ADHD Remote Technology and ADHD transition: predicting and preventing negative outcomes (ART-transition)

对于患有注意力缺陷多动障碍(ADHD)的年轻人来说，青春期后期是一个极具挑战性和潜在的关键时期，这可能为不同的成年轨迹奠定基础。许多经常与ADHD同时出现的情况，如抑郁、犯罪和滥用药物，往往首先出现在青春期。这个年龄段的重大生活转变，如辍学、开始工作或搬离父母之家，导致了多种新的需求和现有支持网络的变化，进一步增加了患有ADHD的年轻人的脆弱性。这一脆弱阶段恰逢从儿童和青少年精神卫生保健向成人ADHD服务过渡，这本身就是当前主要临床关注的焦点：英国的新数据显示，大多数患有ADHD的青年没有成功地转移到成人服务机构，尽管需要进行持续的治疗。因此，许多患有ADHD的年轻人在他们可能最需要的时候没有得到适当的干预。由于年轻人脱离临床服务，以及我们对更全面干预的现实世界目标的了解有限，干预的机会目前还没有完全实现。我们提出了一项研究计划，直接满足这些需求，并与最近强调的研究重点相匹配：(1)2022年对ADHD过渡建议的回顾强调了缺乏通过过渡进行的纵向跟踪研究，以及需要智能手机应用程序等现代工具，作为ADHD心理健康护理的一部分；(2)ADHD纵向多模式治疗研究(MTA)2022年的一份出版物表明，ADHD典型地是一种“慢性但消长的障碍”，当生物脆弱性导致临床上显著的症状和损害时，环境因素可能会影响ADHD。MTA的研究强调了可能引发症状和损害波动的环境因素和健康行为，将其作为关键的研究重点。远程测量技术(RMT)提供了以下潜力：a)以以前不可能获得的详细程度获得持续的、长期的、真实世界的数据；b)确定包括环境因素和健康行为在内的真实世界干预目标；以及c)在ADHD过渡期间改变监测、自我管理、个性化治疗和参与临床服务。我们的团队在推动这些进步方面处于独特的地位，使用我们专门为ADHD(16岁以上)开发的RMT：ADHD远程技术系统。我们将解决ADHD患者向成年过渡的三个核心问题：发生了什么变化，预计会发生什么变化，以及我们如何防止负面结果并支持健康的生活方式？我们将在两年的连续评估期内，使用主动和被动监测，远程监测250名患有ADHD的年轻人。主动监控包括参与者在专门打造的智能手机主动应用上完成问卷和语音任务，并在家用电脑上完成认知任务。被动监测包括使用可穿戴设备和专门构建的智能手机被动应用程序收集数据(例如，关于身体活动、睡眠、社交、相对位置、数字使用情况)。然后，我们与患有ADHD的年轻人共同设计了一个新的ADHD过渡智能手机应用程序的原型。它旨在通过促进自我管理、个性化治疗和参与成人服务来防止负面后果并支持健康的生活方式。应用程序组件可以包括个性化反馈、个性化教育组件、提示、警报和与临床医生共享数据。我们的方法侧重于给予患有ADHD的年轻人更大的自主权，与他们的临床医生合作，如何管理他们的ADHD，并将重点放在可改变的环境因素和防止负面后果上。

Late adolescence is a highly challenging and potentially critical period for young people with attention deficit hyperactivity disorder (ADHD) that can lay the foundations for diverging adulthood trajectories. Many of the conditions that frequently co-occur with ADHD, such as depression, delinquency and substance misuse, often first emerge in adolescence. Major life transitions at this age, such as leaving education, starting work or moving out of the parental home, lead to multiple new demands and changes in available support networks, further increasing the vulnerability of young people with ADHD. This vulnerable phase coincides with the transition from child and adolescent mental health care to adult ADHD services, which itself is a focus of major current clinical concern: new UK data show that most youth with ADHD do not successfully transfer to adult services, despite significant needs for ongoing treatment. Therefore, many young people with ADHD do not receive appropriate interventions at a time when they may need them most. Opportunities for intervention are currently not fully realised due to both the young people's disengagement from clinical services and our limited understanding of real-world targets for more holistic interventions. We propose a research programme that directly addresses these needs and matches recently highlighted research priorities: (1) a 2022 review of recommendations for ADHD transition highlights the lack of longitudinal tracking studies through transition and the need for modern tools such as smartphone apps, as part of ADHD mental health care; (2) a 2022 publication from the longitudinal Multimodal Treatment study of ADHD (MTA) suggests ADHD is typically a 'chronic but waxing and waning disorder', where environmental factors likely influence when the biological vulnerability leads to clinically significant symptoms and impairment. The MTA study highlights environmental factors and health behaviours that can trigger fluctuations in symptoms and impairment as a key research priority. Remote measurement technology (RMT) offers the potential to: a) obtain ongoing, long-term, real-world data at a level of detail that was previously impossible; b) identify real-world targets for intervention that include environmental factors and health behaviours; and c) transform monitoring, self-management, personalised treatment and engagement with clinical services during ADHD transition. Our team is in a unique position to drive these advances, using RMT we have developed specifically for ADHD (ages 16+): the ADHD Remote Technology system. We will address three core questions on the transition to adulthood for individuals with ADHD: what changes take place, what predicts them, and how can we prevent negative outcomes and support healthy lifestyles? We will remotely monitor 250 young people with ADHD over a two-year continuous assessment period, using both active and passive monitoring. The active monitoring involves the participant completing questionnaires and a speech task on a purpose-built smartphone Active App and completing cognitive tasks on a home computer. The passive monitoring involves data collection using a wearable device and a purpose-built smartphone Passive App (e.g. on physical activity, sleep, social interaction, relative location, digital usage). We then co-design, with young people with ADHD, a prototype for a new ADHD-transition smartphone app. It aims to prevent negative outcomes and support healthy lifestyles, by facilitating self-management, personalisation of treatment and engagement with adult services. App components may include personalised feedback, personalised educational components, prompts, alerts and data sharing with clinicians. Our approach focuses on giving young people with ADHD greater autonomy in how they manage their ADHD, in collaboration with their clinician, and places the emphasis on modifiable environmental factors and the prevention of negative outcomes.