INTRODUCTION
Children classified as having special needs encompass those with chronic developmental,
behavioural, and emotional conditions requiring specialised and extended health services
beyond those required by children in general. Common types of special needs in Hong Kong
include autism spectrum disorders (ASD), attention-deficit hyperactivity disorders
(ADHD), and developmental disabilities or delays. Notably, there has been a significant
increase in the number of children with special needs in the region. In 2019, the Child
Assessment Centre under the Department of Health reported a rise in newly diagnosed cases
and referrals for specialty follow-up services for preschool-aged children, with annual
growth ranging from 6.2% to 10.7%.
On a broader scale, Hong Kong offers a range of health and social services for families
of children with special needs, but they are marked by prolonged waiting times for
multidisciplinary assessments, diagnoses, and subsequent intensive rehabilitation
services. This extended waiting period not only delays crucial support but also
intensifies the psychological burden experienced by parents. Without a certified
diagnosis from mental health professionals, parents face significant challenges in
accessing public health services for their children's rehabilitation. The local mental
health landscape predominantly focuses on severe mental illness, prioritising the
children's needs over the psychological well-being of parents. Accessing mental health
services becomes even more challenging due to caregiving demands, time constraints,
geographic limitations, and a scarcity of providers with expertise in caring for special
needs children. Self-stigma further impedes parents from seeking psychotherapeutic
support, despite recognising its impact on their well-being and parenting behaviours.
Notably, parents of special needs children exhibit higher levels of parenting stress and
depressive symptoms compared to parents without special needs.
Acceptance and Commitment Therapy
Acceptance and Commitment Therapy (ACT) has recently emerged as a promising, low-intense
psychotherapy for addressing parenting challenges. By practising core ACT skills like
cognitive defusion, acceptance, and value clarification, parents can better navigate
difficult parenting experiences and reconnect with their caregiving qualities. Extensive
research supports the effectiveness of ACT in improving psychological well-being and
reducing somatic complaints across diverse populations. Recent clinical trials targeting
paediatric conditions such as asthma, ASD cerebral palsy, and acquired brain injury have
shown significant reductions in parenting stress, depression, and anxiety symptoms.
However, in-person delivery of ACT poses barriers, particularly for parents of children
with special needs. The COVID-19 pandemic has highlighted the need for virtual healthcare
options, and smartphone-based ACT platforms provide a viable solution. Utilising
smartphones allows convenient access to ACT interventions, accommodating parental
caregiving responsibilities, overcoming traditional treatment limitations, and reducing
resource requirements for healthcare systems. Studies indicate parents' interest and
willingness to incorporate technology into their care, with smartphone-based ACT
interventions demonstrating positive effects on parental well-being, psychological
flexibility, mindfulness skills, and children's quality of life. Yet, challenges persist
in maintaining user engagement in these publicly accessible mental health initiatives,
with over 70% of individuals discontinuing use shortly after downloading.
Pai.ACT
To address these gaps, the current study proposes a pilot investigation of "Pai.ACT," a
smartphone-based application designed to engage more than 1,000 Hong Kong-based parents.
Funded by the Information and Technology Fund (ITF), Pai.ACT employs a conversational
agent using voice-to-text capabilities to simulate ACT counsellors' responses in
Cantonese. This application serves as a comprehensive digital ACT platform, offering
multiple tiers of intervention, from self-help materials to personalized video
conferencing sessions grounded in ACT principles. The platform's development incorporated
analysis of an extensive dataset of over 10,000 tagged text instances from individual ACT
sessions to train a deep-learning language model, facilitating precise psychotherapeutic
interactions tailored to parents' needs.
STUDY AIMS AND HYPOTHESIS TO BE TESTED
The aim of this two-arm, repeated-measure, randomised controlled trial is to assess the
feasibility, acceptability, and potential efficacy of a deep-learning, smartphone-enabled
Acceptance and Commitment Therapy (ACT), referred to as Pai.ACT, is specifically designed
for parents of children with special needs. This study seeks to determine whether this
technological intervention can foster enhanced mental well-being for these parents over a
three-month post-intervention period.
This study hypothesizes that the implementation of Pai.ACT will lead to substantial
improvements in mental well-being and psychological flexibility for parents of children
with special needs. Compared to the control group receiving treatment-as-usual (TAU), we
anticipate the intervention group receiving Pai.ACT will significantly ameliorate their
mental health status immediately after the intervention and at a three-month
post-intervention follow-up. This will underscore the potential of Pai.ACT as an
effective and accessible tool for psychological support and resilience-building in this
population.