Testing a Mobile App to Improve Toothbrushing Skills and Habits in Teens with Autism.

测试移动应用程序以提高自闭症青少年的刷牙技能和习惯。

• 批准号: 10738080
• 负责人: Donald Leslie Chi
• 金额: $ 32.08万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-15 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10738080
• 关键词: Activities of Daily Living; Address; Adolescent; Affect; Age; Attention; Behavior; Behavior Therapy; Behavioral; Caregivers; Cartoons; Centers for Disease Control and Prevention (U.S.); Child; Childhood; Clinical; Computer software; Data; Dental Care; Dental Hygiene; Dental Offices; Dental caries; Dentistry; Dentists; Devices; Discover, Design, Build, and Test Framework; Disparity; Educational process of instructing; Engineering; Exhibits; Face; Family; France; Frequencies; Friends; Funding; General Anesthesia; Goals; Grant; Habits; Home; Industrialization; Intake; Intervention; Intervention Studies; Interview; Learning; Measures; Mediator; Mobile Health Application; Modeling; Modification; Mouth Diseases; Neurologist; Occupational Therapist; Oral health; Outcome; Participant; Persons; Phase; Protocols documentation; Psychologist; Quality of life; Randomized; Recommendation; Research; Resistance; Risk; Self Efficacy; Sensory; Surveys; Technology; Teenagers; Testing; Time; Tooth structure; Toothbrushing; Training; Unhealthy Diet; United States National Institutes of Health; Validity and Reliability; Visit; Work; adolescent with autism spectrum disorder; arm; autism spectrum disorder; autistic children; behavior change; design; digital; effectiveness trial; efficacy trial; experience; experimental arm; family burden; handheld mobile device; health inequalities; high risk; improved; individuals with autism spectrum disorder; innovation; interest; life time cost; mobile application; pilot test; preadolescence; prevent; primary outcome; programs; prototype; recruit; secondary outcome; skills; sugar; tooth surface; treatment arm; usability

Project Summary/Abstract One in 60 U.S. children has autism and many are at high risk for poor oral health – a problem that could be addressed in part through improved toothbrushing. Technologies like mobile health apps are an ideal platform to deliver toothbrushing interventions, but few app-based interventions have focused on teens with autism and the work to date has critical limitations. Our team developed an interactive toothbrushing training app called Brush Up, which incorporates concepts from Video Self Modeling. The app helps users develop toothbrushing skills through repeated self-observation and interactions with a cartoon exemplar that reinforces correct brushing. A front-facing (“selfie”) camera on the mobile device displays the child’s face and teeth. Children brush in tandem with the cartoon exemplar. We tested the app with typically developing children ages 5 to 6 years and found significant improvements in toothbrushing duration after only one week of app use. We then piloted the same app in individuals with autism ages 4 to 22 years. Caregivers of teens with autism were particularly enthusiastic about the app and recommended ways to make the app more autism-friendly by including features that account for sensory sensitivities common in autism. We further identified missing app features that if included would increase the odds of long-term behavior change. In this 6-year UG3/UH3 grant, we have 2 Aims: (1) Pilot the app-based intervention; and (2) Conduct a Stage II efficacy trial. During the 2- year UG3 phase, we will use the Discover, Design+Build, and Test Framework to modify our existing app to make it autism-friendly, develop a control app with only a digital mirror and timer, pilot the intervention with 40 adolescents with autism ages 10 to 17 years (Waisman score ≥21), and make necessary adjustments. In the 4-year UH3 phase, we will recruit 270 adolescents with autism, randomize participants to 1 of 2 arms, and compare outcomes. The trial will last 3 months. The primary outcome is toothbrushing distribution, defined as the mean proportion of tooth surfaces brushed during the last month of the 3-month intervention and measured in each arm by the respective app. Secondary outcomes are toothbrushing duration and frequency. We hypothesize adolescents in the experimental arm will exhibit better toothbrushing distribution, duration, and frequency than those in the control arm. App data will be collected continuously during the 3-month trial and up to 3-months post-trial. Survey data will be collected at baseline, 2 weeks, 1 months, 2 months, and 3 months to assess mediators (e.g., self-efficacy) and exploratory outcomes (e.g., habit formation, quality of life). Post-trial surveys will assess long-term change and interviews with 60 participants from the 2 arms will identify ways to further improve the intervention. If found to be efficacious, our findings could address an unresolved problem that affects over 1.2 million U.S. children and teens with autism. Our long-term goal is to develop comprehensive strategies to prevent caries and reduce oral health inequities that affect teens with autism.

项目总结/摘要 每60名美国儿童中就有一名患有自闭症，许多儿童口腔健康状况不佳的风险很高--这一问题可能是 部分通过改进刷牙来解决。像移动的健康应用程序这样的技术是一个理想的平台 提供刷牙干预措施，但很少有基于应用程序的干预措施专注于青少年自闭症， 迄今为止的工作有严重的局限性。我们的团队开发了一个交互式刷牙培训应用程序， Brush Up，融合了Video Self Modeling的概念。该应用程序帮助用户开发刷牙 通过反复的自我观察和与卡通榜样的互动，加强正确的技能 刷牙移动终端上的前置（“自拍”）相机显示儿童的面部和牙齿。儿童 与卡通样本一起刷。我们在5到6岁的儿童中测试了这款应用程序 研究人员发现，在使用应用程序一周后，刷牙时间有了显着改善。然后我们 在4到22岁的自闭症患者中试用了同样的应用程序。自闭症青少年的照顾者 对该应用程序特别热情，并推荐了通过以下方式使该应用程序对自闭症更加友好的方法 包括自闭症中常见的感觉敏感性特征。我们进一步确定了失踪的应用程序 这些特征如果包括在内，将增加长期行为改变的可能性。在这个为期6年的UG 3/UH 3赠款中， 我们有两个目标：（1）试点基于应用程序的干预;（2）进行第二阶段疗效试验。在2- 在UG 3阶段，我们将使用发现、设计+构建和测试框架来修改现有应用程序， 使其对自闭症友好，开发一个只有数字镜子和计时器的控制应用程序， 年龄在10 ~ 17岁的自闭症青少年（韦斯曼评分≥21），并进行必要的调整。在 4-在第3年的UH 3阶段，我们将招募270名自闭症青少年，将参与者随机分为两组， 比较结果。审判将持续3个月。主要结果是刷牙分布，定义为 在3个月干预的最后一个月期间刷牙的牙齿表面的平均比例， 次要结果是刷牙持续时间和频率。我们 假设实验组的青少年将表现出更好的刷牙分布，持续时间， 在3个月的试验期间及以后，将持续收集应用程序数据 到审判后3个月。将在基线、2周、1个月、2个月和3个月时收集调查数据， 评估介体（例如，自我效能）和探索性结果（例如，习惯形成、生活质量）。审判后 调查将评估长期变化，对来自两个部门的60名参与者的访谈将确定如何 进一步加强干预。如果发现有效，我们的发现可以解决一个悬而未决的问题， 影响了超过120万美国自闭症儿童和青少年。我们的长期目标是发展 预防龋齿和减少影响自闭症青少年的口腔健康不平等的综合战略。