ACT-Based Parenting Improves Management of Pediatric Asthma With Comorbid ADHD

Acceptance and commitment therapy–based parenting program (ACT-PAM) reduced health care use, improved asthma control, and alleviated attention-deficit/hyperactivity disorder (ADHD) symptoms, demonstrating its efficacy in managing pediatric asthma with comorbid ADHD.1

“There is a growing call in the literature to move beyond understanding the asthma-ADHD association and toward integrating mental health and medical care. However, current clinical guidelines for asthma rarely mention ADHD, and ADHD care guidelines do not address asthma.This lack of dual approach care may result in symptoms, such as hyperactivity, impulsivity, or inattention, being misattributed to an adjustment reaction or adverse effects of asthma treatment rather than recognizing the potential interaction between the 2 conditions,” lead investigator Yuen Yu Chong, PhD, The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China, and colleagues wrote.1

Chong and colleagues conducted an assessor-blinded randomized clinical trial between April 2021 to August 2023 at a Hong Kong public hospital that enrolled 118 parents of children with asthma and comorbid ADHD randomized to receive either ACT-PAM plus standard asthma care as treatment as usual (TAU) or TAU alone. The investigators analyzed the data from December 2023 to March 2024 using an intention-to-treat principle.

The trial included 6 ACT-PAM group sessions focused on acceptance, mindfulness, values-based parenting, and asthma management. ACT-PAM aims to foster psychological flexibility and aims to enhance resilience in caregiving.2 The primary outcome was the number of unscheduled health care visits for asthma exacerbations over 12 months and 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.

Overall, the trial included 118 parent-child dyads with a mean parent age of 40.3 years (standard deviation [SD], 5.5) and mean child age of 7.9 years (SD, 2.2); 92% (n = 108) of parents were female and 26% (n = 31) of children were female.1

Chong and colleagues found that 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]). Furthermore, C-ACT scores improved by an aMD of 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 by an aMD of −0.5 (95% CI, −0.8 to −0.3; Cohen d, −0.94 [95% CI, −1.32 to −0.56]). They also found that parental psychological inflexibility improved with an aMD of −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 improved with an aMD of 0.8 (95% CI, 0.4-1.2; Cohen d, 1.20; 95% CI, 0.78-1.68) with the combination of ACT-PAM and TAU.1

“In conclusion, in this randomized clinical trial, ACT-PAM demonstrated sustained reductions in unplanned health care use for asthma exacerbations at 12 months postintervention in children with asthma and ADHD. Given the limited resources for these families, these findings support ACT as a promising intervention to improve long-term outcomes,” Chong and colleagues concluded.1

REFERENCES

1. Chong YY, Chien WT, Fung KP, Leung SP, Lam SY. Acceptance and Commitment Therapy–Based Parenting Program in Children With Co-Occurring Asthma and ADHD: A Randomized Clinical Trial. JAMA Pediatr. Published online June 02, 2025. doi:10.1001/jamapediatrics.2025.1313

2. HayesSC, KingGA.Acceptance and commitment therapy: what the history of ACT and the first 1,000 randomized controlled trials reveal. J Contextual Behav Sci. 2024;33:100809. doi:10.1016/j.jcbs.2024.100809