Photography-Based Intervention for Children With Attention Deficit Hyperactivity Disorder

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 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: Active, not recruiting
• Conditions: Attention Deficit Hyperactivity Disorder
• Intervention / Treatment: Behavioral: Photography-based psychoedication

• Study Type: Interventional
• Enrollment (Actual): 60
• Phase: Not Applicable

Contacts and Locations

Study Locations

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

Participation Criteria

Eligibility Criteria

• 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

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
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

Outcome Measure	Measure Description	Time Frame
Emotional Awareness	Participants' emotional functioning was evaluated by a licensed clinical psychologist using an adapted version of the Emotion Awareness Questionnaire (EAQ; Rieffe et al., 2007). 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 8 weeks and 3-month follow-up

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Emotion Recognition	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 established by Ekman and Friesen (1975). 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 8 weeks and 3-month follow up
Happiness	The 4-item Subjective Happiness Scale (SHS; Lyubomirsky & Lepper, 1999) 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 8 weeks and 3-month follow-up
ADHD symptoms	The teacher-rated Chinese version of the Swanson, Nolan, and Pelham, Version IV (SNAP-IV-18) 18-item scale (Swanson, 1992), 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 8 weeks and 3-month follow up

Collaborators and Investigators

• Sponsor: The Hong Kong Polytechnic University

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2024
• Primary Completion (Actual): May 30, 2025
• Study Completion (Estimated): September 30, 2026

Study Registration Dates

• First Submitted: June 10, 2026
• First Submitted That Met QC Criteria: June 10, 2026
• First Posted (Actual): June 15, 2026

Study Record Updates

• Last Update Posted (Actual): June 15, 2026
• Last Update Submitted That Met QC Criteria: June 10, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: ADHD; Attention; Impulsivity; Emotion recognition; Emotional wellbeing; Photography-based intervention
• Additional Relevant MeSH Terms: Mental Disorders; Neurodevelopmental Disorders; Attention Deficit and Disruptive Behavior Disorders; Behavior; Attention Deficit Disorder with Hyperactivity; Impulsive Behavior
• Other Study ID 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