
Measurement Invariance of the Child and Adolescent Mindfulness Measure
5-minute read
The last four decades have seen a growth in research interest in the concept of mindfulness, the development of interventions for increasing mindfulness and the creation of measures for quantifying it. Mindfulness has been defined as “the awareness that emerges through paying attention on purpose, in the present moment, and non-judgmentally to the unfolding of experience moment by moment” (Kabat-Zinn, 2003).
Mindfulness-based interventions (MBIs) have been developed to improve mental and physical health outcomes by targeting the regulation of emotional and coping processes. MBI techniques encourage intentionality, a shift of focus to the present moment and encourage the individual to accept negative and unpleasant experiences without engaging with or actively trying to change them (Perry-Parrish et al., 2016).
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MBIs such as mindfulness-based stress reduction (MBSR; Kabat-Zinn, 1982) and Mindfulness-Based Cognitive Therapy (MBCT; Teasdale et al., 2000) can improve a broad range of outcomes in adults, including executive functioning, depression, anxiety (Dunning et al., 2019), insomnia (Gross et al., 2011) and irritable bowel syndrome (Zernicke et al., 2013). These MBIs have been adapted for children and adolescents by shortening the mindfulness techniques and using more age-appropriate language and activities (Perry-Parrish et al., 2016).
A recent meta-analysis of MBIs delivered in school settings with adolescents aged between 12 and 18 years found statistically signifcant but small efects on stress, depression and anxiety (Fulambarkar et al., 2023). Similarly, a meta-analysis by Dunning et al. (2022) found that compared to passive control groups, MBIs were effective at improving anxiety, attention, executive function, and negative and social behaviour at post-intervention, but there was no evidence of sustained benefits at follow-up. Although evidence for the success of MBIs in both child and adolescent populations is growing, there is a need for further investigation into its long-term effects (Kalmar et al., 2022).
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Mindfulness-based interventions for improving mental health of children and adolescents are increasingly being evaluated in randomised controlled trials (Dunning et al., 2019, 2022). Valid measures are required in such studies to evaluate the impact of the intervention on mindfulness and to evaluate mindfulness as a mediator of the intervention effect on the distal mental health outcomes (Goodman et al., 2017). As well as being time-invariant under natural conditions, the meaning and interpretation of the CAMM needs to be invariant between participants that do and those that do not receive the intervention in order to obtain unbiased estimates of effect (Bartos et al., 2023).
It has been noted that changes in the conceptualisation of mindfulness that can result from receiving an intervention can lead to a response shift where the recipients score lower on mindfulness than their counterparts that do not receive mindfulness training, the increased awareness and understanding of the concept of mindfulness making them aware of the extent to which they lack the trait (Grossman, 2011). In the context of a trial, a more subtle response shift may result in the benefit of the intervention being underestimated (Bartos et al., 2023).