title: The effect of a family-based mindfulness intervention on children with attention deficit and hyperactivity symptoms and their parents: design and rationale for a randomized, controlled clinical trial (Study protocol).
abstract: BACKGROUND
  About 4 % of children in Hong Kong have attention deficit hyperactivity disorder (ADHD). The parents of children with ADHD report higher levels of stress and show more negative parenting behavior. Medication and behavior training are evidence-based treatments, but both show significant limitations. In short, medical treatment is not suitable for preschool children and would suppress growth, whereas parents under stress may not be capable of consistently applying behavior management skills. Mindfulness training can improve attention and facilitate cognitive development and overall functioning. It has been widely adopted as a treatment option in health care, but its application in a family context is limited. In this context, a family-based mindfulness intervention (FBMI) has been developed to promote the attention and mental health of children with attention symptoms and to reduce the stress experienced by their parents. This article describes the design and conduct of the trial.
  
  
  METHODS
  A multicenter, 8-week, waitlist, randomized controlled trial of FBMI is currently being conducted in Hong Kong (from mid-2015 to mid-2016). Its effectiveness will be examined by comparing the participants who receive treatment to those in a waitlist control group. The study population consists of one hundred twenty children with ADHD, or with symptoms of inattention and hyperactivity, between 5 and 7 years of age and their parents. To be included in the study, the children are required to meet or exceed the borderline cutoff score of the Chinese version of the Strengths and Weaknesses of ADHD Symptoms and Normal Behaviors Rating Scale (SWAN-C). The primary outcome measures are the children's ADHD symptoms and behavior and the parents' stress. The secondary outcome measures include the children's overall behavioral problems and performance on the Attention Network Test, the parents' ADHD symptoms, the parents' mindful parenting scores, and heart rate variability of parents.
  
  
  CONCLUSIONS
  This study is probably the first randomized controlled trial of FBMI for young children and their caregivers. A rigorous design and multiple outcome measures are used to examine the effectiveness of FBMI. If the hypotheses are confirmed, FBMI may serve as an additional treatment option for children with ADHD.
  
  
  BACKGROUND
  This study is registered with the Chinese Clinical Trial Registry (reference number: ChiCTR-IOR-15007292 ). Registered 28 October 2015.
authors.affiliation: Department of Applied Social Sciences, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong, SAR, China. hm.lo@cityu.edu.hk.
authors.forename: Herman H M
authors.initials: HH
authors.lastname: Lo
authors.affiliation: Division of Family Medicine and Primary Health Care, School of Public Health and Health Care, The Chinese University of Hong Kong, Hong Kong, SAR, China.
authors.forename: Samuel Y S
authors.initials: SY
authors.lastname: Wong
authors.affiliation: School of Nursing, The University of Hong Kong, Hong Kong, SAR, China.
authors.forename: Janet Y H
authors.initials: JY
authors.lastname: Wong
authors.affiliation: Department of Psychological Studies, The Hong Kong Institute of Education, Hong Kong, SAR, China.
authors.forename: Simpson W L
authors.initials: SW
authors.lastname: Wong
authors.affiliation: Department of Applied Social Sciences, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong, SAR, China.
authors.forename: Jerf W K
authors.initials: JW
authors.lastname: Yeung
mesh_terms: D001288:Attention; D001289:Attention Deficit Disorder with Hyperactivity / Q000523:psychology / Q000628:therapy*; D001521:Behavior Therapy / Q000379:methods; D017028:Caregivers; D002648:Child; D002675:Child, Preschool; D005190:Family / Q000523:psychology*; D005260:Female; D006723:Hong Kong; D006801:Humans; D008297:Male; D008603:Mental Health; D064866:Mindfulness; D016487:Parenting / Q000523:psychology; D010290:Parents / Q000523:psychology*; D012107:Research Design
keywords: Attention deficit hyperactivity disorder; Child development; Executive functioning; Family-based intervention; Mindfulness-based intervention