How to Design a Positive Study: Meditation for Childhood ADHD…..

Several news sources and blogs have recently reported on a study looking into the benefit of transcendental meditation (TM) in children diagnosed with ADHD. A January 5th report from Reuters Health, a news service which claims to be “internationally recognized as unbiased, authoritative, timely and dependable, with the reputation for quality that one expects from a Reuters company“, actually serves as a perfect example of how not to cover science or health news. With a skeptical mindset, a few minutes of spare time and an internet connection, I was easily able to discover the dubious reality behind this “landmark” research.

The study, led by “cognitive learning specialist” Sarina J. Grosswald, involved the instruction in TM techniques of 10 students previously diagnosed with ADHD and enrolled in a private school for children with learning disabilities. These students were followed over three months, at the end of which they were evaluated for improvement in a number of areas.  According to the Reuters’ piece,

“After three months, Grosswald and her colleagues found, the students reported lower stress and anxiety levels, while their ADHD symptoms also improved, based on questionnaires given to teachers and parents.”

Impressive. For those who are confused, TM is a form of meditation developed by Maharishi Mahesh Yogi in the 1950’s which involves the repetition of a meaningless sound, or mantra, while sitting quietly with eyes shut. This allows the practitioner to quiet the mind and discover the “source of thought”. The mind and body are then able to achieve a state of calm and, according to proponents, reap myriad medical benefits far beyond that of simply increased peace of mind. Believers in TM have also been known to claim that an extension of the technique can lead to fighting crime with their minds and flying. I’m not kidding.

This is a pilot study published in a online education journal edited by graduate students, something which does no inspire confidence in me. I do not think that a reputable peer-reviewed medical journal would have accpeted it. At least the authors do admit in the discussion section that it would be inappropriate to make claims regarding a cause and effect relationship between TM and any improvement in ADHD symptoms based on these results. That doesn’t stop them from making bold statements regarding the benefit of TM, however, as I will soon get to. 

The flaws in this study are numerous. The number of subjects is too small, there is no control group and it isn’t blinded. The study reveals that some of the children are on medication but it does not take into account the possibility of recent changes in medical therapy, or improved compliance while on the study. It is based purely on self-report and subjective questionairres and there is very high liklihood that a placebo effect could have been the sole responsible factor in the subjects’ apparent improvements. The authors then call for larger and better designed studies, something which I don’t think is justified for these reasons, but my problem with this study, and concerns regarding the credulous take by the media, go much deeper than what I’ve already explained.

What led me to dig deeper after reading the Reuters’ report was the following quote:

“The effect was much greater than we expected,” lead researcher Sarina J. Grosswald, a cognitive learning specialist in Arlington, Virginia, said in a written statement.” 

I wondered why the researcher had expected an effect and hypothesized that there may be a connection between the researchers and TM more significant than academic curiosity. I was quickly able to discover that Grosswald is a hardcore believer in TM. Just read this quote by Grosswald from a website called Ask The Doctors, which provides a forum for specialists to answer questions related to TM and health:

“The TM technique is the exact opposite of harmful. It reduces your risk of getting serious chronic health problems like hypertension, diabetes, and heart disease. In fact, research on the Transcendental Meditation program shows that people who practice it go to the doctor about 50% less than the general population. And if they are in the hospital for some reason, their hospital stay is 50% shorter, on average. For some conditions, the need for medical care is as much as 87% less for TM meditators. Practicing the Transcendental Meditation technique is one of the best things you can do for your health.”

She clearly does not come across as an unbiased investigator. In reading her other responses on the “Ask The Doctors” website, and especially after listening to a 16-minute talk she gave in 2005, when this research actually took place, which is posted on a Maharishi Vedic Education Development Corporation sponsored website that focuses on “ADHD, the Mind and the Transcendental Meditation technique” called Insights in Health, it is obvious that she is a true believer. That doesn’t prove the research is bogus by itself, but it is a red flag.

A more concerning red flag, and one which was also discovered in the talk given by Grosswald, is the fact that the 10 children involved in the study may have been coached. In the last few minutes of the presentation, Grosswald presents clips of the children meeting with the TM proponents prior to the initiation of the study, where it appears that they are told what the expected outcome of the trial is, that their symptoms will improve with TM. 

Not only are these kids aged 11 to 14 being told what the expected outcome of the study is by study investigators, the headmaster of the school, Linda Handy, can be seen at the very end of the video discussing how amazing the technique is and how it will change the students’ futures for the better. I am forced to question whether the teachers, whose evaluations of the study subjects’ behavior and performance are an integral component of the study conclusions of positive effect, might have been hesitant to give a negative evaluation when their boss is clearly also a true believer.

In the acknowledgments section, The authors thank the Abramson Family Foundation for funding and the Institute for Community Enrichment for support. The Abramson Family Foundation is an organization which believes that TM can help students achieve the full potential of their brain.

“The Abramson Family Foundation has been funding research on Transcendental Meditation and providing scholarships for students to learn the technique for the past 20 years. This has been a rewarding investment in the youth of our nation. Here is a common sense approach—a sound and scientific way—of fulfilling the purpose of education, which is to create intelligent, dynamic, happy, healthy and successful human beings.”

Of note, Grosswald sits on the Board of Advisors for the foundation. Joining her on the Board is none other than the  school headmaster Linda Handy. Whatever doubt I had in my lack of enthusiasm for this study fell by the wayside upon that discovery. While it may not have been intentional on the part of the study authors, the school headmaster, or the pro-TM funding organizations, this study was designed in a way that coulnd’t possibly yield anything other than a positive result. And calls for further study, especially with public funds in addition to the over twenty million already spent by the NIH on TM, are unwarranted.

It wasn’t difficult to look at this study and see that the claims being made by TM supporters aren’t valid. It wasn’t even that hard to uncover the connections between the investigators, the school where the study was conducted and pro-TM organizations. Yet I was unable to find one news report that displayed even the slightest amount of critical thinking, instead reading like press releases from TM believers. The current state of science and health reporting is rather depressing, and I don’t see things improving any time soon as more and more dedicated science writers are falling prey to the poor economy.