Chong Yuen Yu, Chien Wai Tong, Fung Kenneth P, Leung Sui Ping, Lam Shu Yan
The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
JAMA Pediatr. 2025 Jun 2. doi: 10.1001/jamapediatrics.2025.1313.
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.
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.
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.
儿童同时患有哮喘和注意力缺陷多动障碍（ADHD）会增加护理的复杂性和医疗保健的使用，这凸显了针对这两种病症进行整体干预的必要性。
研究基于接受与承诺疗法的育儿项目（ACT-PAM）在干预后12个月内对哮喘和ADHD患儿及其父母健康状况的疗效。
设计、地点和参与者：这项评估者盲法随机临床试验于2021年4月1日至2023年8月31日在香港一家公立医院进行，招募了118名哮喘合并ADHD患儿的父母。参与者被随机分为两组，一组接受ACT-PAM加标准哮喘护理作为常规治疗（TAU），另一组仅接受TAU。数据于2023年12月1日至2024年3月31日进行分析，采用意向性分析原则。
ACT-PAM组进行六次课程，重点是接受、正念、基于价值观的育儿和哮喘管理。
主要结局是12个月内因哮喘加重而进行的非计划医疗就诊次数。次要结局包括哮喘控制（通过儿童哮喘控制测试[C-ACT]）、儿童ADHD症状（通过家长对ADHD症状与正常行为优势与劣势[SWAN]量表的评分）、父母心理灵活性以及哮喘管理自我效能感。
在118对亲子中（父母平均[标准差]年龄为40.3[5.5]岁；儿童平均[标准差]年龄为7.9[2.2]岁；108名母亲[92%]和31名女童[26%]），与仅接受TAU相比，ACT-PAM加TAU显著减少了非计划医疗就诊次数（调整后平均差[aMD]，-0.8次就诊；95%置信区间，-1.6至-
