Photography-Based Intervention for Children With Attention Deficit Hyperactivity Disorder

September 2, 2026 updated by: The Hong Kong Polytechnic University

Photography-Based Intervention to Improve Emotion Wellbeing and Symptoms in Children With Attention Deficit Hyperactivity Disorder

The aims are to evaluate the feasibility and acceptability of the photography-based intervention in children with Attention Deficit Hyperactivity Disorder (ADHD) and to provide preliminary evidence of its effectiveness in alleviating emotion recognition, attention, and impulsivity in this population. Photo-taking is a common daily activity that significantly impacts people's lives. Given the effectiveness of photography in addressing social skills, communication, and emotional well-being, and its ease of use, a photography-based intervention is proposed as an adjunct tool to teach children with ADHD emotional recognition and improve their ADHD symptoms. To the best of my knowledge, no previous study has adopted photography to teach emotional recognition in children with ADHD. This photography-based intervention not only teaches children with ADHD photography skills but also improves their ability to recognize and express emotions. Appropriate emotional processing and expression may have a positive impact on these children's confidence and ability to develop and maintain positive relationships with their peers, leading to better overall well-being and social integration.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Active, not recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Attention-Deficit/Hyperactivity Disorder (ADHD) remains one of the most prevalent neurodevelopmental disorders, affecting a significant percentage of school-aged children across the globe. While the condition is primarily characterized by symptoms of inattention and impulsivity, there is a growing consensus that ADHD is fundamentally underpinned by profound impairments in emotional functioning. This emotional dysregulation is considered a transdiagnostic feature that significantly predicts long-term functional impairment in daily life. Specifically, children with ADHD exhibit marked deficits in emotion recognition and emotional awareness, which often manifests as an inability to accurately differentiate between various internal affective states. This socio-emotional dysregulation creates a cascading negative impact, not only exacerbating behavioral symptoms but also undermining subjective well-being, particularly within high-pressure educational ecologies such as Hong Kong.

Currently, the clinical landscape for ADHD emotional intervention is dominated by pharmacological treatments and behavioral modalities, including Cognitive Behavioral Therapy and Social Skills Training. While research supports the efficacy of these traditional approaches in reducing overt behavioral disruptions, their impact on the core neurocognitive processing of emotions remains inconsistent. Meta-analytic evidence indicates that individuals with ADHD exhibit pervasive deficits in underlying emotional regulation and specific impairments in non-verbal emotional decoding-areas that standard interventions often fail to significantly improve, even when outward compliance is achieved. Furthermore, while creative arts therapies like art or play therapy have emerged as helpful adjunctive tools, much of the existing literature is constrained by methodological limitations, such as small sample sizes, a lack of rigorous control designs, and a reliance on unblinded informant reports. To date, there is no standardized psychoeducational modality that specifically targets the cognitive architecture of emotional processing in ADHD through a visual medium.

The practical implementation of traditional psychoeducation faces a critical theoretical bottleneck: the high cognitive load placed on participants. According to Cognitive Load Theory, human working memory has a strictly finite capacity. Traditional programs rely heavily on dense textual materials and didactic verbal instruction. For children with ADHD, whose neurocognitive profile is inherently compromised by deficits in executive functioning and sustained attention, this text-centric design imposes an overwhelming extraneous cognitive load. When a child's cognitive resources are exhausted by the effort of processing complex linguistic instructions, the available capacity for internalizing actual emotional regulation strategies is depleted. This leads to premature disengagement and poor adherence to the therapeutic process. Therefore, there is an urgent clinical need for innovative modalities that optimize cognitive load by bypassing heavy linguistic processing in favor of more accessible formats.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
60

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Hong Kong
    • Hong Kong
      • Hong Kong, Hong Kong, Hong Kong
        • Ka Po Wong

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Child

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • ethnic Chinese aged between 8-12 years old
  • documented diagnosis of ADHD by a psychiatrist according to the ICD-10 HKD or DSM-5 criteria
  • stable on current treatment for ADHD eight weeks before baseline
  • ability to read Chinese and listen to Cantonese
  • able to operate a camera; 8) willingness of
  • their guardians to provide informed consent

Exclusion Criteria:

  • general intellectual functioning below the low-average range (estimated IQ < 80)
  • unstable screened via parental declaration and medication review
  • comorbid psychiatric disorder, severe physical or learning disability that prevents functional participation in photography tasks

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Supportive Care
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Photography-based intervention group
The participants in this group will have a six-weekly photography course. Each session is about 60 minutes. Four participants will be arranged together to conduct one session. In each session, a photographer will teach the participants basic photography skills and give a theme for the participants to take photos which will be used for sharing in the next session. Themes mainly are emotions and objects. In the sharing, the photographer will ask the participants to explain the reasons why take these photos and the photographer will explain the different types of emotions to the participants based on the themes. The participants can express their views and feelings regarding their photos.
Behavioral: Photography-based psychoedication

The programme follows a structured progression across six sessions, each building upon previous learning whilst introducing new skills and concepts. For the first session, participants build rapport and introduce photography techniques (composition, lighting) alongside emotional awareness to capture basic emotional states.

For the second and third sessions, they explore personal emotions and triggers through self-portraits and visual documentation. For the fourth and fifth sessions, they focus on the ADHD journey via strength-based photo narratives and collaborative projects to enhance peer support and social learning. In the last session, they consolidated skills into personal visual toolkits for ongoing regulation, concluding with a final project presentation and maintenance planning.
No Intervention: Waitlist control group
The participants maintained their Treatment-as-Usual (TAU). Participants in the waitlist group received the identical photography-based psychoeducation program immediately after the post-intervention assessment.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Emotional Awareness
Time Frame: From enrollment to the end of treatment at 6 weeks and 3-month follow-up
Participants' emotional functioning was evaluated by a licensed clinical psychologist using an adapted version of the Emotion Awareness Questionnaire (EAQ). To fit the clinical evaluation context and focus specifically on the core processing stages of emotion identification and expression, the questionnaire was adapted into an informant-report format consisting of two selected subscales (10 items in total): Verbal Sharing of Emotions (3 items) and Differentiating Emotions (7 items). Items in this adapted version were rated on a 4-point Likert scale ranging from 1 (never) to 4 (always).
From enrollment to the end of treatment at 6 weeks and 3-month follow-up

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Emotion Recognition
Time Frame: From enrollment to the end of treatment at 6 weeks and 3-month follow up
Participants' ability to accurately identify emotional states from non-verbal cues was evaluated using a customized, 7-item Facial Emotion Recognition Task (FERT) based on the universal emotional categories. Children were presented with seven distinct facial-expression stimuli, each representing a specific emotion category: happiness, surprise, anger, contempt, disgust, fear, and sadness. The facial stimuli were presented on a computer screen by a licensed clinical psychologist. For each item, participants were instructed to identify or label the displayed emotion. The performance was scored based on overall accuracy (total correct answers out of 7), with higher scores indicating a better capacity for facial emotion recognition.
From enrollment to the end of treatment at 6 weeks and 3-month follow up
Subjective well-being
Time Frame: From enrollment to the end of treatment at 6 weeks and 3-month follow-up
The 4-item Subjective Happiness Scale (SHS) was utilized to measure subjective happiness. Respondents rated items on a 7-point Likert scale (1 = strongly disagree 1=strongly disagree, 7 = strongly agree 7=strongly agree).
From enrollment to the end of treatment at 6 weeks and 3-month follow-up
ADHD symptoms
Time Frame: From enrollment to the end of treatment at 6 weeks and 3-month follow up
The teacher-rated Chinese version of the Swanson, Nolan, and Pelham, Version IV (SNAP-IV-18) 18-item scale, which assesses inattention (9 items) and hyperactivity/ impulsivity (9 items). A 4-point Likert scale will be used, ranging from 0 (not at all) to 3 (very much).
From enrollment to the end of treatment at 6 weeks and 3-month follow up
Satisfaction of the intervention
Time Frame: At 6 weeks (post-intervention)
Evaluated using a child-friendly, single-item 7-point visual facial Likert scale. Children were directly asked to rate their overall satisfaction with the photography-based program by selecting one of seven standardized facial expressions, ranging from 1 (a very unhappy/dissatisfied face) to 7 (a very happy/satisfied face).
At 6 weeks (post-intervention)
Feasibility of the study
Time Frame: From enrollment to the end of treatment at 6 weeks and 3-month follow up
Operationalized through intervention attendance, completion rates, and protocol adherence. Attendance was tracked weekly by group facilitators, with successful feasibility defined a priori as an overall session attendance rate of ≥ 80 % and a study completion/retention rate of ≥ 85 % across the 6-week intervention period.
From enrollment to the end of treatment at 6 weeks and 3-month follow up

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
The Hong Kong Polytechnic University

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Ka Po Wong, PhD, The Hong Kong Polytechnic University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
June 15, 2026

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
October 18, 2026

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
October 30, 2026

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
June 10, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
June 10, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
June 15, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
September 8, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
September 2, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
January 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • HSEARS20230714001

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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