Effectiveness of Multiple Family Narrative Therapy for Chinese Families of Children with Attention-Deficit/Hyperactivity Disorder

Background. Chinese families of Children with Attention-Deficit/Hyperactivity Disorder (CFCA) in Hong Kong are experiencing intensive parent-child conflicts. ADHD puts parents and children against each other by causing misunderstandings, frustration, and challenges in communication. However, on-site school services target improving children’s behavioral performance over intrafamilial needs. Multiple Family Narrative Therapy (MFNT) is a family-based intervention that targets to improve parent-child relationships by integrating multiple family therapy and narrative therapy. This study examined the effectiveness of MFNT in reducing their psychological distress and improving their parent-child relationships.

Methods. Sixty-one families were recruited from local primary schools and were randomized by site to the treatment group or the waitlist control group. For the treatment group (n = 35), data were collected at baseline/pre-intervention (T1), post-intervention (T2), and at 3-month follow-up; for the waitlist control group (n = 26), data were collected at baseline (T1), pre-intervention (T2), post-intervention, and 3-month follow-up. While participants in the treatment group received immediate intervention, participants in the waitlist control group received intervention after the completion of T2 data collection. Psychological distress of CFCA was measured by Kessler Psychological Distress Scale; parent-child relationship was measured by Parent-Child Relationship Scale, Parental Bonding Instrument, and Child—Parental Acceptance-Rejection Questionnaire. A series of 2 x 2 repeated measure ANOVAs were used to examine any significant differences between groups and within groups from T1 to T2. Paired-sample t-tests were then used to examine the sustainability of MFNT.

Results. MFNT was shown to be beneficial to CFCA in lowering psychological distress and enhancing parent-child relationships. Specifically, parents of the intervention group demonstrated a significant reduction from T1 to T2 in psychological distress (partial η 2 = 0.056), while the waitlist control group showed no difference. Children of the intervention group showed significant reductions from T1 to T2 in child-perceived paternal overprotection (partial η 2 = 0.088) and parental rejection (partial η 2 = 0.089), compared to the waitlist control group. The effects lasted at 3-month follow-up.

Conclusions. The novelty of this study is its cultural relevance in applying a brief-MFNT for CFCA in local primary schools. Despite a 10-hour brief-MFNT was implemented, the effects of MFNT lasted at 3-month follow-up. While ADHD limits opportunities and options of CFCA, MFNT provided a space for fostering positive changes in parental perspective towards their children with ADHD. Interfamilial interaction helped parents review their current perspectives by seeing the differences in perceiving and managing ADHD conditions among CFCA, resulting in adopting a more strength-based perspective regarding their children and ADHD. Positive intrafamilial changes were reflected through MFNT family activities which aimed to help parents and children reclaim their stand to face ADHD and reconcile their relationships. On-site school services for children with ADHD and their families should address intrafamilial concerns by jointly involving parents and children. ADHD symptoms are similar across cultures, but the divergent cultural meanings can pose different impacts on families. MFNT sets the foundation for improving parent-child relationships and psychological well-being among these families by transforming parental perspectives on ADHD and increasing positive parent-child interaction.