Digital Health Intervention for Children with ADHD: Improving Mental Health Intervention, Patient Experiences, and Outcomes

针对多动症儿童的数字健康干预：改善心理健康干预、患者体验和结果

• 批准号: 10430782
• 负责人: Kimberley Dawn Lakes
• 金额: $ 13万
• 依托单位: UNIVERSITY OF CALIFORNIA RIVERSIDE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2027-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10430782
• 关键词: Digital; Health; Intervention; Children; ADHD

Given the chronic and pervasive impairments associated with Attention Deficit Hyperactivity Disorder (ADHD), high rates of comorbidity with other mental health disorders, and heightened problems in child social interactions and relationships, these children remain at risk for poor outcomes despite readily available medical treatments. Moreover, the COVID-19 pandemic, which led to disruption in receipt of some services – particularly educational supports – may lead to increased mental health problems among children with ADHD and increased stress and conflict in their families, as they cope with increases in behavioral problems and the loss of social and institutional supports. Technology-enabled interventions can potentially fill this gap, but the availability of such interventions is limited, and research evidence is scarce. Effective treatment requires communication and collaboration between patients, providers, and caregivers at multiple points of care including clinics, home, and school. Current approaches to information-sharing depend on subjective recall, on-the-fly conversations, phone calls, and a variety of messaging applications. This often results in a lack of reliable and valid information sharing, a less targeted and effective treatment approach, and delays in initiation or titration of treatment or other needed interventions. Moreover, monitoring symptoms and adhering to treatment recommendations requires considerable self-regulation in children and parents; self-regulation is impaired in children with ADHD, and the multiple stressors associated with ADHD may challenge parent self-regulation. To address these critical barriers to progress, our DHI uses Patient-Centered Digital Healthcare Technologies to promote self-regulation (child/parent), capture patient data, support efficient healthcare delivery by improving communication and access to reliable data, and facilitate shared decision-making. In the proposed innovative and developmental work (R21), we will work with stakeholders to identify, refine, and add features to our prototype to support multiple points of care. This participatory design work will inform further development of the current system with additional design features that will: 1) reinforce mental health intervention, 2) address adherence to treatment for children with ADHD and their caregivers, 3) use sensors, self-reports, and caregiver reports to capture and create visualizations of daily health behaviors and symptoms, and 4) provide reporting options to facilitate communication, shared decision-making, and tracking of progress over time. In the subsequent phase (R33), we will conduct a randomized clinical trial (RCT) to evaluate the impact of the DHI on patient, parent/caregiver, and provider experiences and outcomes. We expect that this system will integrate treatment across multiple points of care and will enable health care providers, caregivers, and children to share reliable and targeted information that will facilitate collaborative decision-making, which in turn will improve patient experiences and outcomes, particularly among children at high risk for poor outcomes.

鉴于与注意力缺陷多动障碍 (ADHD) 相关的慢性和普遍损伤， 与其他精神健康障碍合并症的比例很高，儿童社交互动问题也加剧 尽管有现成的医疗手段，但这些儿童仍然面临着不良后果的风险。 此外，COVID-19 大流行导致某些服务（尤其是教育服务）的接收中断 支持——可能会导致多动症儿童的心理健康问题增加，压力和压力增加 他们的家庭冲突，因为他们要应对行为问题的增加以及社会和制度的丧失 支持。技术支持的干预措施有可能填补这一空白，但此类干预措施的可用性 的研究有限，研究证据也很少。有效的治疗需要沟通和协作 在诊所、家庭和学校等多个护理点的患者、提供者和护理人员之间。当前的 信息共享的方法取决于主观回忆、即时对话、电话和 各种消息应用程序。这通常会导致缺乏可靠和有效的信息共享， 有针对性和有效的治疗方法，以及延迟开始或滴定治疗或其他所需的治疗 干预措施。此外，监测症状并遵守治疗建议需要 儿童和父母有很强的自我调节能力；多动症儿童的自我调节能力受到损害， 与多动症相关的多种压力源可能会挑战父母的自我调节。为了解决这些关键障碍 为了进步，我们的 DHI 使用以患者为中心的数字医疗技术来促进自我监管 （儿童/家长），捕获患者数据，通过改善沟通和访问支持高效的医疗服务 可靠的数据，并促进共同决策。在拟议的创新和发展工作（R21）中， 我们将与利益相关者合作，确定、完善原型并添加功能，以支持多个点 关心。这项参与式设计工作将为当前系统的进一步开发和附加设计提供信息 其特点将：1) 加强心理健康干预，2) 解决患有以下疾病的儿童坚持治疗的问题 ADHD 及其护理人员，3) 使用传感器、自我报告和护理人员报告来捕获和创建 日常健康行为和症状的可视化，4) 提供报告选项以促进 沟通、共同决策以及跟踪一段时间内的进展。在随后的阶段（R33）中， 我们将进行一项随机临床试验 (RCT)，以评估 DHI 对患者、家长/护理人员、 以及提供者的经验和成果。我们预计该系统将整合多个领域的治疗 护理点，将使医疗保健提供者、护理人员和儿童能够分享可靠且有针对性的信息 有助于协作决策的信息，从而改善患者体验和 成果，特别是对于成果不良的高风险儿童。