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: 10657558
• 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 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10657558
• 关键词: Address; Administrator; Adoption; Agreement; Behavior; Behavioral; Case Study; Cellular Phone; Child; Collaborations; Communication; 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; burnout; clinical decision support; community partnership; data reduction; design; digital health; digital technology; digital tool; 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.

项目总结 该项目将开发和中试个性化医疗移动健康情绪调节应用程序 (M-Health EMORE应用程序)，整合了生理压力测量以支持基于证据的 减少自闭症谱系障碍(ASD)儿童挑战性行为的做法。高达80% 的自闭症儿童表现出挑战性的行为，这可能会对个人和家庭产生毁灭性的影响 健康，导致教师职业倦怠，需要经常住院治疗。循证实践 减少这些行为强调找出诱因，但家长和老师经常报告说，这具有挑战性 行为毫无征兆地浮出水面。由情绪失调引起的挑战行为可能是最 很难预测，因为患有自闭症的儿童通常在导致抑郁之前难以沟通 具有挑战性的行为。令人振奋的最新数字技术进步现在允许测量瞬时 情绪失调，使用生理指标。我们从四个不同样本获得的试点数据表明 心率加快预示着ASD儿童挑战行为的开始。为了量身定制移动健康 在目标1中，我们将评估EMORE应用程序的可接受性， APP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和挑战性行为，通过采访患有ASD的儿童的老师和儿童的父母 与ASD和学校管理人员合作，并与教师进行有组织的课堂观察。通过 在Aim 2的活动中，我们将改进我们的移动医疗EMORE应用程序，以我们最初的应用程序原型为基础，在 与我们已建立的研究伙伴，儿童医院翻译信息学单位合作 费城，以及我们的社区合作伙伴费城学区。我们会把这件事做完 1)心率增加对挑战行为的特异性、APP临床决策的探索性工作 支持计时，以及APP假阳性和阴性与运动或儿童因素的关联；2) 每月与专家利益相关者举行顾问委员会会议，以获得应用程序开发指导；以及3)快速周期 与10个教育团队(即1-2名患有自闭症的儿童，以及他们的老师和教室)一起制作应用程序的原型 助手，如果他们有的话)。这将允许根据每个用户的体验进行迭代改进。通过AIM 3、我们将对APP的可用性、可接受性、可行性和适当性进行测试，以及初步的 在为期3个月的随机等待名单现场试验中，对30个教育团队进行了有效性测试。成功 完成这些目标将产生一款新的移动健康应用程序，旨在帮助教师支持情绪调节。 并使用循证策略减少或预防自闭症儿童的挑战性行为。这些 活动将为R01全面评估移动健康EMORE应用程序的有效性奠定基础- 规模随机田间试验。我们的建议与机构间自闭症协调的战略计划相一致 委员会，最大限度地发挥以技术为基础的干预措施的潜力，以改善自闭症患者的生活。

项目成果

Disrupted Care Continuity: Testing Associations between Social Networks and Transition Success for Children with Autism.

护理连续性中断：测试社交网络与自闭症儿童过渡成功之间的关联。

• DOI: 10.3390/socsci10070247
• 发表时间: 2021
• 期刊: Social sciences
• 作者: Hassrick,ElizabethMcGhee;Shih,Wendy;Nuske,HeatherJ;Vejnoska,SarahF;Hochheimer,Samantha;Linares,DeborahE;Ventimiglia,Jonas;Carley,Kathleen;Stahmer,AubynC;Smith,Tristram;Mandell,David;Kasari,Connie
• 通讯作者: Kasari,Connie

Systematic review: emotion dysregulation and challenging behavior interventions for children and adolescents on the autism spectrum with graded key evidence-based strategy recommendations.

系统回顾：针对自闭症谱系儿童和青少年的情绪失调和挑战性行为干预措施，并提供分级的关键循证策略建议。

• DOI: 10.1007/s00787-023-02298-2
• 发表时间: 2023
• 期刊: European child & adolescent psychiatry
• 影响因子: 6.4
• 作者: Nuske,HeatherJ;Young,AmandaV;Khan,FarzanaY;Palermo,EmmaH;Ajanaku,Bukola;Pellecchia,Melanie;Vivanti,Giacomo;Mazefsky,CarlaA;Brookman-Frazee,Lauren;McPartland,JamesC;Goodwin,MatthewS;Mandell,DavidS
• 通讯作者: Mandell,DavidS

Self-Regulation is Bi-Directionally Associated with Cognitive Development in Children with Autism.

自我调节与自闭症儿童的认知发展双向相关。

• DOI: 10.1016/j.appdev.2020.101139
• 发表时间: 2020
• 期刊: Journal of applied developmental psychology
• 影响因子: 3
• 作者: Nuske,HeatherJ;Pellecchia,Melanie;Kane,Cary;Seidman,Max;Maddox,BrennaB;Freeman,LauraMacMullen;Rump,Keiran;Reisinger,EricaM;Xie,Ming;Mandell,DavidS
• 通讯作者: Mandell,DavidS

Mindfulness-based school interventions: A systematic review of outcome evidence quality by study design.

• DOI: 10.1007/s12671-022-01885-9
• 发表时间: 2022-07
• 期刊: MINDFULNESS
• 影响因子: 3.6
• 作者: Phan, Mary L;Renshaw, Tyler L;Caramanico, Julie;Greeson, Jeffrey M;MacKenzie, Elizabeth;Atkinson-Diaz, Zabryna;Doppelt, Natalie;Tai, Hungtzu;Mandell, David S;Nuske, Heather J
• 通讯作者: Nuske, Heather J

Evaluating commercially available wireless cardiovascular monitors for measuring and transmitting real-time physiological responses in children with autism.

• DOI: 10.1002/aur.2633
• 发表时间: 2022-01
• 期刊: AUTISM RESEARCH
• 影响因子: 4.7
• 作者: Nuske, Heather J.;Goodwin, Matthew S.;Kushleyeva, Yelena;Forsyth, Daniel;Pennington, Jeffrey W.;Masino, Aaron J.;Finkel, Emma;Bhattacharya, Anushua;Tan, Jessica;Tai, Hungtzu;Atkinson-Diaz, Zabryna;Bonafide, Christopher P.;Herrington, John D.
• 通讯作者: Herrington, John D.