Treatment Efficacy of Multiple Family Therapy for Chinese Families of Children with Attention Deficit Hyperactivity Disorder

• Date: 01 June 2018
• Author: Lily Li Li Xia,Kelly Y. C. Lai,Joyce L. C. Ma
• DOI: http://doi.org/10.1111/famp.12297
• Published date: 01 June 2018

Treatment Efficacy of Multiple Family Therapy for

Chinese Families of Children with Attention Deficit

Hyperactivity Disorder

JOYCE L. C. MA*

KELLY Y. C. LAI

†

LILY LI LI XIA*

The treatment efficacy of multiple family therapy (MFT) for Chinese families of children

with attention deficit hyperactivity disorder (ADHD) has not been studied in the past. In

this paper, the effect of MFT on different aspects of the lives of the parents in the experimen-

tal group (n=61) was compared with the effect of only the psychoeducational talks on par-

ents in the control group (n=53). The results of a MANOVA have shown that by the time

they reached the posttreatment phase, the parents who had completed the full 42 hours of

the MFT program perceived their children’s ADHD symptoms as being less serious and less

pathological than they had originally thought compared to the parents in the control

group. The effect of MFT on parent–child relationships, parenting stress, parental efficacy,

hope, and perceived social support was statistically insignificant. Contributions and limi-

tations of our study are discussed.

Keywords: Treatment Efficacy; Multiple Family Therapy; Chinese; Families; Children;

Attention Deficit Hyperactivity Disorder

Fam Proc 57:399–414, 2018

INTRODUCTION

Attention deficit hyperactivity disorder (ADHD), characterizedby a cluster of symptoms

comprising inattention, hyperactivity, and impulsivity, is a universal mental health

problem with a prevalence rate of 5% in school-age children worldwide (APA, 2013) and

8.9% in school-age children in Hong Kong (Leung et al., 1996). The ratio of the incidence

of occurrence between boys and girls is about 3:1 (American Psychiatric Association,

2013). There is rising evidence suggesting that genetic heritability contributes to the dis-

order (Chronis, Jones, & Raggi, 2006). However, psychosocial factors such as hostility or

scapegoating of a child, harsh parenting (Richards, 2013), and maltreatment in parent–

child relationships (Ma, Lai, & Wan, 2015) are also linked to developing and maintaining

the ADHD symptoms. If unidentified and improperly managed, the disorder may

unfavorably affect a child’s short-term development (e.g., academic underachievement,

self-perception, parent–child relationships, and peer relationships) and long-term

*Department of Social Work, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.

†

Department of Psychiatry, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.

Correspondence concerning this article should be addressed to Joyce C. L. Ma, Department of Social

Work, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong. E-mail: joycelai@

cuhk.edu.hk.

The Research Grants Council (RGC) of Hong Kong financially supports this study (RGC Ref. No.

CUHK449012).

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Family Process, Vol. 57, No. 2, 2018 ©2017 Family Process Institute

doi: 10.1111/famp.12297

development (e.g., increased school drop-out, antisocial behavior, unstable intimate

relationships, and unemployment) (Barkley, 2006).

Parental responses to and ways of coping with raising children with ADHD are likely to

vary across different cultures due to differences in societal norms and expectations of par-

enting practices (Malacrida, 2003). Being a former British colony, Hong Kong is a melting

pot of Western and Eastern cultures where the majority of the population is Chinese.

Under the influence of traditional Chinese culture, children in Hong Kong are socialized

to be co-operative, prosocial, and obedient in order to preserve interpersonal and social

harmony, which is different from the case of their counterparts in the West where individ-

ual freedom and autonomy are emphasized (Chen & French, 2008). Children’s ADHD

symptoms challenge our existing social norms. Similar to the experiences of overseas par-

ents (e.g., Austin & Carpenter, 2008; Singh, 2004), Chinese parents in Hong Kong feel

they are being blamed for their child’s misbehavior. Their culpability is reinforced by two

dominant cultural discourses: (a) parents have to take active roles in educating their off-

spring, jiao yao (教養) (Ma & Lai, 2016); and (b) a filial child has to obey his or her parents

during childhood, honor the family name through his or her achievement in adulthood,

and take care of his or her aging parents (Yi, 2013). Parents of children with ADHD have

become increasingly socially isolated as support from school, health care, and social ser-

vices have become insufficient (Ma & Lai, 2014). They have also been found to suffer from

high parenting stress (Chan, Hung, Lee, & Wong, 2010). Parent–child conflicts and mal-

treatment in parent–child relationships have been discerned in a clinical sample (n=22)

of families receiving multiple family therapy (Ma, Lai, & Wan, 2016). The multiple stres-

ses experienced by these parents may in turn exacerbate their children’s ADHD behavior.

Mothers and fathers tend to differ in the way they perceive their children’s ADHD

symptoms (Singh, 2003; Singh, 2004) and in their patterns of child rearing. The results of

Ma and Lai’s (2016) study (n=121) have shown that Chinese fathers (n=49) did not per-

ceive their children’s ADHD to be as serious and as pathological as the children’s mothers

(n=72) did, which might be explained by the fathers’ tendency to adopt a masculine lens

when viewing the child’s behavior, the long working hours of the fathers (Lau, Ma, Wan,

Wong, & Lai, 2012), and their under-involvement in childcare. The disparity between the

paternal and maternal experiences in caring for children with ADHD may be a source of

the couple’s marital conflicts. Viewing this from a positive perspective, Chinese fathers

may be potential healers in the family in terms of providing emotional support to their

spouse and their active involvement in child rearing. However, it is usually the mother s

who seek help from mental health services, probably due to an inflexible gendered division

of labor between men and women in the family (Ma & Lai, 2016). Despite the importance

of paternal care in raising children with ADHD, little has been done in Hong Kong to

engage fathers actively in the assessment and treatment of their children.

To date, treatment for children with ADHD in Hong Kong is primarily dominated by

the mainstream treatments comprising stimulant medication and behavioral training (So,

Leung, & Hung, 2008). While appreciating the contributions of medication to helping

these children improve their psychosocial functioning at school and in the family, about

30% of the children with ADHD did not respond to stimulant medication (Chan et al.,

2010). Parents have reservations and concerns about the short-term side effects of stimu-

lant medication such as appetite suppression and insomnia and its potential long-term

side effects (Chronis et al., 2006; So et al., 2008). Richards (2013) has criticized the

mainstream treatments as simplistic solutions for resolving complex psychosocial issues

associated with the ADHD symptoms (e.g., scapegoating of a child and maltreatment in

parent–child relationships). In addition, the mainstream treatments are deficit-oriented,

child-focused, and expert-oriented rather than strengths-based and family focused (Ma &

Lai, 2016). Insufficient professional effort and time has been taken to tap family resources

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