The Magic of Mindfulness: Evidence Based Guidelines for Practicing the Art of Mindfulness in Children

Introduction

Hello everybody! I have lived in a variety of countries over the course of my life. I think this fact is pertinent to this talk because as I was born in India, I grew up in Zambia, which is in Africa, and I went to school in England. Then, I came to the U.S. for university. One thing that I have noticed having lived in all these countries is that in Western culture if a person is not stressed and time-poor, then they are not being productive. This is why I delved into this topic of mindfulness. Multitasking and being busy are an all-time high.

There was a study recently by Harvard that suggested that being time poor and possessing a lack of leisure time is now perceived as a status symbol as it suggests that we are in high demand. And, this is not always a conscious decision. There is so much input in the environment that we are constantly bombarded with notifications, texts, and emails. We have a choice that we can turn off our phones or notifications. There is also an intrinsic element to the busyness of our environment and the constant chatter in your brain. How do you shut that off? How this can impact us as OTs and impact the population we serve is what I want to discuss today. 

What is Mindfulness?

• “Mindfulness means paying attention in a particular way; On purpose, in the present moment, and nonjudgmentally.”

-Jon Kabat-Zinn (1982)- Founder of Mindfulness-Based Stress Reduction (MBSR)

The term mindfulness has been around for about two decades ago. I was initially introduced to mindfulness to bridge a gap between the medical and mental health contexts. In particular, mindfulness was used to reduce stress and chronic pain within the medical model. Mindfulness focuses on mind-body connections and a series of attentional practices to help patients experience their thoughts and feelings with a level of detachment. Mindfulness can help to view pain with detachment and has been described as the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally, to let things unfold moment by moment.

Mindfulness Myths

• Spiritual or religious
• Long periods of passive sitting and navel-gazing
• Living only in the present. Never thinking about the past or planning for the future.
• Hypnosis
• Suppressing emotion
• Thinking about nothing
• A form of discipline
• Being happy ALL THE TIME and loving EVERY SINGLE MINUTE of life.

There are lots of myths about mindfulness. I myself thought mindfulness was all about having to meditate like the Sadhus in India. However, you do not have to be religious or spiritual to use mindfulness. It can be a spiritual experience and can be incorporated into religions, but it does not have to be. It also does not have to be about having to meditate in those long, deep, passive sitting sessions. And, it is not all about these various aspects like hypnosis or suppressing emotion. It is none of those. The biggest thing I think people think is, "If if I'm mindful, I can't think about the future and I have to be happy all the time." That is also not what mindfulness is. It is about being an observer. It is as if you were an alien and you came to this planet to observe what is going on. You are enamored by all the sensory input (audio and visual) and are not judging. You are only observing.

State or Practice?

Is mindfulness a state or a practice? Examples are in Figure 1.

Figure 1. Examples of mindfulness as a state and practice.

It can be both. Mindfulness can be a state of awareness or a mindset that we can carry through life. However, this state can be developed and enhanced through activities. These activities are often also referred to as meditation or a "mindfulness practice." That would be a formal way of doing things. Formal practice is mindfulness meditation where you might sit, close your eyes, and focus your attention on one thing, and then you usually use your breath or other sensations within your body. It does require a lot of discipline, and it is not easy for all of us to do. Informal practice, on the other hand, is what is so profound. I am quite enamored by it because you can do it anytime and anyplace. You are bringing the same kind of improved attention that you have during a formal practice and applying it to everyday situations. This is directing your full and nonjudgmental attention to the activity you are currently doing. This could be as simple as washing the dishes, brushing your teeth, chatting to a friend, and studying. One example in my life is taking my dog out to go potty. He is a large St. Bernard, and I take him out on a leash. I take the time during this break in my routine to be mindful. I take in my environment, look at the trees, the sun shining, or whatever it is, I really try to be present in the few moments that I have during the day. This might only be 30 seconds or two minutes, but that is the time that I have built into my schedule.

Mindfulness is Like a Gym for the Mind

• Strengthens the brain’s grey matter in the prefrontal cortex and hippocampus.
• Mind’s ability to focus
• Pay attention
• Reduce worry

Mindfulness is not a one-time thing. It is not, "Let me just do a little bit here, and a little bit here." You are not going to see the optimum benefits of that. It requires practice because mindfulness is a mental exercise. It literally strengthens the brain's gray matter in the prefrontal cortex and the hippocampus. These are the two key learning areas that really support the mind's ability to focus, pay attention, and reduce worry. The more you practice, the stronger it becomes. Just like the gym, you cannot expect to get a six-pack going to the gym once a week. It is not going to happen. So if mindfulness is like physical exercise, it stands to reason that we cannot just go to the gym and enjoy the benefits for half an hour that we are there. You cannot just enjoy the benefits at that moment. We go to the gym in order to enjoy the benefits for the long term. This is what mindfulness is. The more you do it, the effects increase over time and it really compounds over time to create a long term plan for well-being. Thus, you need to find the gaps in your lifestyle to incorporate it.

Do Children Need Mindfulness?

• Elementary-Middle School​: 1 in 7 experience mental health problems
• High school: 1 in 4 experience mental health problems
• The World Health Organization has projected that depression will become one of the leading health problems worldwide.

While there is no doubt that we need mindfulness, do my children need it too? Adults and children both can benefit from mindfulness. One of the key reasons is that the World Health Organization has projected that depression will become one of the leading health problems worldwide. We really need something that is going to help us address those challenges. In schools, one in seven elementary school children and one in four high schoolers are experiencing these problems. These statistics really are alarming and really indicate the clear benefits offered by mindfulness. In England, mindfulness is actually part of the curriculum. And, I know a lot of schools here in the U.S. are trying to develop that within their social-emotional plan.

Physiological Mapping of Mindfulness

• Practicing mindfulness strengthens areas of the brain that control ‘executive function’.

How does it actually work? What is the physiological mapping of mindfulness? If you look at brain scans, people who practice mindfulness show a thickening of the gray matter in the prefrontal cortex and the hippocampus (see Figure 2).

Figure 2. Thickened areas of the brain after mindfulness.

These are the same areas that are responsible for attention, self-regulation, executive functioning, and planning. Those who practice mindfulness also show reduced activity in the amygdala. The amygdala is associated with distractions, fear, anxiety, depression, and stress. This is the default mode network associated with worry, rumination, depression, and schizophrenia. Mindfulness strengthens executive functioning, and it lowers the reactivity of the fight and flight response. For these two reasons, mindfulness leads to better attention, memory, regulation, and self-awareness. In turn, these improvements can lead to reduced stress, better academics, and social skills.

Figure 3. Stressed vs. relaxed brain.

It gives us a more relaxed brain which results in more thoughtful responses. A relaxed brain tones down those primitive reactions to allow you to make more appropriate decisions. Mindfulness causes an actual change in brain structure and activity. And if you pair it with the science of neuroplasticity, the advantages, these brain changes become permanent versus just behavioral changes. These are actual changes in the brain.

Advantages of Neuroplasticity

• We have the power to influence our brains.
• Positive thoughts strengthen certain neural circuits and become neural traits.
• Self-Directed Neuroplasticity =
  • Nurture positive states of mind to strengthen and build those neural networks. 
• Make Happiness a Habit! 

When you are mindful, you are very aware of what is going on but you are not labeling those emotions. You might be sad but you are not reacting to that emotion of being sad. It is a positivity that you are creating that can really change your brain. There are positive neural connections made producing a positive aura and impact. This is what we see when we use mindfulness with patients with depression and chronic pain.

Mindfulness on Academic Performance

• Readiness to learn
• Social-emotional learning
• Self-regulation
• Decision-making

As pediatric OTs, specifically working in the academic setting, it is important to understand the positive impact of mindfulness in schools. Readiness to learn, social-emotional learning, regulation, and decision-making are some factors and areas that mindfulness can really address. There is no doubt that in schools today there are many mental health issues, decreased engagement, and academic challenges. In fact, one in five students are disengaged from school, and disengaged students are on average one to two years behind their peers. School engagement is a huge concern, although it is not very surprising. Students are so vulnerable because they just do not possess that full range of emotional, behavioral, and attention regulation skills to overcome some of these personal factors and social issues that they face.

Mindfulness can really help in several ways. The three ways that I would like to point out are attention, emotional reactivity, and cognitive flexibility (see Figure 4). 

Figure 4. Metacognition components.

Attention

First, mindfulness improves attention. This means that students are able to focus on learning.  Many students who have ADHD anxiety can really benefit from mindfulness. If they have improved attention, they are more capable of taking in new information without being distracted by internal reactions or by perspectives from peers and teachers.

Cognitive Flexibility

The second thing it does is improve working memory. It provides cognitive flexibility, reasoning, planning, and self-regulation. These are so important especially when you are trying to learn new information.

Emotional Reactivity

It also reduces emotional reactivity. We see this with a lot of our sensory students. Mindfulness practice can really help with behavioral issues, anxiety, and depression.

This means that students have fewer potential obstacles standing in the way of their learning, and school becomes a positive experience. And if it feels good, then students are more likely to engage.

The other thing that mindfulness does, which is so incredibly profound, is that mindfulness improves the student's ability to learn. This is because they are actually thinking about the fact that they are thinking or metacognition. They are so much more aware of their own thinking style. They think about their own way of learning and therefore can improve learning not just in one subject but across the board in various other aspects and domains. 

Mindfulness and Social-Emotional Learning

Mindfulness also impacts social-emotional learning (see Figure 5). 

Figure 5. Mindfulness improves a student's ability to learn.

In a study, 60% of approximately 6000 students increased in all these areas of better emotion and behavior regulation, academic performance, social skills, and lowered depression and anxiety. The data is quite profound. Mindfulness provides a brilliant foundation so that we can build personal and social capacities for these students.

How Often Should We Practice?

How often do we need it? Based on the research, it was shown that only 90 minutes a week, or 18 minutes per day, essentially 6% of the school day, can make a difference. If you are an OT seeing students perhaps once a week for 15-30 minutes, you could feasibly incorporate mindfulness into your sessions. Typically, I start mindfulness with all my students, and depending on how much time I have been allocated, you can do anywhere from two to 10 minutes. It just depends, but you could easily incorporate it. We engage in many sensory activities, and it is quite easy to sprinkle in mindfulness. The biggest thing about mindfulness, especially in the school setting or in the home with your own children, it has to be a part of the whole game plan. 

Mindfulness Complements Well-Being

• Self-awareness: studies have shown that it improves self-awareness in young people.
• Social awareness: improves social skills in youth.
• Self-management: improves self-regulation and impulse control, vital for self-management.
• Relationship skills:  listen to their peers, teachers, and parents, and less emotionally reactive, they naturally develop better relationships.
• Decision Making: The need for immediate gratification is reduced, and the ability to consider long term goals is increased.

Mindfulness is driven by an increased performance by all the key players including teachers or therapists. Their well-being also plays into mindfulness. It is a very ethereal sort of concept. That positive glow seeps into other aspects of your life. The more mindful we are as therapists, the more we can contribute to mindful practices in school or at home. Mindfulness includes self-awareness, social awareness, self-management, relationship skills, and decision-making.

For the purpose of this presentation, I would really like to focus on relationship skills and decision-making because these are two concepts that not only impact us professionally but can also impact us personally. I want you to think about a situation that you have encountered in the past few weeks or months. For example, did somebody make a snide comment or send you a nasty text or an off-color remark? What was your reaction? Are you the type of personality that reacts really fast and then regrets it? Or, are you a thinker and step back and say, "I'm not going to respond right now. I'm going to wait it out and then respond." The more we can practice that sort of decision-making the better we are.

Without Mindfulness

Without mindfulness, a lot of people may encounter a situation and have an aversive reaction or an impulsive reaction which they may regret (see Schematic in Figure 6).

Figure 6. Mindfulness response.

With mindfulness, there is space that is created to take a step back. You take that time to be mindful and think, "I'm feeling these feelings, but I'm not going to make a decision right now. I'm just going to acknowledge everything, and then I'm going to make an informed choice and appropriate response." This is so profound and helpful for students to learn as students often do not have that capacity for regulation, especially students who already have sensory processing difficulties. If you can create that space, this can really be a game-changer for them.

Scope of Practice for OT

• The occupational profile guides the selection and depth of mindfulness interventions a therapist uses with his or her client, in keeping with a client-centered approach.
• If a client finds mindfulness meditation meaningful, the intervention is itself an occupation, improving occupational performance.
• OTs have a holistic perspective, are trained in psychology and biology, and understand the mind-body-spirit connection.
• OTs address the whole person and understand contexts that influence the whole person.                  

(Jackman, 2014)

How does this work in OT? Is it within our scope of practice? Our aim as OTs is to provide a holistic perspective. We really do a good job of integrating complementary alternative medicine and wellness participation programs into our practice. And, we are well suited for this as we are trained in psychology and biology and have an understanding of the mind, body, and spirit connection. OTs address the whole person and understand the context and the influence of the whole person. For example, if you did an occupational profile on a student and found that mindfulness might be an intervention to use, you are using a client-centered approach. Perhaps for older clients, you might see that mindfulness again is meaningful and that intervention itself can improve occupational performance. So, it is certainly within our scope of practice.

Conceptual Framework for Mindfulness in OT

• Mindfulness can increase awareness of performance patterns and improve occupational engagement as a prevention measure (AOTA, 2014; Jackman, 2014).
• In a review of studies on mindfulness in a rehabilitation setting, (Hardison & Roll, 2016) noted that different interventions were consistent with the OTPF-III’s designations of occupations and activities, education and training, group interventions, and preparatory methods and tasks (AOTA, 2014).

Mindfulness also increases awareness of performance patterns and engagement. The value of mindfulness for both patients and therapists is increasingly recognized in OT. There was a study by Olson in 2007. They stated that weaving mindfulness into treatment sessions is an evidence-based approach as it enhances engagement in occupations. It is about integrating and weaving integrative practice. Mindfulness is also used by practitioners. There was a recent article in 2014 where OT students used mindfulness to determine their own stress levels. Many OT practitioners experience burnout and mindfulness can be helpful in these cases as well.

Mindfulness for OT Practitioners

• Students and clinicians in an allied health profession possess a demanding workload and are susceptible to burnout, which may reduce the ability to attend, concentrate, and make good decisions. (Gura, 2014)

This quote is from the research article by Stew (2011). This OT student, practicing mindfulness, stated, "I was shocked at how busy my mind was with continuous chattering even in the shower. I was rehearsing a conversation with friends. It was so poignant to me because I do it to myself. The point here is to let you know that mindfulness is not just for our patients, it's actually for ourselves too."

Three Types of Mindfulness Practices

• Mindfulness-Based Stress Reduction: Informal practice is defined as maintaining the qualities of mindfulness during routine tasks as well as during practices such as yoga, tai chi, walking meditation, body scans, and mindful eating (Elliot, 2015; McCorquodale, 2013) or Formal meditation practice.
• General mindfulness: Examples of these goals included occupational engagement, engagement in therapy, reduced anxiety, awareness of bodily sensations, and a nonjudgmental attitude.
• Acceptance and Commitment Therapy (ACT) psychological intervention stemming from clinical behavioral analysis and mindfulness principles. The primary goals of ACT were to improve psychological flexibility and engagement in therapy through pain acceptance and buffering of other psychological experiences. (AOTA, 2014).

There are three types of mindful practices. The first one is Mindfulness-Based Stress Reduction. This is the one I introduced in the beginning. This is where mindfulness originated in the medical field, but it is more about doing mindfulness within yoga, tai chi, meditation, body scans, et cetera. It can be informal or formal. Then, there is general mindfulness. This is really where OT comes in. It is all about practicing it while you are engaged in an occupation and doing something. And lastly, there is Acceptance Commitment Therapy (ACT). Now, this is more of a structured psychological intervention. It stems from the behavior analysis field. It is really about having that cognitive psychological flexibility of accepting situations and being quite linear in your thinking and not branching out into more emotions. That too is a very profound program.

Mindfulness in the Rehabilitative Process

• Children who participated in mindfulness-enhanced therapy improved on at least one component of motor coordination. This therapy also helped parent-child dyads meet their self-directed goals. (Jackman, 2014)
• Studies show that mindfulness also offers robust positive influences, including increased self-esteem, acceptance, and positive attitudes toward eating (Kristeller, 2005; Kristeller & Hallett,1999)
• Improves practitioners’ work lives by increasing self-awareness and openness to new ideas, focus, and patience that contribute to enhanced client intervention as well as fostering a more healthy approach to living (Brenner, 2009; Krausner et al., 2009; Rothaupt & Morgan, 2007; Rybak & RussellChapin, 1998).

Mindfulness in the rehabilitative process is fairly new in some areas. I think chronic pain and TBI were the first few fields to use mindfulness, and then it was adapted to illness and disability. There are various aspects to this. Motor coordination is one area in which mindfulness has been used, and it has helped. Eating disorders are another area where I saw some research articles. There is no doubt we need more research and more applications of mindfulness.

Sensory Processing & Mindfulness

• Individuals whose sensory processing patterns are characterized by poor awareness experience more mind wandering and distraction in daily life. Occupational therapists should consider mindfulness techniques when treating individuals with sensory processing disorders. – (Hebert, 2016)
• Mindfulness approaches can be taught to children, adolescents, and their parents to improve self-regulation, particularly in response to stress. ( Perry-Parish et al., 2017)

Sensory processing is another area that mindfulness is infiltrating. There were two recent studies that I found, but I think this is an area that needs to be explored more. The two studies indicated that mindfulness increased awareness of an individual's ability to process sensory information and also helped to decrease distractions.

General Guidelines

• Should be introduced in the early years - 3 to 5yrs.
• Middle school/High school students are the most vulnerable
• Encourage therapists/teachers to practice alongside students.
• Consistency
• 5-10 minutes mindfulness practice 4-5 days a week

What are the general guidelines? When you have students, the earlier you can start the better. Three to five years is the general guideline of when to start. Middle school and high school students are the most vulnerable. Encourage therapists and teachers to practice alongside and to model the behavior. Again, it is important to have consistency. Five to ten minutes of mindful practice for five days a week is what is recommended to start off with. Keeping your mind still and focused for five minutes can be really hard for some students and adults.

S-T-O-P

• Stop. 
• Take a breath. 
• Observe your thoughts and feelings.
• Pause.  Proceed mindfully.

I use this visual when I first introduce mindfulness to students. It is about slowing down your life. If I have an activity set up, say Legos or something, I might tell them to do it in slow motion. "Stop, take a breath, observe your feelings and thoughts, and now proceed." This centers and organizes students. Here is a nice video of nature sounds that can also help get people into a mindful practice.

Video 1

I personally like to practice mindfulness with the natural quiet sounds of the environment, while others like to have the sounds a little more prominent. You should experiment with it and see how it feels. We are actually going to practice mindfulness right now just for a few minutes. One of the reasons I like to do it in the natural setting without added elements or sounds is because it gives you the versatility of doing mindfulness anywhere. We are going to go ahead and give it a try now.

That is an example of a meditative practice script. While some of you probably did brilliantly, others might have struggled. I struggled the first time I did it. I remember my mind wandering, but I promise you, the more you do it, the better and easier it gets. I actually find myself doing it on my way to work when I am driving. I will just be in the present. How does my hand feel on the steering wheel? I will try to notice things I have not noticed before on my way to work. It really does anchor and ground you. This was just an example of mindful practice and how it can be used with older students and adults. However, younger students are a little different. 

Explaining Mindfulness to Youth

• The Mindful Jar: teaches children how strong emotions can take hold, and how to find peace when these strong emotions feel overwhelming. 
• Cartoons/TV shows
• Check your personal weather report
• Model the behavior

How do you explain mindfulness to children? The mindful jar is a nice metaphor for how your mind feels. Sometimes, I will put something inside a "mindful jar" with glitter. They shake it and then when the glitter settles, they can see the item or written words. This symbolizes that when you can calm your mind, you can really see what is going on and make good decisions.

There are some cartoons and TV shows that I have noticed recently that highlight mindfulness. There is a panda bear who does karate. If you watch some of those episodes, you will see that there is some underlying mindfulness information in there that you can use to explain to students. We can watch those clips on YouTube and then talk about the mindfulness activity or example. Other ideas include checking yourself, Zones of Regulation, checking your own weather report, and of course, modeling the behavior. For older students, it can be a bit challenging to get buy-in. In these cases, I might use the Kawa Model which was developed by Japanese OTs (see Figure 7).

Figure 7. Example of the Kawa model (Iwama, Thompson, & Macdonald, 2009).

The Kawa Model uses a natural metaphor of the river to depict someone's life journey. The river is your life flowing. I like to have them identify challenges and barriers. It is so important for them (and you) to have the skills and assets of mindfulness to help you through it. You can use the Kawa Model in many different ways and this is just one example that I use with students.

Mindful Activities

Activities for Younger Children

1. Mindful Posing: The Superman or The Wonder Woman
2. Spidey Senses
3. Safari
4. Blowing bubbles
5. Pinwheels 
6. Playing with balloons 
7. Texture bag 
8. Blindfolded  
9. Slow-motion Simon Says
10. Eat a raisin
11. Switch on/off
12. Use images
13. Use Story-Telling, Music, and Art

Let's move on to mindful activities. There are a ton of online resources as well as books written on it. One of my favorites is "Spidey Senses." You have the child close their eyes and listen to sounds like Spider-Man. The other one I really like is eating a raisin. You want to eat the raisin as if you have never eaten a raisin before. "Close your eyes and tell me like the texture, the flavor, the size." Those are both brilliant. There is so much out there on the internet. We already use a lot of these strategies, but I think it is important to incorporate the language to reflect on mindfulness within these activities. 

Mindfulness Listening

There are so many apps out there for mindfulness. I like to use a bell. I will ring the bell, and then I will say, "Close your eyes, and I want you to focus on the sound of the bell." It reverberates for a while, and then I have them put their hand up when they do not hear the bell anymore. This makes them really have to listen. The first person to put their hand up after the bell gets a reward. 

Body Scan Meditation

• Links mind with body
• Increases the ability to track body sensations
• Grounding attention
• Increases body awareness
• Trains mind to tolerate sensations

Body scan meditation is a very common method used. It is progressive relaxation. The next clip is kind of a fun thing to use with little kids. They often say they are reading slowly, but they are actually going really fast. It might be hard for them to moderate that so I like this image as I think it helps them. I will say, "Don't blow the candle out. You have to be slow with your breath." It also provides a nice visual because sometimes students have a hard time with either focusing on something, they get too focused, or they do not focus on one particular thing. 

Video 2

I have read some articles about Buddhist schools. In the first six to eight weeks, all students do is learn how to use their breath which I thought was phenomenal. This is because your breath is a sensory tool that you always have with you. Training students to use their breath is really profound in its application. I like to use it as an anchor.

Mindfulness Games & Worksheets

• Pennies Game
• Water in a spoon race
• Mindful or unmindful worksheets
• Totem the Feel Good Game, Self-Esteem Game for Team Building, Family Bonding, Counseling and Therapy
• The Mindfulness Therapy Games: Social Skills Game That Teaches Mindfulness for Kids, Teens, and Adults | Effective for Self Care, Communication Skills

There are also plenty of mindfulness games and worksheets out there. In the Pennies Game, everyone gets a penny. They have a minute to really look at their penny and then you put all the pennies in a basket. They then have to find their penny based on what they remember. 

Mindfulness Curricula

• The “Wellness Works in Schools” course is one such class, which has been shown to result in increased self-regulation and executive function (Garey, 2017).
• The Hawn Foundation’s MindUP curriculum is also a useful tool for teaching mindfulness to children (Garey, 2017).
• “MonkeyMind and Me: A Mindfulness Course for Children.”

There are also curricula out there that you can use for mindfulness. There are several that I really like. One of my favorites is MonkeyMind and Me. It is a mindfulness course specifically for children. It describes chatter and how your mind is just becoming like a monkey and is all over the place. 

To Learn More

• Full Catastrophe Living by Jon Kabat-Zinn
• Search Inside Yourself by Chade-Meng Tan
• Finding the Space to Lead by Janice Marturano
• The Mayo Clinic Guide to Stress-Free Living
• 10% Happier by Dan Harris
• A Mindful Nation by Congressman Tim Ryan
• Mindfulness: An Eight-Week Plan for Finding Peace in a Frantic World by Mark Penman and Danny Williams

There are several books available. There is also a certification for mindfulness. I think the key here is really making sure that you are on board with the practice before you start teaching it to students. 

The thing I really want to point out is that mindfulness is not a synonym for relaxation. Mindfulness is something that is a byproduct of mindfulness. For example, I have a student who was doing mindfulness, and he was really having a hard time. He was getting frustrated which is the opposite of relaxation. It was not working. I needed to find another way of helping him as he had sensory issues. It was very difficult for him to do any sort of body awareness. One strategy I used was called starfish hand meditation. You hold out your hand and spread out your fingers, close your eyes, take a deep breath, then you take your index finger from the other hand and trace around your fingers of that open hand. You concentrate only on how this feels, and you let other thoughts float away. This worked for the student with SPD.

There is a plethora of information and knowledge out there on different strategies especially for our sensory students who may have a harder time. I have also used some white noise to help students. However, in another case, I had a student who fell asleep because he got so relaxed. The white noise was a sensory calming strategy so we could not even get into mindfulness because he just fell asleep. I think OTs are in a really brilliant place as we can incorporate mindfulness into our intervention to make it meaningful for our clients.

Summary

In conclusion, the demands placed on us as OTs, parents, and individuals continue to mount. The introduction of mindfulness-based training for students and therapists is quite timely. The research suggests that mindfulness is such a viable tool for self-care and well-being. The generally positive response and the exploratory evidence-based studies suggest that mindfulness is efficacious. Naturally, we need more in-depth research specifically for rehabilitative and sensory aspects. The inclusion of mindfulness-based training in OT education is justifiable because of the growing body of evidence, and especially for the health and well-being of healthcare professionals like us. What I do want to leave you with is a quote from Dalai Lama. "Man sacrifices his health to make money, then he sacrifices money to recuperate his health, and then he's so anxious about the future that he does not enjoy the present. The results being that he does not live in the present or the future. He lives as if he's never going to die and then he dies never really having lived." Hopefully, this quote gives you some perspective on how you live your life and the content of this presentation helps you decide if mindfulness is something you should ponder and incorporate into daily practice. 

Questions and Answers

Can mindfulness be taught in groups?

Absolutely. I think it would be better suited for adults. It might be a little bit trickier with children, but I have done it within groups of two or three. Depending on the age, it might just take longer to refine the process, but yes, you can do it in groups.

What age range is the MonkeyMind program intended for?

The MonkeyMind program starts in elementary school, but I cannot recall exactly as there are so many programs out there. I feel like it gets a bit muddied, but I want to say elementary school or preschool. It is one of the most popular, at least in England. I have not seen a lot of schools use it here.

Could you recommend any other YouTube videos that are helpful for introducing and practicing mindfulness with elementary age students? Do you have any particular area you would like to look or keyword?

I would just search "mindfulness for children." When I do a keyword search for that, there are a plethora of YouTube videos. However as I mentioned in my presentation, I try to use videos that are already familiar to students in the form of cartoon characters that they have already seen as they can relate. For example, there was a scene where he said, "Well, I'm just not good at fighting. Maybe I should just sell noodles." He goes through this entire thought process and then comes up with a response. I think it's called Kung Fu Panda.

Do you have any resources or examples of mindful activities you've done for staff training in schools to reduce stress and anxiety?

I have not done a lot with staff training. I have done more with students. However, there are so many resources out there that could guide you. They also have YouTube videos. I would start very slowly and then build on that. Anything by Jon Kabat-Zinn is great. Also, the Mayo Clinic has some great ideas.

Have you ever tried school overhead announcement system with older kids to stop and reframe type moments in the school day? Are there certain times of the day that are better for students? 

I have not tried over the speaker, but that would be a brilliant idea if you could get the whole staff and everyone on board. But as far as the time of day, it really depends if you are trying to do formal practice or trying to embed it into your daily schedule. I will give you an example. Many students get used to it and ask for it. It is about forming that routine just like exercising. Initially, nobody wants to do it, but once you have a routine and it feels good, then it becomes part of your lifestyle. I do it at home, and I have three children. I do it right before dinner.

References

American Occupational Therapy Association (AOTA). (1999). Definition of OT practice for the AOTA Model Practice Act (1999). The American Journal of Occupational Therapy, 53(6), 608.

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