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.

项目摘要/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 部分是通过改进刷牙来解决的。像移动健康应用这样的技术是一个理想的平台 来提供刷牙干预，但很少有基于APP的干预措施专注于患有自闭症和 到目前为止，这项工作存在严重的局限性。我们的团队开发了一款交互式刷牙培训应用程序，名为 Brush Up，它结合了视频自我建模的概念。这款应用程序帮助用户开发刷牙 通过反复自我观察和与卡通范例的互动来加强正确性的技能 刷牙。移动设备上的前置(自拍)摄像头显示了孩子的脸和牙齿。儿童 画笔与卡通样本并排。我们测试了这款应用程序，测试对象通常是5至6岁的发育迟缓儿童 研究发现，仅使用APP一周后，刷牙持续时间就显著延长。然后我们 在4至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是 特别是对这款应用程序的热情，并推荐了让这款应用程序对自闭症更友好的方法 包括自闭症中常见的感官敏感性的特征。我们进一步确认了丢失的应用程序 如果包括这些特征，就会增加长期行为改变的几率。在这项为期6年的UG3/UH3赠款中， 我们有两个目标：(1)试点基于APP的干预；(2)进行第二阶段疗效试验。在2- 年UG3阶段，我们将使用发现、设计+构建和测试框架来修改我们现有的应用程序，以 让它适合自闭症，开发一个只有一个数字镜子和定时器的控制应用程序，用40 10至17岁的自闭症青少年(韦斯曼评分≥21)，并做出必要的调整。在 为期4年的UH3阶段，我们将招募270名患有自闭症的青少年，将参与者随机分配到2个手臂中的1个，以及 比较结果。审判将持续3个月。主要结果是刷牙分布，定义为 在为期3个月的干预的最后一个月中，平均刷牙比例和测量 在每个手臂上都有相应的应用程序。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刷牙的分布、持续时间和 频率高于控制臂中的频率。APP数据将在3个月及以上的试用期内持续收集 至试验后3个月。调查数据将在基线、2周、1个月、2个月和3个月收集到 评估中介因素(如自我效能)和探索性结果(如习惯养成、生活质量)。审判后 调查将评估长期变化，与这两个部门的60名参与者的访谈将确定如何 进一步完善干预措施。如果被发现是有效的，我们的发现可能会解决一个悬而未决的问题 这影响了超过120万患有自闭症的美国儿童和青少年。我们的长远目标是发展 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。