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

鉴于与注意力缺陷多动障碍(ADHD)相关的慢性和普遍的损害， 与其他精神健康障碍的共病比率高，儿童社交中的问题加剧 尽管有现成的医疗服务，但这些儿童仍然面临着不良结局的风险。 此外，新冠肺炎大流行导致一些服务--特别是教育服务--的接收中断 支持--可能会增加ADHD儿童的心理健康问题，增加压力和 家庭中的冲突，因为他们应对行为问题的增加以及社会和机构的损失 支撑物。技术支持的干预措施可能会填补这一空白，但此类干预措施的可用性 是有限的，研究证据也很稀缺。有效的治疗需要沟通和协作 在包括诊所、家庭和学校在内的多个看护点的患者、提供者和照顾者之间进行沟通。当前 信息共享的方法取决于主观回忆、即时对话、电话和 各种消息传递应用程序。这通常导致缺乏可靠和有效的信息共享， 有针对性和有效的治疗方法，以及延迟开始或滴定治疗或其他所需的治疗 干预措施。此外，监测症状和遵守治疗建议需要 儿童和父母有相当大的自律能力；患有ADHD的儿童自律能力受损， 与ADHD相关的多种压力源可能会挑战父母的自我调节。要解决这些关键障碍 为了进步，我们的DHI使用以患者为中心的数字医疗技术来促进自我监管 (儿童/家长)，捕获患者数据，通过改进通信和访问来支持高效的医疗保健提供 以获得可靠的数据，并促进共享决策。在拟议的创新和发展工作(R21)中， 我们将与利益相关者合作，识别、改进并向我们的原型添加功能，以支持多个点 关心。这项参与性设计工作将为当前系统的进一步发展提供额外的设计。 特点将：1)加强心理健康干预，2)解决儿童坚持治疗的问题 ADHD及其照顾者，3)使用传感器、自我报告和照顾者报告来捕获和创建 每日健康行为和症状的可视化，以及4)提供报告选项，以促进 随着时间的推移，沟通、共享决策和跟踪进展。在后续阶段(R33)中， 我们将进行一项随机临床试验(RCT)来评估DHI对患者、父母/照顾者、 以及提供商的体验和结果。我们预计，该系统将跨多个 并将使卫生保健提供者、照顾者和儿童能够分享可靠和有针对性的 有助于协作决策的信息，这反过来又将改善患者体验和 结果，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.