Multiple Family Narrative Therapy for Chinese Families of Children With Attention Deficit Hyperactivity Disorder

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.

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.

Eligibility Criteria:
Inclusion Criteria:

* Participants 7-13 years old and their parents
* ADHD diagnosis (by psychiatrist or educational psychologist)
* Diagnosis with comorbidity of other learning disabilities
* Cantonese speaking participants (child and parents)
* At least one of the parents, but not siblings nor grandparents, can commit to all four sessions
* Participants able to comply with all testing and study requirements

Exclusion Criteria:

* Formal current diagnosis of psychosis
* Limitation in daily communication
* Previous service recipients of Narrative Therapy or Multiple Family Group
* Non-Cantonese speaking child or parent
* Parents or children who refuse to give written consent for their participation in the study