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Parent-administered pediatric tuina for the treatment of attention deficit hyperactivity disorder symptoms: Process
Shu-Cheng Chen1, Hui-Lin Cheng1, Le-Fei Han2
1School of Nursing, The Hong Kong Polytechnic University, HKSAR, China.
Insights
Parent-administered pediatric tuina is a feasible and acceptable intervention for preschool children with attention deficit hyperactivity disorder (ADHD). Refinements in Traditional Chinese Medicine (TCM) pattern identification and outcome settings are recommended for future studies.
Area of Science:
- Integrative Medicine
- Pediatric Health
- Mental Health Research
Background:
- A pilot randomized controlled trial (RCT) investigated parent-administered pediatric tuina for attention deficit hyperactivity disorder (ADHD) in preschool children in China.
- An embedded process evaluation explored implementation barriers and facilitators for a future fully powered study.
Purpose of the Study:
- To examine the feasibility and acceptability of parent-administered pediatric tuina for preschool ADHD.
- To assess preliminary effects of the intervention on ADHD symptoms.
- To identify barriers and facilitators for optimizing future study design.
Main Methods:
- A process evaluation utilized self-reported questionnaires (parents, TCM practitioners, outcome assessor, research assistant), parent logbooks, and focus group interviews.
- Data collection involved 43 parents, 2 TCM practitioners, 1 outcome assessor, 1 research assistant, and 15 focus group participants.
- Template analysis was used for qualitative data, with means calculated for quantitative findings.
Main Results:
- Facilitators included perceived benefits, acceptability by parents and children, and research team support.
- A major barrier was potential inaccuracy in online Traditional Chinese Medicine (TCM) pattern identification, leading to parental doubt.
- Parents reported improvements in children's appetite, sleep quality, and the parent-child relationship, with good adherence.
Conclusions:
- Parent-administered pediatric tuina is feasible and acceptable for preschool ADHD.
- Refinements in TCM pattern identification and outcome settings are suggested for future large-scale studies.
Background:
A pilot randomized controlled trial (RCT) was conducted in mainland China to examine the feasibility, acceptability, and preliminary effects of parent-administered pediatric tuina on attention deficit hyperactivity disorder (ADHD) symptoms in preschool children. An embedded process evaluation was performed to explore barriers and facilitators in the implementation, identify additional questions, and refine the study design for a future fully powered study.
Methods:
The process evaluation comprises the following parts: (a) self-reported questionnaires on parents (n = 43), traditional Chinese medicine (TCM) practitioners (n = 2), outcome assessor (n = 1), and research assistant (n = 1); (b) parent logbook on parent-administered pediatric tuina (n = 32); and (c) focus group interview sessions (n = 15). Accomplishment of the self-report questionnaires was voluntary for all participants and compulsory for research personnel and TCM practitioners. The parent logbook on the intervention was filled out by all participants in the intervention group. Participants of focus group interviews were selected via purposive sampling, and data were analyzed with template analysis. Qualitative findings were summarized in tables, while the mean was calculated to reflect the quantitative findings.
Results:
Perceived benefits, acceptability of parents and children, and professional support from the research team facilitated the implementation of the intervention. Meanwhile, the TCM pattern identification using online mode may limit the accuracy and lead to parents doubting the precision of the TCM pattern. This limitation was regarded as a major barrier. Parents perceived improvements in terms of children's appetite, sleep quality, and parent-child relationship. Participants were generally satisfied with the settings of parent-administered pediatric tuina and showed satisfactory adherence to the implementation.
Conclusions:
Implementation of parent-administered pediatric tuina intervention is feasible and acceptable. The intervention can be refined by improving the TCM pattern identification procedure and adjusting outcome settings in a fully powered study in the future.
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