Reducing Challenging Behaviors In Children With Autism Through Digital Health

通过数字健康减少自闭症儿童的挑战性行为

• 批准号: 10456795
• 负责人: Heather J Nuske
• 金额: $ 17.99万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-17 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10456795
• 关键词: Address; Administrator; Adoption; Behavior; Behavioral; Case Study; Cellular Phone; Child; Collaborations; Communities; Data; Detection; Development; Discipline; Distress; Education; Effectiveness; Emotions; Environment; Evaluation; Evidence based practice; Exhibits; Family; Foundations; Future; Health; Heart Rate; Hospitalization; Individual; Informatics; Intervention; Interview; Measurement; Measures; Mobile Health Application; Movement; Needs Assessment; Notification; Outcome; Parents; Participant; Pediatric Hospitals; Personal Satisfaction; Philadelphia; Physiological; Pilot Projects; Preparation; Psychophysiology; Randomized; Reporting; Research; Research Personnel; Sampling; School-Age Population; Schools; Sensory; Signal Transduction; Specificity; Strategic Planning; Stress; Structure; Students; Surface; System; Technology; Testing; Time; Training; Waiting Lists; Work; adult with autism spectrum disorder; affective neuroscience; autism spectrum disorder; autistic children; base; burnout; clinical decision support; community partnership; data reduction; design; digital; digital health; effectiveness evaluation; emotion dysregulation; emotion regulation; evidence base; experience; follow-up; implementation science; implementation strategy; improved; indexing; individuals with autism spectrum disorder; mHealth; meetings; novel; personalized medicine; personalized strategies; pilot test; prevent; prototype; school district; showing emotion; stress management; stress reduction; teacher; tool; usability

PROJECT SUMMARY The project will develop and pilot test a personalized medicine mobile health EMOtion REgulation application (m-health EMORE app) that incorporates physiological stress measurement to support evidence-based practices for reducing challenging behavior in children with autism spectrum disorder (ASD). As much as 80% of children with ASD exhibit challenging behaviors that can have a devastating impact on personal and family well-being, contribute to teacher burnout and require frequent hospitalization. Evidence-based practices for reducing these behaviors emphasize uncovering triggers, yet parents and teachers often report that challenging behaviors surface without warning. Challenging behaviors caused by emotion dysregulation can be the most difficult to predict, as children with ASD often have difficulty communicating their distress before it results in challenging behavior. Exciting recent advances in digital technology now allow measurement of momentary emotion dysregulation, using physiological indices. Our pilot data from four separate samples demonstrate that increased heart rate predicts onset of challenging behavior in children with ASD. In order to tailor the m-health EMORE app to end users and avoid potential barriers to its adoption, in Aim 1, we will evaluate the acceptability, feasibility, and appropriateness of app, and the needs of educational teams in managing stress in children with ASD and challenging behaviors, by conducting interviews with teachers of children with ASD, parents of children with ASD and school administrators, and conducting structured in-class observations with teachers. Through the activities of Aim 2, we will improve our m-health EMORE app, building on our initial app prototype, in collaboration with our established research partner, the Translational Informatics Unit, Children’s Hospital of Philadelphia, and our established community partner, the School District of Philadelphia. We will do this through 1) exploratory work on the specificity of heart rate increase to challenging behavior, on app clinical decision support timing, and on the association of app false positives and negatives to movement or child factors; 2) monthly advisory board meetings with expert stakeholders for app development guidance, and; 3) rapid-cycle prototyping of the app with 10 educational teams (i.e. 1-2 children with ASD, and their teacher and classroom aide, if they have one). This will allow for iterative improvement based on each user’s experience. Through Aim 3, we will test the app for usability, acceptability, feasibility and appropriateness, as well as preliminary effectiveness with 30 educational teams in a randomized waitlist field trial over a 3-month period. Successful completion of these aims will result in a novel m-health app designed to help teachers support emotion regulation, and reduce or prevent challenging behavior in children with ASD, using evidence-based strategies. These activities will lay the foundation for an R01 to evaluate the effectiveness of the m-health EMORE app in a full- scale randomized field trial. Our proposal aligns with the strategic plan of the Interagency Autism Coordinating Committee, to maximize the potential for technology-based interventions to improve the lives of people with ASD.

项目摘要 该项目将开发和试点测试个性化医疗移动的健康情绪调节应用程序 （移动健康EMORE应用程序），结合生理压力测量，以支持基于证据的 减少自闭症谱系障碍（ASD）儿童挑战行为的实践。高达80% 的ASD儿童表现出具有挑战性的行为，这些行为可能对个人和家庭产生毁灭性的影响。 健康，有助于教师倦怠，需要经常住院。循证实践， 减少这些行为强调发现触发因素，但家长和教师经常报告说， 行为毫无征兆地出现。由情绪失调引起的焦虑行为可能是 很难预测，因为ASD儿童在导致自闭症之前通常很难表达他们的痛苦。 挑战行为。令人兴奋的数字技术的最新进展现在允许测量瞬时 情绪失调，使用生理指标。我们从四个独立样本中获得的试验数据表明， 心率增加可预测ASD儿童挑战行为的发生。为了量身定制移动健康 EMORE应用程序的最终用户，并避免其采用的潜在障碍，在目标1，我们将评估的可接受性， 应用程序的可行性和适当性，以及教育团队在管理儿童压力方面的需求 ASD和挑战行为，通过与ASD儿童的教师，儿童的父母进行访谈， 与ASD和学校管理人员，并与教师进行结构化的课堂观察。通过 目标2的活动，我们将改进我们的移动健康EMORE应用程序，建立在我们最初的应用程序原型， 与我们既定的研究合作伙伴，翻译信息学单位，儿童医院的合作， 费城，以及我们的既定社区合作伙伴费城学区。我们将通过 1)关于心率增加对挑战行为的特异性的探索性工作，关于app临床决策 支持定时，以及应用程序误报和漏报与运动或儿童因素的关联; 2） 每月与专家利益相关者举行咨询委员会会议，以指导应用程序开发; 3）快速周期 与10个教育团队（即1-2名ASD儿童及其教师和教室）一起制作应用程序原型 如果有的话，如果有的话）。这将允许基于每个用户的体验进行迭代改进。通过Aim 3，我们将测试应用程序的可用性，可接受性，可行性和适当性，以及初步的 在一项为期3个月的随机等候名单实地试验中，对30个教育团队的有效性进行了研究。成功 完成这些目标将产生一种新型的移动健康应用程序，旨在帮助教师支持情绪调节， 减少或预防ASD儿童的挑战行为，使用基于证据的策略。这些 活动将为R 01奠定基础，以全面评估移动医疗EMORE应用程序的有效性， 规模随机田间试验。我们的建议符合机构间自闭症协调的战略计划， 委员会，以最大限度地发挥基于技术的干预措施的潜力，以改善ASD患者的生活。