Childhood attention deficit/hyperactivity disorder (ADHD), characterized by inattention, impulsivity, and hyperactivity, often persists into adulthood. The ADHD Dual Pathway Model proposes that ADHD reflects two core deficits: executive dysfunction and difficulty tolerating delay. Mindfulness-based interventions (MBIs) have the potential to address both deficits. Meta-analytic evidence suggests that MBIs can reduce ADHD symptom severity and improve quality of life in adults with ADHD. Few studies have examined MBI effects explicitly from the standpoint of the Dual Pathway Model, possibly clarifying how changes in trait mindfulness relate to changes in executive function, delay tolerance, and ADHD symptoms. 

Kang et al. [Behavior Therapy] conducted a randomized controlled trial comparing an MBI with a waitlist control group and tested mediational relationships among changes in trait mindfulness, executive functioning, delay tolerance, and symptoms.

The researchers randomly assigned 120 adults in Hong Kong (average age = 25 years; 75% male) with elevated ADHD symptoms to a mindfulness group or a waitlist control. Participants were recruited via Chinese social media platforms and from physical locations at universities and companies. Eligibility was determined using self-report screening criteria, including a cutoff score of ≥17 on the Adult ADHD Self-Report Scale (ASRS), along with additional self-reported ADHD symptom criteria.

The study employed the 8-week Mindful Awareness Program (MAP) adapted for adults with ADHD and used in prior work. The program was delivered in synchronous online video-conference group meetings with 90-minute weekly sessions. MAP integrates mindfulness skills with practices drawn from cognitive-behavioral and dialectical behavior therapies. MAP emphasized attention-control practices in sessions 1–6 and meta-awareness techniques in sessions 7–8, and it included added content throughout the program intended to reduce delay aversion related to bodily sensations, emotions, and thoughts.

Participants were assessed pre- and post-intervention, and at two-month follow-up on ADHD symptoms (using the Conners Adult ADHD Rating Scale-Short Version), trait mindfulness (Five Facet Mindfulness Questionnaire), executive dysfunction (75-item Behavior Rating Inventory of Executive Function–Adult Version), and delay aversion (10-item Quick Delay Questionnaire). 

The results showed that the mindfulness group improved significantly more than controls on trait mindfulness (ηp2=0.08), ADHD symptoms (ηp2=0.10), executive dysfunction (ηp2=0.13), and delay tolerance (ηp2=0.05). Increases in trait mindfulness scores were significantly correlated with decreases in executive dysfunction scores (r = -.60) and delay intolerance (r=-.45). 

Between post-intervention and follow-up, similarly sized correlations were obtained between increases in trait mindfulness and decreases in executive dysfunction and delay intolerance. Changes in ADHD symptoms were also correlated with changes in executive dysfunction and delay intolerance. A mediation analysis indicated that trait mindfulness mediated the group effect on executive dysfunction and delay tolerance. 

This study shows that MAP can improve self-reported ADHD symptoms, trait mindfulness, executive dysfunction, and delay tolerance in adults with elevated ADHD symptoms. The study is limited by its reliance on self-report outcomes. The sample may not be typical of the population with diagnosed ADHD. The sample highly educated (81%had college degrees) and people were excluded from the study if currently using ADHD medication, in psychotherapy, or with recent psychiatric comorbidity. 

Reference:

Kang, M. Y., Ho Cheung, Y. C., & Keung Wong, D. F. (2026). Mindfulness Intervention Reduced Executive Dysfunction, Delay Aversion, and ADHD Symptoms: A Randomized Controlled Trial Based on the Dual Pathway Model. Behavior Therapy. 

Link to study