The study aims to examine the effectiveness of a psychotherapy approach called Facilitator-guided Acceptance and Commitment Bibliotherapy (FAB) in improving the psychological health of parents of young children with neurodevelopmental disorders (NDD) and reducing the emotional and behavioral symptoms of NDD children. The study will involve 154 Cantonese-speaking parents of children aged 2-6 years diagnosed with NDD in Hong Kong. The study hopes to find that FAB can improve parent-child dyads' health outcomes by enhancing psychological flexibility, parental psychological health, and mindful parenting skills.
Cantonese-speaking Hong Kong residents,
aged ≥ 21 years,
have a child aged between two and six years old (preschool age) with a clinically documented diagnosis/suspected NDD diagnosis according to DSM-5 criteria (e.g., ASD, ADHD, developmental delay) and enrolled in the SWD subvented pre-school rehabilitation services offered by NGOs,
caregivers who adopted the responsibility of taking care of the child, living together with the child, and
None
Parallel
Facilitator-guided Acceptance and Commitment Bibliotherapy (FAB)
BehavioralThe Facilitator-guided Acceptance and Commitment Bibliotherapy (FAB) is a 12-week self-help parenting program that integrates Acceptance and Commitment Therapy (ACT) principles with web-based modules and group-based sessions. The program includes a self-help workbook/manual and ACT protocols that cover various self-help exercises such as guided imagery, grounding, mindfulness, and values clarifications. To make the programme more relatable to Hong Kong parents caring for children with NDD, storytelling vignettes and therapeutic narratives will be included. Parents will work on each module at their own pace within 2-3 weeks and meet with trained facilitators in a video-conferencing format after completing each module to review their progress and learn positive parenting techniques.
General Parenting Education and Advice
BehavioralBoth the FAB group and the Control Group will receive routine family support services from collaborating NGOs, including education on managing the emotional and behavioral symptoms of children with NDD. To control for the interaction/social effect present in the FAB group, the Control Group will also receive four video-conferencing sessions guided by a trained research assistant over 12 weeks. These sessions will facilitate parents to discuss their parenting challenges, identify parenting traps, and provide general parenting advice as recommended by the Child Assessment Services, Department of Health under the HKSAR government.
Parenting stress
The Parenting Stress Index-Short Form (PSI-SF, 36 items, 5-point Likert scale). The PSI-SF evaluates parenting stress in three dimensions: parental distress, parent-child dysfunctional interaction, and difficult child behaviour (12 items each), with all items summed to indicate the total parenting stress \[48\]. Parents are asked to rate how much they agree or disagree with each statement using a 5-point Likert scale, ranging from "strongly agree" to "strongly disagree". Higher scores indicate higher levels of parenting stress. The Chinese version of PSI-SF (and its subscales) demonstrated strong convergent validity, discriminant validity and internal consistency (α =.79-.88) in Chinese parents.
Child's emotional and behavioural symptoms
The Strengths and Difficulties Questionnaire (SDQ, 25 items, 3-point Likert scale). The SDQ consists of 25 items that assess five domains: emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems, and prosocial behavior. Each item is rated on a 3-point Likert scale, with higher scores indicating greater symptom severity for the emotional and behavioral problem domains and greater prosocial behavior for the prosocial behavior domain. The Chinese version of SDQ reported adequate test-retest reliabilities (ICC=.75-.86) and discriminant validity in Hong Kong parents.
Parental symptoms of anxiety and depression
The Hospital Anxiety and Depression Scale (HADS, 14-item, 4-point Likert Scale). The HADS is a widely used self-rating scale assessing symptoms of anxiety and depression (7 items per subscale). Each item is rated on a 4-point Likert scale, ranging from 0 to 3, with higher scores indicating greater symptom severity, and its total subscale score ≥ 8 indicates considerable symptoms. The total score for each subscale ranges from 0 to 21, with higher scores indicating more severe anxiety or depression symptoms. This Chinese version of HADS demonstrated adequate construct validity and internal consistency in the Hong Kong sample (α =.67-.79).
Parental psychological flexibility
The Psyflex questionnaire (6-item, 5-point Likert scale). The Psyflex questionnaire consists of 6 items that use a 5-point Likert scale to assess different aspects of psychological flexibility, such as the ability to be present in the moment, to accept difficult thoughts and emotions, and to focus on what matters most. Higher scores on the Psyflex questionnaire indicate greater psychological flexibility, which has been associated with better mental health outcomes. The Psyflex possesses excellent convergent validity, divergent validity, and reliability (Raykov's r = .91). Its Chinese version has been validated in the PI's work.
Parenting behaviour
is a self-report measure consisting of 31 items, which use a 5-point Likert scale to assess mindfulness in parenting. The questionnaire evaluates various aspects of mindfulness in parenting, such as being present with one's child and responding to their emotions with compassion. Parents are asked to rate how frequently they engage in each behavior, with responses ranging from "never" to "very often". The IM-P generates a total score, as well as scores for five subscales: "Listening with Full Attention", "Emotional Nonreactivity to Child Distress", "Nonjudgmental Acceptance of Parenting Experience", "Compassionate Responding to Child's Needs", and "Emotion Regulation in Parenting". Higher scores on the IM-P reflect greater levels of mindfulness in parenting. The Chinese version of IM-P, which has been used in our Co-I's trial, demonstrated good convergent validity and internal consistency (α =.70-.84) among parents.
Child's use of health care and rehabilitation services
The types and frequencies of rehabilitation service use from private and/or public health sectors per month over the past six months will be reported by parents, and cross-checked with the records provided by the On-site Pre-school Rehabilitation Services (OPRS) teams.
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Chinese University of Hong Kong
Lead sponsor
Hong Kong Sheng Kung Hui Welfare Council Limited
Collaborator
