To develop a mindfulness-based intervention module for symptom improvement in adolescents with ADHD and their parents, and assess its feasibility 

To evaluate the effect of the newly developed mindfulness-based intervention 

Will a group mindfulness-based intervention be feasible to deliver to children with ADHD and their parents in Indian culture? 

 What will be the effect of the newly developed mindfulness-based intervention? 

The group mindfulness-based intervention will not be feasible in adolescents with ADHD and their parents. 

There will be no beneficial effect of the new intervention on adolescents with ADHD. 

Review of literature. A thorough literature search will be conducted to review the present findings and existing modules in order to assess their key components, usage with different populations and techniques utilised. 

Key interviews with mindfulness experts. Interviews will be carried out till saturation of themes. A semi-structured interview guide will be prepared for this purpose with open ended questions covering the broad areas of the research objective for the key interviews. This will be evaluated by experts to check for the language and the ability to measure the broad research constructs. Review comments will be incorporated, and questions will be reframed accordingly. The key interviews will be transcribed for further analysis, using thematic analysis. 

Development of the initial provisional intervention module. An initial provisional intervention module will be developed based on the above findings and will be evaluated by experts for content validity. Changes suggested will be incorporated. 

Pilot testing. The refined module will be delivered to one group of 5-6 participants selected using the following selection criteria. Baseline measurement will be done for the participants before the intervention and assessments will be repeated post intervention. Feasibility will be assessed using a structured questionnaire and visual analogue scales (VAS) after each session. A focused group discussion will be conducted with the participants at the end of the sessions. The discussion will be transcribed, and thematic analysis will be carried out. 

Sociodemographic and clinical sheet. Containing information on age, gender, class, socio-economic status, family type, residence, duration of illness, psychiatric diagnosis, treatment availed. 

Raven’s Standard Progressive Matrices (RSPM). RSPM, developed by Raven, Court & Raven (1938), is a measure of fluid intelligence. It measures a person’s capacity at the time of the test to apprehend meaningless figures presented for his/her observation, see the relations between them, conceive the nature of the figure completing each system of relations presented, and by doing so, developing a systematic method of reasoning. The scale consists of 60 problems divided into five sets of 12. In each set, the first problem is nearly as self-evident as possible. The problems that follow become progressively more difficult. RSPM was designed to cover the widest possible range of mental ability and to be equally useful with persons of all ages, whatever their nationality, education, or physical conditions. The scores will be converted to IQ scores. 

Raven’s Coloured Progressive Matrices (RCPM). RCPM, developed by J. C. Raven (1949), was designed for children aged 5 through 11, the elderly, and mentally and physically impaired individuals. It contains sets A and B from the RSPM, with a further set of 12 items inserted between the two, as set AB. Most items are presented on a coloured background to make the test visually stimulating for participants. The scores will be converted to IQ scores. 

Children’s Colour Trail Test (CCTT). Developed by Llorente et al. (2003), it assesses sustained attention, divided attention, sequencing, and speed of mental processing in children between 8 to 16 years. The test-retest reliability ranged from r=0.45 to 0.68, alternate form reliability from r=0.85 to 0.90, and concurrent validity from r=0.54 to 0.74. Construct and factorial validity were also established. 

Conner’s Parent Rating (IV ed.). Conners Short (4th ed.) is a 53-item tool for the assessment of ADHD and associated symptoms. It is the shorter version of the Conner Full Version. It has a negative impression scale, scales for inattention, hyperactivity, impulsivity and emotional dysregulation, an impairment and functional outcomes scale, and an ADHD index. It can be completed by any parent or guardian of a child between 6-18 years of age. The rating is done on a 4-point Likert scale rating. It takes about 7 minutes to administer. The internal consistency of the test (median omega=0.92) has been established with a low standard error of measurement (SEM). The test-retest reliability was found to be 0.83 to 0.94, and the inter-rater reliability was 0.68 to 0.81 for two parents. 

Child and Adolescent Mindfulness Measure (CAMM). Developed by Greco et al. (2011), CAMM is a 10-item scale that measures mindfulness skills, including non-judgmental attitude, current awareness, and responses to thoughts and feelings. It can be administered to adolescents aged 10-17 years. The rating is done along a 5-point Likert scale. The internal consistency (α=0.81) was established. The scale was found to be positively correlated to Youth Quality of Life-Revised (YQL-R; r=0.25) and Academic Competence Scale (ACS; r=0.25, p<0.01), and negatively correlated to Children’s Somatization Inventory-Short Form (r = -0.40), internalizing (r = -0.51) and externalizing (r = -0.36) symptoms (Symptoms and Functioning Scale, SFS). 

Clinical Global Impression (CGI). CGI was developed by the National Institute of Mental Health (NIMH), USA (1976). It assesses the patient’s global functioning prior to and after initiating an intervention along a 7-point Likert scale. It has been found to be significantly correlated to MHQ and DASS. 

Child Global Assessment Scale (CGAS). CGAS was developed by Shaffer et al. (1983). It is designed to reflect the lowest level of functioning of an individual under 18 years of age during a specified period. Scores range from 0 to 100. The interclass correlation (r=0.84) was established with low SEM. The test-retest reliability ranged from 0.69-0.95. 

Kidscreen-27. The Kidscreen-27 (Revens-Sieberer et al., 2007) measures five domains of health-related quality of life (HRQoL), including physical and psychological well-being, autonomy and parent relations, peers and social support, and school environment. It has been standardised for children between 8-18 years. The internal consistency was found to be greater than 0.70 for all the dimensions, and correlations with corresponding scales of Kidscreen-52 ranged from 0.63 to 0.96. The correlations between other HRQoL questionnaires and Kidscreen-27 dimensions were moderate to high for those assessing similar constructs (r=0.36-0.63).

Family Management Measure (FaMM). Developed by Knafl et al. (2011), FaMM measures how families caring for a child with a chronic condition function along six subscales, condition management ability, child’s daily life, condition management effort, family life difficulty, view of condition impact, and parent mutuality. The internal consistency ranged from 0.72 to 0.91, and test-retest reliability ranged from 0.71 to 0.94. FaMM was found to be moderately correlated with established measures of family functioning.  

Five Factor Mindfulness Questionnaire (FFMQ). FFMQ was developed by Baer et al. (2006) and is used to measure mindfulness across five domains: observing, describing, acting with awareness, non-judgement, and non-reactivity. It can be used with individuals over 16 years of age. There are 15 items that are rated along a 5-point Likert scale. The internal consistency ranged between 0.75 to 0.91. 

Parental Stress Scale (PSS). This scale measures stress associated with caring for a child and was developed by Berry and Jones (1995). It has 18 items and is rated along a 5-point Likert scale. It can be used with adults. The internal consistency ranged between 0.83 to 0.86, and test-retest reliability was 0.81. 

Sample. At least 40 adolescents and their parents will be equally randomized into two groups based on the inclusion and exclusion criteria discussed above.   

Randomisation. The selected sample will be randomised through simple random sampling using computer generated random numbers. 

Allocation. 1:1 allocation will be done to both study and control groups.  

Blinding. The participants will be blinded to the group allocation. 

Sociodemographic and clinical sheet. Containing information on age, gender, class, socio-economic status, family type, residence, duration of illness, psychiatric diagnosis, treatment availed. 

Raven’s Standard Progressive Matrices (RSPM). RSPM, developed by Raven, Court & Raven (1938), is a measure of fluid intelligence. It measures a person’s capacity at the time of the test to apprehend meaningless figures presented for his/her observation, see the relations between them, conceive the nature of the figure completing each system of relations presented, and by doing so, developing a systematic method of reasoning. The scale consists of 60 problems divided into five sets of 12. In each set, the first problem is as self-evident as possible. The problems that follow become progressively more difficult. RSPM was designed to cover the widest possible range of mental ability and to be equally useful with persons of all ages, whatever their nationality, education, or physical conditions. The scores will be converted to IQ scores. 

Raven’s Coloured Progressive Matrices (RCPM). RCPM, developed by J. C. Raven (1949), was designed for children aged 5 through 11, the elderly, and mentally and physically impaired individuals. It contains sets A and B from the RSPM, with a further set of 12 items inserted between the two, as set AB. Most items are presented on a coloured background to make the test visually stimulating for participants. The scores will be converted to IQ scores. 

Children’s Colour Trail Test (CCTT). Developed by Llorente et al. (2003), it assesses sustained attention, divided attention, sequencing, and speed of mental processing in children between 8 to 16 years. The test-retest reliability ranged from r=0.45 to 0.68, alternate form reliability from r=0.85 to 0.90, and concurrent validity from r=0.54 to 0.74. Construct and factorial validity were also established. 

Conner’s Parent Rating (IV ed.). Conners Short (4th ed.) is a 53-item tool for the assessment of ADHD and associated symptoms. It is the shorter version of the Conner Full Version. It has a negative impression scale, scales for inattention, hyperactivity, impulsivity and emotional dysregulation, an impairment and functional outcomes scale, and an ADHD index. It can be completed by any parent or guardian of a child between 6-18 years of age. The rating is done on a 4-point Likert scale rating. It takes about 7 minutes to administer. The internal consistency of the test (median omega=0.92) has been established with a low standard error of measurement (SEM). The test-retest reliability was found to be 0.83 to 0.94, and the inter-rater reliability was 0.68 to 0.81 for two parents. 

Child and Adolescent Mindfulness Measure (CAMM). Developed by Greco et al. (2011), CAMM is a 10-item scale that measures mindfulness skills, including non-judgmental attitude, current awareness, and responses to thoughts and feelings. It can be administered to adolescents aged 10-17 years. The rating is done along a 5-point Likert scale. The internal consistency (α=0.81) was established. The scale was found to be positively correlated to Youth Quality of Life-Revised (YQL-R; r=0.25) and Academic Competence Scale (ACS; r=0.25, p<0.01), and negatively correlated to Children’s Somatization Inventory-Short Form (r = -0.40), internalizing (r = -0.51) and externalizing (r = -0.36) symptoms (Symptoms and Functioning Scale, SFS). 

Clinical Global Impression (CGI). CGI was developed by the National Institute of Mental Health (NIMH), USA (1976). It assesses the patient’s global functioning prior to and after initiating an intervention along a 7-point Likert scale. It has been found to be significantly correlated to MHQ and DASS. 

Child Global Assessment Scale (CGAS). CGAS was developed by Shaffer et al. (1983). It is designed to reflect the lowest level of functioning of an individual under 18 years of age during a specified period. Scores range from 0 to 100. The interclass correlation (r=0.84) was established with low SEM. The test-retest reliability ranged from 0.69-0.95. 

Kidscreen-27. The Kidscreen-27 (Revens-Sieberer et al., 2007) measures five domains of health-related quality of life (HRQoL), including physical and psychological well-being, autonomy and parent relations, peers and social support, and school environment. It has been standardized for children between 8-18 years. The internal consistency was found to be greater than 0.70 for all the dimensions, and correlations with corresponding scales of Kidscreen-52 ranged from 0.63 to 0.96. The correlations between other HRQoL questionnaires and Kidscreen-27 dimensions were moderate to high for those assessing similar constructs (r=0.36-0.63). 

Family Management Measure (FaMM). Developed by Knafl et al. (2011), FaMM measures how families caring for a child with a chronic condition function along six subscales, condition management ability, child’s daily life, condition management effort, family life difficulty, view of condition impact, and parent mutuality. The internal consistency ranged from 0.72 to 0.91, and test-retest reliability ranged from 0.71 to 0.94. FaMM was found to be moderately correlated with established measures of family functioning.  

Five Factor Mindfulness Questionnaire (FFMQ). FFMQ was developed by Baer et al. (2006) and is used to measure mindfulness across five domains: observing, describing, acting with awareness, non-judgement, and non-reactivity. It can be used with individuals over 16 years of age. There are 15 items that are rated along a 5-point Likert scale. The internal consistency ranged between 0.75 to 0.91. 

Parental Stress Scale (PSS). This scale measures stress associated with caring for a child and was developed by Berry and Jones (1995). It has 18 items and is rated along a 5-point Likert scale. It can be used with adults. The internal consistency ranged between 0.83 to 0.86, and test-retest reliability was 0.81.