement
at risk of weekends; life skills diastolic in systolic blood
cardio-vascular 14 hr total; BAM) training blood pressure; BAM group
disease taken from MBSR pressure; showed greater
overnight reduction in diastolic
sodium blood pressure and
excretion; heart rate compared to
self-report: LST; No change in
perceived perceived stress.
stress
Studies targeting parents, carers or teachers
Singh et al., 2010 3 African American Care-givers Home Multiple-baseline 7 session mindfulness None Number of non- Training carers in
caregivers own across participants training compliant mindfulness in group
children provided to carers responses home setting lead to
aged 9–16 to work made by < in non-compliant
with individuals in children responses in carers
their care own children.
Duncan et al., 5 Families of nine 11.5 years School Uncontrolled pilot 7 · 2-hr sessions None Parent report: Qualitative feedback
2009b children in study (14 hr; MSFP) qualitative showing usefulness
6th grade feedback and acceptability
of MSFP to parents.

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Child Adolesc Ment Health 2012; 17(4): 195–208
 Table 1. Continued

Participant Study Research Control

Study N Type Age(years) Setting design Treatment group group DV Results
th th
Coatsworth 65 Families of 5 –7 Child 11.7 School 3-group RCT (stratified 7 · 2-hr sessions 1)7 · 2-hr 2) Parent report: > in parental report
et al., 2010 grade students years; by school district) (14 hr) of wait list mindful of mindful parenting
transitioning mother 39.4 pre test post-test (MSFP) - parents control parenting; in MSFP group; > use
from elementary years and youth Child of effective child
school both involved management management practices
in sessions strategies; in both SFP and
Maternal MSFP groups. > in
anger and youth report of
affect parental
toward child discipline consistency
Youth in MSFP group.
doi:10.1111/j.1475-3588.2011.00643.x

report:
discipline
consistency
Gold et al., 2010 11 Qualified 20–50 years School Pre test post-test 8 · 2.5 hr weekly None Psychological < in depression, stress,
teachers sessions distress, but not anixety; > in
teaching (25 hr) of a mindfulness Ôaccept without
assistants mindfulness judgmentÕ
course taught by MBSR scale, but not other
teacher scales of the KIMS.
Franco et al., 68 Secondary school 24–58 years School Pre test post-test 10 · 1.5 hr sessions (15 hr) Listening Psychological < in psychological
2010 teachers of mindfulness program to relaxing distress distress
music
Jennings et al., 31 & 39 Teachers Mean age School Study 1: pre test Two day weekend Study 1: none Teacher Study 1 < in time
2011 - reported working in teachers post-test Study 2; workshop, Study 2: self-report: urgency; >
2 studies a high-poverty was 40 waitlist control phone coaching and waitlist well being; in mindfulness. No
urban setting (study 1); one day workshop - The depression; change
(study 1) and mean Cultivating Awareness time in wellbeing,
student teachers age of and Resilience in urgency; depression,
working in a student Education physical physical symptoms,
semi-rural/ teachers (CARE) professional symptoms; motivation
suburban was 21 development program motivation orientation
college (Study 2) orientation; or teacher efficacy.
town setting teacher Study 2 > in
(study 2) efficacy; motivation
mindfulness. orientation (support
Observations: student autonomy); >
classroom in teacher efficacy. No
climate difference in

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(study 2 only) wellbeing,
depression, physical
symptoms, mindfulness
or classroom climate.
Mindfulness-based therapies for families

MBSR, Mindfulness Based Stress Reduction; MBCT, Mindfulness Based Cognitive Therapy; BAM, Breathing Awareness Meditation; MSFP Mindfulness-Enhanced Strengthening
Families Program; KIMS, Kentucky Inventory of Mindfulness Skills. < indicates decrease in outcome; > indicates increase in outcome.
199
200 Paul H. Harnett & S. Dawe
independent ratings raises concerns about the reliability
of these findings. Mendelson et al. (2010) employed a
mindfulness-based intervention to improve self-regula-
tory capacities in fourth and fifth grade children from
disadvantaged backgrounds. The current intervention
included yoga-based physical activity, breathing tech-
niques and guided mindfulness practice designed to
help children manage arousal and stress levels. Ran-
domization occurred at the school level with two schools
receiving the intervention four days per week for
12 weeks while the other two schools served as wait list
controls. The treatment was acceptable to both students
and teachers and some significant reductions were
found in the subscales and total score on a measure of
involuntary response to stress. No effects were found on
negative or positive affect, depression or peer relation-
ships, although a trend was noted for greater trust in
friends.
There has been one small randomized trial in which a
mindfulness-based intervention was compared to an
active intervention focusing on improving depression
and anxiety (Liehr & Diaz, 2010). In this study involving
18 children, minority and disadvantaged children re-
cruited from a summer camp were randomly assigned
to either a mindfulness-based intervention or to heath
education. Children attended ten 15 min classes of
mindful breathing and mindful movement over two
weeks. There was a significant reduction in depression
symptoms for those in the mindfulness group and a
reduction in anxiety for both groups, in the immediate
post-treatment follow up. Using a waitlist control,
Semple et al. (2010) assessed the impact of a 12-week
group program based on mindfulness-based cognitive
therapy in children who were struggling academically.
The authors proposed that anxiety influences attention,
which in turn impacts academic performance. Signifi-
cant improvements were found on measures of atten-
tion compared to the wait list. There were reductions in
anxiety and behavior problems, although no group dif-
ferences at posttest or follow-up. While the authorÕs
suggestion that mindfulness served to enhance self-
management of attention and emotion regulation was
supported, whether this, in turn, influenced academic
performance was not tested. One randomized study
investigated the impact of mindful breathing meditation
on 166 Afro-American adolescents at risk of cardio-
vascular disease (Gregoski, Barnes, Tingen, Harshfield,
& Treiber, 2011). Three-month interventions were of-
fered in two high schools during regular health educa-
tion classes. The interventions were delivered by
teachers who were each randomly assigned to deliver
one of the interventions. The teachers were provided
with training in an intervention and treatment fidelity
measures assessed adherence to treatment. Breathing
awareness meditation produced greater reductions in
systolic blood pressure compared to Life Skills Training
(LST) or the usual Health Education program. Partici-
pants taught breathing meditation also showed greater
reductions for 24 hr diastolic blood pressure and heart
rate compared to LST.
Six studies reported interventions that targeted the
parents, carers or teachers of children. Singh et al.
(2010) investigated the transfer of mindfulness skills
following mindfulness training of carers in a group
home for individuals with severe physical and intellec-
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Child Adolesc Ment Health 2012; 17(4): 195–208
tual disabilities. Records were kept of non-compliant
responses by the carersÕ own children. Results showed
that the mindfulness training they received in the work
context transferred to the home context, demonstrated
by a reduction in noncompliant responses by the carers
children. A small pilot study involving five families
reported by Duncan et al. (2009b) described a modifi-
cation of the Strengthening Families Program (SFP), an
evidence-based, universal, family focused intervention
designed to reduce risk factors and enhance protective
factors as a means of preventing adolescent substance
use and problem behaviors. The modifications included
teaching the principles of mindfulness and specific
mindfulness practices such as mindful breathing.
Results were limited to positive qualitative feedback.
However, in a larger scale study, Coatsworth et al.
(2010) found the addition of the mindfulness compo-
nent in MSFP resulted in improvements on a newly
developed measure of mindful parenting, while the
youths reported their parents to be more consistent in
their use of discipline. Two studies targeting teachers
found that a course in mindfulness lead to reduced
psychological distress for those who participated
(Franco et al., 2010; Gold et al., 2010). Jennings et al.
(2011) found mixed support for the Cultivating Aware-
ness and Resilience in Education (CARE) professional
development program designed to reduce teachersÕ
distress and promote improvements in teachersÕ well
being, motivational orientation/efficacy, and mindful-
ness. A significant increase in mindfulness was found
in only one of the two studies reported. One study found
a decrease in teacherÕs sense of time urgency, sug-
gesting that teachers experienced less stress associated
with time demands after participating in the program.
The increase in mindfulness was found when CARE was
offered to a group of experienced teachers working in an
urban district with high levels of poverty, a high pro-
portion of at-risk students and a context of limited
institutional support. CARE was designed for teachers
working in the context of high emotional stress that can
lead to emotional reactivity in the classroom. The pro-
gram did not appear to be relevant to a group of student
teachers and mentors working in a less stressful semi-
rural setting with few at risk students and effective
institutional support.
On balance there is reasonable cause for optimism
when considering whether to include mindfulness-
based approaches within an existing school curriculum
and targeting both students and teachers. Positive
mood does appear to be increased while more tradi-
tional measures of mood symptoms in particular
depression, show reductions. What is clearly needed,
however, is a clearer understanding of what treatment
should consist of and the dose of treatment that is
necessary to effect change given the considerable vari-
ability noted across the studies reviewed above. Vari-
ability in outcome measures and methodological
limitations of studies, which are discussed in more
detail below, limit conclusions that can be drawn.
Mindfulness-based interventions delivered in
clinical settings
Single case studies have been conducted by Singh and
colleagues using meditation-based strategies to reduce
aggressive behavior in young people with autism or
doi:10.1111/j.1475-3588.2011.00643.x
Asperger syndrome (Singh, Lancioni, Manikam, et al.
2011; Singh, Lancioni, Singh, et al. 2011). In these
studies mothers, after being trained in a meditative
procedure, taught their children to redirect attention
from an aggression-triggering event to a neutral body
part – the soles of their feet. In both studies parents and
siblings reported a decrease in the frequency of
aggressive incidents suggesting that the adolescents
with developmental disorders can learn, and effectively
use, a mindfulness-based procedure to self-manage
their physical aggression.
Several studies reported on the effectiveness of
mindfulness-based treatments incorporated into either
an existing treatment process or delivered as a stand-
alone treatment in clinical populations. Britton et al.
(2010) conducted a prospective uncontrolled clinical
trial of 55 adolescents who had been recent inpatients
receiving substance abuse treatment. Six 90 min group
sessions based on MBSR aimed to improve sleep with
the rationale that poor sleep contributes to mood
problems, which in turn may increase the risk of
relapse to substance use. Outcomes were emotional
distress, relapse and substance use measured across
60 weeks. Completion (defined as attendance at 4 of 6
sessions) was poor (42%) and substance use increased
across the group. There were, however, significant
improvements on measures of emotional distress with a
trend favoring those who were classified as completers
and a reduction in daytime sleepiness for those who
completed the program. A study of youth who were
either HIV infected or Ôat riskÕ who were attending a
pediatric primary care clinic investigated the impact of
an MBSR program on health-related quality of life and
psychological distress. Youth self-reports found a sta-
tistically significant decrease in hostility and general
and emotional discomfort. However, significant
improvement was found on only three of 18-subscales.
A small-scale uncontrolled trail of a mindfulness-based
program for adolescents diagnosed with ADHD found
little change on a variety of measures (van de Weijer-
Bergsma, Formsma, Bruin, & Bögels, 2011). While
there was some improvement in the adolescentsÕ
behavior and attention, and some reduction of parent-
ing stress in fathers and overreactivity in mothers,
these changes were not reported by all informants and
were generally not sustained at follow-up. However, the
study was very small, with data from only eight partic-
ipants available for analysis. Thus, the statistical power
to detect change was very low.
Two randomized controlled trials compared mind-
fulness-based treatment with an active alternative
treatment. In a small study of depressed adolescents,
Hayes, Boyd, and Sewell (2011) found that an adapta-
tion of Acceptance and Commitment Therapy for ado-
lescents produced greater decreases in a measure of
depression compared to treatment as usual (cognitive
behavioral therapy). There were also decreases in
behavior problems, although this difference was not
significantly greater for the ACT condition. Finally,
Catani and colleagues investigated the effectiveness of
meditation-relaxation compared to narrative exposure
therapy in traumatized children living in refugee camps
in Sri Lanka (Catani et al., 2009). The latter treatment
protocol was designed specifically for people who have
been exposed to enduring trauma associated with war
 2012 The Authors. Child and Adolescent Mental Health  2012 Association for Child and Adolescent Mental Health.
Mindfulness-based therapies for families 201
and torture. Treatment was delivered by local therapists
trained in the two models. Treatment duration was of
equal length (six 60–90 min sessions over two weeks).
Follow up occurred 4–5 weeks and again 6 months later
by interviewers blind to the treatment condition. While
there were no differences between the two treatments,
the reductions in post-traumatic symptoms were
striking, with recovery rates of 81% for the narrative
exposure group and 71% for the meditation relaxation
group post-treatment. The improvements were main-
tained at 6 months. Oord, Bögels, and Peijnenburg
(2011) reported on a randomized controlled trial with a
short (8 weeks) follow-up period. The study evaluated
an 8-week mindfulness course for children displaying
symptoms of ADHD that included a parallel course for
parents. Statistically significant changes between pre-
and post-intervention included a decrease in both child
and parent ADHD symptoms and an increase in
parental mindfulness as measured by the Mindfulness
Attention and Awareness Scale. No changes were
observed in parenting stress or parenting style. At fol-
low-up, the reduced levels of ADHD symptoms
remained for both children and parents. A reduction
was found in over-reactive parenting and parental
stress between the pre-intervention and follow-up
assessment. However, mindfulness scores did not vary
between pre-intervention and follow-up.
Our own work in this area has involved the evalua-
tion of an intensive home visiting program focusing on
multiproblem families characterized by emotional dys-
regulation, maternal psychopathology, and substance
abuse. The program, Parents Under Pressure (PuP), is
based on the premise that sensitive and responsive
parenting requires emotional regulation skills that are
generally dysfunctional in parents with a history of
trauma or psychopathology, including substance mis-
use and mood disorders. Thus the program draws from
the recent literature on emotional regulation with an
explicit adaption of mindfulness strategies integrated
with parenting skills. The PuP program has been eval-
uated in three separate case studys (Dawe, Harnett,
Rendalls, & Staiger, 2003; Frye & Dawe, 2008; Harnett
& Dawe, 2008) and one randomized controlled trial
(Dawe & Harnett, 2007). These studies found a reduc-
tion in child abuse potential as well as reductions in
maternal mood difficulties and parenting stress. Nota-
bly, the studies did not directly measure mindful par-
enting or parental emotional regulation capacity. As in
other studies, measures of mood were used as proxy
measures of this.
Overall, the studies carried out in clinical settings,
like those in educational settings, justify optimism for
the potential of mindfulness based therapies to improve
child, adolescent and family functioning. In addition to
the efficacy of programs that deliver interventions
directly to children and adolescents, programs that
target parents and carers appear to be effective in
improving parental functioning, and in turn, promote
positive child outcomes.
Methodological limitations
While the majority of the studies reviewed were pilot
studies that had a range of methodological problems, a
small number of studies have been randomized control
trials. Thus, some caution needs to be exercised when
 202
Table 2. Summary of mindfulness-based intervention studies in clinical settings

Participant Location of Research Treatment Comparison

Study N Type Age intervention design group treatment DV Results

Singh, Lancioni, 3 Adolescents 13–18 Home Multiple-baseline 17–24 weeks of None Number of aggressive < in aggressive incidents
Singh et al., with across ÔMeditation on incidents maintained over 4 years.
2011a Asperger participants the Soles of the FeetÕ
Syndrome
Lancioni, 3 Adolescents 14–17 Home Multiple-baseline 5 days of training in None Number of aggressive < in aggressive incidents
Manikam, with Autism across Meditation on incidents maintained over 3 years.
Singh et al., participants the Soles of the Feet
2011a
Paul H. Harnett & S. Dawe

Britton et al., 55 Adolescents 16.4 Outpatient Pre-post 6 · 90 min weekly None Self-report: emotional > in substance use; < in
2010 with sleep (SD = 1.2) group sessions (9 hr) distress; relapse emotional distress;< in
problems modified (MBSR) resistance; substance use daytime sleepiness for
following and CBT completers only.
substance
abuse
treatment
Sibinga et al., 33 HIV-infected 13–21 Pediatric Pre-post 8 · ? weekly sessions None Self-report: health related < in one of nine domains
2011 and at-risk primary based on MBRS. quality of life; of psychological distress
youth care hospital psychological distress (hostility); > in two of
clinic nine domains of quality
of life (general and
emotional discomfort).
van de Weijer- 10 Adolescents 11–15 Academic Pre-post with 8 · 90 min weekly group None Adolescent report: behavior; < in externalizing
Bergsma et al., with ADHD treatment 8 week mindfulness sessions for executive functioning; behavior problems
2011 center followup adolescents. Eight mindfulness; fatigue; reported by fathers
parallel sessions with happiness; attention. only; < in executive
parents. Mother and father report: functioning problems
behavior; mindfulness; reported by fathers
parenting style; parenting only; > in some
Stress. Teacher report: behavior aspects of attention,
but overall no change;
no change in
adolescent internalizing,
attention problems.
fatigue or happiness;
no change in
adolescent or parent
mindfulness; < in
parenting stress for
fathers but not
mothers at post but
nor follow-up; < in
mothers overreactivity
at post but not follow-up

 2012 The Authors. Child and Adolescent Mental Health  2012 Association for Child and Adolescent Mental Health.
Child Adolesc Ment Health 2012; 17(4): 195–208
 Table 2. Continued

Participant Location of Research Treatment Comparison

Study N Type Age intervention design group treatment DV Results

Hayes et al., 38 Adolescents 12–18 Outpatient RCT ACT -individual sessions TAU-manualized Depression, Emotional and < in depression greater
2011 experiencing psychiatric using published CBT provided by behavioral functioning for ACT than TAU;
moderate clinic treatment manuals the psychiatric greater proportion of
to severe service ACT condition showed
depressive clinically significant
symptoms change in depression;
no change in behavioral
problems.
Catani et al., 31 Children 8–14 Community - RCT 6 sessions Meditation- 6 sessions PTSD symptoms < PTSD symptoms at
doi:10.1111/j.1475-3588.2011.00643.x

2009 affected by transitory relaxation Narrative 1 month for both

tsunami in camp Exposure groups.
northeastern Therapy
Sri Lanka
Oord et al., 22 Children with 8–12 Outpatient Waitlist 8 · 90 min weekly group none Parent report: parenting stress; Pre-post change: < parent
2011 ADHD and mental control; 8 sessions for parents based parenting style; mindful reported child ADHD
their parents health clinic week on MBCBT and awareness; parent ADHD symptoms; < parent
follow-up MBSR.Parallel sessions symptoms. Parent & teacher ADHD symptoms; >
with children. report: child ADHD symptoms; Mindful awareness of
child behavior problems. parents; no change in
parenting stress or
parenting style.
Pre-Follow-up change:
< child ADHD symptoms;
< parent ADHD
symptoms; < parenting
stress; < in over-reactive
parenting style; no
change in parental
mindful awareness.
Dawe et al., 12 Families on 4 years In home, Single case 12 sessions · 1.5 hr/per None Parent report: parenting 9 of 12 completed
2003 methadone parents study, pre session stress, child program, reduction in
maintenance referred by post-measures abuse potential, child behavior variables measured
community problems, drug use, alcohol use, found for 6/7 of the
methadone Risk taking behavior families except risk
clinic behaviors where only
three showed a decrease
Harnett & 10 Families <8 In home, Single case study, Mean number of None Parent report: parenting stress, All 10 families were

 2012 The Authors. Child and Adolescent Mental Health  2012 Association for Child and Adolescent Mental Health.
Dawe, 2008 referred by pre post- sessions 11.5 mood, child abuse potential, followed up. Significant
child protection measures (range 9–13) child behavior problems, social < on all measures
services support pre-post, 2 of 10 families
showed no change on
Mindfulness-based therapies for families

any domain.
203
204 Paul H. Harnett & S. Dawe Child Adolesc Ment Health 2012; 17(4): 195–208

8 remained in treatment,
considering the balance of evidence for including
mindfulness into interventions for children and fami-

measures at 3 month

child abuse potential

child behavior Methadone dose, group, significant <
Significant < on all
lies. The heterogeneity of the populations in which

intervention, > on
potential for brief
Significant < on all
measures for PuP
studies have been conducted makes it difficult to build
Results

on child abuse

in TAU group
a consistent picture of efficacy, although arguably does
follow up speak to the issue of generalizability. Related to
the issue of diversity in populations studies is the
range of outcome measures adopted, again leading to
little consistency to allow for a more measured apprai-
sal of the benefits of mindfulness. The dimensions
Parent report: parenting stress,

Mean number of sessions TAU, 2 sessions Parent report: parenting stress,

of functioning measured included behavioral

mood, child abuse potential,

mood, child abuse potential,

(internalizing and externalizing problems), emotional

(psychological distress, emotional regulation), cognitive
(rumination, attention, self concept) social (peer func-
tioning, relationship with parents), child abuse poten-
DV

tial and health (blood pressure). Only a small number of

child behavior

studies measured the construct of mindfulness itself,

which is largely explained by the lack of a suitable
instrument to measure mindfulness in young people
over the period the studies were conducted. Only
recently has a promising measure been described in the
literature (Greco, Baer, & Smith, 2011). While the
on parenting
Comparison

information
clinic based

interventions being evaluated can be classified as

treatment

Ômindfulness-basedÕ, there was in fact a large variation

in both the content and dose of the interventions eval-
None

uated. In around half of the studies, the intervention

involved an adaptation of the Mindfulness Based Stress
MBSR, Mindfulness Based Stress Reduction; ACT, Acceptance and Commitment Therapy; TAU, treatment as usual.

Reduction program (Kabat-Zinn, 2003), although there

sessions for treatment

was no single agreed adaptation of this program. Other

programs adapted included Mindfulness Based Cogni-
Treatment

Mean number of

tive Therapy and Acceptance and Commitment Therapy

group

10.5 (SD = 2.9)

for PuP group
post- & 3-month completers 20
(range 11–38)

– programs that have differing theoretical underpin-

nings and were developed for adults. The adaptations
described for use with children and adolescents were
generally practical concerns (e.g., shorter duration
sessions for children with limited attention spans)
< indicates significant decrease in outcome; > indicates significant increase in outcome.

rather than adaptations informed by models of child

development and family functioning. In general, the
Research

Randomized
design

sample size of the studies reviewed was small, com-

controlled
study, pre
Single case

follow up
measures

promising the power to detect changes in participant

functioning. Most studies assessed only the short-term
trial

impact of interventions using pre-post designs. When

follow-up assessments were included they were gener-
by community

ally short (around 8 weeks). Thus it is not possible to

intervention
Location of

methadone
12 Women offenders 5.6 years In home or

determine how enduring the treatment effects may be

referred
3.5 years In home,
security

parents

both in the presence and absence of ongoing meditative

in low

prison

clinic

practice. A primary concern was the lack of focus on

evaluation mechanisms of change, a point we turn to
next.
Age

Parental mindfulness and proposed

mechanisms of change
Participant

maintenance

Despite the methodological limitations, sufficient

just released

methadone
security or
Type

64 Families on

studies showed evidence that mindfulness-based tech-

niques led to positive changes to justify optimism for
in low

the inclusion of mindfulness-based techniques as part

of a practitionerÕs therapeutic repertoire for treating
Table 2. Continued

children and families. However, we see a problem for

N

the field to be the proliferation of Ômindfulness-basedÕ

Harnett, 2007

interventions targeting children and families that vary

Frye & Dawe

both in content and dose, as well as their theoretical

Dawe &

underpinnings. Kazdin has persuasively argued that

Study

the emphasis of research in the child and family field

should be on developing a greater understanding of the

 2012 The Authors. Child and Adolescent Mental Health  2012 Association for Child and Adolescent Mental Health.
doi:10.1111/j.1475-3588.2011.00643.x
active ingredients of programs if any are to be optimally
effective (Kazdin, 2007; Kazdin & Nock, 2003). While
ÔmindfulnessÕ as a psychological construct is assumed
to be responsible for improved outcomes, this was not
systematically investigated in any of the studies above.
One obstacle for research on mechanisms of change is
the lack of psychometrically sound measures of the
construct of ÔmindfulnessÕ as it relates to parents and
children. We note that two measures are in develop-
ment that will help to facilitate such research in the
future (Coatsworth, Duncan, Greenberg, & Nix, 2009;
Greco et al., 2011). However, another obstacle has been
the lack of an agreed model of mindful parenting to
guide research on mechanisms of change. An important
development, then, are recent attempts to identify the
mechanisms that change as a consequence of improved
parental mindfulness. Duncan, Coatsworth, and
Greenberg (2009a) describe a model of mindful
parenting that focuses on the benefits of mindfulness-
based interventions to enhance the parent-child rela-
tionship. Specifically, the authors suggest that parents
who acquire mindfulness skills will have an enhanced
capacity to listen with full attention (increased sensi-
tivity to the childÕs cues); will adopt a more nonjudg-
mental acceptance of self and child (a balance between
parent-orientated, child-orientated, and relationship
orientating goals); have greater emotional awareness of
self and child (acknowledgment of the childÕs emotional
state and responding to the childÕs needs with less
negative emotions); be better able to self-regulate in the
parenting relationship (maintaining a focus on long
term parental goals and values and avoidance of short-
term automated reactive responses); and display more
compassion for self and child (the expression of more
positive affect toward the child and avoidance of
self-blame in the parenting role). More recently Bögels,
Lehtonen, and Restifo (2010) have argued that mind-
fulness-based interventions improve aspects of atten-
tion, in particular the ability to disengage from
unexpected and emotionally charged stimuli. Integrat-
ing findings from the experimental literature on mind-
fulness, the authors suggest mindfulness-based
parenting interventions may exert their effects by: (a)
reducing parental stress; (b) reducing parental preoc-
cupation resulting from parental and/or child psycho-
pathology; (c) improving parental executive functioning
(in particular reduced impulsivity); (d) reducing the
impact of dysfunctional upbringing schemas and hab-
its; (e) increasing self-nourishing attention; and (f)
improving marital functioning and co-parenting. In a
recent cross-sectional study of Duncan et al.Õs (2009a)
model, Parent et al. (2011) investigated the relationship
between parental mindfulness, parental depression,
positive and negative parenting practices (based on
observations of parent-child interactions) and child
outcomes (internalizing and externalizing problems).
Correlational analyses carried out on the results of 180
families involving 242 children aged 9–15 showed that
parental mindfulness was associated with both inter-
nalizing and externalizing problems of the children.
Regression analyses failed to find that parental
depressive symptoms or positive or negative parenting
behaviors acted as intervening variables to explain
the significant association. While this might suggest
mindfulness has a direct effect on child outcomes, the
 2012 The Authors. Child and Adolescent Mental Health  2012 Association for Child and Adolescent Mental Health.
Mindfulness-based therapies for families 205
authors speculated that other variables not measured
in their study, possibly parental emotion regulation or
adaptive coping skills, might be candidates to explain
the relationship. This conclusion is consistent with the
model of mindful parenting put forward by Duncan
et al.Õs (2009a) and the mechanisms proposed by Bö-
gels et al. (2010); specifically that heightened parental
awareness of their own and their childÕs emotional
states and enhanced parental emotional regulation
skills allow the parent to respond more flexibly to the
child, as opposed to responding with a ÔmindlessÕ
automated negative reactivity.
Placing mindfulness within a broader context
While the ÔmindfulnessÕ of children and parents is a
variable that may prove to be a key factor in adaptive
functioning, there is a danger that a focus on mindful-
ness in isolation from other variables influencing the
development of children and functioning of families
could limit consideration of the full range of variables
that potentially mediate outcomes in treatment. We
suggest the benefits of mindfulness-based interventions
targeting families would be better considered within the
context of an integrated framework of family function-
ing, one that is itself informed by existing models of
child development and family functioning (Cicchetti &
Cohen, 2006; Sameroff, 2010). That is, we suggest that
mindfulness-based interventions may be better con-
sidered as one strategy for obtaining positive outcomes
when working with children and their families rather
than an endeavor in its own right. We present here an
integrated framework (Figure 2) for working with fami-
lies and consider below how mindfulness-based inter-
ventions can sit within and complement other
intervention strategies. Indeed an important implica-
tion of the integrated framework is that changes in
mindfulness can be tested as mediators and modera-
tors of change across multiple domains of functioning.
The integrated framework we propose takes, as its
starting point, the aim of promoting positive child
developmental outcomes across multiple domains of a
childÕs functioning and across time. This is achieved by
targeting both proximal and more distal domains of
family functioning. Those influences most proximal to
a child are (a) the quality of the parent child relation-
ship and (b) how the parent behaves in their parenting
role. In regards to the quality of the parent child rela-
tionship, the framework draws on BiringenÕs work on
emotional availability (Biringen, 2000, 2004). This
model delineates the dimensions of the parent-child
relationship that predict the quality of parent-child
attachment and other child developmental outcomes.
Four dimensions describe the behavior of the parents –
the ability to respond sensitively to the child (sensi-
tivity), provide structure to help the child manage their
emotions and behaviors (structuring), promote auton-
omy (non-intrusiveness); and minimize angry and
hostile interactions (non-hostility). In addition to being
emotionally available, the integrated framework high-
lights the importance of parental values and expecta-
tions of the child as major influences on the choices a
parent make about issues such as their style of disci-
pline, level of child monitoring and importance of
family routines.
206 Paul H. Harnett & S. Dawe
Figure 2. Integrated framework
Critically, however, and an area that typically
receives less focus in many traditional family focused
interventions, the integrated framework suggests that
the extent to which the parentsÕ capacity to be emo-
tionally available and ability to consistently implement
parenting practices based on fair and reasonable values
and expectations is directly influenced by the parentÕs
emotion regulatory capacities. Parents create a social
and emotional climate to which children must learn to
self-regulate, as well as provide the safety net when self-
regulation fails (Sameroff, 2010). High levels of parental
emotional dysregulation results in a high stress envi-
ronment and impairs the parentÕs capacity to be emo-
tionally available. Thus a significant contribution that
mindfulness can make is to provide a therapeutic
approach that may directly enhance this self-regulatory
capacity. However, the integrated framework acknowl-
edges parental functioning and a childÕs development
are affected by multiple influences, including the
resources (or lack of) available to the family, schools,
neighborhoods, culture and economic and political
climate (e.g., Bronfenbrenner, 1986; Sameroff, 2010).
Thus, the ecological context in which the family is
embedded is an important target for therapy – by
helping parents manage those aspects of the social
ecology that are amenable to change, such as managing
life stressors and engaging support.
Mindfulness and the integrated framework
A common theme of the articles reviewed was that
mindfulness leads to greater acceptance of problem
child behavior by parents, carers and teachers that
leads to an increase in the quality of the relationship
with the children in their care. For example, Singh et al.
(2010) speculated that mindfulness training might
produce a transformational change in carers that does
not occur following training in contingency manage-
ment and specific methods of behavior management.
On the contrary, mindfulness training leads to
 2012 The Authors. Child and Adolescent Mental Health  2012 Association for Child and Adolescent Mental Health.
Child Adolesc Ment Health 2012; 17(4): 195–208
nonjudgmental acceptance of problem behavior that is
responded to more favorably by the children in their
care, improving the quality of the carer–child interac-
tions. This was echoed by Coatsworth et al. (2010) who
found changes in parental discipline and monitoring by
mothers in the standard Strengthening Families Pro-
gram was not received well by the youth in their study.
Children whose mothers received mindfulness training
in addition to SFP reported their mothers to be more
consistent in their use of discipline and more likely to
monitor where they were and who they were with.
Children from the SFP group reported slight increases
in motherÕs negative affect directed toward them, while
MSFP children reported a decrease in negative affect
(despite positive affect remaining high throughout).
Mothers in the MSFP condition perceived their children
to display more positive and less negative affect,
whereas mothers in the SFP condition perceived less
positive affect and more negative affect from their chil-
dren. The authors suggested that when disciplinary
strategies are taught in conjunction with mindful par-
enting, parents are able to modulate their emotional
reactivity to their childrenÕs behavior and this may have
contributed to building a closer and more loving rela-
tionship between parent and children (Coatsworth
et al., 2010). Within the school environment Gold et al.
(2010) noted that teachers described the intervention to
be helpful in controlling their stress because they
became more accepting and nonjudging. The authors
report that ÔResponding, not reacting, teaches us to take
controlÕ (p. 188). There is some empirical support for
this suggestion. Two studies by Bluth and Wahler
(2011a,b) tested the hypotheses that mothersÕ everyday
mindfulness would covary inversely with the effort they
put into parenting, that mothersÕ mindfulness will co-
vary inversely with their reports of their childrenÕs
problem behavior, and that mindfulness would mediate
or moderate the correlation between their effort and
their reports of their childrenÕs problem behavior. Par-
enting effort was described as emotionally taxing
doi:10.1111/j.1475-3588.2011.00643.x
struggles parents have when trying to handle chal-
lenging situations with their children, such as reacting
emotionally in the moment rather than disciplining in a
manner more in line with their values. Bluth and
Wahler found that mothers reporting high mindfulness
were less intrusive and more able to avoid the escala-
tion of conflicts with their adolescents (Bluth & Wahler,
2011a) and pre-schoolers (Bluth & Wahler, 2011b)
compared to mothers who were classified as low mind-
fulness. The authors argued that parental mindfulness
has the potential to interrupt or de-escalate a chaotic or
emotionally charged situation. Mindful parents can be
more aware of their habitual patterns of parent-child
interaction, leading to a less reactive and more nuanced
responses, that requires less effort.
Our integrated framework acknowledges the impor-
tant influence of the social ecology within which the
family is embedded. At this level mindfulness-based
therapeutic techniques have a potentially important
role to play. Duncan and Bardacke (2010) in a study of
pregnant women reported that mindfulness training
helped the women cope with stressful aspects of preg-
nancy and family life post-intervention, expanding their
repertoire of skills to cope with contextual demands
such as poverty, major life events, work related stress
and interpersonal tensions (Duncan & Bardacke,
2010). The ability to employ mindfulness skills to pro-
tect against such adversity is worthy of increased
attention given the negative impact of stressors asso-
ciated with low SES on individual and family func-
tioning (McEwen & Gianaros, 2010). In a recent study
Sturge-Apple, Skibo, Rogosch, Ignjatovic, and Heinzel-
man (2011) found that mothers facing the stress of
extremely low social economic status displayed abnor-
mal sympathovagal activity (hyporarousal). This phys-
iological reaction, the result of the need to adjust to
chronic stress, was associated with disengaged and
insensitive interactions with their children during
observations of free play. Importantly, Ganzel, Morris,
and Wethington (2010) have presented evidence point-
ing to the potential of mindfulness-based therapies to
significantly influence the physiological processes
associated with individuals physiological adjustment to
ongoing stress – raising the hope that mindfulness-
based therapies can potentially promote improved
family functioning and child outcomes in socially and
economically disadvantaged families (see Repetti,
Robles, & Reynolds, 2011).
Conclusion
The results of the research conducted thus far suggest
that mindfulness-based techniques have the potential
to improve aspects of individual and family functioning
that are associated with better developmental outcomes
for children and families. However, we argue that the
outcomes of interventions targeting children, adoles-
cents, and families will be most informative if the
mindfulness-based therapeutic techniques are inte-
grated into existing programs that address multiple
domains of family functioning rather than pursued as
an independent endeavor. It is important that the field
avoids continued proliferation of programs and focuses
more on understanding the mechanisms responsible
for change. ÔMindfulnessÕ is emerging as an active
 2012 The Authors. Child and Adolescent Mental Health  2012 Association for Child and Adolescent Mental Health.
Mindfulness-based therapies for families 207
ingredient of interventions, but is unlikely to be the sole
variable responsible for the changes in outcome.
Acknowledgement
This review article was commissioned by the Editors of the
journal, for which the first author received a small honor-
arium towards expenses. The authors have both declared
that they have no competing or potential conflicts of in-
terest arising from the publication of this article.
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Accepted for publication: 9 November 2011
Published online: 17 January 2012
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