Background: Attention deficit hyperactivity disorder and asthma are two of the most
common pediatric chronic conditions. A meta-analysis of 49 datasets worldwide and a
population-based cohort analysis of 1.5 million individuals showed an adjusted OR of 1.6
for ADHD during school years if the child has asthma at early childhood. Multiple
mechanisms underlying this temporal association have been suggested, including the
impacts of inflammatory mechanism or immune dysregulation on brain development, as well
as the chronic sleep disruption after allergic symptoms. Compared with children with only
asthma, asthmatic children with neurodevelopmental diseases have a higher risk of
emergency care visits due to an asthma attack (adjusted prevalence = 1.5). Although the
exact mechanism is still unclear, it has been shown that parents' psychological
difficulties play an influential role in the cascade of family, biological and
psychological influences on children's asthma. Compared with non-ADHD families, parents
of children with ADHD have higher parenting stress, and the risk of depression/anxiety is
almost tripled. Due to parental distress, these parents may weaken their motivation and
coping ability to manage childhood asthma, leading to poor asthma outcomes.
Although studies have shown that asthma education and parental programs are effective
ways to improve asthma management skills and parenting skills, none of these
interventions addresses the psychological needs of parents when dealing with children
with ADHD. This study is a randomized controlled trial designed to examine the
effectiveness of the family-based asthma management program in Hong Kong that uses
Acceptance and Commitment Therapy (ACT) in fostering parents' psychological flexibility,
bettering their psychological difficulties acceptance, and striving toward values-based
goals to healthy functioning. It is expected that the ACT-based asthma management
training program can help parents to be aware of their emotional state when interacting
with asthmatic children with ADHD enabling them to effectively implement the children's
asthma management and parenting skills they have learned, leading to the ultimate
improvement of children's health outcomes. If it is found that the plan can effectively
improve their lives by addressing the unmet psychological needs of parents of asthmatic
children with ADHD, it can be incorporated into existing services in hospitals and
community settings in Hong Kong and other Chinese communities.
Aim and hypothesis to be tested: When compared with the treatment-as-usual group,
participants in the ACT-based Asthma Management Training Program will:
reduce asthmatic children' unscheduled visits due to his/her asthma exacerbations,
reduce asthmatic children' asthma symptoms,
reduce asthmatic children' ADHD symptoms,
reduce asthmatic children' asthma-related behavioral problems,
improve asthmatic children' caregivers' psychological flexibility and adjustment,
enhance parenting competence, parental asthma management self-efficacy, and parental
and family functioning
Design: An randomized controlled trial with a two-arm and repeated-measures design
Participants: 118 Cantonese-speaking asthmatic children aged 3 - 12 years old with ADHD
condition and their primary caregiver.
Instruments: Validated questionnaires
Interventions: The ACT-based Asthma Management Training Program consists of a two-weekly
group Positive Parenting Program (Triple-P) workshop and a four-weekly group Acceptance
and Commitment Therapy (ACT) program.
Primary outcome measure: Children's unplanned health care service visits due to asthma
exacerbations over 12 months
Expected results: After participating in the ACT-based asthma management program, parents
will become more psychologically flexible in caring for children with asthma comorbid
with ADHD. Parents also acquire better parenting competence and children's asthma
management skills, improving parental and family functioning and child health outcomes.: