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

Importance: 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. Objective: 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. Design, Setting, and Participants: 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. Interventions: Six ACT-PAM group sessions focused on acceptance, mindfulness, values-based parenting, and asthma management. Main Outcomes and Measures: 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. Results: 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. Conclusions and Relevance: 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. Trial Registration: ClinicalTrials.gov Identifier: NCT04991649.