Doctor Yoon Suk Hwang is an adjunct fellow at the University of Queensland here in Australia and a practitioner of mindfulness and positive behavioural support. As an author of journal articles, book chapters, and a book, Doctor. Hwang's research interests include applications of mindfulness for empowering individuals with social, emotional, behavioral, and learning difficulties, learning and well-being, students' voices, and engagement and special needs and family support. Welcome, Dr Yoon Suk.

Thank you, Rob. Thank you so much for your kind introduction.

Hello, everyone.

My name is doctor Yoon Suk Hwang. And, yes, I as introduced, I am currently working as a positive behavior support practitioner with the network profit organization and as an adjunct research fellow at University of Queensland. Welcome to the presentation on mindfulness, disability, and mindful support. Next slide, please. K. First of all, I'd like to attribute this presentation to professor who was the founding editor of several journals, including the journal Mindfulness. He was a pioneer of the applications of mindfulness for enhancing the quality of life of people living with developmental disabilities. Without his dedication to this field, this presentation would have not existed. Thank you. Next slide, please.

This presentation has three parts. We will first touch briefly on the concepts and the practices of mindfulness. Second, we will discuss research studies examining the effects of ah, okay. Can you hear me better? Seems like my voice is too soft. How about now? Can you hear me okay? Can you hear me okay now?

I think that's better. Thank you, Yoon Suk. That helps.

Thank you. Okay. So let me, begin again. This presentation has three parts. We will first touch briefly on the concepts and practices of mindfulness. Second, we'll discuss research studies examining the effects of training children, adolescents, and adult adults with different conditions of developmental disabilities in mindfulness. Lastly, we will explore research studies reporting the effects of training key supports of people with developmental disabilities in mindfulness, such as parents and professional carers. Next slide, please. Next one, please. Okay. There are a range of definitions and practices of mindfulness. Mindfulness has been studied and practiced over two thousand years in various traditions. What.

Will be discussed here today about mindfulness is just a tip of an iceberg. So the word mindfulness came from an ancient Indian word sati. Sati means memory of the present. It is about keeping one's consciousness alive to the present experience and reality. So it is a practice of remembering to be here and now. It is also a practice of just being here and now. So there are two styles of practices that are conducive to developing mindfulness. They are serenity and Vipassana. So serenity practice aims to calm and unify the mind. And inside practices, well, inside practice aims to see things as they really are. So using breathing as an example, we may stay with the sensations of breathing in and out repeatedly over time.

Which comes and unifies our mind. When our mind is calm and unified, then it is easier to be aware and to pay attention to what we experience now, including our thoughts and feelings. Breathing has been often used for mindfulness practices because it is always happening here and now. Next slide, please. The most cited definition in research of mindfulness comes from. So, mindfulness, was defined operationally defined as the awareness that emerges through paying attention on purpose in the present moment and nonjudgmentally to the unfolding of experience moment by moment. And, mindfulness in the field of ADHD has been used as a nonpharmacological intervention. Next slide, please. Before we move to the next sections of the presentation.

I would like to share with you the CDC definition of developmental disabilities that I am following in this presentation. So here well, developmental disabilities according to CDC, it's a group of conditions due to an impairment in physical, learning, language, or behavior areas. These conditions begin during the child's developmental period, may impact day to day functioning, and usually last throughout a person's lifetime. Most developmental disabilities begin before a year, before a baby is born, and some can happen after birth because of injury, infection, or other factors. And developmental disabilities include ADHD, autism, intellectual disability, and some other, neurodivergent conditions. The reason I am talk I'm referring to CDC.

Definition of developmental disabilities is I'm going to refer to or talk about different research studies. And, in order to, explain to the participants and the conditions they live with, I think it's better to stick to the CDC definition. Okay. Next slide, please. Okay. We use we usually see three approaches when using mindfulness for supporting people living with, developmental disabilities. First, training people with the developmental disabilities directly in mindfulness. Second, training their key supports in mindfulness, such as their parents, professional carers, or teachers. And the third approach is combining the two by training both people with developmental disabilities and their key supports in mindfulness. Next slide, please.

Okay. There are, mindfulness based intervention studies training children or adults with ADHD in mindfulness. Two frequently reported outcomes were, first, reductions in ADHD symptoms such as hyperactivity, and second, increases in attentional or executive functioning. These outcomes were usually based on self reports. So people live with ADHD conditions learn to practice mindfulness, and then they report, yeah, the what experience they have. And then proxy reports, so, like, parents or teachers of children or adolescents, with ADHD after they observe, their children or their students with ADHD learning to practice mindfulness and then see a change in their behavior, for example, or neurocognitive tasks. And, so in addition to these.

Outcomes, like reductions in ADHD symptoms or increases in attentional functioning. Improved mental health and increases in compliance to mother's requests were also reported. Then there are also studies reporting the effects of training people with intellectual impairment to autism, in mindfulness. And, well, then then with that, the studies reported the successful applications of mindfulness training. Well, there are areas they talked about, like, yes. Mindfulness actually was useful for behavior self management. Also, it was useful and effective for, well, teaching, making a healthy life chain yeah. Lifestyle change exactly, especially for people with, like, Prader Willi syndrome who have difficulties with, like, eating, feeling.

Full after eating, yeah, good amount of food, and then still they may not know that they had enough food, but, yeah, a healthy lifestyle, then controlling overeating and controlling weight, yeah, weight reduction or working on weight reduction. Mindfulness has been used as a self management strategies for this kind of, health issues. Then a common feature of these reported outcomes is that the changes were made from within the participants. So they chose they chose to practice mindfulness. They chose to apply what they have learned to, yeah, in their everyday life. So the last thing, actually, what we can expect to do is making or forcing people to be mindful. And, then can I please, can you please have the next slide? Yes.

This shows, like this is a showcase. It shows how mindfulness can be used for young adults with ADHD, and this is one of the early studies there was done. In this study, a total of 10 young adults with ADHD attended eight weekly training sessions, and each session lasted for about one and a half hours. And they learned and practiced mindfulness in a small group setting with their peers. They learned to focus and enhance attention, awareness, and self control by engaging in a range of mindfulness exercises. For example, they practiced a breathing space to be aware and address the ADHD symptoms, and they practiced it through role play and also homework assignments. When they demonstrated good comply good compliance.

During and after the exercises, it was also positively acknowledged by their trainers. There were usually two two trainers during this study intervention. And, next slide, please. K. Next example study is a seminal one. A 27 year old man with a mild intellectual disability and mental health conditions was at risk of losing his community living arrangement because of his uncontrolled aggressive behavior. He was receiving psychotropic, medication and behavior therapy without much success. He learned to engage in meditation on soles of the feet, which is a mindful, yeah, based practice and procedures. So what he learned, basically, yeah, it's it can be practiced, like, as short as five minutes.

It can be practiced as long as twenty minutes, even longer. Then the the basic structure is first establishing a natural posture and then breathing naturally and cast his mind back to an anger provoking incident and stay with this anger and then shift his attention to the soles of his feet. Stay there until calmness and clarity of mind is established, and then walk away from the situation with a smile on his face. These procedures were taught by the author, the first author of the study, twice a day for five days. And the young man continued to practice the soles of the feet to the degree he managed his aggressive behavior, self managed, and retained his community living arrangement. Next slide, please. Yeah.

It's the second part of the presentation. So let's move on to the studies that are reporting the effects of training parents of children with ADHD in mindfulness. These studies in general provided eight to 12 mindfulness based intervention sessions in a group setting. The concept of mindfulness was taught, and the meditation exercises were practiced, and the importance of, especially, paying attention to parent child interaction was stressed along with mindfulness in everyday life. The reported outcomes of such interventions include improvements in self reported mindful parenting, parenting stress, and interestingly, satisfaction with interactions with their children who have ADHD and their own ADHD symptoms parents own ADHD symptoms.

These studies took, like, a combined approach, meaning training both people with ADHD and their key supports in ADHD. So it is difficult to tell whether positive changes occurred because of the mindfulness training for parents or because of the training mindfulness training for their children with ADHD or both. From a research perspective, it's hard to tell, where the positive change comes from. May be a little bit of an issue. But from a practical side of view, if you live with ADHD or if you're a parent of children, or child living with ADHD, then, actually, it doesn't matter if positive changes occur. It's correct. Next slide, please. Okay. Then from here, we'll talk about the the the, the last interventional approach, which is training.

Only parents or professional carers in mindfulness and then see what kind of change it makes. So an example study is 2014 study, which examined the effects of training 46 parents of young children with developmental delay in mindfulness. And then this study provided a standard eight week mindfulness based stress reduction program, and, the findings include reductions in parental stress and depression in those who practiced mindfulness. And the findings also showed parent reported reductions in their children's, behavioral issues or problems. And, the children with ADHD or no. Actually, develop development delay, they did not learn mindfulness. And, these findings together suggest, like, transactional, relationship.

Between parental stress and child behavior problems and also the importance of self care to care for others. So when mothers or parents of young children with with development delay learned to practice mindfulness, the reported outcomes, yes, it was good for reductions in parent as well as reductions in their children's behavior. And, then well, it shows maybe if parents and children are connected in their problems, it may be they also connected in their well-being. And, so it it was it was a good reminder in terms of, for whatever reason, if we cannot teach our children or young adults in ADHD or other different types of neurodivergent condition, then maybe there is also a way to help them through helping their key supports, parents.

Or professional carers. Then, this approach, like using mindfulness based interventions such as MBSR, mindfulness mindfulness based stress reduction, teaches the ways to reduce one's own stress levels, but does not necessarily teach ways of managing their children's behavior. Then what happens when these two components are combined? The next slide shows what happens. Next slide, please. K. This study examined the effects of providing mindfulness based positive behavior support, training to 47 mothers of young children with autism and behaviors of concern and 45 mothers of young adults with intellectual impairment and behavior of concern. And in m b PBS, the m b part addresses stress reduction and self care in in those matters.

And the PBS part speaks to ways of supporting children with developmental disabilities to self manage their behavior, like physical aggression type of. Then training was provided for three days, learning and practicing concepts and practices of mindfulness and, four sublime states. So four sublime states include loving kindness, compassion, altruistic joy, and equanimity. Practicing those, mental states and also beginner's mind. Yeah. It has a long list of, programs, but they are the examples. Then PBS, positive behavior support. The PBS training included principles, assessment, and designing PBS plans and data collection methods and etcetera. And findings also showed reductions in their children's aggressive and disruptive behavior.

Who did not learn MVPs. Of course, it showed also reductions in mothers' self reported stress, who learned mindful MVPs. So, in this case, again, it shows, yes, we can influence, children or young adults with development delay or development disabilities behavior through supporting mothers and their mothers and, through supporting, their mothers to reduce their stress levels and also ups yeah. By upskilling them to manage their children's behavior and teach them to make more positive, yeah, behavior choice. Then the next slide, please. With this, like, when parents or other kid supports a learning mindfulness, then makes positive change or influence to the care recipients or children's behavior, then we want to know how how it can happen.

So, there is also a study then ex examining the nature of change in care provider and care recipients' interactions after seven days of MBPBS training. And, in this study, MVPBS training occurred over nine weeks, including self practice in between training days. And, carer and client engagements were video recorded and analyzed using microanalysis of partial interval recording methods. I know it's mouthful, and also it's technical. But, basically, what, industry research happened was the care recipients and carers interactions were video recorded for ten minutes, and ten minutes video recording was, divided into one minute segment. And then two behavior analysts actually observed and analyzed.

Whether the engagement between the two parties happened. If so, the quality of engagements and things like that. So the results include in this study, first, increases in caregiver and care recipients in their engagement during learning and leisure activities. And second, decreases in client's challenging behavior. So, yes, the challenging behavior decreased, and, also, the duration and the latency of carers' attention to client challenging behavior were reduced. What it means is carers became quicker to attend to client's challenging behavior, and they spent less time to address challenging behavior. The results also include increases in clients' socially appropriate behavior and increases in the duration.

Of carers' attention to clients' socially appropriate behavior along with decreased latency. What it means is carers became quicker to attend to their client's behavior, whether it was the behavior of concern, like challenging behavior or socially appropriate behavior. And when the carers attended the client's challenging behavior, it was also found that the attention was immediate, and it was short. It was also low quality, which contrasted with the high quality attention they provide to socially appropriate behavior of clients. This way, pair carers positively reinforced their clients' socially appropriate behavior, making it highly probable to reoccur. And client's challenging behavior did not get positive reinforcement.

Which means making it less probable to reoccur. In other words, the carers may have caught their clients who live, have developmental disabilities being good and being skillful. Next slide, please. So, in conclusion today, we discussed mindfulness as a way of supporting people living with developmental disabilities. Direct mindfulness training appears to nurture change from within, like self management of behavior of concern or avoiding behavior or even, although I didn't talk about it today, smoking cessation. And, reduction reductions in ADHD symptoms were also reported. And, especially behavior self management reduces external interventions, which has positive implications for protecting.

Human rights of people with developmental delays or developmental disabilities. And for whatever reason, if people with developmental disabilities cannot learn and practice mindfulness, we may be able to indirectly support them through supporting their kids adults. And, in the sense, their kids' adult self care would be instrumental for positively influencing care recipients' behavior. And lastly, both direct and indirect training can be combined, like family training. And, yeah, I discussed a lot of studies reporting positive outcomes of training people living with the development of disabilities in mindfulness. However, I would like to stress that these studies are not without methodological limitations. Mindfulness.

Research in the field of development disabilities is still in its infancy, and it needs to be further advanced through trial and error. K. Thank you.

Thank you, Yoon Suk. That was absolutely fascinating. It's terrific to see a number of presentations in this conference for things other than just the pharmacological approach. It's it's it's really enlightened. Just a few questions, if I may. Yep. The the quantitative studies that you you cited, is there some evidence that this approach is more effective when compared to, say, a pharmacological only regime?

My answer is quickly. No.

So if you augment it, is is that the best way of looking at it?

Yes. So a recent randomized controlled trial, which is relatively larger study with ninety one children with ADHD. K? This study compared the effects of mindfulness based interventions with the effects of taking ADHD medication. And the the findings showed that first, both approaches, mindfulness and medication, were effective to reduce the core symptoms of ADHD, childhood ADHD. And then, also, then no difference between treatment were found on neuropsychological tasks. So they were both they were both effective. Then medication was more effective than mindfulness on multi informant questionnaires, like questionnaires of children's ADHD symptoms or behavior completed by parents, teachers, and things like that, multiple people.

Mhmm. In the short term and in the midterm. Yeah. However, in the midterm, when mindfulness treatment had already finished, but medicinal medication was still taken, the differences between medication and mindfulness diminished.

Interesting. Interesting. Interesting. Yes.

Yes. That's right. And in the long term, differences between the the two groups further diminished.

Interesting. So it also seems like a bit of a multiplier effect as well for those who were also taking medication. Excellent. So for our Australian viewers, where would they go to get this training? Would it be the psychologist, psychiatrist, coaches? Where would they go?

Well, my simple answer is, I don't know. Because it's a matter of finding who do you have in your area. Yeah. Geographical area or online area. It's a matter of finding, like, I say, the the it's not based on the job. It's like psychologist or psychiatrist or things like that. It's based on who is practicing mindfulness genuinely and who knows mindfulness at a theoretical level as well as experiential level. And on top of that, those who understand what it is like to live with ADHD. So for example, when you look when we look for teachers who can teach mindfulness people with ADHD, we need to look at at least two different aspects of it. First is understanding mindfulness inside the.

Theoretical inter and experientially as I pointed out. And second, the conditions of living with ADHD, what it is like. So there are programs, like, for example, MBSR, mindfulness based stress reduction, so MBCT, mindfulness based cognitive therapy. Then they are standardized programs. Then that we need to modify the ways of presenting the content, the ways of teaching how to practice mindfulness according to the learning requirements or the learning styles different learning styles of neurodivergent people, then it can be done through trial and error, and it can be done if we know what mindfulness is, how to practice it, and what ADHD may present in us. Yeah.

Awesome. Well, thank you so much for your time. We really appreciate your contribution contribution of all our speakers today. It's it's excellent, and I hope you've reached a wide audience here. So thank you very much, doctor. Thank you.