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.

项目摘要 该项目将开发和试点测试个性化医学移动健康情绪调节应用 （M-Health Emore应用），该应用结合了身体压力测量以支持基于证据的 减少自闭症谱系障碍儿童（ASD）挑战者行为的实践。多达80％ ASD表现出挑战行为的儿童可能会对个人和家庭产生毁灭性影响 幸福感，有助于老师的倦怠，需要经常住院。基于证据的实践 减少这些行为强调发现触发因素，但父母和老师经常报告挑战 行为表现出无警告。由情绪失调引起的挑战行为可能是最大的 很难预测，因为患有ASD的孩子通常在遇到困扰之前很难沟通 具有挑战性的行为。现在，数字技术的最新进展现在可以衡量瞬间 情绪失调，使用身体指数。我们来自四个单独样本的试验数据表明 心率预测ASD儿童挑战者行为的心率预测增加。为了量身定制M-Health Emore应用程序以最终用户并避免采用其采用的潜在障碍，在AIM 1中，我们将评估可接受性， 应用程序的可行性和适当性，以及教育团队在管理患有压力的儿童压力方面的需求 ASD和挑战行为，通过与儿童的儿童的老师，孩子的父母进行访谈 与ASD和学校管理员一起，并与教师进行结构化的课堂观察。通过 AIM 2的活动2，我们将改进我们的M-Health Emore应用程序，以我们的初始应用程序原型为基础 与我们既定的研究合作伙伴，翻译信息学部门的合作，儿童医院 费城和我们成熟的社区合作伙伴，费城学区。我们将通过 1）关于挑战行为的心率提高的探索性工作，在应用程序临床决策上 支持时机，以及应用程序误报和对运动或儿童因素的否定性的关联； 2） 每月与专家利益相关者的顾问委员会会议，以获取应用程序开发指导，并且； 3）快速循环 该应用程序与10个教育团队的原型制作（即1-2位ASD儿童及其老师和课堂 助手，如果他们有一个）。这将允许根据每个用户的体验进行迭代改进。通过目标 3，我们将测试该应用程序的可用性，可接受性，可行性和适当性以及初步 在3个月的随机候补名单中试验中，有30个教育团队的有效性。成功的 这些目标的完成将导致一个新颖的M-Health应用程序，旨在帮助教师支持情绪调节， 使用基于循证的策略减少或防止ASD儿童的挑战行为。这些 活动将为R01奠定基础，以评估M-Health Emore应用程序在完整的 比例随机现场试验。我们的建议与机构间自闭症协调的战略计划保持一致 委员会，以最大程度地提高基于技术的干预措施来改善ASD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

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.

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