Acceptance and Commitment Therapy–Based Parenting Program in Children With Co-Occurring Asthma and ADHD

Co-occurring asthma and attention-deficit/hyperactivity disorder (ADHD) in children increase caregiving complexity and health care use, underscoring the need for holistic interventions addressing both conditions. To examine the efficacy of an acceptance and commitment therapy-based parenting program (ACT-PAM) on health outcomes in children with asthma and ADHD and their parents over 12 months postintervention. This assessor-blinded randomized clinical trial was conducted from April 1, 2021, to August 31, 2023, at a Hong Kong public hospital and enrolled 118 parents of children with asthma and comorbid ADHD. Participants were randomized to receive either ACT-PAM plus standard asthma care as treatment as usual (TAU) or TAU alone. Data were analyzed from December 1, 2023, to March 31, 2024, using an intention-to-treat principle. Six ACT-PAM group sessions focused on acceptance, mindfulness, values-based parenting, and asthma management. The primary outcome was the number of unscheduled health care visits for asthma exacerbations over 12 months. Secondary outcomes included asthma control (via the Childhood Asthma Control Test [C-ACT]), ADHD symptoms in children (via parent-rated scores on Strengths and Weaknesses of ADHD Symptoms and Normal Behaviors [SWAN] scale), parental psychological inflexibility, and asthma management self-efficacy. Among 118 parent-child dyads (mean [SD] parent age, 40.3 [5.5] years; mean [SD] child age, 7.9 [2.2] years; 108 female parents [92%] and 31 female children [26%]), ACT-PAM plus TAU significantly reduced unscheduled health care visits compared with TAU alone (adjusted mean difference [aMD], -0.8 visits; 95% CI, -1.6 to -0.1; adjusted incidence rate ratio, 0.33; 95% CI, 0.19-0.55). C-ACT scores improved (aMD, 4.4; 95% CI, 2.5-6.5; Cohen d, 1.40; 95% CI, 1.10-1.79), while parent-rated SWAN combined scores decreased (aMD, -0.5; 95% CI, -0.8 to -0.3; Cohen d, -0.94; 95% CI, -1.32 to -0.56). Parental psychological inflexibility (aMD, -10.0; 95% CI, -15.6 to -4.5; Cohen d, -1.08; 95% CI, -1.47 to -0.69) and asthma management self-efficacy (aMD, 0.8; 95% CI, 0.4-1.2; Cohen d, 1.20; 95% CI, 0.78-1.68) were also improved with the combination of ACT-PAM and TAU. In this randomized clinical trial, ACT-PAM reduced health care use, improved asthma control, and alleviated ADHD symptoms, demonstrating its efficacy in managing pediatric asthma with comorbid ADHD. ClinicalTrials.gov Identifier: NCT04991649.