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

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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.