Multiple Family Narrative Therapy for Chinese Families of Children With Attention Deficit Hyperactivity Disorder
Condition: Attention-deficit/Hyperactivity Disorder; Special Education; Special Needs Children; Attention Deficit Disorder; Hyperactivity Disorder
MeSH terms: Hyperkinesis; Attention Deficit Disorder with Hyperactivity
Study type: Interventional

Summary: 
      The goal of this randomized controlled trial is to develop and to implement a multiple family
      narrative therapy intervention consisting of parent-child relationships training among
      Chinese families of children with attention deficit hyperactivity disorder (ADHD). The
      intervention aims to reduce the psychological distress of parents and their child, thus
      improving parent-child relationships, and the trial aims to assess the effectiveness of MFNT
      among them. A RCT design supplemented by qualitative interviews will be used to evaluate the
      effectiveness of multiple family narrative therapy intervention on family welfare.
    

Detailed description: 
      Attention deficit hyperactivity disorder (ADHD) affects 6.4% of children in Hong Kong while
      medicating children with ADHD in Hong Kong has increased 36-fold between 2001 and 2015.
      Global studies provide evidence that children with ADHD have experienced a substantial amount
      of stress due to the childrearing distress of their parents. The education system in Hong
      Kong is exceptionally competitive and academically focused. When parenting skills are
      measured against the academic achievement of children, parents may feel helpless and
      hopeless, which contribute to social isolation during stressful times that stem from caring
      for a child with ADHD or other developmental disabilities. Chinese parents who are heavily
      burdened by the pressure of preventing the academic failure of their children typically
      resort to outing their children in privately operated tutorial classes and giving them
      additional home-based assignments. These remedial actions often increase the stress levels of
      both parents and child. In the Chinese culture, academic failure shames the family, which
      leads to parent-child conflicts and mental health issues. These family problems can
      negatively affect Chinese children with ADHD.

      Related support services in Hong Kong are also inadequate and insufficient. The management of
      ADHD in Hong Kong follows the international mainstream treatments that comprise prescribing
      stimulant medication and behavioural interventions. Few studies on psychoeducation models
      have focused on parent-child relationships, parental stress for families of children with
      learning disabilities in Hong Kong. The available psychological approaches mainly address the
      behavioural changes of children with special educational needs (SENs). However, the
      psychoeducation approach does not reduce the social isolation of parents and the
      stigmatisation of medication by parents who fear the side effects and long-term effects. To
      address this research gap, a psychotherapy model is used to evaluate the impact of its
      intervention on both parents and their child with SENs, especially ADHD, which has been
      recently seen an increase in demand. At the same time, it is crucial to examine the process
      of change in attitudes and interactions among family members who participate in Multiple
      Family Narrative Therapy (MFNT) so that helping professionals can learn from this qualitative
      part to refine the design and session plan of MFNT.

      This study addresses a need in the Hong Kong Chinese community with four anticipated
      outcomes: 1) the effectiveness of MFNT as a brief-targeted intervention model with CFCAs is
      determined; 2) a participatory approach that engages both parents and children is realised;
      3) a culturally applicable practice manual for the Chinese context is produced; and 4) the
      use of the practice manual by school and integrative family services is encouraged.

      This study evidence-informed and knowledge-building results will support a brief-targeted
      MFNT approach in Hong Kong to supplement the "treatment as usual" school-focused process in
      working with Chinese families of children with ADHD (CFCAs) towards a collaborative model
      where family members can reassess their identity and adopt alternative interaction
      behaviours. Excessive school-based work increases the pressure of students in an academic
      achievement-driven culture, which intensifies conflicts in parent-child relationships.

      A randomized controlled trial (RCT) design and qualitative interviews will be used to
      evaluate the effectiveness of MFNT on family welfare. The first objective is to examine the
      effectiveness of a brief-targeted MFNT for CFCAs in Hong Kong. The aim is to reduce their
      psychological distress to enhance parent-child relationships. The second objective is to
      assess and document the course of change in attitudes and interactions among the MFNT
      participants.
    

Intervention name(s): Multiple Family Narrative Therapy (MFNT); School services for families of children with ADHD
Intervention type(s): Behavioral; Behavioral
Intervention description(s): MFNT consist of 4 weekly group sessions with selected themes from both multiple family therapy (MFT) and narrative therapy (NT) offered in a group format. Parents participates in four mentored sessions, while their children attend the second and fourth sessions. The family is treated as a system through both psychodynamic practices and attachment theories to manage symptoms, to achieve family resilience, and to empower both parents and child to share their unique and lived value-driven experiences. MFNT provides families with therapeutic environments that are conducive to learning and modelling in order to facilitate the process of building healthier parent-child dyads.; Selected school social personnel will deliver services as usual for the control group.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Attention deficit; Hyperactivity disorder; Multiple family group; Narrative therapy; Efficacy; Special educational needs; Intervention; Parent-child