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.

重要性：儿童哮喘和注意力缺陷多动障碍（ADHD）共病增加了照护复杂性和医疗使用频率，强调了需要综合干预措施来解决这两种情况。

目的：评估基于接纳承诺疗法的育儿项目（ACT-PAM）对患有哮喘和ADHD的儿童及其父母健康结果在12个月随访期中的有效性。

设计、设置与参与者：这项评价员盲法随机临床试验于2021年4月1日至2023年8月31日期间在香港公立医院进行，共纳入了118名患有哮喘和伴随ADHD的儿童的父母。参与者被随机分配接受ACT-PAM加标准哮喘护理（作为常规治疗TAU）或单独接受TAU。数据分析于2023年12月1日至2024年3月31日期间进行，采用了意向性治疗原则。

干预措施：六次ACT-PAM小组会议重点在于接纳、正念、价值观导向的育儿和哮喘管理。

主要结果与测量指标：主要结局是12个月内因哮喘加重而进行的非计划医疗访问次数。次要结局包括哮喘控制（通过儿童哮喘控制测试[C-ACT]评估）、儿童ADHD症状（根据父母评分在注意力缺陷多动障碍症状及正常行为优势和劣势量表[SWAN]上得分）、父母的心理灵活性，以及哮喘管理自我效能。

结果：在118对家长与孩子（平均[标准差]年龄分别为：40.3 [5.5]岁和7.9 [2.2]岁；108名女性父母[占92%] 和 31名女性儿童[占26%]）中，ACT-PAM加TAU相比单纯使用TAU显著减少了非计划医疗访问次数（校正平均差异[aMD]：-0.8次就诊；95%置信区间[CI]：-1.6至-0.1；调整后的发生率比值为0.33，95% CI：0.19至0.55）。C-ACT得分提高了（aMD：4.4；95% CI：2.5至6.5；Cohen d：1.40；95% CI：1.10至1.79），而父母评价的SWAN综合评分下降了（aMD：-0.5；95% CI：-0.8至-0.3；Cohen d：-0.94；95% CI：-1.32至-0.56）。在ACT-PAM和TAU结合使用的情况下，父母的心理灵活性（aMD：-10.0；95% CI：-15.6至-4.5；Cohen d：-1.08；95% CI：-1.47至-0.69）和哮喘管理自我效能（aMD：0.8；95% CI：0.4至1.2；Cohen d：1.20；95% CI：0.78至1.68）也有所改善。

结论与相关性：在这项随机临床试验中，ACT-PAM减少了医疗使用频率，提高了哮喘控制，并减轻了ADHD症状，在管理伴随有ADHD的儿童哮喘方面显示出了有效性。

试验注册：ClinicalTrials.gov识别号：NCT04991649。