Digital Health Intervention for Children with ADHD: Improving Mental Health Intervention, Patient Experiences, and Outcomes

考虑到与注意缺陷多动障碍（ADHD）相关的慢性和普遍性损伤， 与其他精神健康障碍的共病率较高，儿童社会交往问题加剧 然而，尽管有现成的医疗手段，这些儿童仍然面临着不良后果的风险。 此外，2019冠状病毒病大流行导致部分服务中断，特别是教育服务， 支持-可能导致ADHD儿童的心理健康问题增加，压力增加， 冲突在他们的家庭，因为他们科普增加的行为问题和损失的社会和制度 支持.技术支持的干预措施有可能填补这一空白，但这种干预措施的可用性 是有限的，研究证据是稀缺的。有效的治疗需要沟通和协作 在多个护理点（包括诊所、家庭和学校）的患者、提供者和护理人员之间进行沟通。电流 信息共享的方法依赖于主观回忆、即时对话、电话和 各种消息应用程序。这往往导致缺乏可靠和有效的信息共享， 有针对性的和有效的治疗方法，以及延迟开始或滴定治疗或其他需要 干预措施。此外，监测症状和坚持治疗建议需要 儿童和父母的自我调节能力相当强; ADHD儿童的自我调节能力受损， 与ADHD相关的多种压力源可能会挑战父母的自我调节。为了解决这些关键障碍， 为了取得进展，我们的DHI使用以患者为中心的数字医疗保健技术来促进自我调节 （儿童/父母），捕获患者数据，通过改善沟通和访问来支持高效的医疗保健服务 可靠的数据，并促进共同决策。在拟议的创新和发展工作（R21）中， 我们将与利益相关者合作，确定、完善并向我们的原型添加功能，以支持多个点， 在乎这一参与式设计工作将为进一步开发现有系统提供信息，并提供额外的设计 这些特点将：1）加强心理健康干预，2）解决儿童的治疗依从性问题， ADHD和他们的照顾者，3）使用传感器，自我报告和照顾者报告来捕获和创建 日常健康行为和症状的可视化，以及4）提供报告选项以促进 沟通，共同决策，并随着时间的推移跟踪进展。在随后的阶段（R33）中， 我们将进行一项随机临床试验（RCT），以评估DHI对患者、父母/护理人员 提供者的经验和成果。我们预计，该系统将整合多个治疗 护理点，并将使卫生保健提供者，照顾者和儿童共享可靠和有针对性的 有助于协作决策的信息，这反过来又会改善患者体验， 特别是在结果不佳的高风险儿童中。

Given the chronic and pervasive impairments associated with Attention Deficit Hyperactivity Disorder (ADHD), high rates of comorbidity with other mental health disorders, and heightened problems in child social interactions and relationships, these children remain at risk for poor outcomes despite readily available medical treatments. Moreover, the COVID-19 pandemic, which led to disruption in receipt of some services – particularly educational supports – may lead to increased mental health problems among children with ADHD and increased stress and conflict in their families, as they cope with increases in behavioral problems and the loss of social and institutional supports. Technology-enabled interventions can potentially fill this gap, but the availability of such interventions is limited, and research evidence is scarce. Effective treatment requires communication and collaboration between patients, providers, and caregivers at multiple points of care including clinics, home, and school. Current approaches to information-sharing depend on subjective recall, on-the-fly conversations, phone calls, and a variety of messaging applications. This often results in a lack of reliable and valid information sharing, a less targeted and effective treatment approach, and delays in initiation or titration of treatment or other needed interventions. Moreover, monitoring symptoms and adhering to treatment recommendations requires considerable self-regulation in children and parents; self-regulation is impaired in children with ADHD, and the multiple stressors associated with ADHD may challenge parent self-regulation. To address these critical barriers to progress, our DHI uses Patient-Centered Digital Healthcare Technologies to promote self-regulation (child/parent), capture patient data, support efficient healthcare delivery by improving communication and access to reliable data, and facilitate shared decision-making. In the proposed innovative and developmental work (R21), we will work with stakeholders to identify, refine, and add features to our prototype to support multiple points of care. This participatory design work will inform further development of the current system with additional design features that will: 1) reinforce mental health intervention, 2) address adherence to treatment for children with ADHD and their caregivers, 3) use sensors, self-reports, and caregiver reports to capture and create visualizations of daily health behaviors and symptoms, and 4) provide reporting options to facilitate communication, shared decision-making, and tracking of progress over time. In the subsequent phase (R33), we will conduct a randomized clinical trial (RCT) to evaluate the impact of the DHI on patient, parent/caregiver, and provider experiences and outcomes. We expect that this system will integrate treatment across multiple points of care and will enable health care providers, caregivers, and children to share reliable and targeted information that will facilitate collaborative decision-making, which in turn will improve patient experiences and outcomes, particularly among children at high risk for poor outcomes.