TY - JOUR AU - Santoso, Budi Dian AU - Kristanti, Sinta Martina AU - Nurputra, Kesumapramudya Dian AU - Sutomo, Retno PY - 2025/4/10 TI - Development of a Mobile-Based Personal Health Record for Pediatric Attention-Deficit/Hyperactivity Disorder Management: Protocol for a Study Based on Action Research Design JO - JMIR Res Protoc SP - e60216 VL - 14 KW - ADHD KW - attention deficit and hyperactivity KW - mobile app KW - personal health records KW - action research KW - pediatric N2 - Background: Attention-deficit/hyperactivity disorder (ADHD) is one of the most widespread neurobehavioral problems during childhood. A child?s personal health record (PHR) plays an important role in the controlled routine monitoring of ADHD symptom improvement. Along with the advantages, the convenience offered by mobile technology, and the ubiquity of smartphones in contemporary society, there is a compelling need for PHR to be available in the form of a mobile app. Objective: This study aims to identify stakeholder needs, followed by designing, developing, testing, and evaluating a mobile-based PHR in the context of pediatric ADHD management. Methods: This study will adopt an action research design structured into 4 stages: diagnosing, planning, taking, and evaluating action. Stakeholders, including parents, pediatricians, occupational therapists, clinical psychologists, and teachers, will participate actively. In stage 1, stakeholder requirements for the mobile-based PHR will be explored through in-depth interviews, focus group discussions (FGDs), and document reviews. Thematic analysis will be used to identify key needs and challenges. In stage 2, a systematic literature review will be conducted to enhance user requirements analysis by synthesizing insights from existing mobile apps for pediatric ADHD management. A mobile-based PHR prototype will be designed and developed based on user requirements enhanced with systematic review results. In stage 3, the prototype will undergo a 6-week trial with participants to evaluate its functionality and address any identified issues. In stage 4, both quantitative and qualitative methods will be used to assess the app?s usability and quality. The System Usability Scale (SUS) and the User Version of the Mobile App Rating Scale (uMARS) will be used for quantitative evaluation, while interviews and FGDs will be conducted for qualitative evaluation. Results: This study commenced in October 2024. As of December 2024, 13 participants (n=5, 38.5%, parents; n=2, 15.4%, pediatricians; n=2, 15.4%, occupational therapists; n=2, 15.4%, clinical psychologists; and n=2, 15.4%, teachers) have been enrolled, meeting the minimum participant requirements for stage 1. Stage 1 was completed at the end of 2024, with stage 2 expected to be completed by September 2025, stage 3 by December 2025, and stage 4 by February 2026. The findings from each stage will inform iterative refinements to the mobile-based PHR. The final results, including usability and quality assessments, are anticipated for publication by the middle of 2026. Conclusions: This study protocol outlines a pivotal initiative to enhance the management of pediatric ADHD. By using an action research methodology and actively engaging stakeholders, the study aims to contribute significantly to the field. The iterative cycles of the research seek to develop a mobile-based PHR that is not only user friendly but also effective and uniquely attuned to the diverse needs of those involved in pediatric ADHD care. International Registered Report Identifier (IRRID): PRR1-10.2196/60216 UR - https://www.researchprotocols.org/2025/1/e60216 UR - http://dx.doi.org/10.2196/60216 UR - http://www.ncbi.nlm.nih.gov/pubmed/40208656 ID - info:doi/10.2196/60216 ER - TY - JOUR AU - Mishina, Kaisa AU - Baumel, Amit AU - Kinnunen, Malin AU - Ristkari, Terja AU - Heinonen, Emmi AU - Hinkka-Yli-Salomäki, Susanna AU - Sourander, Andre PY - 2025/3/13 TI - BePresent Universal Internet-Based Parenting Intervention: Single-Arm Pre-Post Intervention Study JO - J Med Internet Res SP - e65391 VL - 27 KW - parent training KW - universal intervention KW - online intervention KW - irritability KW - conduct problems KW - hyperactivity KW - preschool KW - mental health KW - strongest families KW - positive parenting KW - parenting skills KW - parent-child relationships KW - parent satisfaction KW - BePresent KW - feasibility study KW - single-arm pre-post intervention study N2 - Background: Internet-based parenting programs have great potential to promote positive parent-child relationships as well as to reach and engage parents. Objective: This study aimed to assess the universal internet-based BePresent parenting intervention for families with 3-year-old children and how it influences the child?s behavior and daily-life situations assessed by parents. The first aim of the study was to assess the change from baseline to follow-up in child hyperactivity and conduct problems, affective reactivity, and daily activities. The second aim was to assess intervention completion rates. The third aim was to evaluate parent satisfaction with the intervention. The fourth aim was to assess all outcomes by comparing those who completed the intervention and those who did not. Methods: We conducted a single-arm pre- and postintervention study. Parents attending their child?s 3-year health check-up were recruited from children?s health clinics. The intervention was an unguided internet-based parenting program consisting of 5 modules. Self-reported measures were collected at baseline and at an 8-week follow-up. Linear mixed-effects models were used to analyze the changes from baseline to follow-up. Results: Altogether, 752 parents registered, and 515 started the intervention. Of those, 36% (n=183) completed the intervention. Parents reported high satisfaction with the intervention: the majority (68.8%?84.9%) were satisfied with various aspects of the program, and 89.9% said the intervention provided information about positive parenting skills. The findings show significant decreases with small effect sizes in parents? ratings of child hyperactivity (P=.03; d=0.12) and conduct problems (P=.001; d=0.20) between baseline and the 8-week follow-up. A similar finding was observed in the parent ratings of child irritability (P?.001; d=0.27) using the Affective Reactivity Index. Parents reported improvement in the daily functioning of their child when it was measured with a questionnaire adapted from the Barkley Home Situations Questionnaire (P=.01; d=0.14). Conclusions: Universal digital interventions have the potential to be implemented widely in community settings to improve knowledge and positive parenting skills. However, there is a need to assess the efficacy of digital universal interventions using randomized controlled designs and to examine additional ways to increase adherence to universal programs. UR - https://www.jmir.org/2025/1/e65391 UR - http://dx.doi.org/10.2196/65391 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65391 ER - TY - JOUR AU - Ram, Sharan AU - Corbin, Marine AU - 't Mannetje, Andrea AU - Eng, Amanda AU - Kvalsvig, Amanda AU - Baker, G. Michael AU - Douwes, Jeroen PY - 2025/2/28 TI - Antibiotic Use In Utero and Early Life and Risk of Chronic Childhood Conditions in New Zealand: Protocol for a Data Linkage Retrospective Cohort Study JO - JMIR Res Protoc SP - e66184 VL - 14 KW - early childhood KW - chronic childhood conditions KW - antibiotics KW - data linkage KW - study protocol KW - routine data N2 - Background: The incidence of many common chronic childhood conditions has increased globally in the past few decades, which has been suggested to be potentially attributed to antibiotic overuse leading to dysbiosis in the gut microbiome. Objective: This linkage study will assess the role of antibiotic use in utero and in early life in the development of type 1 diabetes (T1D), attention-deficit/hyperactive disorder (ADHD), and inflammatory bowel disease. Methods: The study design involves several retrospective cohort studies using linked administrative health and social data from Statistics New Zealand?s Integrated Data Infrastructure. It uses data from all children who were born in New Zealand between October 2005 and December 2010 (N=334,204) and their mothers. Children?s antibiotic use is identified for 4 time periods (at pregnancy, at ?1 year, at ?2 years, and at ?5 years), and the development of T1D, ADHD, and inflammatory bowel disease is measured from the end of the antibiotic use periods until death, emigration, or the end of the follow-up period (2021), whichever came first. Children who emigrated or died before the end of the antibiotic use period are excluded. Cox proportional hazards regression models are used while adjusting for a range of potential confounders. Results: As of September 2024, data linkage has been completed, involving the integration of antibiotic exposure and outcome variables for 315,789 children. Preliminary analyses show that both prenatal and early life antibiotic consumption is associated with T1D. Full analyses for all 3 outcomes will be completed by the end of 2025. Conclusions: This series of linked cohort studies using detailed, complete, and systematically collected antibiotic prescription data will provide critical new knowledge regarding the role of antibiotics in the development of common chronic childhood conditions. Thus, this study has the potential to contribute to the development of primary prevention strategies through, for example, targeted changes in antibiotic use. International Registered Report Identifier (IRRID): DERR1-10.2196/66184 UR - https://www.researchprotocols.org/2025/1/e66184 UR - http://dx.doi.org/10.2196/66184 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053783 ID - info:doi/10.2196/66184 ER - TY - JOUR AU - Murray, Louise Aja AU - Thye, Melissa AU - Obsuth, Ingrid AU - Cai, Shufang AU - Lui, Michael AU - Orr, Corina AU - Saravanan, Anusha PY - 2025/2/27 TI - A Narrative Review to Identify Promising Approaches for Digital Health Interventions to Support Emotion Regulation for Adolescents With Attention-Deficit/Hyperactivity Disorder JO - JMIR Ment Health SP - e56066 VL - 12 KW - attention-deficit/hyperactivity disorder KW - ADHD KW - digital health intervention KW - adolescence KW - emotion regulation KW - emotion dysregulation KW - mobile phone KW - emotion KW - teens KW - youths KW - narrative review KW - support KW - development KW - design KW - regulation KW - young people KW - evaluation KW - neurodiversity KW - neurodivergent KW - attention deficit KW - neurodiverse KW - neuroscience KW - mental health KW - digital mental health UR - https://mental.jmir.org/2025/1/e56066 UR - http://dx.doi.org/10.2196/56066 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053767 ID - info:doi/10.2196/56066 ER - TY - JOUR AU - Fang, Hao AU - Fang, Changqing AU - Che, Yan AU - Peng, Xinyuan AU - Zhang, Xiaofan AU - Lin, Di PY - 2025/2/24 TI - Reward Feedback Mechanism in Virtual Reality Serious Games in Interventions for Children With Attention Deficits: Pre- and Posttest Experimental Control Group Study JO - JMIR Serious Games SP - e67338 VL - 13 KW - serious games KW - virtual reality KW - attention deficit KW - inhibitory control ability KW - reward feedback N2 - Background: Virtual reality (VR) serious games, due to their high level of freedom and realism, influence the rehabilitation training of inhibitory control abilities in children with attention-deficit/hyperactivity disorder (ADHD). Although reward feedback has a motivating effect on improving inhibitory control, the effectiveness and differences between various forms of rewards lack empirical research. Objective: This study aimed to investigate the effectiveness of different forms of reward feedback on the inhibitory control abilities of children with attention deficits in a VR serious game environment. Methods: This study focuses on children who meet the diagnostic criteria for ADHD tendencies, using a 2 (material rewards: coin reward and token reward) × 2 (psychological rewards: verbal encouragement and badge reward) factorial between-subject design (N=84), with a control group (n=15) for pre- and posttest experiments. The experimental group received VR feedback reinforcement training, while the control group underwent conventional VR training without feedback. The training period lasted 0.5 months, with each intervention session lasting 25 minutes, occurring twice daily with an interval of at least 5 hours for 28 sessions. Before and after training, the Swanson, Nolan, and Pelham, Version IV Scale (SNAP-IV) Scale, stop signal task, inhibition conflict task, and Simon task were administered to assess the hyperactivity index and the 3 components of inhibitory control ability. The pretest included the SNAP-IV Scale and 3 task tests to obtain baseline data; the posttest involved repeating the above tests after completing all training. Data were entered and analyzed using SPSS (IBM) software. Independent sample t tests were performed on the experimental and control groups? pre- and posttest task results to determine whether significant differences existed between group means. Paired sample t tests were also conducted on the SNAP-IV Scale?s pre- and posttest results to assess the intervention effect?s significance. Results: Reward feedback was more effective than no reward feedback in improving behaviors related to attention deficits in children. Material rewards showed significant effects in the Stop-Signal Task (F1=13.04, P=.001), Inhibition Conflict Task (F1=7.34, P=.008), and SNAP-IV test (F1=69.23, P<.001); mental rewards showed significant effects in the Stop-Signal Task (F1=38.54, P<.001) and SNAP-IV test (F1=70.78, P<.001); the interaction between the 2 showed significant effects in the Stop-Signal Task (F1=4.47, P=.04) and SNAP-IV test (F1=23.85, P<.001). Conclusions: Combining material and psychological rewards within a VR platform can effectively improve attention-deficit behaviors in children with ADHD, enhancing their inhibitory control abilities. Among these, coin rewards are more effective than token rewards, and verbal encouragement outperforms badge rewards. The combined feedback of coin rewards and verbal encouragement yields the most significant improvement in inhibitory control abilities. UR - https://games.jmir.org/2025/1/e67338 UR - http://dx.doi.org/10.2196/67338 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67338 ER - TY - JOUR AU - Chen, Shu-Cheng AU - Lo, Kwai-Ching AU - Li, Han AU - Wong, Pong-Ming AU - Pang, Lok-Yi AU - Qin, Jing AU - Yeung, Wing-Fai PY - 2025/1/30 TI - Parental Experiences of Administering Pediatric Tuina for Sleep and Appetite in Early School-Aged Children With Attention-Deficit/Hyperactivity Disorder: Qualitative Study in Hong Kong JO - JMIR Pediatr Parent SP - e65471 VL - 8 KW - pediatric massage KW - child KW - traditional Chinese medicine KW - TCM KW - ADHD KW - qualitative study KW - complementary medicine KW - attention deficit KW - hyperactivity KW - massage KW - tuina KW - tui na KW - mental health KW - sleep KW - appetite KW - parent KW - parenting KW - interview KW - focus group KW - anmo KW - attention-deficit/hyperactivity disorder N2 - Background: Previous research suggested that parent-administered pediatric tuina could improve symptoms of attention-deficit/hyperactivity disorder (ADHD), such as sleep quality and appetite. Objective: This study aimed to explore the experiences and perceptions of parents administering pediatric tuina to school-aged children with ADHD in Hong Kong. Methods: This qualitative study was embedded in a pilot randomized controlled trial on parent-administered pediatric tuina for improving sleep and appetite in school-aged children diagnosed with ADHD. Purposive sampling was used to invite 12 parents who attended a pediatric tuina training program and delivered the intervention to their children at home for at least 8 weeks. Data were collected through semistructured focus group interviews and individual interviews, which were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Results: Two main themes emerged: (1) effects of parent-administered pediatric tuina and (2) parents? experience of administering pediatric tuina. Parents reported significant improvements in children?s sleep quality, appetite, behavior, mental state, and academic performance. Facilitators provided professional guidance and applied a user-friendly course design. Challenges included difficulties in mastering techniques, locating acupuncture points, and time management. Participants suggested the need for more traditional Chinese medicine pattern diagnostic sessions, real-time supervision methods, and extended follow-up to better observe long-term effects. Conclusions: Parent-administered pediatric tuina was perceived to improve children?s sleep quality and appetite significantly, along with other aspects of well-being. Professional guidance and a structured training program facilitated implementation, and challenges highlighted the need for more frequent diagnostic sessions, real-time supervision, and extended follow-up. Trial Registration: ClinicalTrials.gov NCT06007742; https://clinicaltrials.gov/study/NCT06007742 UR - https://pediatrics.jmir.org/2025/1/e65471 UR - http://dx.doi.org/10.2196/65471 ID - info:doi/10.2196/65471 ER - TY - JOUR AU - Sankesara, Heet AU - Denyer, Hayley AU - Sun, Shaoxiong AU - Deng, Qigang AU - Ranjan, Yatharth AU - Conde, Pauline AU - Rashid, Zulqarnain AU - Asherson, Philip AU - Bilbow, Andrea AU - Groom, J. Madeleine AU - Hollis, Chris AU - Dobson, B. Richard J. AU - Folarin, Amos AU - Kuntsi, Jonna PY - 2025/1/29 TI - Identifying Digital Markers of Attention-Deficit/Hyperactivity Disorder (ADHD) in a Remote Monitoring Setting: Prospective Observational Study JO - JMIR Form Res SP - e54531 VL - 9 KW - ADHD KW - smartphones KW - wearable devices KW - mobile health KW - mHealth KW - remote monitoring KW - surveillance KW - digital markers KW - attention-deficit/hyperactivity disorder KW - behavioral data KW - real world KW - adult KW - adolescent KW - participants KW - digital signals KW - restlessness KW - severity KW - predicting outcomes N2 - Background: The symptoms and associated characteristics of attention-deficit/hyperactivity disorder (ADHD) are typically assessed in person at a clinic or in a research lab. Mobile health offers a new approach to obtaining additional passively and continuously measured real-world behavioral data. Using our new ADHD remote technology (ART) system, based on the Remote Assessment of Disease and Relapses (RADAR)?base platform, we explore novel digital markers for their potential to identify behavioral patterns associated with ADHD. The RADAR-base Passive App and wearable device collect sensor data in the background, while the Active App involves participants completing clinical symptom questionnaires. Objective: The main aim of this study was to investigate whether adults and adolescents with ADHD differ from individuals without ADHD on 10 digital signals that we hypothesize capture lapses in attention, restlessness, or impulsive behaviors. Methods: We collected data over 10 weeks from 20 individuals with ADHD and 20 comparison participants without ADHD between the ages of 16 and 39 years. We focus on features derived from (1) Active App (mean and SD of questionnaire notification response latency and of the time interval between questionnaires), (2) Passive App (daily mean and SD of response time to social and communication app notifications, the SD in ambient light during phone use, total phone use time, and total number of new apps added), and (3) a wearable device (Fitbit) (daily steps taken while active on the phone). Linear mixed models and t tests were employed to assess the group differences for repeatedly measured and time-aggregated variables, respectively. Effect sizes (d) convey the magnitude of differences. Results: Group differences were significant for 5 of the 10 variables. The participants with ADHD were (1) slower (P=.047, d=1.05) and more variable (P=.01, d=0.84) in their speed of responding to the notifications to complete the questionnaires, (2) had a higher SD in the time interval between questionnaires (P=.04, d=1.13), (3) had higher daily mean response time to social and communication app notifications (P=.03, d=0.7), and (4) had a greater change in ambient (background) light when they were actively using the smartphone (P=.008, d=0.86). Moderate to high effect sizes with nonsignificant P values were additionally observed for the mean of time intervals between questionnaires (P=.06, d=0.82), daily SD in responding to social and communication app notifications (P=.05, d=0.64), and steps taken while active on the phone (P=.09, d=0.61). The groups did not differ in the total phone use time (P=.11, d=0.54) and the number of new apps downloaded (P=.24, d=0.18). Conclusions: In a novel exploration of digital markers of ADHD, we identified candidate digital signals of restlessness, inconsistent attention, and difficulties completing tasks. Larger future studies are needed to replicate these findings and to assess the potential of such objective digital signals for tracking ADHD severity or predicting outcomes. UR - https://formative.jmir.org/2025/1/e54531 UR - http://dx.doi.org/10.2196/54531 ID - info:doi/10.2196/54531 ER - TY - JOUR AU - Sarai, Gurdeep AU - Jayaraman, Prakash Prem AU - Tirosh, Oren AU - Wickramasinghe, Nilmini PY - 2025/1/29 TI - Exploring Virtual Reality and Exercise Simulator Interventions in Patients With Attention Deficit Hyperactivity Disorder: Comprehensive Literature Review JO - JMIR Serious Games SP - e57297 VL - 13 KW - exercise-based simulator KW - exergame KW - virtual reality KW - physical activity KW - attention-deficit/hyperactivity disorder N2 - Background: This review explores virtual reality (VR) and exercise simulator?based interventions for individuals with attention-deficit/hyperactivity disorder (ADHD). Past research indicates that both VR and simulator-based interventions enhance cognitive functions, such as executive function and memory, though their impacts on attention vary. Objective: This study aimed to contribute to the ongoing scientific discourse on integrating technology-driven interventions into the management and evaluation of ADHD. It specifically seeks to consolidate findings on how VR and exercise simulators may support individuals with ADHD, acknowledging associated challenges and implications inherent in both technological approaches. Methods: This research looks at existing literature to examine the potential efficacy of VR and exercise simulator?based interventions for individuals with ADHD. It evaluates the capacity of these interventions to address specific challenges along with an emphasis on the adjustments for accommodating unique user behaviors. Additionally, it underscores the limited exploration of user perceptions of exercise simulator?based interventions and the undervalued role of motor function in both ADHD assessment and symptom management. Results: The findings of this scoping review reveal that, while these interventions enhance user motivation and enjoyment, certain challenges resist modification through technology. Furthermore, this study explores the intricate complexities involved in customizing these technologies to accommodate the diverse aspects of user behavior and highlights the potential limitations in the use of VR. Conclusions: This scoping review contributes to the ongoing research on enhancing interventions to support individuals with ADHD. It advocates for participant-centric approaches that aim to optimize both cognitive and motor outcomes while prioritizing the enhancement of user experiences. This study emphasizes the need for a comprehensive approach to interventions, recognizing the relationship between cognitive and motor abilities, and calls for improving technological interventions to address the varied needs of individuals with ADHD. UR - https://games.jmir.org/2025/1/e57297 UR - http://dx.doi.org/10.2196/57297 UR - http://www.ncbi.nlm.nih.gov/pubmed/39879092 ID - info:doi/10.2196/57297 ER - TY - JOUR AU - Martin-Moratinos, Marina AU - Bella-Fernández, Marcos AU - Rodrigo-Yanguas, María AU - González-Tardón, Carlos AU - Li, Chao AU - Wang, Ping AU - Royuela, Ana AU - Lopez-Garcia, Pilar AU - Blasco-Fontecilla, Hilario PY - 2025/1/8 TI - Effectiveness of a Virtual Reality Serious Video Game (The Secret Trail of Moon) for Emotional Regulation in Children With Attention-Deficit/Hyperactivity Disorder: Randomized Clinical Trial JO - JMIR Serious Games SP - e59124 VL - 13 KW - attention-deficit/hyperactivity disorder KW - ADHD KW - emotional regulation KW - serious video games KW - virtual reality KW - cognitive training KW - music KW - chess N2 - Background: Difficulties in emotional regulation are often observed in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Innovative complementary treatments, such as video games and virtual reality, have become increasingly appealing to patients. The Secret Trail of Moon (MOON) is a serious video game developed by a multidisciplinary team featuring cognitive training exercises. In this second randomized clinical trial, we evaluated the impact of a 20-session treatment with MOON on emotional regulation, as measured by the Strengths and Difficulties Questionnaire. Objective: We hypothesize that patients with ADHD using MOON will show improvements in (1) emotional regulation, (2) core ADHD symptoms, (3) cognitive functioning, and (4) academic performance, compared to a control group; additionally, we anticipate that (5) changing the platform (from face-to-face using virtual reality to the web) will not affect emotional regulation scores; and (6) the video game will not cause any clinically significant side effects. Methods: This was a prospective, unicentric, randomized, unblinded, pre- and postintervention study with block-randomized sequence masking. Participants included individuals aged between 7 and 18 years who had a clinical diagnosis of ADHD and were receiving pharmacological treatment. They were randomized into 2 groups using an electronic case report form: the MOON group, receiving standard pharmacological treatment plus personalized cognitive training via a serious video game, and the control group, receiving standard pharmacological treatment. We provided both the groups with psychoeducational support on ADHD. Analysis was conducted using the Student 2-tailed t test and 2-factor ANOVA. An independent monitor supervised the study. Results: A total of 76 patients with ADHD participated in the trial, with an equal randomization (MOON: n=38, 50% and control: n=38, 50%) and a total dropout rate of 7. The primary hypothesis, a 3- or 4-point reduction in the global Strengths and Difficulties Questionnaire score, was not met. However, significant improvements were observed in material organization (P=.03), working memory (P=.04), and inhibition (P=.05), particularly among patients more engaged with the MOON treatment. Conclusions: Serious video games, when integrated into a multimodal treatment plan, can enhance outcomes for symptoms associated with ADHD. Trial Registration: ClinicalTrials.gov NCT06006871; https://clinicaltrials.gov/study/NCT06006871 International Registered Report Identifier (IRRID): RR2-10.2196/53191 UR - https://games.jmir.org/2025/1/e59124 UR - http://dx.doi.org/10.2196/59124 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59124 ER - TY - JOUR AU - Liu, Zhongling AU - Li, Jinkai AU - Zhang, Yuanyuan AU - Wu, Dan AU - Huo, Yanyan AU - Yang, Jianxin AU - Zhang, Musen AU - Dong, Chuanfei AU - Jiang, Luhui AU - Sun, Ruohan AU - Zhou, Ruoyin AU - Li, Fei AU - Yu, Xiaodan AU - Zhu, Daqian AU - Guo, Yao AU - Chen, Jinjin PY - 2024/11/29 TI - Auxiliary Diagnosis of Children With Attention-Deficit/Hyperactivity Disorder Using Eye-Tracking and Digital Biomarkers: Case-Control Study JO - JMIR Mhealth Uhealth SP - e58927 VL - 12 KW - attention deficit disorder with hyperactivity KW - eye-tracking KW - auxiliary diagnosis KW - digital biomarker KW - antisaccade KW - machine learning N2 - Background: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in school-aged children. The lack of objective biomarkers for ADHD often results in missed diagnoses or misdiagnoses, which lead to inappropriate or delayed interventions. Eye-tracking technology provides an objective method to assess children?s neuropsychological behavior. Objective: The aim of this study was to develop an objective and reliable auxiliary diagnostic system for ADHD using eye-tracking technology. This system would be valuable for screening for ADHD in schools and communities and may help identify objective biomarkers for the clinical diagnosis of ADHD. Methods: We conducted a case-control study of children with ADHD and typically developing (TD) children. We designed an eye-tracking assessment paradigm based on the core cognitive deficits of ADHD and extracted various digital biomarkers that represented participant behaviors. These biomarkers and developmental patterns were compared between the ADHD and TD groups. Machine learning (ML) was implemented to validate the ability of the extracted eye-tracking biomarkers to predict ADHD. The performance of the ML models was evaluated using 5-fold cross-validation. Results: We recruited 216 participants, of whom 94 (43.5%) were children with ADHD and 122 (56.5%) were TD children. The ADHD group showed significantly poorer performance (for accuracy and completion time) than the TD group in the prosaccade, antisaccade, and delayed saccade tasks. In addition, there were substantial group differences in digital biomarkers, such as pupil diameter fluctuation, regularity of gaze trajectory, and fixations on unrelated areas. Although the accuracy and task completion speed of the ADHD group increased over time, their eye-movement patterns remained irregular. The TD group with children aged 5 to 6 years outperformed the ADHD group with children aged 9 to 10 years, and this difference remained relatively stable over time, which indicated that the ADHD group followed a unique developmental pattern. The ML model was effective in discriminating the groups, achieving an area under the curve of 0.965 and an accuracy of 0.908. Conclusions: The eye-tracking biomarkers proposed in this study effectively identified differences in various aspects of eye-movement patterns between the ADHD and TD groups. In addition, the ML model constructed using these digital biomarkers achieved high accuracy and reliability in identifying ADHD. Our system can facilitate early screening for ADHD in schools and communities and provide clinicians with objective biomarkers as a reference. UR - https://mhealth.jmir.org/2024/1/e58927 UR - http://dx.doi.org/10.2196/58927 UR - http://www.ncbi.nlm.nih.gov/pubmed/39477792 ID - info:doi/10.2196/58927 ER - TY - JOUR AU - Yu, Chuanwen AU - Wang, Cheng AU - Xie, Qi AU - Wang, Chaoxin PY - 2024/11/27 TI - Effect of Virtual Reality Technology on Attention and Motor Ability in Children With Attention-Deficit/Hyperactivity Disorder: Systematic Review and Meta-Analysis JO - JMIR Serious Games SP - e56918 VL - 12 KW - virtual reality KW - VR KW - immersive technology KW - attention deficit hyperactivity disorder KW - ADHD KW - hyperactivity KW - attention deficit KW - neurodevelopment KW - neurodevelopmental disorder KW - attention KW - motor ability KW - virtual reality technology N2 - Background: Attention-deficit/hyperactivity disorder (ADHD) is one of the common neurodevelopmental disorders in children and virtual reality (VR) has been used in the diagnosis and treatment of ADHD. Objective: This paper aims to systematically evaluate the effect of VR technology on the attention and motor ability of children with ADHD. Methods: The intervention method of the experimental group was VR technology, while the control group adopted non-VR technology. The population was children with ADHD. The outcome indicators were attention and motor abilities. The experimental design was randomized controlled trial. Two researchers independently searched PubMed, Cochrane Library, Web of Science, and Embase for randomized controlled trials related to the effect of VR technology on ADHD children?s attention and motor ability. The retrieval date was from the establishment of each database to January 4, 2023. The PEDro scale was used to evaluate the quality of the included literature. Stata (version 17.0; StataCorp LLC) was used for effect size combination, forest map-making, subgroup analyses, sensitivity analyses, and publication bias. GRADEpro (McMaster University and Evidence Prime Inc) was used to evaluate the level of evidence quality. Results: A total of 9 literature involving 370 children with ADHD were included. VR technology can improve ADHD children?s attention (Cohen d=?0.68, 95% CI ?1.12 to ?0.24; P<.001) and motor ability (Cohen d=0.48, 95% CI 0.16-0.80; P<.001). The intervention method and diagnosis type for VR technology had a moderating effect on the intervention? impact on children?s attention (P<.05). The improvement in children?s attention by ?immersive? VR technology was statistically significant (Cohen d=?1.05, 95% CI ?1.76 to ?0.34; P=.004). The improvement of children?s attention by ?nonimmersive? VR technology was statistically significant (Cohen d=?0.28, 95% CI ?0.55 to ?0.01; P=.04). VR technology had beneficial effects on both children with an ?informal diagnosis? (Cohen d=?1.47, 95% CI ?2.35 to ?0.59; P=.001) and those with a ?formal diagnosis? (Cohen d=?0.44, 95% CI ?0.85 to ?0.03; P=.03). Conclusions: VR technology can improve attention and motor ability in children with ADHD. Immersive VR technology has the best attention improvement effect for informally diagnosed children with ADHD. Trial Registration: PROSPERO CRD42024499199; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=499199 UR - https://games.jmir.org/2024/1/e56918 UR - http://dx.doi.org/10.2196/56918 ID - info:doi/10.2196/56918 ER - TY - JOUR AU - Konaç, Asli AU - Bini, Maristella AU - Fusco, Naomi AU - Bourdin-Kreitz, Pierre PY - 2024/11/22 TI - Enhancing Executive Function Skills in Children With Attention-Deficit/Hyperactivity Disorder via Immersive Virtual Reality Interventions: Scoping Review JO - JMIR XR Spatial Comput SP - e57225 VL - 1 KW - immersive virtual reality KW - ADHD KW - neurofeedback KW - executive functions KW - systematic review KW - adolescent KW - attention-deficit/hyperactivity disorder KW - behavioral therapy KW - digital health tools KW - neurodiversity KW - virtual reality KW - digital mental health N2 - Background: This scoping review investigated immersive virtual reality (IVR) interventions for improving executive function skills of children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Objective: This study aimed to identify and closely inspect the characteristics of these interventions and provide a summary of key findings to guide researchers in their future investigations. Methods: A search across Web of Science, Scopus, PubMed, and APA PsycInfo databases was carried out with restrictions of publication date (2000?2023) and language (English). The inclusion criteria were (1) research articles, excluding protocols, book chapters, reviews, and meta-analyses; (2) usage of IVR, excluding computer-based VR or augmented reality technologies; (3) aim of targeting executive function skills; (4) sample of children and adolescents diagnosed with ADHD (with or without learning disorder comorbidity); and (5) intervention studies (quasi-experimental clinical trials and randomized controlled trials, excluding assessments). Finally, the characteristics of the studies were summarized and inspected. Results: The search yielded 2484 potential records. After a rigorous screening process, 6 articles (5 randomized controlled trials and 1 pilot study) were included. A certain heterogeneity in duration, designs of IVR interventions, and outcome measures were observed. All studies reported overall improvements in the attentional performances of children; however, only a few reported improvements in executive functions. In addition, a tendency toward integration of neurofeedback systems with IVR technologies was observed. Conclusions: Because of the specific objectives and related inclusion and exclusion criteria of this review, only a few interventions could be included and analyzed. Even though there seem to be promising applications of IVR for children and adolescents with ADHD, heterogeneity in intervention characteristics accompanied by observed overall high or serious risk of bias prevented the authors from making generalized conclusions. UR - https://xr.jmir.org/2024/1/e57225 UR - http://dx.doi.org/10.2196/57225 ID - info:doi/10.2196/57225 ER - TY - JOUR AU - Gollier-Briant, Fanny AU - Ollivier, Laurence AU - Joalland, Pierre-Hugues AU - Mouchabac, Stéphane AU - Leray, Philippe AU - Bonnot, Olivier PY - 2024/11/21 TI - Digital Homework Support Program for Children and Adolescents With Attention-Deficit/Hyperactivity Disorder: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e44553 VL - 13 KW - attention-deficit/hyperactivity disorder KW - mobile app KW - assisted homework session KW - digital mental health KW - e-health KW - smartphone KW - psychiatry KW - neurodeveloppemental disorders N2 - Background: Attention-deficit/hyperactivity disorder (ADHD) affects 4% to 5% of the general population. Homework sessions are frequent conflictual moments characterized by increased anxiety in children and stress in their parents, contributing to a lower family quality of life. Children with ADHD experience more severe homework problems than typically developing peers. Poor academic performance in individuals with ADHD is partly attributed to challenging homework. Psychoeducational and school-based approaches are time-consuming and not fully accessible to professionals. Digital tools, such as smartphone and tablet apps, might offer an interesting alternative. We present our digital homework support program for children and adolescents, known as ?Programme d?Aide Numérique aux Devoirs pour Enfant avec TDA-H? (PANDAH), along with the study protocol of our ongoing randomized controlled trial. Objective: This study aims to test PANDAH?s efficacy in improving homework performance and family quality of life. Methods: Individuals aged 9-16 years with an ADHD diagnosis and no comorbid psychiatric disorders are included. This is a multicenter study involving 9 reference centers for ADHD in France. The study comprises (1) a 3-month period with a randomized controlled trial design, where participants are divided into 2 parallel groups (group 1: care as usual or waiting list; group 2: PANDAH app), followed by (2) an extension period of 3 months (months 3-6), during which all participants will have access to the app. This second phase serves as a crucial incentive for patients initially randomly assigned to group 1. Assessments will be conducted at baseline, month 3, and month 6 for each patient by trained psychologists. The primary end point will be the global Homework Performance Questionnaire (HPQ), Parent version score at 6 months. The main analysis will adhere to the ?intent-to-treat principle? (all patient data will be analyzed according to their initial group determined by randomization). We expect (1) HPQ score improvement in individuals using the app during the first 3-month period compared to individuals not using the app; (2) greater HPQ score improvement for individuals using the app for 6 months compared to those using the app for 3 months only; and (3) adherence to the PANDAH program, measured with in-app metrics. Results: Recruitment began in January 2024, and the trial is ongoing. Conclusions: This study contributes to the digital transformation of health care. The use of smartphone apps in self-care and self-management is a societal phenomenon, and its implementation in the field of psychiatry is of particular interest. The app might serve as both valuable support for patients and an opportunity for parents to distance themselves from conflict-laden homework sessions. Since the market for smartphone apps in the health care and well-being sector is primarily industry driven, it is crucial to have an academic conception and evaluation of such digital tools. Trial Registration: ClinicalTrials.gov NCT04857788; https://clinicaltrials.gov/ct2/show/NCT04857788 International Registered Report Identifier (IRRID): PRR1-10.2196/44553 UR - https://www.researchprotocols.org/2024/1/e44553 UR - http://dx.doi.org/10.2196/44553 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/44553 ER - TY - JOUR AU - Wong, Po Ka AU - Zhang, Bohan AU - Lai, Yi Cynthia Yuen AU - Xie, Jie Yao AU - Li, Yan AU - Li, Chen AU - Qin, Jing PY - 2024/10/28 TI - Empowering Social Growth Through Virtual Reality?Based Intervention for Children With Attention-Deficit/Hyperactivity Disorder: 3-Arm Randomized Controlled Trial JO - JMIR Serious Games SP - e58963 VL - 12 KW - attention deficit and hyperactivity disorder KW - virtual reality KW - social skills KW - social skills training KW - emotional control KW - social growth KW - digital world KW - social learning theory N2 - Background: Attention-deficit/hyperactivity disorder (ADHD) usually begins in childhood and is often accompanied by impairments in social functioning. Virtual reality (VR) has emerged as an adjunctive tool to embed in social skills training to enhance the social skills of children with ADHD, but its effectiveness requires further investigation. Objective: This study aims to enhance the social skills of children with ADHD by examining the feasibility and effectiveness of VR-based training in comparison to traditional social skills training. Methods: A 3-arm randomized controlled trial was conducted with 90 children with ADHD aged 6-12 years. Participants were randomly assigned to 3 weeks of 12-session VR-based social skills training, traditional social skills training, or a waitlist control group of equivalent duration. Outcome measures included assessments by a clinical psychologist who was blinded to group assignments, the Social Skills Improvement System Rating Scale, the Behavior Rating Inventory of Executive Function, and the Simulator Sickness Questionnaire, conducted at baseline and after the intervention. Results: The preliminary results support the feasibility and acceptability of VR training for children with ADHD aged 6-12 years. Analysis showed that the VR and traditional social skills training groups experienced a statistically significant improvement in the clinical psychologist assessment of social skills and parent-rated self-control, initiative, and emotional control after the intervention compared with baseline. The VR group performed significantly better than the traditional social skills group on social skills assessed by clinical psychologists (F2,85=76.77; P<.001) and on parent-rated self-control (F2,85=18.77; P<.001), initiative (F2,85=11.93; P<.001), and emotional control (F2,85=17.27; P<.001). No significant between-group differences were found for parent-rated cooperation and inhibition (all P>.05). Conclusions: The findings provide preliminary evidence supporting the feasibility and superior effectiveness of VR-based social skills training compared to traditional approaches for enhancing social skills and related executive functions in children with ADHD. These results suggest that VR may be a valuable tool to embed within social skills interventions for this population. Further research is warranted to explore the long-term impacts and generalizability of these benefits. Trial Registration: ClinicalTrials.gov NCT05778526; https://clinicaltrials.gov/study/NCT05778526 International Registered Report Identifier (IRRID): RR2-10.2196/48208 UR - https://games.jmir.org/2024/1/e58963 UR - http://dx.doi.org/10.2196/58963 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58963 ER - TY - JOUR AU - Cho, Yunah AU - Talboys, L. Sharon PY - 2024/10/15 TI - Trends in South Korean Medical Device Development for Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder: Narrative Review JO - JMIR Biomed Eng SP - e60399 VL - 9 KW - ADHD KW - attention-deficit/hyperactivity disorder KW - ASD KW - autism spectrum disorder KW - medical device KW - digital therapeutics N2 - Background: Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are among the most prevalent mental disorders among school-aged youth in South Korea and may play a role in the increasing pressures on teachers and school-based special education programming. A lack of support for special education; tensions between teachers, students, and parents; and limited backup for teacher absences are common complaints among Korean educators. New innovations in technology to screen and treat ADHD and ASD may offer relief to students, parents, and teachers through earlier and efficient diagnosis; access to treatment options; and ultimately, better-managed care and expectations. Objective: This narrative literature review provides an account of medical device use and development in South Korea for the diagnosis and management of ADHD and ASD and highlights research gaps. Methods: A narrative review was conducted across 4 databases (PubMed, Korean National Assembly Library, Scopus, and PsycINFO). Journal articles, dissertations, and government research and development reports were included if they discussed medical devices for ADHD and ASD. Only Korean or English papers were included. Resources were excluded if they did not correspond to the research objective or did not discuss at least 1 topic about medical devices for ADHD and ASD. Journal articles were excluded if they were not peer reviewed. Resources were limited to publications between 2013 and July 22, 2024. Results: A total of 1794 records about trends in Korean medical device development were categorized into 2 major groups: digital therapeutics and traditional therapy. Digital therapeutics resulted in 5 subgroups: virtual reality and artificial intelligence, machine learning and robot, gaming and visual contents, eye-feedback and movement intervention, and electroencephalography and neurofeedback. Traditional therapy resulted in 3 subgroups: cognitive behavioral therapy and working memory; diagnosis and rating scale; and musical, literary therapy, and mindfulness-based stress reduction. Digital therapeutics using artificial intelligence, machine learning, and electroencephalography technologies account for the biggest portions of development in South Korea, rather than traditional therapies. Most resources, 94.15% (1689/1794), were from the Korean National Assembly Library. Conclusions: Limitations include small sizes of populations to conclude findings in many articles, a lower number of articles discussing medical devices for ASD, and a majority of articles being dissertations. Emerging digital medical devices and those integrated with traditional therapies are important solutions to reducing the prevalence rates of ADHD and ASD in South Korea by promoting early diagnosis and intervention. Furthermore, their application will relieve pressures on teachers and school-based special education programming by providing direct supporting resources to students with ADHD or ASD. Future development of medical devices for ADHD and ASD is predicted to heavily rely on digital technologies, such as those that sense people?s behaviors, eye movement, and brainwaves. UR - https://biomedeng.jmir.org/2024/1/e60399 UR - http://dx.doi.org/10.2196/60399 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60399 ER - TY - JOUR AU - Wähnke, Laura AU - Dose, Christina AU - Klemp, Marie-Theres AU - Mühlenmeister, Judith AU - Plück, Julia AU - Döpfner, Manfred PY - 2024/9/4 TI - The Relationship Between Symptom Change and Use of a Web-Based Self-Help Intervention for Parents of Children With Externalizing Behavior Disorders: Exploratory Study JO - JMIR Pediatr Parent SP - e54051 VL - 7 KW - web-based self-help KW - eHealth KW - parent management training KW - externalizing symptom KW - ADHD KW - attention-deficit hyperactivity disorder KW - self-help KW - use KW - child KW - children KW - parent KW - parents KW - management KW - management training KW - symptom KW - symptoms KW - caregiver KW - ODD KW - oppositional defiant disorder KW - treatment KW - web-based KW - caregivers KW - longitudinal data N2 - Background: Web-based self-help (WASH) has been found to be effective in the treatment of child externalizing behavior disorders. However, research on the associations of caregivers? use of WASH and symptom changes of child externalizing behaviors is lacking. Objective: This study examined the longitudinal and reciprocal associations between the use of WASH by caregivers of children with externalizing behavior disorders and their children?s externalizing behavior symptoms. Methods: Longitudinal data of 276 families from 2 intervention conditions of a randomized controlled trial (either unguided or supported by a therapist over the phone) were analyzed. Caregiver- and clinician-rated child externalizing behavior symptoms were assessed before (T1), in the middle (T2), and after the 6-month WASH intervention (T3). Additionally, 2 indicators of the caregivers? use of the WASH intervention were considered: number of log-ins (frequency) and the percentage of completed material (intensity). Associations of caregivers? use during early (T1-T2) and late (T2-T3) treatment with child externalizing behavior symptoms were analyzed using path analyses (structural equation modeling). Results: Frequency and intensity of use were higher during the first 3 months than during the next 3 months of the intervention period. The number of log-ins at early treatment was significantly but weakly associated with caregiver-reported child externalizing behavior symptoms in the long term (T3). Moreover, caregiver-reported child externalizing severity at T2 predicted the number of log-ins in the late treatment. The results were not replicated when considering the percentage of completed material as a measure of use or when considering clinician ratings of child externalizing behavior symptoms. Conclusions: The findings provide the first, albeit weak, evidence for longitudinal associations between caregivers? use of WASH and improvements in caregiver-rated child externalizing behavior symptoms. However, as the associations were rather weak and could not be replicated across different rater perspectives and operationalizations of use, further research is needed to better understand these relations and their interplay with other putative influence factors (eg, quality of the implementation of the interventions, changes in parenting behaviors). Trial Registration: German Clinical Trials Register DRKS00013456; https://www.drks.de/DRKS00013456 International Registered Report Identifier (IRRID): RR2-10.1186/s12888-020-2481-0 UR - https://pediatrics.jmir.org/2024/1/e54051 UR - http://dx.doi.org/10.2196/54051 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54051 ER - TY - JOUR AU - Jostrup, Erica AU - Nyström, Marcus AU - Tallberg, Pia AU - Söderlund, Göran AU - Gustafsson, Peik AU - Claesdotter-Knutsson, Emma PY - 2024/8/15 TI - Effects of Auditory and Visual White Noise on Oculomotor Inhibition in Children With Attention-Deficit/Hyperactivity Disorder: Protocol for a Crossover Study JO - JMIR Res Protoc SP - e56388 VL - 13 KW - white noise KW - attention-deficit/hyperactivity disorder KW - eye tracking KW - cognitive performance KW - auditory KW - visual KW - oculomotor KW - child KW - children KW - protocol KW - crossover study KW - impairment KW - impairments KW - psychiatric disorders KW - cross modal KW - sensory stimulation KW - eye movement KW - noise N2 - Background: In attention-deficit/hyperactivity disorder (ADHD), poor inhibitory control is one of the main characteristics, with oculomotor inhibition impairments being considered a potential biomarker of the disorder. While auditory white noise has demonstrated the ability to enhance working memory in this group, visual white noise is still unexplored and so are the effects of both types of white noise stimulation on oculomotor inhibition. Objective: This crossover study aims to explore the impact of auditory and visual white noise on oculomotor inhibition in children with ADHD and typically developing (TD) children. The study will investigate the impact of different noise levels (25% and 50% visual, 78 dB auditory), and performance will be evaluated both with and without noise stimulation. We hypothesize that exposure to white noise will improve performance in children with ADHD and impair the performance for TD children. Methods: Memory-guided saccades and prolonged fixations, known for their sensitivity in detecting oculomotor disinhibition in ADHD, will be used to assess performance. Children diagnosed with ADHD, withdrawing from medication for 24 hours, and TD children without psychiatric disorders were recruited for the study. Results: Data collection was initiated in October 2023 and ended in February 2024. A total of 97 participants were enrolled, and the first results are expected between September and November 2024. Conclusions: This study will examine whether cross-modal sensory stimulation can enhance executive function, specifically eye movement control, in children with ADHD. In addition, the study will explore potential differences between auditory and visual noise effects in both groups. Our goal is to identify implications for understanding how noise can be used to improve cognitive performance. Trial Registration: ClinicalTrials.gov NCT06057441; https://clinicaltrials.gov/study/NCT06057441 International Registered Report Identifier (IRRID): DERR1-10.2196/56388 UR - https://www.researchprotocols.org/2024/1/e56388 UR - http://dx.doi.org/10.2196/56388 UR - http://www.ncbi.nlm.nih.gov/pubmed/39146010 ID - info:doi/10.2196/56388 ER - TY - JOUR AU - Grazioli, Silvia AU - Crippa, Alessandro AU - Buo, Noemi AU - Busti Ceccarelli, Silvia AU - Molteni, Massimo AU - Nobile, Maria AU - Salandi, Antonio AU - Trabattoni, Sara AU - Caselli, Gabriele AU - Colombo, Paola PY - 2024/7/29 TI - Use of Machine Learning Models to Differentiate Neurodevelopment Conditions Through Digitally Collected Data: Cross-Sectional Questionnaire Study JO - JMIR Form Res SP - e54577 VL - 8 KW - digital-aided clinical assessment KW - machine learning KW - random forest KW - logistic regression KW - computational psychometrics KW - telemedicine KW - neurodevelopmental conditions KW - parent-report questionnaires KW - attention-deficit/hyperactivity disorder KW - autism spectrum disorder KW - ASD KW - autism KW - autistic KW - attention deficit KW - hyperactivity KW - classification N2 - Background: Diagnosis of child and adolescent psychopathologies involves a multifaceted approach, integrating clinical observations, behavioral assessments, medical history, cognitive testing, and familial context information. Digital technologies, especially internet-based platforms for administering caregiver-rated questionnaires, are increasingly used in this field, particularly during the screening phase. The ascent of digital platforms for data collection has propelled advanced psychopathology classification methods such as supervised machine learning (ML) into the forefront of both research and clinical environments. This shift, recently called psycho-informatics, has been facilitated by gradually incorporating computational devices into clinical workflows. However, an actual integration between telemedicine and the ML approach has yet to be fulfilled. Objective: Under these premises, exploring the potential of ML applications for analyzing digitally collected data may have significant implications for supporting the clinical practice of diagnosing early psychopathology. The purpose of this study was, therefore, to exploit ML models for the classification of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) using internet-based parent-reported socio-anamnestic data, aiming at obtaining accurate predictive models for new help-seeking families. Methods: In this retrospective, single-center observational study, socio-anamnestic data were collected from 1688 children and adolescents referred for suspected neurodevelopmental conditions. The data included sociodemographic, clinical, environmental, and developmental factors, collected remotely through the first Italian internet-based screening tool for neurodevelopmental disorders, the Medea Information and Clinical Assessment On-Line (MedicalBIT). Random forest (RF), decision tree, and logistic regression models were developed and evaluated using classification accuracy, sensitivity, specificity, and importance of independent variables. Results: The RF model demonstrated robust accuracy, achieving 84% (95% CI 82-85; P<.001) for ADHD and 86% (95% CI 84-87; P<.001) for ASD classifications. Sensitivities were also high, with 93% for ADHD and 95% for ASD. In contrast, the DT and LR models exhibited lower accuracy (DT 74%, 95% CI 71-77; P<.001 for ADHD; DT 79%, 95% CI 77-82; P<.001 for ASD; LR 61%, 95% CI 57-64; P<.001 for ADHD; LR 63%, 95% CI 60-67; P<.001 for ASD) and sensitivities (DT: 82% for ADHD and 88% for ASD; LR: 62% for ADHD and 68% for ASD). The independent variables considered for classification differed in importance between the 2 models, reflecting the distinct characteristics of the 3 ML approaches. Conclusions: This study highlights the potential of ML models, particularly RF, in enhancing the diagnostic process of child and adolescent psychopathology. Altogether, the current findings underscore the significance of leveraging digital platforms and computational techniques in the diagnostic process. While interpretability remains crucial, the developed approach might provide valuable screening tools for clinicians, highlighting the significance of embedding computational techniques in the diagnostic process. UR - https://formative.jmir.org/2024/1/e54577 UR - http://dx.doi.org/10.2196/54577 UR - http://www.ncbi.nlm.nih.gov/pubmed/39073858 ID - info:doi/10.2196/54577 ER - TY - JOUR AU - Mendes, Guimarães Camila AU - de Paula, Jardim Jonas AU - Miranda, Marques Débora PY - 2024/7/18 TI - Effects of Background Music on Attentional Networks of Children With and Without Attention Deficit/Hyperactivity Disorder: Case Control Experimental Study JO - Interact J Med Res SP - e53869 VL - 13 KW - attention KW - background music KW - ADHD KW - children KW - adolescents KW - music KW - attention network KW - effects KW - preliminary study KW - attention deficit/hyperactivity disorder N2 - Background: To sustain performance during a task that requires attention may be a challenge for children with attention deficit/hyperactivity disorder (ADHD), which strongly influences motivation for tasks and has been connected to the level of arousal. Objective: This study aimed to analyze the effect of musical stimulus on attentional performance in children with ADHD and typically developing children. Methods: A total of 76 boys (34 with ADHD and 42 typically developing) performed the Attention Network Test (ANT) for children under 2 experimental conditions (with and without music). Four attentional measures were extracted from the ANT. We tested the effect of the experimental condition and its interaction with the group using repeated measures ANOVA. Results: We found no significant main effects or interactions for the reaction times of the alerting, orienting, and conflict attentional networks of the ANT (all P>.05). Regarding ANT errors, we found a significant main effect for music, with a moderate effect size (F1,72=9.83; P=.03; ?p2=0.06) but the condition×group interaction was not significant (F1,72=1.79; P=.18). Participants made fewer errors when listening to music compared to the control condition. Conclusions: Music seems not to interfere in the attentional network in children and adolescents. Perhaps background music affects motivation. Future studies will be needed to validate this. Trial Registration: ReBEC.gov U1111-12589039; https://ensaiosclinicos.gov.br/rg/RBR-8s22sh8 UR - https://www.i-jmr.org/2024/1/e53869 UR - http://dx.doi.org/10.2196/53869 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53869 ER - TY - JOUR AU - Zhao, Licong AU - Agazzi, Heather AU - Du, Yasong AU - Meng, Hongdao AU - Maku, Renya AU - Li, Ke AU - Aspinall, Peter AU - Garvan, Wilson Cynthia AU - Fang, Shuanfeng PY - 2024/5/10 TI - A Digital Cognitive-Physical Intervention for Attention-Deficit/Hyperactivity Disorder: Randomized Controlled Trial JO - J Med Internet Res SP - e55569 VL - 26 KW - school-age children KW - cognitive training KW - exercise therapy KW - gamification KW - ADHD KW - attention deficit KW - attention-deficit/hyperactivity disorder KW - RCT KW - randomized controlled trial KW - executive function KW - digital intervention KW - AR KW - augmented reality N2 - Background: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders among children. Pharmacotherapy has been the primary treatment for ADHD, supplemented by behavioral interventions. Digital and exercise interventions are promising nonpharmacologic approaches for enhancing the physical and psychological health of children with ADHD. However, the combined impact of digital and exercise therapies remains unclear. Objective: The aim of this study was to determine whether BrainFit, a novel digital intervention combining gamified cognitive and exercise training, is efficacious in reducing ADHD symptoms and executive function (EF) among school-aged children with ADHD. Methods: This 4-week prospective randomized controlled trial included 90 children (6-12 years old) who visited the ADHD outpatient clinic and met the diagnostic criteria for ADHD. The participants were randomized (1:1) to the BrainFit intervention (n=44) or a waitlist control (n=46) between March and August 2022. The intervention consisted of 12 30-minute sessions delivered on an iPad over 4 weeks with 3 sessions per week (Monday, Wednesday, and Friday after school) under the supervision of trained staff. The primary outcomes were parent-rated symptoms of attention and hyperactivity assessed according to the Swanson, Nolan, and Pelham questionnaire (SNAP-IV) rating scale and EF skills assessed by the Behavior Rating Inventory of Executive Function (BRIEF) scale, evaluated pre and post intervention. Intention-to-treat analysis was performed on 80 children after attrition. A nonparametric resampling-based permutation test was used for hypothesis testing of intervention effects. Results: Among the 145 children who met the inclusion criteria, 90 consented and were randomized; ultimately, 80 (88.9%) children completed the study and were included in the analysis. The participants? average age was 8.4 (SD 1.3) years, including 63 (78.8%) male participants. The most common ADHD subtype was hyperactive/impulsive (54/80, 68%) and 23 (29%) children had severe symptoms. At the endpoint of the study, the BrainFit intervention group had a significantly larger improvement in total ADHD symptoms (SNAP-IV total score) as compared to those in the control group (?=?12.203, 95% CI ?17.882 to ?6.523; P<.001), owing to lower scores on the subscales Inattention (?=?3.966, 95% CI ?6.285 to ?1.647; P<.001), Hyperactivity/Impulsivity (?=?5.735, 95% CI ?8.334 to ?3.137; P<.001), and Oppositional Defiant Disorder (?=?2.995, 95% CI ?4.857 to ?1.132; P=.002). The intervention was associated with significant reduction in the Metacognition Index (?=?6.312, 95% CI ?10.973 to ?1.650; P=.006) and Global Executive Composite (?=?5.952, 95% CI ?10.214 to ?1.690; P=.003) on the BRIEF. No severe intervention-related adverse events were reported. Conclusions: This novel digital cognitive-physical intervention was efficacious in school-age children with ADHD. A larger multicenter effectiveness trial with longer follow-up is warranted to confirm these findings and to assess the durability of treatment effects. Trial Registration: Chinese Clinical Trial Register ChiCTR2300070521; https://www.chictr.org.cn/showproj.html?proj=177806 UR - https://www.jmir.org/2024/1/e55569 UR - http://dx.doi.org/10.2196/55569 UR - http://www.ncbi.nlm.nih.gov/pubmed/38728075 ID - info:doi/10.2196/55569 ER - TY - JOUR AU - Klein, Z. Ari AU - Gutiérrez Gómez, Agustín José AU - Levine, D. Lisa AU - Gonzalez-Hernandez, Graciela PY - 2024/3/25 TI - Using Longitudinal Twitter Data for Digital Epidemiology of Childhood Health Outcomes: An Annotated Data Set and Deep Neural Network Classifiers JO - J Med Internet Res SP - e50652 VL - 26 KW - natural language processing KW - machine learning KW - data mining KW - social media KW - Twitter KW - pregnancy KW - epidemiology KW - developmental disabilities KW - asthma UR - https://www.jmir.org/2024/1/e50652 UR - http://dx.doi.org/10.2196/50652 UR - http://www.ncbi.nlm.nih.gov/pubmed/38526542 ID - info:doi/10.2196/50652 ER - TY - JOUR AU - Martin-Moratinos, Marina AU - Bella-Fernández, Marcos AU - Rodrigo-Yanguas, Maria AU - González-Tardón, Carlos AU - Sújar, Aaron AU - Li, Chao AU - Wang, Ping AU - Royuela, Ana AU - Lopez-Garcia, Pilar AU - Blasco-Fontecilla, Hilario PY - 2024/2/23 TI - Effectiveness of a Serious Video Game (MOON) for Attention Deficit Hyperactivity Disorder: Protocol for a Randomized Clinical Trial JO - JMIR Res Protoc SP - e53191 VL - 13 KW - attention deficit hyperactivity disorder KW - ADHD KW - emotional dysregulation KW - serious video games KW - virtual reality KW - cognitive training KW - music KW - chess KW - video game KW - video games KW - children KW - child KW - adolescents KW - adolescent KW - teen KW - teens KW - emotional regulation KW - neurodevelopmental disorder KW - multimodal treatment KW - intervention KW - motivational tools N2 - Background: Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in childhood and adolescence, with a prevalence of 5% and associated difficulties and worse prognosis if undetected. Multimodal treatment is the treatment of choice. However, sometimes treatment can be insufficient or have drawbacks. Objective: This study protocol aims to demonstrate the effectiveness of cognitive training through the serious video game The Secret Trail of Moon (MOON) in improving emotional regulation in people with ADHD. Methods: This is a prospective, unicenter, randomized, unblinded, pre- and postintervention study. The groups will be randomized (MOON vs control) via an electronic case report form. The MOON intervention will be performed 2 times per week for 10 weeks (30 minutes per session). The first 5 weeks (10 sessions) will be conducted face-to-face at the Puerta de Hierro University Hospital, and the remaining weeks will be conducted via the internet at the participants? homes. The total sample consists of 152 patients aged between 7 and 18 years. All participants have a clinical diagnosis of ADHD under pharmacological treatment. Data collection will be used to obtain demographic and clinical data. The data will be recorded using REDCap. Measures will be made through clinical scales for parents and objective tests of cognitive functioning in patients. Additional information on academic performance will be collected. The study has a power greater than 80% to detect differences. Student t test, 2-factor analysis of variance (ANOVA), and Mann-Whitney analyses will be performed according to each variable?s characteristics. Results: The study was approved by the Research Ethics Committee of the Puerta de Hierro University Hospital on December 14, 2022. As of September 26, 2023, we have enrolled 62 participants, and 31 participants have completed the study. This clinical trial was funded by the Comunidad de Madrid (IND2020/BMD-17544). The approximate completion date is March 2024. Conclusions: Serious video games such as MOON can be motivational tools that complement multimodal treatment for ADHD. Trial Registration: ClinicalTrials.gov; NCT06006871; https://clinicaltrials.gov/study/NCT06006871 International Registered Report Identifier (IRRID): DERR1-10.2196/53191 UR - https://www.researchprotocols.org/2024/1/e53191 UR - http://dx.doi.org/10.2196/53191 UR - http://www.ncbi.nlm.nih.gov/pubmed/38393773 ID - info:doi/10.2196/53191 ER - TY - JOUR AU - Kurokawa, Shunya AU - Nomura, Kensuke AU - Hosogane, Nana AU - Nagasawa, Takashi AU - Kawade, Yuko AU - Matsumoto, Yu AU - Morinaga, Shuichi AU - Kaise, Yuriko AU - Higuchi, Ayana AU - Goto, Akiko AU - Inada, Naoko AU - Kodaira, Masaki AU - Kishimoto, Taishiro PY - 2024/2/19 TI - Reliability of Telepsychiatry Assessments Using the Attention-Deficit/Hyperactivity Disorder Rating Scale-IV for Children With Neurodevelopmental Disorders and Their Caregivers: Randomized Feasibility Study JO - J Med Internet Res SP - e51749 VL - 26 KW - acceptability KW - ADHD KW - application KW - attention-deficit/hyperactivity disorder KW - autism spectrum disorders KW - autism KW - child KW - children KW - diagnosis KW - management KW - neurodevelopmental disorder KW - neurodevelopmental KW - psychiatrists KW - reliability KW - telepsychitatry N2 - Background: Given the global shortage of child psychiatrists and barriers to specialized care, remote assessment is a promising alternative for diagnosing and managing attention-deficit/hyperactivity disorder (ADHD). However, only a few studies have validated the accuracy and acceptability of these remote methods. Objective: This study aimed to test the agreement between remote and face-to-face assessments. Methods: Patients aged between 6 and 17 years with confirmed Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnoses of ADHD or autism spectrum disorder (ASD) were recruited from multiple institutions. In a randomized order, participants underwent 2 evaluations, face-to-face and remotely, with distinct evaluators administering the ADHD Rating Scale-IV (ADHD-RS-IV). Intraclass correlation coefficient (ICC) was used to assess the reliability of face-to-face and remote assessments. Results: The participants included 74 Japanese children aged between 6 and 16 years who were primarily diagnosed with ADHD (43/74, 58%) or ASD (31/74, 42%). A total of 22 (30%) children were diagnosed with both conditions. The ADHD-RS-IV ICCs between face-to-face and remote assessments showed ?substantial? agreement in the total ADHD-RS-IV score (ICC=0.769, 95% CI 0.654-0.849; P<.001) according to the Landis and Koch criteria. The ICC in patients with ADHD showed ?almost perfect? agreement (ICC=0.816, 95% CI 0.683-0.897; P<.001), whereas in patients with ASD, it showed ?substantial? agreement (ICC=0.674, 95% CI 0.420-0.831; P<.001), indicating the high reliability of both methods across both conditions. Conclusions: Our study validated the feasibility and reliability of remote ADHD testing, which has potential benefits such as reduced hospital visits and time-saving effects. Our results highlight the potential of telemedicine in resource-limited areas, clinical trials, and treatment evaluations, necessitating further studies to explore its broader application. Trial Registration: UMIN Clinical Trials Registry UMIN000039860; http://tinyurl.com/yp34x6kh UR - https://www.jmir.org/2024/1/e51749 UR - http://dx.doi.org/10.2196/51749 UR - http://www.ncbi.nlm.nih.gov/pubmed/38373022 ID - info:doi/10.2196/51749 ER - TY - JOUR AU - Nordby, S. Emilie AU - Guribye, Frode AU - Schønning, Viktor AU - Andersen, Lindholm Sander AU - Kuntsi, Jonna AU - Lundervold, J. Astri PY - 2024/1/17 TI - A Blended Intervention Targeting Emotion Dysregulation in Adults With Attention-Deficit/Hyperactivity Disorder: Development and Feasibility Study JO - JMIR Form Res SP - e53931 VL - 8 KW - ADHD KW - adult KW - adults KW - app KW - applications KW - apps KW - attention deficit KW - blended intervention KW - blended KW - develop KW - development KW - digital KW - emotion regulation KW - emotion KW - emotional KW - emotions KW - feasibility KW - group session KW - group sessions KW - hybrid KW - hyperactivity KW - inattention KW - mental health KW - neurodevelopmental KW - psychotherapy KW - satisfaction KW - skill KW - training N2 - Background: Many adults with attention-deficit/hyperactivity disorder (ADHD) experience difficulties related to emotion regulation. Such difficulties are known to substantially impact quality of life and overall functioning. Yet, there is a lack of treatment interventions specifically designed to address these challenges. Objective: This study aimed to describe the development and assess the feasibility, along with the initial clinical outcomes, of a novel blended intervention for adults with ADHD. The blended intervention combines both face-to-face and digital components and is specifically designed to address emotion dysregulation in ADHD. Methods: This intervention was an 8-week blended intervention combining weekly face-to-face group sessions with a supplementary digital companion app. The intervention is based on elements from dialectic behavioral therapy skills training and positive psychology. To evaluate its feasibility, we performed a 10-week feasibility study with an uncontrolled pre-post study design, including 16 adults with ADHD and co-occurring emotion dysregulation. The feasibility measures encompassed adherence, satisfaction, and perceived credibility of the intervention. Clinical outcomes were evaluated by self-reported symptoms of emotion dysregulation, inattention, hyperactivity-impulsivity, executive function, depression, anxiety, and a measure of quality of life. Paired sample 2-tailed t tests were used to analyze clinical outcomes with a Bonferroni-corrected significance level. Results: Both treatment credibility and treatment satisfaction were rated favorably by the majority of the participants. In particular, the participants emphasized meeting others with ADHD as beneficial. In terms of adherence, 3 participants withdrew before initiating the intervention, while another 4 participants did not complete the intervention. On average, the participants who enrolled in the intervention attended 6.2 of the 8 group sessions and completed 6.7 of the 8 skills training modules in the companion app. In terms of clinical outcomes, there was a reduction in symptoms of emotion dysregulation from before to after the intervention (d=2.0). Significant improvements were also observed in measures of inattention (d=1.1) and hyperactivity-impulsivity (d=0.9). However, no significant improvements were found in the domains of depression, anxiety, quality of life, and executive functioning. Conclusions: The results are encouraging, both in terms of feasibility and the preliminary clinical results on emotion dysregulation. The blended format, combining digital and face-to-face elements, may also seem to offer some advantages: the group-based format was valued as it facilitated peer interaction, while a rather high completion of modules in the companion app highlights its potential to enhance skills training between the group sessions. Future randomized controlled trials are called for to further evaluate the clinical effectiveness of the intervention. Trial Registration: ClinicalTrials.gov NCT05644028; https://clinicaltrials.gov/study/NCT05644028 UR - https://formative.jmir.org/2024/1/e53931 UR - http://dx.doi.org/10.2196/53931 UR - http://www.ncbi.nlm.nih.gov/pubmed/38231536 ID - info:doi/10.2196/53931 ER - TY - JOUR AU - Vonthron, Francois AU - Yuen, Antoine AU - Pellerin, Hugues AU - Cohen, David AU - Grossard, Charline PY - 2024/1/11 TI - A Serious Game to Train Rhythmic Abilities in Children With Dyslexia: Feasibility and Usability Study JO - JMIR Serious Games SP - e42733 VL - 12 KW - serious game KW - rhythm KW - dyslexia KW - musical abilities KW - design framework KW - reading skills KW - children KW - digital health intervention KW - attention-deficit/hyperactivity disorder KW - ADHD KW - child development KW - mobile phone N2 - Background: Rhythm perception and production are related to phonological awareness and reading performance, and rhythmic deficits have been reported in dyslexia. In addition, rhythm-based interventions can improve cognitive function, and there is consistent evidence suggesting that they are an efficient tool for training reading skills in dyslexia. Objective: This paper describes a rhythmic training protocol for children with dyslexia provided through a serious game (SG) called Mila-Learn and the methodology used to test its usability. Methods: We computed Mila-Learn, an SG that makes training remotely accessible and consistently reproducible and follows an educative agenda using Unity (Unity Technologies). The SG?s development was informed by 2 studies conducted during the French COVID-19 lockdowns. Study 1 was a feasibility study evaluating the autonomous use of Mila-Learn with 2500 children with reading deficits. Data were analyzed from a subsample of 525 children who spontaneously played at least 15 (median 42) games. Study 2, following the same real-life setting as study 1, evaluated the usability of an enhanced version of Mila-Learn over 6 months in a sample of 3337 children. The analysis was carried out in 98 children with available diagnoses. Results: Benefiting from study 1 feedback, we improved Mila-Learn to enhance motivation and learning by adding specific features, including customization, storylines, humor, and increasing difficulty. Linear mixed models showed that performance improved over time. The scores were better for older children (P<.001), children with attention-deficit/hyperactivity disorder (P<.001), and children with dyslexia (P<.001). Performance improved significantly faster in children with attention-deficit/hyperactivity disorder (?=.06; t3754=3.91; P<.001) and slower in children with dyslexia (?=?.06; t3816=?5.08; P<.001). Conclusions: Given these encouraging results, future work will focus on the clinical evaluation of Mila-Learn through a large double-blind randomized controlled trial comparing Mila-Learn and a placebo game. UR - https://games.jmir.org/2024/1/e42733 UR - http://dx.doi.org/10.2196/42733 UR - http://www.ncbi.nlm.nih.gov/pubmed/37830510 ID - info:doi/10.2196/42733 ER - TY - JOUR AU - Wong, Po Ka AU - Qin, Jing AU - Xie, Jie Yao AU - Zhang, Bohan PY - 2023/11/21 TI - Effectiveness of Technology-Based Interventions for School-Age Children With Attention-Deficit/Hyperactivity Disorder: Systematic Review and Meta-Analysis of Randomized Controlled Trials JO - JMIR Ment Health SP - e51459 VL - 10 KW - attention-deficit/hyperactivity disorder KW - school-age children KW - computer-assisted training program KW - ADHD KW - neurofeedback training KW - virtual reality KW - cognitive functions N2 - Background: Attention-deficit/hyperactivity disorder (ADHD) is relatively common among school-age children. Technology-based interventions, such as computer-assisted training programs, neurofeedback training, and virtual reality, show promise in regulating the behaviors and cognitive functions of children with ADHD. An increasing number of randomized controlled trials have been conducted to evaluate the effectiveness of these technologies in improving the conditions of children with ADHD. Objective: This study aims to conduct a systematic review of technological interventions for school-age children with ADHD and perform a meta-analysis of the outcomes of technology-based interventions. Methods: A total of 19 randomized controlled studies involving 1843 participants were selected from a pool of 2404 articles across 7 electronic databases spanning from their inception to April 2022. ADHD behaviors, cognitive functions, learning ability, and quality of life were addressed in this study. Results: Random effects meta-analyses found that children with ADHD receiving technology-based intervention showed small and significant effect sizes in computer-rated inattention (standardized mean difference [SMD] ?0.35; P<.04), parent-rated overall executive function measured by the Behavior Rating Inventory of Executive Function (SMD ?0.35; P<.04), parent-rated disruptive behavior disorder measured by the Child Behavior Checklist (SMD ?0.50; P<.001) and Disruptive Behavior Disorder Rating Scale (SMD ?0.31; P<.02), and computer-rated visual attention measured by the Continuous Performance Test (SMD ?0.42; P<.001) and Reaction Time (SMD ?0.43; P<.02). Conclusions: Technology-based interventions are promising treatments for improving certain ADHD behaviors and cognitive functions among school-age children with ADHD. Trial Registration: PROSPERO CRD42023446924; https://tinyurl.com/7ee5t24n UR - https://mental.jmir.org/2023/1/e51459 UR - http://dx.doi.org/10.2196/51459 UR - http://www.ncbi.nlm.nih.gov/pubmed/37988139 ID - info:doi/10.2196/51459 ER - TY - JOUR AU - Tsirmpas, Charalampos AU - Nikolakopoulou, Maria AU - Kaplow, Sharon AU - Andrikopoulos, Dimitrios AU - Fatouros, Panagiotis AU - Kontoangelos, Konstantinos AU - Papageorgiou, Charalabos PY - 2023/10/11 TI - A Digital Mental Health Support Program for Depression and Anxiety in Populations With Attention-Deficit/Hyperactivity Disorder: Feasibility and Usability Study JO - JMIR Form Res SP - e48362 VL - 7 KW - precision medicine KW - internet-based intervention KW - mobile apps KW - major depressive disorder KW - anxiety disorders KW - attention-deficit/hyperactivity disorder KW - personalized medicine KW - comorbidity KW - quality of life KW - mobile phone N2 - Background: A total of 1 in 2 adults with attention-deficit/hyperactivity disorder (ADHD) struggles with major depressive or anxiety disorders. The co-occurrence of these disorders adds to the complexity of finding utility in as well as adherence to a treatment option. Digital therapeutic solutions may present a promising alternative treatment option that could mitigate these challenges and alleviate symptoms. Objective: This study aims to investigate (1) the feasibility and acceptance of a digital mental health intervention, (2) participants? engagement and retention levels, and (3) the potential efficacy with respect to anxiety and depression symptoms in a population with ADHD. Our main hypothesis was that a digital, data-driven, and personalized intervention for adults with coexisting ADHD and depressive or anxiety symptoms would show high engagement and adherence, which would be accompanied by a decrease in depressive and anxiety symptoms along with an increase in quality of life and life satisfaction levels. Methods: This real-world data, single-arm study included 30 adult participants with ADHD symptomatology and coexisting depressive or anxiety symptoms who joined a 16-week digital, data-driven mental health support program. This intervention is based on a combination of evidence-based approaches such as cognitive behavioral therapy, mindfulness, and positive psychology techniques. The targeted symptomatology was evaluated using the Patient Health Questionnaire?9, Generalized Anxiety Disorder?7, and Barkley Adult ADHD Rating Scale?IV. Quality of life aspects were evaluated using the Satisfaction With Life Scale and the Life Satisfaction Questionnaire, and user feedback surveys were used to assess user experience and acceptability. Results: The study retention rate was 97% (29/30), and high engagement levels were observed, as depicted by the 69 minutes spent on the app per week, 5 emotion logs per week, and 11.5 mental health actions per week. An average decrease of 46.2% (P<.001; r=0.89) in depressive symptoms and 46.4% (P<.001; r=0.86) in anxiety symptoms was observed, with clinically significant improvement for more than half (17/30, 57% and 18/30, 60%, respectively) of the participants. This was followed by an average increase of 23% (P<.001; r=0.78) and 20% (P=.003; r=0.8) in Satisfaction With Life Scale and Life Satisfaction Questionnaire scores, respectively. The overall participant satisfaction level was 4.3 out of 5. Conclusions: The findings support the feasibility, acceptability, and value of the examined digital program for adults with ADHD symptomatology to address the coexisting depressive or anxiety symptoms. However, controlled trials with larger sample sizes and more diverse participant profiles are required to provide further evidence of clinical efficacy. UR - https://formative.jmir.org/2023/1/e48362 UR - http://dx.doi.org/10.2196/48362 UR - http://www.ncbi.nlm.nih.gov/pubmed/37819688 ID - info:doi/10.2196/48362 ER - TY - JOUR AU - Wong, Po Ka AU - Qin, Jing PY - 2023/9/18 TI - Effectiveness of Social Virtual Reality Training in Enhancing Social Interaction Skills in Children With Attention-Deficit/Hyperactivity Disorder: Protocol for a Three-Arm Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e48208 VL - 12 KW - attention-deficit/hyperactivity disorder KW - social interaction skills KW - executive functioning KW - emotional control KW - 3-arm randomized controlled trial KW - ADHD KW - attention deficit KW - hyperactive KW - hyperactivity KW - randomized KW - RCT KW - social interaction KW - social interactions KW - social skills KW - child KW - children KW - youth KW - pediatric KW - pediatrics KW - VR KW - virtual reality KW - childhood KW - neurodevelopmental N2 - Background: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders among children. Children with ADHD have challenges in understanding social cues and behavioral problems when entering a social setting. Virtual reality (VR) has been applied to improve cognitive behaviors in children with ADHD. Previous studies have not adopted VR to improve social interaction competence and appropriateness in children with ADHD. VR offers a more effective alternative to therapeutic strategies for children with ADHD. Objective: This study aims to examine the feasibility and effectiveness of social VR training in enhancing social interaction skills compared to traditional social skills training in children with ADHD. We hypothesize that participants in the social VR training group are likely to perform better on social interaction skills than those in the traditional social skills training group. Methods: In this nonblinded, 3-arm randomized controlled trial (RCT), 90 participants with ADHD recruited from the community will be randomized 1:1:1 to the social VR intervention group, traditional social skills training group, or waitlist control group. The child psychiatrist will conduct assessments for each participant at baseline and after the intervention. The Social Skills Rating Scale?Parent will be used to assess the social interaction skills of the participants before and after the intervention. Participants in the social VR intervention group and traditional social skills training group will receive twelve 20-minute training sessions for 3 weeks. The participants in the waitlist control group will receive no training. The primary outcome measure is training acceptability and compliance. The secondary outcome measures are the child psychiatrist's assessment and the Social Skills Rating Scale?Parent before and after the intervention. Another outcome measure is the Behavior Rating Inventory of Executive Function and Attention. Differences in the scale scores will be examined using a t test and an F test. Results: This study is set to commence in the fourth quarter of 2023. It is anticipated that participants in the social VR intervention group will exhibit superior social interaction skills than those in the traditional social skills training group. Conclusions: To our knowledge, this RCT is the first study examining the feasibility and effectiveness of a social VR-based intervention for enhancing the social interaction skills of children with ADHD in Hong Kong. The VR-based social skills training is expected to provide a safer and more effective environment for children with ADHD to learn than the traditional approach. This study can lead to a full-scale RCT. Trial Registration: ClinicalTrials.gov NCT05778526; https://clinicaltrials.gov/study/NCT05778526 International Registered Report Identifier (IRRID): PRR1-10.2196/48208 UR - https://www.researchprotocols.org/2023/1/e48208 UR - http://dx.doi.org/10.2196/48208 UR - http://www.ncbi.nlm.nih.gov/pubmed/37721790 ID - info:doi/10.2196/48208 ER - TY - JOUR AU - Scholze, A. Danielle AU - Gosdin, M. Melissa AU - Perez, L. Susan AU - Schweitzer, B. Julie PY - 2023/9/11 TI - Identifying the Information Needs and Format Preferences for Web-Based Content Among Adults With or Parents of Children With Attention-Deficit/Hyperactivity Disorder: Three-Stage Qualitative Analysis JO - JMIR Form Res SP - e47409 VL - 7 KW - ADHD KW - pediatric KW - adult KW - mobile phone KW - developmental disorder KW - neurodevelopmental KW - mental disorder KW - information-seeking KW - information need KW - attention deficit disorder KW - hyperactive KW - hyperactivity KW - interview KW - focus group KW - think-aloud KW - web-based KW - online content KW - user experience KW - information behavior KW - web design N2 - Background: Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent childhood and adult behavioral disorder. Internet searches for ADHD information are rising, particularly for diagnosis and treatment. Despite effective ADHD treatments, research suggests that there are delays in seeking help for ADHD. Identifying ways to shorten delays is important for minimizing morbidity associated with ADHD. One way to shorten these delays is to improve internet health information resources. Research shows that parents of children with ADHD feel that much of the information available is technical and not tailored for their child?s needs and verbal instructions given by health care providers were too pharmacologically focused with limited information about how to manage and support ADHD symptoms in daily living. A majority of parents search the internet for general and pharmacological information for ADHD and prefer web-based resources for learning about ADHD, but web-based resources may be inaccurate and of low quality. Ensuring accurate information through the internet is an important step in assisting parents and adults in making informed decisions about the diagnosis and treatment of ADHD. Objective: Although a great deal of information regarding ADHD is available on the internet, some information is not based on scientific evidence or is difficult for stakeholders to understand. Determining gaps in access to accurate ADHD information and stakeholder interest in the type of information desired is important in improving patient engagement with the health care system, but minimal research addresses these needs. This study aims to determine the information needs and formatting needs of web-based content for adults with ADHD and parents of children with ADHD in order to improve user experience and engagement. Methods: This was a 3-phase study consisting of in-depth phone interviews about experiences with ADHD and barriers searching for ADHD-related information, focus groups where participants were instructed to consider the pathways by which they made decisions using web-based resources, and observing participants interacting with a newly developed website tailored for adults with potential ADHD and caregivers of children who had or might have ADHD. Phase 1 individual interviews and phase 2 focus groups identified the needs of the ADHD stakeholders related to website content and format. Interview and focus group findings were used to develop a website. Phase 3 used think-aloud interviews to evaluate website usability to inform the tailoring of the website based on user feedback. Results: Interviews and focus group findings revealed preferences for ADHD website information and content, website layout, and information sources. Themes included a preference for destigmatizing information about ADHD, information specific to patient demographics, and evidence-based information tailored to lay audiences. Conclusions: ADHD stakeholders are specifically seeking positive information about ADHD presented in a user-friendly format. UR - https://formative.jmir.org/2023/1/e47409 UR - http://dx.doi.org/10.2196/47409 UR - http://www.ncbi.nlm.nih.gov/pubmed/37695648 ID - info:doi/10.2196/47409 ER - TY - JOUR AU - Ruf, Alea AU - Neubauer, B. Andreas AU - Koch, D. Elena AU - Ebner-Priemer, Ulrich AU - Reif, Andreas AU - Matura, Silke PY - 2023/8/17 TI - Microtemporal Dynamics of Dietary Intake, Physical Activity, and Impulsivity in Adult Attention-Deficit/Hyperactivity Disorder: Ecological Momentary Assessment Study Within Nutritional Psychiatry JO - JMIR Ment Health SP - e46550 VL - 10 KW - impulsivity KW - nutrition KW - macronutrient intake KW - physical activity KW - ecological momentary assessment KW - EMA KW - attention-deficit/hyperactivity disorder KW - ADHD KW - diet KW - neurodevelopmental KW - hyperactivity KW - macronutrient KW - psychiatry KW - symptoms KW - mobile KW - mobile phone N2 - Background: Increasing attention is being paid to lifestyle factors, such as nutrition and physical activity (PA), as potential complementary treatment options in attention-deficit/hyperactivity disorder (ADHD). Previous research indicates that sugar and saturated fat intake may be linked to increased impulsivity, a core symptom of ADHD, whereas protein intake and PA may be related to reduced impulsivity. However, most studies rely on cross-sectional data that lack microtemporal resolution and ecological validity, wherefore questions of microtemporal dynamics (eg, is the consumption of foods high in sugar associated with increased impulsivity within minutes or hours?) remain largely unanswered. Ecological momentary assessment (EMA) has the potential to bridge this gap. Objective: This study is the first to apply EMA to assess microtemporal associations among macronutrient intake, PA, and state impulsivity in the daily life of adults with and without ADHD. Methods: Over a 3-day period, participants reported state impulsivity 8 times per day (signal-contingent), recorded food and drink intake (event-contingent), and wore an accelerometer. Multilevel 2-part models were used to study the association among macronutrient intake, PA, and the probability to be impulsive as well as the intensity of impulsivity (ADHD: n=36; control: n=137). Results: No association between macronutrient intake and state impulsivity was found. PA was not related to the intensity of impulsivity but to a higher probability to be impulsive (ADHD: ?=?.09, 95% CI ?0.14 to ?0.04; control: ?=?.03, 95% CI ?0.05 to ?0.01). No evidence was found that the combined intake of saturated fat and sugar amplified the increase in state impulsivity and that PA alleviated the positive association between sugar or fat intake and state impulsivity. Conclusions: Important methodological considerations are discussed that can contribute to the optimization of future EMA protocols. EMA research in the emerging field of nutritional psychiatry is still in its infancy; however, EMA is a highly promising and innovative approach as it offers insights into the microtemporal dynamics of psychiatric symptomology, dietary intake, and PA in daily life. UR - https://mental.jmir.org/2023/1/e46550 UR - http://dx.doi.org/10.2196/46550 UR - http://www.ncbi.nlm.nih.gov/pubmed/37590053 ID - info:doi/10.2196/46550 ER - TY - JOUR AU - Denyer, Hayley AU - Deng, Qigang AU - Adanijo, Abimbola AU - Asherson, Philip AU - Bilbow, Andrea AU - Folarin, Amos AU - Groom, J. Madeleine AU - Hollis, Chris AU - Wykes, Til AU - Dobson, JB Richard AU - Kuntsi, Jonna AU - Simblett, Sara PY - 2023/6/30 TI - Barriers to and Facilitators of Using Remote Measurement Technology in the Long-Term Monitoring of Individuals With ADHD: Interview Study JO - JMIR Form Res SP - e44126 VL - 7 KW - attention-deficit/hyperactivity disorder KW - ADHD KW - remote measurement technology KW - engagement KW - barriers and facilitators KW - qualitative analysis KW - mobile phone N2 - Background: Remote measurement technology (RMT) has the potential to address current research and clinical challenges of attention-deficit/hyperactivity disorder (ADHD) symptoms and its co-occurring mental health problems. Despite research using RMT already being successfully applied to other populations, adherence and attrition are potential obstacles when applying RMT to a disorder such as ADHD. Hypothetical views and attitudes toward using RMT in a population with ADHD have previously been explored; however, to our knowledge, there is no previous research that has used qualitative methods to understand the barriers to and facilitators of using RMT in individuals with ADHD following participation in a remote monitoring period. Objective: We aimed to evaluate the barriers to and facilitators of using RMT in individuals with ADHD compared with a group of people who did not have a diagnosis of ADHD. We also aimed to explore participants? views on using RMT for 1 or 2 years in future studies. Methods: In total, 20 individuals with ADHD and 20 individuals without ADHD were followed up for 10 weeks using RMT that involved active (questionnaires and cognitive tasks) and passive (smartphone sensors and wearable devices) monitoring; 10 adolescents and adults with ADHD and 12 individuals in a comparison group completed semistructured qualitative interviews at the end of the study period. The interviews focused on potential barriers to and facilitators of using RMT in adults with ADHD. A framework methodology was used to explore the data qualitatively. Results: Barriers to and facilitators of using RMT were categorized as health-related, user-related, and technology-related factors across both participant groups. When comparing themes that emerged across the participant groups, both individuals with and without ADHD experienced similar barriers and facilitators in using RMT. The participants agreed that RMT can provide useful objective data. However, slight differences between the participant groups were identified as barriers to RMT across all major themes. Individuals with ADHD described the impact that their ADHD symptoms had on participating (health-related theme), commented on the perceived cost of completing the cognitive tasks (user-related theme), and described more technical challenges (technology-related theme) than individuals without ADHD. Hypothetical views on future studies using RMT in individuals with ADHD for 1 or 2 years were positive. Conclusions: Individuals with ADHD agreed that RMT, which uses repeated measurements with ongoing active and passive monitoring, can provide useful objective data. Although themes overlapped with previous research on barriers to and facilitators of engagement with RMT (eg, depression and epilepsy) and with a comparison group, there are unique considerations for people with ADHD, for example, understanding the impact that ADHD symptoms may have on engaging with RMT. Researchers need to continue working with people with ADHD to develop future RMT studies for longer periods. UR - https://formative.jmir.org/2023/1/e44126 UR - http://dx.doi.org/10.2196/44126 UR - http://www.ncbi.nlm.nih.gov/pubmed/37389932 ID - info:doi/10.2196/44126 ER - TY - JOUR AU - Martin-Moratinos, Marina AU - Bella-Fernández, Marcos AU - Blasco-Fontecilla, Hilario PY - 2023/5/12 TI - Effects of Music on Attention-Deficit/Hyperactivity Disorder (ADHD) and Potential Application in Serious Video Games: Systematic Review JO - J Med Internet Res SP - e37742 VL - 25 KW - attention-deficit/hyperactivity disorder KW - music therapy KW - music KW - video games KW - rhythm KW - timing deficits N2 - Background: Attention-deficit/hyperactivity disorder (ADHD) has a considerable impact on an individual?s daily life. Some difficulties with timing deficits may be associated with deficiencies in attention, reading, language skills, or executive function. Music therapy, either active (playing an instrument) or passive (listening to music) has demonstrated its efficacy in reducing symptomatology in many disorders. Video games may prove to be a useful assessment and treatment tool in compensating for the difficulties with multimodal treatment in ADHD. Objective: The aim of the study is to (1) analyze the evidence that music is beneficial in reducing the symptomatology of ADHD using systematic review and (2) propose the application of music in video games following music therapy strategies. Methods: Searches were conducted in PubMed, Embase, PsycINFO, Cochrane, and gray literature (Google Scholar and WorldCat). We used the following search syntax: ((music[Title/Abstract]) or (music therapy[Title/Abstract])) and (attention deficit disorder[MeSH or thesaurus term]). Results: Of the 70 records identified, 17 provided findings that music can be beneficial in various domains of ADHD. Active music therapy improves hemispheric synchrony, social skills, aggressivity, and impulsivity. Passive music therapy improves academic skills like arithmetic, drawing, and reading comprehension, as well as attention and disruptive behaviors. The effects depend on the music genre, tempo, or task difficulty. Music in video games was generally found to be beneficial for people with ADHD. Music improves immersion and flow while playing video games. Using rhythm may also improve timing skills and immersion in patients with ADHD. Regarding the proposed application of aspects of music to therapeutic video games for ADHD, some paradigms in timing and music therapy were considered in the proposed design of video games. Conclusions: Improving ADHD treatment through the application of music in video games is proposed. Trial Registration: PROSPERO CRD42021288226; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=288226 UR - https://www.jmir.org/2023/1/e37742 UR - http://dx.doi.org/10.2196/37742 UR - http://www.ncbi.nlm.nih.gov/pubmed/37171837 ID - info:doi/10.2196/37742 ER - TY - JOUR AU - Ji, HongQing AU - Wu, Shanshan AU - Won, Junyeon AU - Weng, Shiyang AU - Lee, Sujin AU - Seo, Sangmin AU - Park, Jung-Jun PY - 2023/5/9 TI - The Effects of Exergaming on Attention in Children With Attention Deficit/Hyperactivity Disorder: Randomized Controlled Trial JO - JMIR Serious Games SP - e40438 VL - 11 KW - exergame KW - N2 amplitude KW - attention function KW - response time KW - attention deficit/hyperactivity disorder KW - ADHD N2 - Background: Despite growing evidence showing the effects of exercise and cognitive trainings on enhancing attention, little is known about the combined effects of exergame on attention in children with attention deficit/hyperactivity disorder (ADHD). Exergame, a form of exercise using a video game, has both cognitive stimulation and physical activity components and has been shown to improve cognitive function in children. Objective: The purpose of this study was to investigate the effect of exergaming on attention and to compare the effect induced by exergaming with the effect of aerobic exercise on attention in children with ADHD. Methods: In all, 30 children with ADHD, aged 8-12 years, were randomly divided into an exergaming group (EXG; n=16) or a bicycle exercise group (BEG; n=14). Before and after the 4-week intervention, the Frankfurter Aufmerksamkeits-Inventar (FAIR; Frankfurt Attention Inventory) test was administrated, and event-related potentials during the Go/No-go task was measured to assess attention. Results: After intervention, both the EXG and BEG had significantly increased selective attention and continuous attention (all P<.001), as well as self-control on the FAIR test (EXG: P=.02 and BEG: P=.005). Similarly, both the EXG and BEG had significantly reduced response time on the Go/No-go test (all P<.001). For the Go response, the N2 amplitude (frontocentral maximal negativity) was significantly increased in Fz (midfrontal line) in the EXG (P=.003) but was not changed in the BEG (P=.97). Importantly, the N2 amplitude in Fz was significantly greater in the EXG compared to the BEG (Go: P=.001 and No-go: P=.008). Conclusions: Exergaming has the comparable effects to bicycle exercise to enhance attention in children with ADHD, suggesting that exergaming can be used as an alternative treatment for children with ADHD. Trial Registration: Clinical Research Information Service KCT0008239; https://tinyurl.com/57e4jtnb UR - https://games.jmir.org/2023/1/e40438 UR - http://dx.doi.org/10.2196/40438 UR - http://www.ncbi.nlm.nih.gov/pubmed/37159253 ID - info:doi/10.2196/40438 ER - TY - JOUR AU - Rodrigo-Yanguas, María AU - Martín-Moratinos, Marina AU - González-Tardón, Carlos AU - Sanchez-Sanchez, Fernando AU - Royuela, Ana AU - Bella-Fernández, Marcos AU - Blasco-Fontecilla, Hilario PY - 2023/4/24 TI - Effectiveness of a Personalized, Chess-Based Training Serious Video Game in the Treatment of Adolescents and Young Adults With Attention-Deficit/Hyperactivity Disorder: Randomized Controlled Trial JO - JMIR Serious Games SP - e39874 VL - 11 KW - attention-deficit hyperactivity disorder KW - ADHD KW - serious video games KW - cognitive training KW - chess KW - video game KW - teen KW - young adult KW - game KW - intervention KW - treatment KW - emotional KW - control KW - regulation KW - attention KW - school KW - function KW - symptom N2 - Background: Compared with traditional approaches, gaming strategies are promising interventions for the treatment of attention-deficit/hyperactivity disorder (ADHD). We developed a serious game, The Secret Trail of Moon (TSTM), for ADHD treatment. Objective: The main objective of this clinical trial was to demonstrate the effectiveness of an add-on, either TSTM or Therapeutic Chess (TC), in previously optimally drug-titrated, clinically stable patients with ADHD. Methods: This study is a prospective, unicentric, randomized clinical trial in clinically stable patients with ADHD, aged 12 to 22 years. The TSTM (n=35) and TC groups (n=34) performed 12 weekly sessions of their respective treatments. The control group (CG) patients (n=35) were called by phone every week, but they received no cognitive intervention. The primary end point was the change from baseline to end point in the parent ?Behavior Rating Inventory of Executive Function-2? (BRIEF-2; patients? parents) in the per-protocol population (31 serious videogame: 24 TC and 34 CG). Results: Our study failed to probe clear-cut improvements in the global score of the BRIEF-2. However, the TC group showed improvements in measures of emotional control, emotional regulation, and inattention. The TSTM group showed improvements in measures of emotional regulation, inattention, and school context. Conclusions: TSTM and TC did not improve executive function symptoms, but they improved ADHD symptomatology related to emotional regulation. Further studies with bigger samples are required to confirm these preliminary findings. Trial Registration: ClinicalTrials.gov NCT04355065; https://clinicaltrials.gov/ct2/show/NCT04355065 UR - https://games.jmir.org/2023/1/e39874 UR - http://dx.doi.org/10.2196/39874 UR - http://www.ncbi.nlm.nih.gov/pubmed/37093628 ID - info:doi/10.2196/39874 ER - TY - JOUR AU - Costello, Jeremy AU - Kaur, Manpreet AU - Reformat, Z. Marek AU - Bolduc, V. Francois PY - 2023/4/17 TI - Leveraging Knowledge Graphs and Natural Language Processing for Automated Web Resource Labeling and Knowledge Mobilization in Neurodevelopmental Disorders: Development and Usability Study JO - J Med Internet Res SP - e45268 VL - 25 KW - knowledge graph KW - natural language processing KW - neurodevelopmental disorders KW - autism spectrum disorder KW - intellectual disability KW - attention deficit hyperactivity disorder KW - named entity recognition KW - topic modeling KW - aggregation operator N2 - Background: Patients and families need to be provided with trusted information more than ever with the abundance of online information. Several organizations aim to build databases that can be searched based on the needs of target groups. One such group is individuals with neurodevelopmental disorders (NDDs) and their families. NDDs affect up to 18% of the population and have major social and economic impacts. The current limitations in communicating information for individuals with NDDs include the absence of shared terminology and the lack of efficient labeling processes for web resources. Because of these limitations, health professionals, support groups, and families are unable to share, combine, and access resources. Objective: We aimed to develop a natural language?based pipeline to label resources by leveraging standard and free-text vocabularies obtained through text analysis, and then represent those resources as a weighted knowledge graph. Methods: Using a combination of experts and service/organization databases, we created a data set of web resources for NDDs. Text from these websites was scraped and collected into a corpus of textual data on NDDs. This corpus was used to construct a knowledge graph suitable for use by both experts and nonexperts. Named entity recognition, topic modeling, document classification, and location detection were used to extract knowledge from the corpus. Results: We developed a resource annotation pipeline using diverse natural language processing algorithms to annotate web resources and stored them in a structured knowledge graph. The graph contained 78,181 annotations obtained from the combination of standard terminologies and a free-text vocabulary obtained using topic modeling. An application of the constructed knowledge graph is a resource search interface using the ordered weighted averaging operator to rank resources based on a user query. Conclusions: We developed an automated labeling pipeline for web resources on NDDs. This work showcases how artificial intelligence?based methods, such as natural language processing and knowledge graphs for information representation, can enhance knowledge extraction and mobilization, and could be used in other fields of medicine. UR - https://www.jmir.org/2023/1/e45268 UR - http://dx.doi.org/10.2196/45268 UR - http://www.ncbi.nlm.nih.gov/pubmed/37067865 ID - info:doi/10.2196/45268 ER - TY - JOUR AU - Zhang, Melvyn AU - Ranganath, Vallabhajosyula PY - 2022/12/9 TI - An Emotional Bias Modification for Children With Attention-Deficit/Hyperactivity Disorder: Co-design Study JO - JMIR Form Res SP - e36390 VL - 6 IS - 12 KW - emotional bias KW - cognitive biases KW - attention-deficit/hyperactivity disorder KW - ADHD KW - child psychiatry N2 - Background: Attention-deficit/hyperactivity disorder (ADHD) is one of the common neurodevelopment disorders. Children with ADHD typically have difficulties with emotional regulation. Previous studies have investigated the assessment for underlying emotional biases using the visual probe task. However, one of the significant limitations of the visual probe task is that it is demanding and repetitive over time. Previous studies have examined the use of gamification methods in addressing the limitations of the emotional bias visual probe task. There has also been increased recognition of the potential of participatory action research methods and how it could help to make the conceptualized interventions more relevant. Objective: The primary aim of this study was to collate health care professionals? perspectives on the limitations of the existing visual probe task and to determine if gamification elements were viable to be incorporated into an emotional bias modification task. Methods: A co-design workshop was conducted. Health care professionals from the Department of Development Psychiatry, Institute of Mental Health, Singapore, were invited to participate. Considering the COVID-19 pandemic and the restrictions, a web-based workshop was conducted. There were 3 main phases in the workshops. First, participants were asked to identify limitations and suggest potential methods to overcome some of the identified limitations. Second, participants were shown examples of existing gaming interventions in published literature and commercial stores. They were also asked to comment on the advantages and limitations of these interventions. Finally, participants were asked if gamification techniques would be appropriate. Results: Overall, 4 health care professionals consented and participated. Several limitations were identified regarding the conventional emotional bias intervention. These included the nature of the task parameters, included stimulus set, and factors that could have an impact on the accuracy of responding to the task. After examining the existing ADHD games, participants raised concerns about the evidence base of some of the apps. They articulated that any developed ADHD game ought to identify the specific skill set that was targeted clearly. Regarding gamification strategies, participants preferred economic and performance-based gamification approaches. Conclusions: This study has managed to elucidate health care professionals? perspectives toward refining a conventional emotional bias intervention for children with ADHD. In view of the repetitiveness of the conventional task, the suggested gamification techniques might help in influencing task adherence and reduce the attrition rates. UR - https://formative.jmir.org/2022/12/e36390 UR - http://dx.doi.org/10.2196/36390 UR - http://www.ncbi.nlm.nih.gov/pubmed/36485019 ID - info:doi/10.2196/36390 ER - TY - JOUR AU - Kenter, Francisca Robin Maria AU - Schønning, Adrian AU - Inal, Yavuz PY - 2022/10/21 TI - Internet-Delivered Self-help for Adults With ADHD (MyADHD): Usability Study JO - JMIR Form Res SP - e37137 VL - 6 IS - 10 KW - usability testing KW - user evaluation KW - attention-deficit/hyperactivity disorder KW - self-guided intervention KW - internet-delivered KW - self-help KW - adults with attention-deficit/hyperactivity disorder KW - intervention KW - usability study KW - care needs KW - usability N2 - Background: Although effective pharmacological treatment exists, many adults with attention-deficit/hyperactivity disorder (ADHD) prefer a nonpharmacological option for managing their symptoms. Internet-delivered self-help interventions have the potential to address this unmet supportive care need reported by adults with ADHD, at relatively low costs. However, if the intervention does not offer optimal functions, content, and layout, it could decrease adherence and engagement and potentially compromise the effectiveness of such interventions. Thus, there is a need for examining the usability and factors that enhance and impair the usability of internet-delivered self-help interventions. Objective: This study evaluates the usability of an internet-delivered self-help intervention for adults with ADHD (MyADHD). The main goals were to (1) collect qualitative and quantitative data on usability and (2) identify usability problems. Methods: Individual think-aloud interviews and staged usability testing (N=5) were conducted to evaluate the usability of the MyADHD intervention in terms of function, content, and design. MyADHD end users provided iterative feedback to maximize engagement and usability. They performed tasks involved in operating the intervention and provided ?think-aloud? commentary and postsession usability ratings. The interviews were recorded, transcribed verbatim, and analyzed. Results: Participants were satisfied with the overall usability of the program. The average perceived usability score out of 100 was 70 for the first round of testing and improved to 77.5 after applying modifications, with a mean score of 75.5 (SD 5.9) for all rounds of usability testing. The analysis of the interviews revealed 3 central themes: functionality, content, and layout. Conclusions: Optimizing the usability of internet-delivered self-guided interventions is a critical step in the design and development process. The usability testing in this study provided valuable information from users? perspectives on the content and platform of the intervention. Analysis revealed the need for intervention enhancement with regard to design, functionality, and content from the perspective of potential end users. Overall, participants saw value in the MyADHD intervention and were confident that they could use it for the self-management of symptoms and expressed the desire to use the entire intervention when it becomes available. Through this development process, we produced an intervention that is likely to be used successfully and is ready for deployment in a randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT04511169; https://clinicaltrials.gov/ct2/show/NCT04511169 UR - https://formative.jmir.org/2022/10/e37137 UR - http://dx.doi.org/10.2196/37137 UR - http://www.ncbi.nlm.nih.gov/pubmed/36269662 ID - info:doi/10.2196/37137 ER - TY - JOUR AU - Pandria, Niki AU - Petronikolou, Vasileia AU - Lazaridis, Aristotelis AU - Karapiperis, Christos AU - Kouloumpris, Eleftherios AU - Spachos, Dimitris AU - Fachantidis, Anestis AU - Vasiliou, Dimitris AU - Vlahavas, Ioannis AU - Bamidis, Panagiotis PY - 2022/9/28 TI - Information System for Symptom Diagnosis and Improvement of Attention Deficit Hyperactivity Disorder: Protocol for a Nonrandomized Controlled Pilot Study JO - JMIR Res Protoc SP - e40189 VL - 11 IS - 9 KW - attention deficit hyperactivity disorder (ADHD) KW - machine learning KW - web health KW - serious games KW - ADHD monitoring N2 - Background: Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders during childhood; however, the diagnosis procedure remains challenging, as it is nonstandardized, multiparametric, and highly dependent on subjective evaluation of the perceived behavior. Objective: To address the challenges of existing procedures for ADHD diagnosis, the ADHD360 project aims to develop a platform for (1) early detection of ADHD by assessing the user?s likelihood of having ADHD characteristics and (2) providing complementary training for ADHD management. Methods: A 2-phase nonrandomized controlled pilot study was designed to evaluate the ADHD360 platform, including ADHD and non-ADHD participants aged 7 to 16 years. At the first stage, an initial neuropsychological evaluation along with an interaction with the serious game developed (?Pizza on Time?) for approximately 30-45 minutes is performed. Subsequently, a 2-week behavior monitoring of the participants through the mADHD360 app is planned after a telephone conversation between the participants? parents and the psychologist, where the existence of any behaviors characteristic of ADHD that affect daily functioning is assessed. Once behavior monitoring is complete, the research team invites the participants to the second stage, where they play the game for a mean duration of 10 weeks (2 times per week). Once the serious game is finished, a second round of behavior monitoring is performed following the same procedures as the initial one. During the study, gameplay data were collected and preprocessed. The protocol of the pilot trials was initially designed for in-person participation, but after the COVID-19 outbreak, it was adjusted for remote participation. State-of-the-art machine learning (ML) algorithms were used to analyze labeled gameplay data aiming to detect discriminative gameplay patterns among the 2 groups (ADHD and non-ADHD) and estimate a player?s likelihood of having ADHD characteristics. A schema including a train-test splitting with a 75:25 split ratio, k-fold cross-validation with k=3, an ML pipeline, and data evaluation were designed. Results: A total of 43 participants were recruited for this study, where 18 were diagnosed with ADHD and the remaining 25 were controls. Initial neuropsychological assessment confirmed that the participants in the ADHD group showed a deviation from the participants without ADHD characteristics. A preliminary analysis of collected data consisting of 30 gameplay sessions showed that the trained ML models achieve high performance (ie, accuracy up to 0.85) in correctly predicting the users? labels (ADHD or non-ADHD) from their gameplay session on the ADHD360 platform. Conclusions: ADHD360 is characterized by its notable capacity to discriminate player gameplay behavior as either ADHD or non-ADHD. Therefore, the ADHD360 platform could be a valuable complementary tool for early ADHD detection. Trial Registration: ClinicalTrials.gov NCT04362982; https://clinicaltrials.gov/ct2/show/NCT04362982 International Registered Report Identifier (IRRID): RR1-10.2196/40189 UR - https://www.researchprotocols.org/2022/9/e40189 UR - http://dx.doi.org/10.2196/40189 UR - http://www.ncbi.nlm.nih.gov/pubmed/36169998 ID - info:doi/10.2196/40189 ER - TY - JOUR AU - Kaur, Manpreet AU - Costello, Jeremy AU - Willis, Elyse AU - Kelm, Karen AU - Reformat, Z. Marek AU - Bolduc, V. Francois PY - 2022/8/5 TI - Deciphering the Diversity of Mental Models in Neurodevelopmental Disorders: Knowledge Graph Representation of Public Data Using Natural Language Processing JO - J Med Internet Res SP - e39888 VL - 24 IS - 8 KW - concept map KW - neurodevelopmental disorder KW - knowledge graph KW - text analysis KW - semantic relatedness KW - PubMed KW - forums KW - mental model N2 - Background: Understanding how individuals think about a topic, known as the mental model, can significantly improve communication, especially in the medical domain where emotions and implications are high. Neurodevelopmental disorders (NDDs) represent a group of diagnoses, affecting up to 18% of the global population, involving differences in the development of cognitive or social functions. In this study, we focus on 2 NDDs, attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), which involve multiple symptoms and interventions requiring interactions between 2 important stakeholders: parents and health professionals. There is a gap in our understanding of differences between mental models for each stakeholder, making communication between stakeholders more difficult than it could be. Objective: We aim to build knowledge graphs (KGs) from web-based information relevant to each stakeholder as proxies of mental models. These KGs will accelerate the identification of shared and divergent concerns between stakeholders. The developed KGs can help improve knowledge mobilization, communication, and care for individuals with ADHD and ASD. Methods: We created 2 data sets by collecting the posts from web-based forums and PubMed abstracts related to ADHD and ASD. We utilized the Unified Medical Language System (UMLS) to detect biomedical concepts and applied Positive Pointwise Mutual Information followed by truncated Singular Value Decomposition to obtain corpus-based concept embeddings for each data set. Each data set is represented as a KG using a property graph model. Semantic relatedness between concepts is calculated to rank the relation strength of concepts and stored in the KG as relation weights. UMLS disorder-relevant semantic types are used to provide additional categorical information about each concept?s domain. Results: The developed KGs contain concepts from both data sets, with node sizes representing the co-occurrence frequency of concepts and edge sizes representing relevance between concepts. ADHD- and ASD-related concepts from different semantic types shows diverse areas of concerns and complex needs of the conditions. KG identifies converging and diverging concepts between health professionals literature (PubMed) and parental concerns (web-based forums), which may correspond to the differences between mental models for each stakeholder. Conclusions: We show for the first time that generating KGs from web-based data can capture the complex needs of families dealing with ADHD or ASD. Moreover, we showed points of convergence between families and health professionals? KGs. Natural language processing?based KG provides access to a large sample size, which is often a limiting factor for traditional in-person mental model mapping. Our work offers a high throughput access to mental model maps, which could be used for further in-person validation, knowledge mobilization projects, and basis for communication about potential blind spots from stakeholders in interactions about NDDs. Future research will be needed to identify how concepts could interact together differently for each stakeholder. UR - https://www.jmir.org/2022/8/e39888 UR - http://dx.doi.org/10.2196/39888 UR - http://www.ncbi.nlm.nih.gov/pubmed/35930346 ID - info:doi/10.2196/39888 ER - TY - JOUR AU - Sadaka, Yair AU - Horwitz, Dana AU - Wolff, Leor AU - Sela, Tomer AU - Meyerovitch, Joseph AU - Peleg, Assaf AU - Bachmat, Eitan AU - Benis, Arriel PY - 2022/8/5 TI - Trends in the Prevalence of Chronic Medication Use Among Children in Israel Between 2010 and 2019: Protocol for a Retrospective Cohort Study JO - JMIR Res Protoc SP - e36756 VL - 11 IS - 8 KW - psychotropic drugs KW - central nervous system stimulants KW - mental health KW - medication therapy management KW - drug prescriptions KW - attention deficit hyperactivity disorder KW - ADHD, Israel KW - children KW - data mining KW - machine learning KW - electronic medical records KW - pediatrics KW - chronic disease KW - epidemiology N2 - Background: Prescription of psychostimulants has significantly increased in most countries worldwide for both preschool and school-aged children. Understanding the trends of chronic medication use among children in different age groups and from different sociodemographic backgrounds is essential. It is essential to distinguish between selected therapy areas to help decision-makers evaluate not only the relevant expected medication costs but also the specific services related to these areas. Objective: This study will analyze differences in trends regarding medications considered psychobehavioral treatments and medications considered nonpsychobehavioral treatments and will identify risk factors and predictors for chronic medication use among children. Methods: This is a retrospective study. Data will be extracted from the Clalit Health Services data warehouse. For each year between 2010 and 2019, there are approximately 1,500,000 children aged 0-18 years. All medication classes will be identi?ed using the Anatomical Therapeutic Chemical code. A time-trend analysis will be performed to investigate if there is a significant difference between the trends of children?s psychobehavioral and nonpsychobehavioral medication prescriptions. A logistic regression combined with machine learning models will be developed to identify variables that may increase the risk for specific chronic medication types and identify children likely to get such treatment. Results: The project was funded in 2019. Data analysis is currently underway, and the results are expected to be submitted for publication in 2022. Understanding trends regarding medications considered psychobehavioral treatments and medications considered nonpsychobehavioral treatments will support the identification of risk factors and predictors for chronic medication use among children. Conclusions: Analyzing the response of the patient (and their parents or caregivers) population over time will hopefully help improve policies for prescriptions and follow-up of chronic treatments in children. International Registered Report Identifier (IRRID): DERR1-10.2196/36756 UR - https://www.researchprotocols.org/2022/8/e36756 UR - http://dx.doi.org/10.2196/36756 UR - http://www.ncbi.nlm.nih.gov/pubmed/35775233 ID - info:doi/10.2196/36756 ER - TY - JOUR AU - Sújar, Aarón AU - Martín-Moratinos, Marina AU - Rodrigo-Yanguas, María AU - Bella-Fernández, Marcos AU - González-Tardón, Carlos AU - Delgado-Gómez, David AU - Blasco-Fontecilla, Hilario PY - 2022/8/1 TI - Developing Serious Video Games to Treat Attention Deficit Hyperactivity Disorder: Tutorial Guide JO - JMIR Serious Games SP - e33884 VL - 10 IS - 3 KW - serious video games KW - ADHD KW - treatment KW - video games KW - cognitive KW - cognitive disorder KW - games UR - https://games.jmir.org/2022/3/e33884 UR - http://dx.doi.org/10.2196/33884 UR - http://www.ncbi.nlm.nih.gov/pubmed/35916694 ID - info:doi/10.2196/33884 ER - TY - JOUR AU - Lindhiem, Oliver AU - Goel, Mayank AU - Shaaban, Sam AU - Mak, J. Kristie AU - Chikersal, Prerna AU - Feldman, Jamie AU - Harris, L. Jordan PY - 2022/4/25 TI - Objective Measurement of Hyperactivity Using Mobile Sensing and Machine Learning: Pilot Study JO - JMIR Form Res SP - e35803 VL - 6 IS - 4 KW - assessment KW - machine learning KW - hyperactivity KW - attention-deficit/hyperactivity disorder KW - ADHD KW - wearables N2 - Background: Although hyperactivity is a core symptom of attention-deficit/hyperactivity disorder (ADHD), there are no objective measures that are widely used in clinical settings. Objective: We describe the development of a smartwatch app to measure hyperactivity in school-age children. The LemurDx prototype is a software system for smartwatches that uses wearable sensor technology and machine learning to measure hyperactivity. The goal is to differentiate children with ADHD combined presentation (a combination of inattentive and hyperactive/impulsive presentations) or predominantly hyperactive/impulsive presentation from children with typical levels of activity. Methods: In this pilot study, we recruited 30 children, aged 6 to 11 years, to wear a smartwatch with the LemurDx app for 2 days. Parents also provided activity labels for 30-minute intervals to help train the algorithm. Half of the participants had ADHD combined presentation or predominantly hyperactive/impulsive presentation (n=15), and half were in the healthy control group (n=15). Results: The results indicated high usability scores and an overall diagnostic accuracy of 0.89 (sensitivity=0.93; specificity=0.86) when the motion sensor output was paired with the activity labels. Conclusions: State-of-the-art sensors and machine learning may provide a promising avenue for the objective measurement of hyperactivity. UR - https://formative.jmir.org/2022/4/e35803 UR - http://dx.doi.org/10.2196/35803 UR - http://www.ncbi.nlm.nih.gov/pubmed/35468089 ID - info:doi/10.2196/35803 ER - TY - JOUR AU - Ahlers, Joachim AU - Baumgartner, Christian AU - Augsburger, Mareike AU - Wenger, Andreas AU - Malischnig, Doris AU - Boumparis, Nikolaos AU - Berger, Thomas AU - Stark, Lars AU - Ebert, D. David AU - Haug, Severin AU - Schaub, P. Michael PY - 2022/4/20 TI - Cannabis Use in Adults Who Screen Positive for Attention Deficit/Hyperactivity Disorder: CANreduce 2.0 Randomized Controlled Trial Subgroup Analysis JO - J Med Internet Res SP - e30138 VL - 24 IS - 4 KW - attention deficit/hyperactivity disorder KW - ADHD KW - cannabis KW - cannabis use disorder KW - CANreduce KW - web-based self-help tool KW - online tool KW - online health KW - mental health KW - digital health KW - anxiety KW - depression N2 - Background: Prevalence rates for lifetime cannabis use and cannabis use disorder are much higher in people with attention deficit/hyperactivity disorder than in those without. CANreduce 2.0 is an intervention that is generally effective at reducing cannabis use in cannabis misusers. This self-guided web-based intervention (6-week duration) consists of modules grounded in motivational interviewing and cognitive behavioral therapy. Objective: We aimed to evaluate whether the CANreduce 2.0 intervention affects cannabis use patterns and symptom severity in adults who screen positive for attention deficit/hyperactivity disorder more than in those who do not. Methods: We performed a secondary analysis of data from a previous study with the inclusion criterion of cannabis use at least once weekly over the last 30 days. Adults with and without attention deficit/hyperactivity disorder (based on the Adult Attention deficit/hyperactivity disorder Self-Report screener) who were enrolled to the active intervention arms of CANreduce 2.0 were compared regarding the number of days cannabis was used in the preceding 30 days, the cannabis use disorder identification test score (CUDIT) and the severity of dependence scale score (SDS) at baseline and the 3-month follow-up. Secondary outcomes were Generalized Anxiety Disorder score, Center for Epidemiological Studies Depression scale score, retention, intervention adherence, and safety. Results: Both adults with (n=94) and without (n=273) positive attention-deficit/hyperactivity disorder screening reported significantly reduced frequency (reduction in consumption days: with: mean 11.53, SD 9.28, P<.001; without: mean 8.53, SD 9.4, P<.001) and severity of cannabis use (SDS: with: mean 3.57, SD 3.65, P<.001; without: mean 2.47, SD 3.39, P<.001; CUDIT: with: mean 6.38, SD 5.96, P<.001; without: mean 5.33, SD 6.05, P<.001), as well as anxiety (with: mean 4.31, SD 4.71, P<.001; without: mean 1.84, SD 4.22, P<.001) and depression (with: mean 10.25, SD 10.54; without: mean 4.39, SD 10.22, P<.001). Those who screened positive for attention deficit/hyperactivity disorder also reported significantly decreased attention deficit/hyperactivity disorder scores (mean 4.65, SD 4.44, P<.001). There were no significant differences in change in use (P=.08), dependence (P=.95), use disorder (P=.85), attention deficit/hyperactivity disorder status (P=.84), depression (P=.84), or anxiety (P=.26) between baseline and final follow-up, dependent on positive attention-deficit/hyperactivity disorder screening. Attention deficit/hyperactivity disorder symptom severity at baseline was not associated with reduced cannabis use frequency or severity but was linked to greater reductions in depression (Spearman ?=.33) and anxiety (Spearman ?=.28). Individuals with positive attention deficit/hyperactivity disorder screening were significantly less likely to fill out the consumption diary (P=.02), but the association between continuous attention deficit/hyperactivity disorder symptom severity and retention (Spearman ?=?0.10, P=.13) was nonsignificant. There also was no significant intergroup difference in the number of completed modules (with: mean 2.10, SD 2.33; without: mean 2.36, SD 2.36, P=.34), and there was no association with attention deficit/hyperactivity disorder symptom severity (Spearman ?=?0.09; P=.43). The same was true for the rate of adverse effects (P=.33). Conclusions: Cannabis users screening positive for attention deficit/hyperactivity disorder may benefit from CANreduce 2.0 to decrease the frequency and severity of cannabis dependence and attenuate symptoms of depression and attention deficit/hyperactivity disorder-related symptoms. This web-based program?s advantages include its accessibility for remote users and a personalized counselling option that may contribute to increased adherence and motivation to change among program users. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 11086185; http://www.isrctn.com/ISRCTN11086185 UR - https://www.jmir.org/2022/4/e30138 UR - http://dx.doi.org/10.2196/30138 UR - http://www.ncbi.nlm.nih.gov/pubmed/35442196 ID - info:doi/10.2196/30138 ER - TY - JOUR AU - Newson, Jane Jennifer AU - Pastukh, Vladyslav AU - Thiagarajan, C. Tara PY - 2022/4/20 TI - Assessment of Population Well-being With the Mental Health Quotient: Validation Study JO - JMIR Ment Health SP - e34105 VL - 9 IS - 4 KW - psychiatry KW - public health KW - methods KW - mental health KW - population health KW - social determinants of health KW - global health KW - behavioral symptoms KW - diagnosis KW - symptom assessment KW - psychopathology KW - mental disorders KW - mHealth KW - depression KW - anxiety KW - attention deficit disorder with hyperactivity KW - autistic disorder KW - internet N2 - Background: The Mental Health Quotient (MHQ) is an anonymous web-based assessment of mental health and well-being that comprehensively covers symptoms across 10 major psychiatric disorders, as well as positive elements of mental function. It uses a novel life impact scale and provides a score to the individual that places them on a spectrum from Distressed to Thriving along with a personal report that offers self-care recommendations. Since April 2020, the MHQ has been freely deployed as part of the Mental Health Million Project. Objective: This paper demonstrates the reliability and validity of the MHQ, including the construct validity of the life impact scale, sample and test-retest reliability of the assessment, and criterion validation of the MHQ with respect to clinical burden and productivity loss. Methods: Data were taken from the Mental Health Million open-access database (N=179,238) and included responses from English-speaking adults (aged?18 years) from the United States, Canada, the United Kingdom, Ireland, Australia, New Zealand, South Africa, Singapore, India, and Nigeria collected during 2021. To assess sample reliability, random demographically matched samples (each 11,033/179,238, 6.16%) were compared within the same 6-month period. Test-retest reliability was determined using the subset of individuals who had taken the assessment twice ?3 days apart (1907/179,238, 1.06%). To assess the construct validity of the life impact scale, additional questions were asked about the frequency and severity of an example symptom (feelings of sadness, distress, or hopelessness; 4247/179,238, 2.37%). To assess criterion validity, elements rated as having a highly negative life impact by a respondent (equivalent to experiencing the symptom ?5 days a week) were mapped to clinical diagnostic criteria to calculate the clinical burden (174,618/179,238, 97.42%). In addition, MHQ scores were compared with the number of workdays missed or with reduced productivity in the past month (7625/179,238, 4.25%). Results: Distinct samples collected during the same period had indistinguishable MHQ distributions and MHQ scores were correlated with r=0.84 between retakes within an 8- to 120-day period. Life impact ratings were correlated with frequency and severity of symptoms, with a clear linear relationship (R2>0.99). Furthermore, the aggregate MHQ scores were systematically related to both clinical burden and productivity. At one end of the scale, 89.08% (8986/10,087) of those in the Distressed category mapped to one or more disorders and had an average productivity loss of 15.2 (SD 11.2; SEM [standard error of measurement] 0.5) days per month. In contrast, at the other end of the scale, 0% (1/24,365) of those in the Thriving category mapped to any of the 10 disorders and had an average productivity loss of 1.3 (SD 3.6; SEM 0.1) days per month. Conclusions: The MHQ is a valid and reliable assessment of mental health and well-being when delivered anonymously on the web. UR - https://mental.jmir.org/2022/4/e34105 UR - http://dx.doi.org/10.2196/34105 UR - http://www.ncbi.nlm.nih.gov/pubmed/35442210 ID - info:doi/10.2196/34105 ER - TY - JOUR AU - Shimabukuro, Shizuka AU - Daley, David AU - Endo, Takahiro AU - Harada, Satoshi AU - Tomoda, Akemi AU - Yamashita, Yushiro AU - Oshio, Takashi AU - Guo, Boliang AU - Ishii, Atsuko AU - Izumi, Mio AU - Nakahara, Yukiko AU - Yamamoto, Kazushi AU - Yao, Akiko AU - Tripp, Gail PY - 2022/4/19 TI - The Effectiveness and Cost-effectiveness of Well Parent Japan for Japanese Mothers of Children With ADHD: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e32693 VL - 11 IS - 4 KW - ADHD KW - parent training KW - Japan KW - New Forest Parent Programme KW - parent stress management N2 - Background: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder associated with numerous functional deficits and poor long-term outcomes. Internationally, behavioral interventions are recommended as part of a multimodal treatment approach for children with ADHD. Currently, in Japan, there are limited interventions available to target ADHD. Well Parent Japan (WPJ), a new hybrid parent-training program, provides a culturally acceptable and effective way to help support Japanese children with ADHD and their parents. Objective: This pragmatic multicenter randomized controlled trial aims to provide preliminary evidence about the effectiveness and cost-effectiveness of WPJ evaluated against treatment as usual (TAU) within routine Japanese mental health services. Methods: Mothers of children (aged 6-12 years) diagnosed with ADHD were recruited from child and adolescent mental health care services at three hospital sites across Japan (Fukui, Fukuoka, and Okinawa). The mothers were randomized to receive immediate treatment or TAU. The effectiveness and cost-effectiveness of WPJ over TAU at the end of the intervention and at 3-month follow-up will be evaluated. The primary outcome is maternal parent domain stress in the parenting role. The following secondary outcomes will be explored: child behavior, including severity of ADHD symptoms; parenting practices; emotional well-being; and the parent-child relationship and maternal child domain parenting stress. Data analysis will follow intention-to-treat principles with treatment effects quantified through analysis of covariance using multilevel modeling. An incremental cost-effectiveness ratio will be used to analyze the cost-effectiveness of the WPJ intervention. Results: Study funding was secured through a proof-of-concept grant in July 2018. Approval by the institutional review board for the data collection sites was obtained between 2017 and 2019. Data collection began in August 2019 and was completed in April 2022. Participant recruitment (N=124) was completed in May 2021. Effectiveness and cost-effectiveness analyses are expected to be completed by July 2022 and December 2022, respectively. These timelines are subject to change owing to the COVID-19 pandemic. Conclusions: This is the first multisite pragmatic trial of WPJ based on the recruitment of children referred directly to routine clinical services in Japan. This multisite randomized trial tests the effectiveness of WPJ in children and families by comparing WPJ directly with the usual clinical care offered for children diagnosed with ADHD in Japan. We also seek to assess and compare the cost-effectiveness of WPJ with TAU in Japan. Trial Registration: International Standard Randomised Controlled Trial Number ISRCTN66978270; https://www.isrctn.com/ISRCTN66978270 International Registered Report Identifier (IRRID): DERR1-10.2196/32693 UR - https://www.researchprotocols.org/2022/4/e32693 UR - http://dx.doi.org/10.2196/32693 UR - http://www.ncbi.nlm.nih.gov/pubmed/35438647 ID - info:doi/10.2196/32693 ER - TY - JOUR AU - van Eijndhoven, Philip AU - Collard, Rose AU - Vrijsen, Janna AU - Geurts, M. Dirk E. AU - Vasquez, Arias Alejandro AU - Schellekens, Arnt AU - van den Munckhof, Eva AU - Brolsma, Sophie AU - Duyser, Fleur AU - Bergman, Annemiek AU - van Oort, Jasper AU - Tendolkar, Indira AU - Schene, Aart PY - 2022/3/29 TI - Measuring Integrated Novel Dimensions in Neurodevelopmental and Stress-Related Mental Disorders (MIND-SET): Protocol for a Cross-sectional Comorbidity Study From a Research Domain Criteria Perspective JO - JMIRx Med SP - e31269 VL - 3 IS - 1 KW - psychiatry KW - mental health KW - psychiatric disorders KW - neuropsychology KW - stress KW - comorbidity N2 - Background: It is widely acknowledged that comorbidity between psychiatric disorders is common. Shared and diverse underpinnings of psychiatric disorders cannot be systematically understood based on symptom-based categories of mental disorders, which map poorly onto pathophysiological mechanisms. In the Measuring Integrated Novel Dimensions in Neurodevelopmental and Stress-Related Mental Disorders (MIND-SET) study, we make use of current concepts of comorbidity that transcend the current diagnostic categories. We test this approach to psychiatric problems in patients with frequently occurring psychiatric disorders and their comorbidities (excluding psychosis). Objective: The main aim of the MIND-SET project is to determine the shared and specific mechanisms of neurodevelopmental and stress-related psychiatric disorders at different observational levels. Methods: This is an observational cross-sectional study. Data from different observational levels as defined in the Research Domain Criteria (genetics, physiology, neuropsychology, system-level neuroimaging, behavior, self-report, and experimental neurocognitive paradigms) are collected over four time points. Included are adult (aged ?18 years), nonpsychotic, psychiatric patients with a clinical diagnosis of a stress-related disorder (mood disorder, anxiety disorder, or substance use disorder) or a neurodevelopmental disorder (autism spectrum disorder or attention-deficit/hyperactivity disorder). Individuals with no current or past psychiatric diagnosis are included as neurotypical controls. Data collection started in June 2016 with the aim to include a total of 650 patients and 150 neurotypical controls by 2021. The data collection procedure includes online questionnaires and three subsequent sessions with (1) standardized clinical examination, physical examination, and blood sampling; (2) psychological constructs, neuropsychological tests, and biological marker sampling; and (3) neuroimaging measures. Results: We aim to include a total of 650 patients and 150 neurotypical control participants in the time period between 2016 and 2022. In October 2021, we are at 95% of our target. Conclusions: The MIND-SET study enables us to investigate the mechanistic underpinnings of nonpsychotic psychiatric disorders transdiagnostically. We will identify both shared and disorder-specific markers at different observational levels that can be used as targets for future diagnostic and treatment approaches. UR - https://med.jmirx.org/2022/1/e31269 UR - http://dx.doi.org/10.2196/31269 UR - http://www.ncbi.nlm.nih.gov/pubmed/37725542 ID - info:doi/10.2196/31269 ER - TY - JOUR AU - Welch, Victoria AU - Wy, Joshua Tom AU - Ligezka, Anna AU - Hassett, C. Leslie AU - Croarkin, E. Paul AU - Athreya, P. Arjun AU - Romanowicz, Magdalena PY - 2022/3/14 TI - Use of Mobile and Wearable Artificial Intelligence in Child and Adolescent Psychiatry: Scoping Review JO - J Med Internet Res SP - e33560 VL - 24 IS - 3 KW - mobile computing KW - artificial intelligence KW - wearable technologies KW - child psychiatry N2 - Background: Mental health disorders are a leading cause of medical disabilities across an individual?s lifespan. This burden is particularly substantial in children and adolescents because of challenges in diagnosis and the lack of precision medicine approaches. However, the widespread adoption of wearable devices (eg, smart watches) that are conducive for artificial intelligence applications to remotely diagnose and manage psychiatric disorders in children and adolescents is promising. Objective: This study aims to conduct a scoping review to study, characterize, and identify areas of innovations with wearable devices that can augment current in-person physician assessments to individualize diagnosis and management of psychiatric disorders in child and adolescent psychiatry. Methods: This scoping review used information from the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive search of several databases from 2011 to June 25, 2021, limited to the English language and excluding animal studies, was conducted. The databases included Ovid MEDLINE and Epub ahead of print, in-process and other nonindexed citations, and daily; Ovid Embase; Ovid Cochrane Central Register of Controlled Trials; Ovid Cochrane Database of Systematic Reviews; Web of Science; and Scopus. Results: The initial search yielded 344 articles, from which 19 (5.5%) articles were left on the final source list for this scoping review. Articles were divided into three main groups as follows: studies with the main focus on autism spectrum disorder, attention-deficit/hyperactivity disorder, and internalizing disorders such as anxiety disorders. Most of the studies used either cardio-fitness chest straps with electrocardiogram sensors or wrist-worn biosensors, such as watches by Fitbit. Both allowed passive data collection of the physiological signals. Conclusions: Our scoping review found a large heterogeneity of methods and findings in artificial intelligence studies in child psychiatry. Overall, the largest gap identified in this scoping review is the lack of randomized controlled trials, as most studies available were pilot studies and feasibility trials. UR - https://www.jmir.org/2022/3/e33560 UR - http://dx.doi.org/10.2196/33560 UR - http://www.ncbi.nlm.nih.gov/pubmed/35285812 ID - info:doi/10.2196/33560 ER - TY - JOUR AU - Piqueras, A. Jose AU - Vidal-Arenas, Verónica AU - Falcó, Raquel AU - Moreno-Amador, Beatriz AU - Marzo, C. Juan AU - Holcomb, M. Juliana AU - Murphy, Michael PY - 2021/12/1 TI - Short Form of the Pediatric Symptom Checklist-Youth Self-Report (PSC-17-Y): Spanish Validation Study JO - J Med Internet Res SP - e31127 VL - 23 IS - 12 KW - PSC-17-Y KW - psychometric properties KW - screening KW - mental problems KW - adolescents KW - adolescent health KW - adolescent medicine KW - psychiatry KW - psychology KW - psychosocial issues N2 - Background: The short form, 17-item version of the Pediatric Symptom Checklist-Youth Self-Report (PSC-17-Y) is a validated measure that assesses psychosocial problems overall (OVR) and in 3 major psychopathological domains (internalizing, externalizing, and attention-deficit/hyperactivity disorder), taking 5-10 min to complete. Prior research has established sound psychometric properties of the PSC-17-Y for English speakers. Objective: This study extends psychometric evidence for the acceptability of the PSC-17-Y in a large sample of Spanish adolescents, providing proof of its reliability and structure, convergent and discriminant validity, and longitudinal and gender invariance. Methods: Data were collected on 5430 adolescents, aged 12-18 years, who filled out the PSC-17-Y twice during 2018-2019 (7-month interval). We calculated the Cronbach alpha and the McDonald omega coefficients to test reliability, the Pearson correlation for convergent (distress) and criterion validity (well-being, quality of life, and socioemotional skills), confirmatory factor analysis (CFA) for structure validity, and multigroup and longitudinal measurement invariance analysis for longitudinal and gender stability. Results: Within structural analysis for the PSC-17-Y, CFA supported a correlated 3-factor solution, which was also invariant longitudinally and across gender. All 3 subscales showed evidence of reliability, with coefficients near or above .70. Moreover, scores of PSC-17-Y subscales were positively related with convergent measures and negatively related with criterion measures. Normative data for the PSC-17-Y are presented in the form of percentiles (75th and 90th). Conclusions: This work provides the first evidence of the reliability and validity of the Spanish version of the PSC-17-Y administered over the internet to assess mental health problems among adolescents, maintaining the same domains as the long version. UR - https://www.jmir.org/2021/12/e31127 UR - http://dx.doi.org/10.2196/31127 UR - http://www.ncbi.nlm.nih.gov/pubmed/34855614 ID - info:doi/10.2196/31127 ER - TY - JOUR AU - Medina, Rafael AU - Bouhaben, Jaime AU - de Ramón, Ignacio AU - Cuesta, Pablo AU - Antón-Toro, Luis AU - Pacios, Javier AU - Quintero, Javier AU - Ramos-Quiroga, Antoni Josep AU - Maestú, Fernando PY - 2021/11/26 TI - Electrophysiological Brain Changes Associated With Cognitive Improvement in a Pediatric Attention Deficit Hyperactivity Disorder Digital Artificial Intelligence-Driven Intervention: Randomized Controlled Trial JO - J Med Internet Res SP - e25466 VL - 23 IS - 11 KW - ADHD KW - cognitive stimulation KW - magnetoencephalography KW - artificial intelligence KW - Conners continuous performance test KW - KAD_SCL_01 KW - AI KW - cognitive impairment KW - attention deficit hyperactivity disorder KW - pediatrics KW - children KW - rehabilitation N2 - Background: Cognitive stimulation therapy appears to show promising results in the rehabilitation of impaired cognitive processes in attention deficit hyperactivity disorder. Objective: Encouraged by this evidence and the ever-increasing use of technology and artificial intelligence for therapeutic purposes, we examined whether cognitive stimulation therapy implemented on a mobile device and controlled by an artificial intelligence engine can be effective in the neurocognitive rehabilitation of these patients. Methods: In this randomized study, 29 child participants (25 males) underwent training with a smart, digital, cognitive stimulation program (KAD_SCL_01) or with 3 commercial video games for 12 weeks, 3 days a week, 15 minutes a day. Participants completed a neuropsychological assessment and a preintervention and postintervention magnetoencephalography study in a resting state with their eyes closed. In addition, information on clinical symptoms was collected from the child´s legal guardians. Results: In line with our main hypothesis, we found evidence that smart, digital, cognitive treatment results in improvements in inhibitory control performance. Improvements were also found in visuospatial working memory performance and in the cognitive flexibility, working memory, and behavior and general executive functioning behavioral clinical indexes in this group of participants. Finally, the improvements found in inhibitory control were related to increases in alpha-band power in all participants in the posterior regions, including 2 default mode network regions of the interest: the bilateral precuneus and the bilateral posterior cingulate cortex. However, only the participants who underwent cognitive stimulation intervention (KAD_SCL_01) showed a significant increase in this relationship. Conclusions: The results seem to indicate that smart, digital treatment can be effective in the inhibitory control and visuospatial working memory rehabilitation in patients with attention deficit hyperactivity disorder. Furthermore, the relation of the inhibitory control with alpha-band power changes could mean that these changes are a product of plasticity mechanisms or changes in the neuromodulatory dynamics. Trial Registration: ISRCTN Registry ISRCTN71041318; https://www.isrctn.com/ISRCTN71041318 UR - https://www.jmir.org/2021/11/e25466 UR - http://dx.doi.org/10.2196/25466 UR - http://www.ncbi.nlm.nih.gov/pubmed/34842533 ID - info:doi/10.2196/25466 ER - TY - JOUR AU - Mansell, Holly AU - Quinn, Declan AU - Kelly, E. Lauren AU - Szafron, Michael AU - Alcorn, Jane PY - 2021/10/18 TI - Pharmacokinetics and Perceptions of Children and Young Adults Using Cannabis for Attention-Deficit/Hyperactivity Disorder and Oppositional Defiant Disorder: Protocol for a Mixed Methods Proof-of-Concept Study JO - JMIR Res Protoc SP - e31281 VL - 10 IS - 10 KW - attention-deficit/hyperactivity disorder KW - ADHD KW - oppositional defiant disorder KW - cannabis KW - cannabidiol KW - young adults KW - youths KW - pharmacokinetics KW - marijuana N2 - Background: Despite the lack of evidence on the use of cannabis for the treatment of attention-deficit/hyperactivity disorder (ADHD), the growing perception that cannabis is safe has led more patients and caregivers to self-medicate. Some psychiatrists now authorize medicinal cannabis for patients with ADHD with features of oppositional defiant disorder (ODD) to curtail the unregulated (ie, self-medicated) use of recreational cannabis or to offer a therapeutic option to those who continue to experience symptoms after exhausting all other treatment options. Objective: This protocol aims to explore the perceived effectiveness and pharmacokinetics of cannabis in youth and young adults, who are currently taking it as part of their treatment plan for ADHD with features of ODD, under the supervision of a psychiatrist. Methods: Patients between the ages of 12 and 25 years with a diagnosis of ADHD and features of ODD, who are currently taking cannabis herbal extract (at a ?9-tetrahydrocannabinol [THC]:cannabidiol [CBD] ratio of 1:20) as a treatment adjunct to stimulant pharmacotherapy will be recruited. A sample size of 10-20 individuals is estimated. The study interview will consist of (1) validated symptom rating scales (Swanson, Nolan, and Pelham-IV Questionnaire [SNAP-IV], 90-item; Patient Health Questionnaire, 9-item [PHQ-9]; and Screen for Child Anxiety Related Emotional Disorders [SCARED] tool to measure symptoms of ADHD and ODD, depression, and anxiety, respectively); (2) a semistructured interview to probe the experiences of using cannabis; and (3) a cannabis side effects survey. A cannabis product sample as well as 2 blood samples (a trough level and 2-hour postdose level) will be collected to measure plasma concentrations of cannabinoids and relevant metabolites (THC, CBD, 11-hydroxy-THC, 7-hydroxy-CBD, cannabichromene, and 11-nor-9-carboxy-THB) using liquid chromatography?tandem mass spectrometry (LC?MS/MS). Self-report rating scales (SNAP-IV, SCARED, and PHQ-9) will be scored in accordance with standard protocols and compared to retrospective scores obtained from the participant?s chart. Demographic variables (age, weight, and race), symptom scores, and blood levels (peaks and troughs) of THC, CBD, cannabichromene (CBC), and metabolites will be summarized using descriptive statistics. Relationships between plasma concentrations and symptom scores will be determined using analysis of variance, and multiple regression analysis will be performed to determine associations between plasma concentrations and demographic variables (age, weight, and ethnicity). The qualitative data will be audio-recorded and transcribed and organized into themes. Results: The protocol was approved by the Biomedical Research Ethics Board at the University of Saskatchewan (protocol #1726), and recruitment began in May 2021. Conclusions: This proof-of-concept study will explore the potential treatment effectiveness of medical cannabis in participants with ADHD and ODD through a mixed methods approach to inform future research in this area. International Registered Report Identifier (IRRID): DERR1-10.2196/31281 UR - https://www.researchprotocols.org/2021/10/e31281 UR - http://dx.doi.org/10.2196/31281 UR - http://www.ncbi.nlm.nih.gov/pubmed/34661540 ID - info:doi/10.2196/31281 ER - TY - JOUR AU - Burbach, R. Frank AU - Stiles, M. Katie PY - 2021/9/17 TI - Digital Mental Health and Neurodevelopmental Services: Case-Based Realist Evaluation JO - JMIR Form Res SP - e29845 VL - 5 IS - 9 KW - telehealth KW - young people KW - adolescents KW - online psychological therapy KW - online neurodevelopmental assessments KW - digital services KW - realist evaluation KW - multiple case study KW - CBT KW - autism N2 - Background: The rapid movement of mental health services on the internet following the onset of the COVID-19 pandemic has demonstrated the potential advantages of digital delivery and has highlighted the need to learn from prepandemic digital services. Objective: The aim of this study is to explore the different elements of interconnected digital mental health and neurodevelopmental services of a well-established provider to the UK National Health Service and how web-based delivery enables young people and their families to access high-quality assessments and interventions in a more timely, flexible, and person-centered manner than in-person delivery. Methods: A realist evaluation multiple case?study design was used, with 9 pediatric cases (aged 8-15 years) identified as representative of the services provided by Healios. Presenting concerns included autism and ADHD, anxiety and panic attacks, low self-esteem, anger and self-harm. The research literature was used to define the program theory and six context-mechanism-outcome (CMO) statements. The CMOs formed the basis for the initial data extraction, with novel elements added via an iterative process. Results: We identified 10 key elements of web-based services: flexible delivery and timely response, personalized care to the individual, comprehensive care enabled by multiple interconnected services, effective client engagement and productive therapeutic alliances, use of multiple communication tools, client satisfaction with the service, good clinical outcomes, ease of family involvement throughout sessions or from different locations, facilitation of multi-agency working and integration with National Health Services, and management of risk and safeguarding. These elements supported the six CMOs; there was clear evidence that young people and their families valued the responsiveness and flexibility of the web-based mental health service and, in particular, how quickly they were seen. There was also clear evidence of individual needs being met, good therapeutic alliances, and client satisfaction. Multiple communication tools appeared to maximize engagement and working digitally facilitated multi-agency communication and delivery of safe care. The abovementioned factors may be related to the finding of good clinical outcomes, but the methodology of this study does not allow any conclusions to be drawn regarding causality. Conclusions: This study demonstrates the effectiveness of interconnected digital mental health and neurodevelopmental services as well as how web-based delivery enables young people and their families to access assessments and interventions in a more timely, flexible, and person-centered manner than in-person delivery. The 10 key elements of web-based service delivery identified through the 9 case studies suggest the potential advantages of web-based work. These elements can inform future research and aid in the delivery of high-quality digital services. UR - https://formative.jmir.org/2021/9/e29845 UR - http://dx.doi.org/10.2196/29845 UR - http://www.ncbi.nlm.nih.gov/pubmed/34369382 ID - info:doi/10.2196/29845 ER - TY - JOUR AU - Flobak, Eivind AU - Nordby, Sektnan Emilie AU - Guribye, Frode AU - Kenter, Robin AU - Nordgreen, Tine AU - Lundervold, J. Astri PY - 2021/9/14 TI - Designing Videos With and for Adults With ADHD for an Online Intervention: Participatory Design Study and Thematic Analysis of Evaluation JO - JMIR Ment Health SP - e30292 VL - 8 IS - 9 KW - participatory design KW - ADHD KW - online intervention KW - video KW - therapeutic content KW - stigma KW - attention deficit hyperactivity disorder KW - design KW - participatory KW - intervention KW - experience KW - mental health N2 - Background: Adults with attention deficit hyperactivity disorder (ADHD) represent a heterogeneous group with both strengths and difficulties associated with the diagnosis. An online intervention attuned to their needs may improve their everyday functioning. When designing online interventions, it is important to adapt the therapeutic content to the values and needs of the target group. Objective: This paper describes and evaluates a participatory process used to produce content for an online intervention for adults with ADHD by producing video vignettes clarifying core training principles grounded in the participants' everyday experiences. Methods: We report on the qualitative data from 2 research phases: the design and evaluation of video vignettes for an online intervention. In the first phase, 12 adults with ADHD, 2 clinicians, and 2 research assistants participated in the production of video vignettes for the online intervention. In the second phase, participants (n=109) gave feedback on the videos as part of a clinical trial of the intervention. A subgroup (n=7) was interviewed in-depth regarding their experiences with the videos. The qualitative data were analyzed using thematic analysis. Results: In the first phase, the participants with ADHD contributed with experiences from challenging everyday situations. In the process, we navigated between therapeutic principles and the participants' experiential perspectives to create content relevant and consistent with the target group's values and experiences. In the second phase, we identified 3 themes related to the participants' experiences and interpretation of the video vignettes: (1) recognition of ADHD-related challenges, (2) connection with the characters and the situations, and (3) video protagonists as companions and role models for change. Conclusions: A participatory design process for designing online mental health interventions can be used to probe and balance between the therapeutic principles defined by clinicians and the participants? experiences with mental health issues in the production of therapeutic content. In our study, the inclusion of video vignettes in an online intervention enabled a contextualized and relevant presentation of everyday experiences and psychosocial factors in the life of an adult with ADHD. Trial Registration: ClinicalTrials.gov NCT04511169; https://clinicaltrials.gov/ct2/show/NCT04511169 UR - https://mental.jmir.org/2021/9/e30292 UR - http://dx.doi.org/10.2196/30292 UR - http://www.ncbi.nlm.nih.gov/pubmed/34519666 ID - info:doi/10.2196/30292 ER - TY - JOUR AU - Rodrigo-Yanguas, Maria AU - Martin-Moratinos, Marina AU - Menendez-Garcia, Angela AU - Gonzalez-Tardon, Carlos AU - Royuela, Ana AU - Blasco-Fontecilla, Hilario PY - 2021/9/1 TI - A Virtual Reality Game (The Secret Trail of Moon) for Treating Attention-Deficit/Hyperactivity Disorder: Development and Usability Study JO - JMIR Serious Games SP - e26824 VL - 9 IS - 3 KW - attention-deficit/hyperactivity disorder KW - chess KW - virtual reality KW - serious video game KW - psychotherapy KW - cognitive training KW - usability KW - new technologies KW - transfer KW - randomized controlled trial N2 - Background: Attention-deficit/hyperactivity disorder (ADHD) affects between 4% and 8% of children worldwide. The treatment of choice is multimodal treatment. Multimodal interventions for ADHD may be improved by incorporating new treatments, such as treatment via serious video games. The Secret Trail of Moon (TSTM) is a virtual reality serious video game that was designed for cognitive training related to core ADHD symptoms and executive dysfunction. Objective: We aimed to describe the development and usability of TSTM. Methods: The usability study included 37 children and adolescents who tested TSTM during the early usability stage (preinclusion) of a randomized controlled clinical trial for testing the effectiveness of TSTM. Chi-square tests were performed to compare patients with ADHD (ADHD combined subtype vs inattentive subtype) and to compare frequent and infrequent video game players in the second study. We used SPSS version 20 for Macintosh (IBM Corporation). Results: A total of 31/37 (86%) and 30/37 (83%) of participants liked playing TSTM and wanted to continue playing TSTM, respectively. Further, 5/37 (14%) of participants reported that they experienced either perceived dizziness or virtual reality motion sickness. We found no statistically significant differences after comparing the ADHD combined subtype to the inattentive subtype and frequent video game players to infrequent video game players. Conclusions: Serious video games, such as TSTM, may complement the current multimodal approach for treating ADHD. Trial Registration: ClinicalTrials.gov NCT04355065; https://clinicaltrials.gov/ct2/show/NCT04355065 UR - https://games.jmir.org/2021/3/e26824 UR - http://dx.doi.org/10.2196/26824 UR - http://www.ncbi.nlm.nih.gov/pubmed/34468332 ID - info:doi/10.2196/26824 ER - TY - JOUR AU - Sehlin, Helena AU - Hedman Ahlström, Britt AU - Bertilsson, Ingrid AU - Andersson, Gerhard AU - Wentz, Elisabet PY - 2020/12/31 TI - Internet-Based Support and Coaching With Complementary Clinic Visits for Young People With Attention-Deficit/Hyperactivity Disorder and Autism: Controlled Feasibility Study JO - J Med Internet Res SP - e19658 VL - 22 IS - 12 KW - attention-deficit/hyperactivity disorder KW - autism KW - coaching KW - internet-based intervention KW - social support N2 - Background: Individuals with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) can experience obstacles in traditional health care situations due to difficulties associated with their impairment. Objective: This controlled study aims to investigate the feasibility of an internet-based support and coaching intervention (IBSC), including 2 weekly chat sessions and 2 complementary clinic visits with coaches over the course of 8 weeks, for adolescents and young adults with ADHD and/or ASD in 2 naturalistic routine care settings. Methods: Individuals with ADHD and/or ASD aged 15-32 years were recruited in 2 clinical settings, where they received either IBSC (n=24) or treatment as usual (TAU; n=20). Outcome measures included self-report questionnaires assessing quality of life (Manchester Short Assessment for Quality of Life), sense of coherence (Sense Of Coherence 29), self-esteem (Rosenberg Self-Esteem Scale), and anxiety and depressive symptoms (Hospital Anxiety and Depression Scale [HADS] and Montgomery-Åsberg Depression Rating Scale-Self-reported, respectively). Results: Significant between-group effects were observed in measures of anxiety (HADS) at postintervention (P=.02) as well as at the 6-month follow-up (P=.004). Significant between-group effects were also noted for depressive symptoms (HADS) postintervention (P=.04). The between-group effects were partially explained by a deterioration in the TAU group. A significant increase in self-esteem (P=.04) as well as a decrease in anxiety (P=.003) at the 6-month follow-up was observed in the intervention group following IBSC. Findings from a qualitative study of the intervention are consistent with the results. Conclusions: The findings from this study suggest that IBSC holds promise as a feasible complement or alternative to traditional face-to-face health care meetings. UR - http://www.jmir.org/2020/12/e19658/ UR - http://dx.doi.org/10.2196/19658 UR - http://www.ncbi.nlm.nih.gov/pubmed/33382381 ID - info:doi/10.2196/19658 ER - TY - JOUR AU - Zhang, Melvyn AU - Vallabhajosyula, Ranganath AU - Fung, Daniel PY - 2020/12/23 TI - Emotional Bias Modification for Individuals With Attention Deficit Hyperactivity Disorder: Protocol for a Co-Design Study JO - JMIR Res Protoc SP - e24078 VL - 9 IS - 12 KW - emotional bias KW - cognitive biases KW - ADHD KW - child psychiatry N2 - Background: Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with a worldwide prevalence rate of 5%. Individuals with ADHD often tend to have difficulties with emotional regulation. The advances in experimental psychology have led to the discovery of emotional biases. Targeting emotional biases could potentially help improve the core symptoms of irritability and short-temperedness among these individuals. Emotional biases refer to the preferential allocation of attention toward emotional stimuli. A recent study reported the presence of emotional biases among individuals with ADHD when they compared individuals with ADHD with those without. Gamification technologies have been explored to help diminish the repetitiveness of the task and increase the intrinsic motivation to train. These inconsistent findings of the impact of gaming on the effectiveness of mobile interventions call for further work to better understand the needs of patients (users) and health care professionals. Objective: The aim of this research study is to collate health care professionals? perspectives on the limitations of the existing task, and to determine if gamification elements could be incorporated, to refine the conventional intervention. Methods: A qualitative research approach, that of a focus group, will be used. Health care professionals from the Department of Development Psychiatry, Institute of Mental Health, Singapore will be invited to participate in this qualitative research. During the focus group, participants are to comment on the limitations of the existing emotional bias intervention; recommend strategies to improve the intervention; and provide their perspectives pertaining to the use of gamification to improve the intervention. Results: We expect that the study will be completed in 12 months from the publication of this protocol. Conclusions: To our best knowledge, this is perhaps one of the only few studies that have attempted to explore emotional biases among adolescents with ADHD. International Registered Report Identifier (IRRID): PRR1-10.2196/24078 UR - http://www.researchprotocols.org/2020/12/e24078/ UR - http://dx.doi.org/10.2196/24078 UR - http://www.ncbi.nlm.nih.gov/pubmed/33355536 ID - info:doi/10.2196/24078 ER - TY - JOUR AU - Adamou, Marios AU - Fullen, Tim AU - Galab, Nazmeen AU - Mackintosh, Isobel AU - Abbott, Karl AU - Lowe, Deborah AU - Smith, Claire PY - 2020/12/15 TI - Psychological Effects of the COVID-19 Imposed Lockdown on Adults with Attention Deficit/Hyperactivity Disorder: Cross-Sectional Survey Study JO - JMIR Form Res SP - e24430 VL - 4 IS - 12 KW - adult ADHD KW - pandemic KW - lockdown KW - COVID-19 KW - well-being KW - psychological KW - intervention KW - ADHD N2 - Background: The psychological effects of the COVID-19 government-imposed lockdown have been studied in several populations. These effects however have not been studied in adult populations with attention deficit/hyperactivity disorder (ADHD). Objective: We wanted to investigate the psychological effects of the COVID-19 imposed lockdown on an adult population with ADHD. Methods: We conducted a cross-sectional survey by administering the Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7, Brief Adjustment Scale-6, Perceived Stress Scale, and Multidimensional Scale of Perceived Social Support to a pragmatic sample of adults with ADHD. Results: In total, 24 individuals (male: n=18, 75%; female: n=6, 25%; age: mean 21.75 years, SD 1.85 years) were included in this study. The adults with ADHD we surveyed had significant levels of emotional distress during the COVID-19 pandemic period. However, there was no evidence of significant deterioration to the mental health of our sample during the COVID-19 pandemic. Conclusions: When treatment for ADHD is maintained, the effects of the COVID-19 pandemic on the mental health of adults with ADHD are mild. Targeted psychological interventions may be useful in such circumstances. UR - https://formative.jmir.org/2020/12/e24430 UR - http://dx.doi.org/10.2196/24430 UR - http://www.ncbi.nlm.nih.gov/pubmed/33108312 ID - info:doi/10.2196/24430 ER - TY - JOUR AU - French, Blandine AU - Hall, Charlotte AU - Perez Vallejos, Elvira AU - Sayal, Kapil AU - Daley, David PY - 2020/12/11 TI - Evaluation of a Web-Based ADHD Awareness Training in Primary Care: Pilot Randomized Controlled Trial With Nested Interviews JO - JMIR Med Educ SP - e19871 VL - 6 IS - 2 KW - ADHD KW - primary care KW - general practice KW - randomized controlled trial KW - online intervention KW - interviews N2 - Background: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting up to 5% of children and adults. Undiagnosed and untreated ADHD can result in adverse long-term health, educational, and social impacts for affected individuals. Therefore, it is important to identify this disorder as early as possible. General practitioners (GPs) frequently play a gatekeeper role in access to specialist services in charge of diagnosis and treatment. Studies have shown that their lack of knowledge and understanding about ADHD can create barriers to care. Objective: This pilot randomized controlled trial assesses the efficacy of a web-based psychoeducation program on ADHD tailored for GPs. Methods: A total of 221 participants were randomized to either a sham intervention control or an awareness training intervention and they completed questionnaires on ADHD knowledge, confidence, and attitude at 3 time points (preintervention, postintervention, and 2-week follow-up). Participants in the intervention arm were invited to participate in a survey and follow-up interview between 3 and 6 months after the intervention. Results: The responses of 109 GPs were included in the analysis. The knowledge (P<.001) and confidence (P<.001) of the GPs increased after the intervention, whereas misconceptions decreased (P=.04); this was maintained at the 2-week follow-up (knowledge, P<.001; confidence, P<.001; misconceptions, P=.03). Interviews and surveys also confirmed a change in practice over time. Conclusions: These findings demonstrate that a short web-based intervention can increase GPs? understanding, attitude, and practice toward ADHD, potentially improving patients? access to care. Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN45400501; http://www.isrctn.com/ISRCTN45400501. UR - http://mededu.jmir.org/2020/2/e19871/ UR - http://dx.doi.org/10.2196/19871 UR - http://www.ncbi.nlm.nih.gov/pubmed/33306027 ID - info:doi/10.2196/19871 ER - TY - JOUR AU - Chu, Kuo-Chung AU - Lu, Hsin-Ke AU - Huang, Ming-Chun AU - Lin, Shr-Jie AU - Liu, Wen-I AU - Huang, Yu-Shu AU - Hsu, Jen-Fu AU - Wang, Chih-Huan PY - 2020/6/19 TI - Using Mobile Electroencephalography and Actigraphy to Diagnose Attention-Deficit/Hyperactivity Disorder: Case-Control Comparison Study JO - JMIR Ment Health SP - e12158 VL - 7 IS - 6 KW - actigraphy KW - ADHD KW - attention deficit disorder with hyperactivity KW - clinical decision-making KW - electroencephalography KW - neuropsychological tests N2 - Background: Children with attention-deficit/hyperactivity disorder (ADHD), a neurobehavioral disorder, display behaviors of inattention, hyperactivity, or impulsivity, which can affect their ability to learn and establish proper family and social relationships. Various tools are currently used by child and adolescent psychiatric clinics to diagnose, evaluate, and collect information and data. The tools allow professional physicians to assess if patients need further treatment, following a thorough and careful clinical diagnosis process. Objective: We aim to determine potential indicators extracted from a mobile electroencephalography (EEG) device (Mindset; NeuroSky) and an actigraph (MotionWatch 8; CamNtech) and to validate them for diagnosis of ADHD. The 3 indicators are (1) attention, measured by the EEG; (2) meditation, measured by the EEG; and (3) activity, measured by the actigraph. Methods: A total of 63 participants were recruited. The case group comprised 40 boys and 9 girls, while the control group comprised 5 boys and 9 girls. The groups were age matched. The test was divided into 3 stages?pretest, in-test, and posttest?with a testing duration of 20 minutes each. We used correlation analysis, repeated measures analysis of variance, and regression analysis to investigate which indicators can be used for ADHD diagnosis. Results: With the EEG indicators, the analysis results show a significant correlation of attention with both hit reaction time (RT) interstimulus interval (ISI) change (r=?0.368; P=.003) and hit standard error (SE) ISI change (r=?0.336; P=.007). This indicates that the higher the attention of the participants, the smaller both the hit RT change and the hit SE ISI change. With the actigraph indicator, confidence index (r=0.352; P=.005), omissions (r=0.322; P=.01), hit RT SE (r=0.393; P=.001), and variability (r=0.351; P=.005) were significant. This indicates that the higher the activity amounts, the higher the impulsive behavior of the participants and the more target omissions in the continuous performance test (CPT). The results show that the participants with ADHD present a significant difference in activity amounts (P<0.001). The actigraph outperforms the EEG in screening ADHD. Conclusions: When the participants with ADHD are stimulated under restricted conditions, they will present different amounts of activity than in unrestricted conditions due to participants? inability to exercise control over their concentration. This finding could be a new electronic physiological biomarker of ADHD. An actigraph can be used to detect the amount of activity exhibited and to help physicians diagnose the disorder in order to develop more objective, rapid auxiliary diagnostic tools. UR - http://mental.jmir.org/2020/6/e12158/ UR - http://dx.doi.org/10.2196/12158 UR - http://www.ncbi.nlm.nih.gov/pubmed/32558658 ID - info:doi/10.2196/12158 ER - TY - JOUR AU - Bossenbroek, Rineke AU - Wols, Aniek AU - Weerdmeester, Joanneke AU - Lichtwarck-Aschoff, Anna AU - Granic, Isabela AU - van Rooij, W. Marieke M. J. PY - 2020/3/24 TI - Efficacy of a Virtual Reality Biofeedback Game (DEEP) to Reduce Anxiety and Disruptive Classroom Behavior: Single-Case Study JO - JMIR Ment Health SP - e16066 VL - 7 IS - 3 KW - anxiety KW - disruptive behavior KW - single-case study KW - applied game KW - serious games KW - special education KW - attention-deficit/hyperactivity disorder (ADHD) KW - autism spectrum disorder (ASD) KW - adolescents N2 - Background: Many adolescents in special education are affected by anxiety in addition to their behavioral problems. Anxiety leads to substantial long-term problems and may underlie disruptive behaviors in the classroom as a result of the individual?s inability to tolerate anxiety-provoking situations. Thus, interventions in special needs schools that help adolescents cope with anxiety and, in turn, diminish disruptive classroom behaviors are needed. Objective: This study aimed to evaluate the effect of a virtual reality biofeedback game, DEEP, on daily levels of state-anxiety and disruptive classroom behavior in a clinical sample. In addition, the study also aimed to examine the duration of the calm or relaxed state after playing DEEP. Methods: A total of 8 adolescents attending a special secondary school for students with behavioral and psychiatric problems participated in a single-case experimental ABAB study. Over a 4-week period, participants completed 6 DEEP sessions. In addition, momentary assessments (ie, 3 times a day) of self-reported state-anxiety and teacher-reported classroom behavior were collected throughout all A and B phases. Results: From analyzing the individual profiles, it was found that 6 participants showed reductions in anxiety, and 5 participants showed reductions in disruptive classroom behaviors after the introduction of DEEP. On a group level, results showed a small but significant reduction of anxiety (d=?0.29) and a small, nonsignificant reduction of disruptive classroom behavior (d=?0.16) on days when participants played DEEP. Moreover, it was found that the calm or relaxed state of participants after playing DEEP lasted for about 2 hours on average. Conclusions: This study demonstrates the potential of the game, DEEP, as an intervention for anxiety and disruptive classroom behavior in a special school setting. Future research is needed to fully optimize and personalize DEEP as an intervention for the heterogeneous special school population. UR - http://mental.jmir.org/2020/3/e16066/ UR - http://dx.doi.org/10.2196/16066 UR - http://www.ncbi.nlm.nih.gov/pubmed/32207697 ID - info:doi/10.2196/16066 ER - TY - JOUR AU - Kim, Gyu Myeong AU - Kim, Jungu AU - Kim, Cheol Su AU - Jeong, Jaegwon PY - 2020/2/24 TI - Twitter Analysis of the Nonmedical Use and Side Effects of Methylphenidate: Machine Learning Study JO - J Med Internet Res SP - e16466 VL - 22 IS - 2 KW - methylphenidate KW - social media KW - Twitter KW - prescription drug misuse KW - drug-related side effects and adverse reactions KW - machine learning KW - support vector machine N2 - Background: Methylphenidate, a stimulant used to treat attention deficit hyperactivity disorder, has the potential to be used nonmedically, such as for studying and recreation. In an era when many people actively use social networking services, experience with the nonmedical use or side effects of methylphenidate might be shared on Twitter. Objective: The purpose of this study was to analyze tweets about the nonmedical use and side effects of methylphenidate using a machine learning approach. Methods: A total of 34,293 tweets mentioning methylphenidate from August 2018 to July 2019 were collected using searches for ?methylphenidate? and its brand names. Tweets in a randomly selected training dataset (6860/34,293, 20.00%) were annotated as positive or negative for two dependent variables: nonmedical use and side effects. Features such as personal noun, nonmedical use terms, medical use terms, side effect terms, sentiment scores, and the presence of a URL were generated for supervised learning. Using the labeled training dataset and features, support vector machine (SVM) classifiers were built and the performance was evaluated using F1 scores. The classifiers were applied to the test dataset to determine the number of tweets about nonmedical use and side effects. Results: Of the 6860 tweets in the training dataset, 5.19% (356/6860) and 5.52% (379/6860) were about nonmedical use and side effects, respectively. Performance of SVM classifiers for nonmedical use and side effects, expressed as F1 scores, were 0.547 (precision: 0.926, recall: 0.388, and accuracy: 0.967) and 0.733 (precision: 0.920, recall: 0.609, and accuracy: 0.976), respectively. In the test dataset, the SVM classifiers identified 361 tweets (1.32%) about nonmedical use and 519 tweets (1.89%) about side effects. The proportion of tweets about nonmedical use was highest in May 2019 (46/2624, 1.75%) and December 2018 (36/2041, 1.76%). Conclusions: The SVM classifiers that were built in this study were highly precise and accurate and will help to automatically identify the nonmedical use and side effects of methylphenidate using Twitter. UR - http://www.jmir.org/2020/2/e16466/ UR - http://dx.doi.org/10.2196/16466 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130160 ID - info:doi/10.2196/16466 ER - TY - JOUR AU - Spencer, Lucy AU - Potterton, Rachel AU - Allen, Karina AU - Musiat, Peter AU - Schmidt, Ulrike PY - 2019/07/09 TI - Internet-Based Interventions for Carers of Individuals With Psychiatric Disorders, Neurological Disorders, or Brain Injuries: Systematic Review JO - J Med Internet Res SP - e10876 VL - 21 IS - 7 KW - internet KW - carers KW - mental health KW - technology KW - review N2 - Background: Nonprofessional carers who provide support to an individual with a psychiatric or neurological disorder will often themselves experience symptoms of stress, anxiety, or low mood, and they perceive that they receive little support. Internet-based interventions have previously been found to be effective in the prevention and treatment of a range of mental health difficulties in carers. Objective: This review seeks to establish the status of internet-based interventions for informal (nonprofessional) carers of people with psychiatric or neurological disorders by investigating (1) the number and quality of studies evaluating the efficacy or effectiveness of internet-based carer interventions and (2) the impact that such interventions have on carer mental health, as well as (3) how internet-based interventions compare with other intervention types (eg, face-to-face treatment). Methods: A systematic literature search was conducted in January 2019 using the EMBASE (1974-present), Ovid MEDLINE (1946-present), PsychARTICLES, PsychINFO (1806-present), and Global Health (1973-present) databases, via the Ovid Technologies database. Search terms included carer, caregiver, online, technology, internet-based, internet, interactive, intervention, and evaluation. Studies selected for inclusion in this review met the following predetermined criteria: (1) delivering an intervention aimed primarily at informal carers, (2) carers supporting individuals with psychiatric disorders, stroke, dementia, or brain injury, (3) the intervention delivered to the carers was primarily internet based, (4) the study reported a pre- and postquantitative measure of carer depression, anxiety, stress, burden, or quality of life, (5) appeared in a peer-reviewed journal, and (6) was accessible in English. Results: A total of 46 studies were identified for inclusion through the detailed search strategy. The search was conducted, and data were extracted independently by 2 researchers. The majority of studies reported that 1 or more measures relating to carer mental health improved following receipt of a relevant intervention, with interventions for carers of people with traumatic brain injury showing a consistent link with improved outcomes. Conclusions: Studies investigating internet-based interventions for carers of individuals with diverse psychiatric or neurological difficulties show some evidence in support of the effectiveness of these interventions. In addition, such interventions are acceptable to carers. Available evidence is of varying quality, and more high-quality trials are needed. Further research should also establish how specific intervention components, such as structure or interactivity, contribute to their overall efficacy with regard to carer mental health. UR - https://www.jmir.org/2019/7/e10876/ UR - http://dx.doi.org/10.2196/10876 UR - http://www.ncbi.nlm.nih.gov/pubmed/31290399 ID - info:doi/10.2196/10876 ER - TY - JOUR AU - Powell, Lauren AU - Parker, Jack AU - Harpin, Val AU - Mawson, Susan PY - 2019/04/03 TI - Guideline Development for Technological Interventions for Children and Young People to Self-Manage Attention Deficit Hyperactivity Disorder: Realist Evaluation JO - J Med Internet Res SP - e12831 VL - 21 IS - 4 KW - attention deficit disorder with hyperactivity KW - technology N2 - Background: Attention deficit hyperactivity disorder (ADHD) is a complex neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. ADHD can affect the individual, the individual?s family, and the community. ADHD is managed using pharmacological and nonpharmacological treatments, which principally involves others helping children and young people (CAYP) manage their ADHD rather than learning self-management strategies themselves. Over recent years, technological developments have meant that technology has been harnessed to create interventions to facilitate the self-management of ADHD in CAYP. Despite a clear potential to improve the effectiveness and personalization of interventions, there are currently no guidelines based on existing evidence or theories to underpin the development of technologies that aim to help CAYP self-manage their ADHD. Objective: The aim of this study was to create evidence-based guidelines with key stakeholders who will provide recommendations for the future development of technological interventions, which aim to specifically facilitate the self-management of ADHD. Methods: A realist evaluation (RE) approach was adopted over 5 phases. Phase 1 involved identifying propositions (or hypotheses) outlining what could work for such an intervention. Phase 2 involved the identification of existing middle-range theories of behavior change to underpin the propositions. Phase 3 involved the identification and development of context mechanism outcome configurations (CMOCs), which essentially state which elements of the intervention could be affected by which contexts and what the outcome of these could be. Phase 4 involved the validation and refinement of the propositions from phase 1 via interviews with key stakeholders (CAYP with ADHD, their parents and specialist clinicians). Phase 5 involved using information gathered during phases 1 to 4 to develop the guidelines. Results: A total of 6 specialist clinicians, 8 parents, and 7 CAYP were recruited to this study. Overall, 7 key themes were identified: (1) positive rewarding feedback, (2) downloadable gaming resources, (3) personalizable and adaptable components, (4) psychoeducation component, (5) integration of self-management strategies, (6) goal setting, and (7) context (environmental and personal). The identified mechanisms interacted with the variable contexts in which a complex technological intervention of this nature could be delivered. Conclusions: Complex intervention development for complex populations such as CAYP with ADHD should adopt methods such as RE, to account for the context it is delivered in, and co-design, which involves developing the intervention in partnership with key stakeholders to increase the likelihood that the intervention will succeed. The development of the guidelines outlined in this paper could be used for the future development of technologies that aim to facilitate self-management in CAYP with ADHD. UR - https://www.jmir.org/2019/4/e12831/ UR - http://dx.doi.org/10.2196/12831 UR - http://www.ncbi.nlm.nih.gov/pubmed/30942692 ID - info:doi/10.2196/12831 ER - TY - JOUR AU - Powell, Lauren AU - Parker, Jack AU - Harpin, Valerie PY - 2017/10/13 TI - ADHD: Is There an App for That? A Suitability Assessment of Apps for the Parents of Children and Young People With ADHD JO - JMIR Mhealth Uhealth SP - e149 VL - 5 IS - 10 KW - attention deficit disorder with hyperactivity KW - mobile applications KW - technology N2 - Background: Attention-deficit hyperactivity disorder (ADHD) is a highly comorbid disorder that can impact significantly on the individual and their family. ADHD is managed via pharmacological and nonpharmacological interventions. Parents also gain support from parent support groups, which may include chat rooms, as well as face-to-face meetings. With the growth of technology use over recent years, parents have access to more resources that ever before. A number of mobile apps have been developed to help parents manage ADHD in their children and young people. Unfortunately many of these apps are not evidence-based, and little is known of their suitability for the parents or whether they are helpful in ADHD management. Objective: The aim of this study was to explore the (1) parents? views of the suitability of the top ten listed apps for parents of children and young people with ADHD and (2) the views of clinicians that work with them on the suitability and value of the apps. Methods: The top 10 listed apps specifically targeted toward the parents of children and young people with ADHD were identified via the Google Play (n=5) and iTunes store (n=5). Interviews were then undertaken with 7 parents of children or young people with ADHD and 6 clinicians who specialize in working with this population to explore their opinions of the 10 apps identified and what they believe the key components are for apps to be suitable and valuable for this population. Results: Four themes emerged from clinician and parent interviews: (1) the importance of relating to the app, (2) apps that address ADHD-related difficulties, (3) how the apps can affect family relationships, and (4) apps as an educational tool. Two additional themes emerged from the clinician interviews alone: monitoring ADHD symptoms and that apps should be practical. Parents also identified an additional theme: the importance of the technology. Overall, the characteristics of the current top 10 listed apps did not appear to match well to the views of our sample. Conclusions: Findings suggest that these apps may not fully meet the complex needs of this parent population. Further research is required to explore the value of apps with this population and how they can be tailored to their very specific needs. UR - http://mhealth.jmir.org/2017/10/e149/ UR - http://dx.doi.org/10.2196/mhealth.7941 UR - http://www.ncbi.nlm.nih.gov/pubmed/29030325 ID - info:doi/10.2196/mhealth.7941 ER - TY - JOUR AU - Powell, Lauren AU - Parker, Jack AU - Robertson, Naomi AU - Harpin, Valerie PY - 2017/10/04 TI - Attention Deficit Hyperactivity Disorder: Is There an App for That? Suitability Assessment of Apps for Children and Young People With ADHD JO - JMIR Mhealth Uhealth SP - e145 VL - 5 IS - 10 KW - attention deficit disorder with hyperactivity KW - mobile applications KW - technology N2 - Background: Attention-deficit/hyperactivity disorder (ADHD) is a complex highly comorbid disorder, which can have a huge impact on those with ADHD, their family, and the community around them. ADHD is currently managed using pharmacological and nonpharmacological interventions. However, with advances in technology and an increase in the use of mobile apps, managing ADHD can be augmented using apps specifically designed for this population. However, little is known regarding the suitability and usability of currently available apps. Objective: The aim of this study was to explore the suitability of the top 10 listed apps for children and young people with ADHD and clinicians who work with them. It is hypothesized that mobile apps designed for this population could be more suitably designed for this population. Methods: The top 10 listed apps that are specifically targeted toward children and young people with ADHD in the United Kingdom were identified via the Google Play (n=5) and iTunes store (n=5). Interviews were then undertaken with 5 clinicians who specialize in treating this population and 5 children and young people with ADHD themselves, to explore their opinions of the 10 apps identified and what they believe the key components are for apps to be suitable for this population. Results: Five themes emerged from clinician and young people interviews: the accessibility of the technology, the importance of relating to apps, addressing ADHD symptoms and related difficulties, age appropriateness, and app interaction. Three additional themes emerged from the clinician interviews alone: monitoring symptoms, side effects and app effect on relationships, and the impact of common comorbid conditions. The characteristics of the apps did not appear to match well with the views of our sample. Conclusions: These findings suggest that the apps may not be suitable in meeting the complex needs associated with this condition. Further research is required to explore the value of apps for children and young people with ADHD and their families and, in particular, any positive role for apps in the management of ADHD in this age group. A systematic review on how technology can be used to engage this population and how it can be used to help them would be a useful way forward. This could be the platform to begin exploring the use of apps further. UR - http://mhealth.jmir.org/2017/10/e145/ UR - http://dx.doi.org/10.2196/mhealth.7371 UR - http://www.ncbi.nlm.nih.gov/pubmed/28978497 ID - info:doi/10.2196/mhealth.7371 ER - TY - JOUR AU - Rosenblum, Sara AU - Yom-Tov, Elad PY - 2017/04/21 TI - Seeking Web-Based Information About Attention Deficit Hyperactivity Disorder: Where, What, and When JO - J Med Internet Res SP - e126 VL - 19 IS - 4 KW - attention deficit hyperactivity disorder KW - Internet KW - search engine KW - coping behavior KW - parents N2 - Background: Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder, prevalent among 2-10% of the population. Objective: The objective of this study was to describe where, what, and when people search online for topics related to ADHD. Methods: Data were collected from Microsoft?s Bing search engine and from the community question and answer site, Yahoo Answers. The questions were analyzed based on keywords and using further statistical methods. Results: Our results revealed that the Internet indeed constitutes a source of information for people searching the topic of ADHD, and that they search for information mostly about ADHD symptoms. Furthermore, individuals personally affected by the disorder made 2.0 more questions about ADHD compared with others. Questions begin when children reach 2 years of age, with an average age of 5.1 years. Most of the websites searched were not specifically related to ADHD and the timing of searches as well as the query content were different among those prediagnosis compared with postdiagnosis. Conclusions: The study results shed light on the features of ADHD-related searches. Thus, they may help improve the Internet as a source of reliable information, and promote improved awareness and knowledge about ADHD as well as quality of life for populations dealing with the complex phenomena of ADHD. UR - http://www.jmir.org/2017/4/e126/ UR - http://dx.doi.org/10.2196/jmir.6579 UR - http://www.ncbi.nlm.nih.gov/pubmed/28432038 ID - info:doi/10.2196/jmir.6579 ER - TY - JOUR AU - Delgado-Gomez, David AU - Peñuelas-Calvo, Inmaculada AU - Masó-Besga, Eduardo Antonio AU - Vallejo-Oñate, Silvia AU - Baltasar Tello, Itziar AU - Arrua Duarte, Elsa AU - Vera Varela, Constanza María AU - Carballo, Juan AU - Baca-García, Enrique PY - 2017/03/20 TI - Microsoft Kinect-based Continuous Performance Test: An Objective Attention Deficit Hyperactivity Disorder Assessment JO - J Med Internet Res SP - e79 VL - 19 IS - 3 KW - kinect KW - attention deficit hyperactivity disorder KW - continuous performance test KW - impulsivity KW - hyperactivity N2 - Background: One of the major challenges in mental medical care is finding out new instruments for an accurate and objective evaluation of the attention deficit hyperactivity disorder (ADHD). Early ADHD identification, severity assessment, and prompt treatment are essential to avoid the negative effects associated with this mental condition. Objective: The aim of our study was to develop a novel ADHD assessment instrument based on Microsoft Kinect, which identifies ADHD cardinal symptoms in order to provide a more accurate evaluation. Methods: A group of 30 children, aged 8-12 years (10.3 [SD 1.4]; male 70% [21/30]), who were referred to the Child and Adolescent Psychiatry Unit of the Department of Psychiatry at Fundación Jiménez Díaz Hospital (Madrid, Spain), were included in this study. Children were required to meet the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria of ADHD diagnosis. One of the parents or guardians of the children filled the Spanish version of the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior (SWAN) rating scale used in clinical practice. Each child conducted a Kinect-based continuous performance test (CPT) in which the reaction time (RT), the commission errors, and the time required to complete the reaction (CT) were calculated. The correlations of the 3 predictors, obtained using Kinect methodology, with respect to the scores of the SWAN scale were calculated. Results: The RT achieved a correlation of -.11, -.29, and -.37 with respect to the inattention, hyperactivity, and impulsivity factors of the SWAN scale. The correlations of the commission error with respect to these 3 factors were -.03, .01, and .24, respectively. Conclusions: Our findings show a relation between the Microsoft Kinect-based version of the CPT and ADHD symptomatology assessed through parental report. Results point out the importance of future research on the development of objective measures for the diagnosis of ADHD among children and adolescents. UR - http://www.jmir.org/2017/3/e79/ UR - http://dx.doi.org/10.2196/jmir.6985 UR - http://www.ncbi.nlm.nih.gov/pubmed/28320691 ID - info:doi/10.2196/jmir.6985 ER - TY - JOUR AU - DeHoff, A. Beth AU - Staten, K. Lisa AU - Rodgers, Christine Rylin AU - Denne, C. Scott PY - 2016/12/22 TI - The Role of Online Social Support in Supporting and Educating Parents of Young Children With Special Health Care Needs in the United States: A Scoping Review JO - J Med Internet Res SP - e333 VL - 18 IS - 12 KW - health communication KW - child KW - social media KW - health education KW - health resources KW - early childhood KW - disability KW - neonatal intensive care unit KW - family KW - maternal-child health services N2 - Background: When parents of young children with special health care needs (CSHCN) receive their child?s diagnosis, they encounter information they may not understand, emotions they may not know how to cope with, and questions about their child?s immediate and long-term future that frequently lack answers. The challenge of health care providers is how to prepare parents for caring for their CSHCN, for coping with any resulting challenges, and for accessing the systems and services that can assist them. Objective: The purpose of this work was to review evidence of the information and support needs of parents of young CSHCN and to determine whether online social support can serve as an avenue for learning and empowerment for these parents. Methods: A scoping review identified the challenges, coping mechanisms, and support needs among parents of CSHCN, and the reach and effectiveness of digital technologies with these families and health care providers. We also conducted interviews with professionals serving parents of CSHCN. Results: The literature review and interviews suggested that parents best learn the information they need, and cope with the emotional challenges of raising a CSHCN, with support from other parents of CSHCN, and that young parents in recent years have most often been finding this parent-to-parent support through digital media, particularly social media, consistent with the theory of online social support. Evidence also shows that social media, particularly Facebook, is used by nearly all women aged 18-29 years across racial and socioeconomic lines in the United States. Conclusions: Parents of young CSHCN experience significant stress but gain understanding, receive support, and develop the ability to care for and be advocates for their child through parent-to-parent emotional and informational social support. Online social support is most effective with young adults of childbearing age, with social media and apps being the most useful within the theoretical framework of social support. This opens new opportunities to effectively educate and support parents of young CSHCN. Providers seeking to inform, educate, and support families of CSHCN should develop strategies to help parents find and use social support through digital resources to facilitate their emotional adjustment and practical abilities to care for and access services for their child. UR - http://www.jmir.org/2016/12/e333/ UR - http://dx.doi.org/10.2196/jmir.6722 UR - http://www.ncbi.nlm.nih.gov/pubmed/28007689 ID - info:doi/10.2196/jmir.6722 ER - TY - JOUR AU - Simons, Lucy AU - Valentine, Z. Althea AU - Falconer, J. Caroline AU - Groom, Madeleine AU - Daley, David AU - Craven, P. Michael AU - Young, Zoe AU - Hall, Charlotte AU - Hollis, Chris PY - 2016/03/23 TI - Developing mHealth Remote Monitoring Technology for Attention Deficit Hyperactivity Disorder: A Qualitative Study Eliciting User Priorities and Needs JO - JMIR mHealth uHealth SP - e31 VL - 4 IS - 1 KW - attention deficit hyperactivity disorder KW - mHealth KW - eMental Health KW - remote monitoring technology KW - mental health services KW - qualitative methods KW - feasibility testing KW - user requirements N2 - Background: Guidelines in the United Kingdom recommend that medication titration for attention deficit hyperactivity disorder (ADHD) should be completed within 4-6 weeks and include regular reviews. However, most clinicians think that weekly clinic contact is infeasible, and audits have shown that this timeline is rarely achieved. Thus, a more effective monitoring and review system is needed; remote monitoring technology (RMT) may be one way to improve current practice. However, little is known about whether patients with ADHD, their families, and clinicians would be interested in using RMT. Objective: To explore patients?, parents?, and health care professionals? views and attitudes toward using digital technology for remote monitoring during titration for ADHD. Methods: This was a qualitative study, and data were collected through 11 focus groups with adults and young people with ADHD, parents of children with ADHD, and health care professionals (N=59). Results: All participant groups were positive about using RMT in the treatment of ADHD, but they were also aware of barriers to its use, especially around access to technology and integrating RMT into clinical care. They identified that RMT had the most potential for use in the ongoing management and support of ADHD, rather than during the distinct titration period. Participants identified features of RMT that could improve the quality of consultations and support greater self-management. Conclusions: RMT has the potential to augment support and care for ADHD, but it needs to go beyond the titration period and offer more to patients and families than monitoring through outcome measures. Developing and evaluating an mHealth app that incorporates the key features identified by end users is required. UR - http://mhealth.jmir.org/2016/1/e31/ UR - http://dx.doi.org/10.2196/mhealth.5009 UR - http://www.ncbi.nlm.nih.gov/pubmed/27009498 ID - info:doi/10.2196/mhealth.5009 ER - TY - JOUR AU - Bul, CM Kim AU - Kato, M. Pamela AU - Van der Oord, Saskia AU - Danckaerts, Marina AU - Vreeke, J. Leonie AU - Willems, Annik AU - van Oers, JJ Helga AU - Van Den Heuvel, Ria AU - Birnie, Derk AU - Van Amelsvoort, AMJ Thérèse AU - Franken, HA Ingmar AU - Maras, Athanasios PY - 2016/02/16 TI - Behavioral Outcome Effects of Serious Gaming as an Adjunct to Treatment for Children With Attention-Deficit/Hyperactivity Disorder: A Randomized Controlled Trial JO - J Med Internet Res SP - e26 VL - 18 IS - 2 KW - attention deficit-hyperactivity disorder KW - ADHD KW - serious game KW - Internet KW - children KW - treatment KW - randomized controlled trial N2 - Background: The need for accessible and motivating treatment approaches within mental health has led to the development of an Internet-based serious game intervention (called ?Plan-It Commander?) as an adjunct to treatment as usual for children with attention-deficit/hyperactivity disorder (ADHD). Objective: The aim was to determine the effects of Plan-It Commander on daily life skills of children with ADHD in a multisite randomized controlled crossover open-label trial. Methods: Participants (N=170) in this 20-week trial had a diagnosis of ADHD and ranged in age from 8 to 12 years (male: 80.6%, 137/170; female: 19.4%, 33/170). They were randomized to a serious game intervention group (group 1; n=88) or a treatment-as-usual crossover group (group 2; n=82). Participants randomized to group 1 received a serious game intervention in addition to treatment as usual for the first 10 weeks and then received treatment as usual for the next 10 weeks. Participants randomized to group 2 received treatment as usual for the first 10 weeks and crossed over to the serious game intervention in addition to treatment as usual for the subsequent 10 weeks. Primary (parent report) and secondary (parent, teacher, and child self-report) outcome measures were administered at baseline, 10 weeks, and 10-week follow-up. Results: After 10 weeks, participants in group 1 compared to group 2 achieved significantly greater improvements on the primary outcome of time management skills (parent-reported; P=.004) and on secondary outcomes of the social skill of responsibility (parent-reported; P=.04), and working memory (parent-reported; P=.02). Parents and teachers reported that total social skills improved over time within groups, whereas effects on total social skills and teacher-reported planning/organizing skills were nonsignificant between groups. Within group 1, positive effects were maintained or further improved in the last 10 weeks of the study. Participants in group 2, who played the serious game during the second period of the study (weeks 10 to 20), improved on comparable domains of daily life functioning over time. Conclusions: Plan-It Commander offers an effective therapeutic approach as an adjunct intervention to traditional therapeutic ADHD approaches that improve functional outcomes in daily life. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 62056259; http://www.controlled-trials.com/ISRCTN62056259 (Archived by WebCite at http://www.webcitation.org/6eNsiTDJV). UR - http://www.jmir.org/2016/2/e26/ UR - http://dx.doi.org/10.2196/jmir.5173 UR - http://www.ncbi.nlm.nih.gov/pubmed/26883052 ID - info:doi/10.2196/jmir.5173 ER - TY - JOUR AU - Cosmo, Camila AU - Baptista, Fontes Abrahão AU - de Sena, Pondé Eduardo PY - 2015/05/18 TI - Contribution of Transcranial Direct Current Stimulation on Inhibitory Control to Assess the Neurobiological Aspects of Attention Deficit Hyperactivity Disorder: Randomized Controlled Trial JO - JMIR Res Protoc SP - e56 VL - 4 IS - 2 KW - Attention deficit hyperactivity disorder KW - inhibitory control KW - transcranial direct current stimulation N2 - Background: The applicability of transcranial direct current stimulation (tDCS) in individuals with attention deficit hyperactivity disorder (ADHD) has not yet been investigated. This low-cost, non-invasive, and safe technique optimized to modulate the inhibitory response might be a useful treatment option for those affected by this condition. Objective: The aim of this single center, parallel, randomized, double-blinded, sham-controlled trial is to investigate the efficacy of transcranial direct current stimulation over the prefrontal cortex on the modulation of inhibitory control in adults with attention deficit hyperactivity disorder. Methods: A total of 60 individuals will be divided into 2 groups by block randomization to receive active or sham stimulation. Anodal stimulation over the left dorsolateral prefrontal cortex will be applied at 1 mA during a single 20-minute session. Before and after interventions, subjects will perform 2 go/no go tasks and the brain electrical activity will be recorded by electroencephalogram (EEG) with 32 channels, according to the 10-20 international EEG system. Results: The trial began in May 2013 and we are currently performing the statistical analysis for the secondary outcomes. Conclusions: The findings from this study will provide preliminary results about the role of prefrontal cortex activation through tDCS on ADHD patients. Trial Registration: Clinicaltrials.gov NCT01968512; http://clinicaltrials.gov/ct2/show/NCT01968512 (Archived by WebCite at www.webcitation.org/6YMSW2tkD). UR - http://www.researchprotocols.org/2015/2/e56/ UR - http://dx.doi.org/10.2196/resprot.4138 UR - http://www.ncbi.nlm.nih.gov/pubmed/25986784 ID - info:doi/10.2196/resprot.4138 ER - TY - JOUR AU - Wahlström, Viktor AU - Åhlander, Fredrik AU - Wynn, Rolf PY - 2015/02/12 TI - Auditory Brainstem Response as a Diagnostic Tool for Patients Suffering From Schizophrenia, Attention Deficit Hyperactivity Disorder, and Bipolar Disorder: Protocol JO - JMIR Res Protoc SP - e16 VL - 4 IS - 1 KW - brainstem audiometry KW - diagnosis KW - schizophrenia KW - ADHD KW - bipolar disorder N2 - Background: Psychiatric disorders, such as schizophrenia, attention deficit hyperactivity disorder (ADHD), and bipolar disorder, may sometimes be difficult to diagnose. There is a great need for a valid and reliable diagnostic tool to aid clinicians in arriving at the diagnoses in a timely and accurate manner. Prior studies have suggested that patients suffering from schizophrenia and ADHD may process certain sound stimuli in the brainstem in an unusual manner. When these patient groups have been examined with the electrophysiological method of brainstem audiometry, some studies have found illness-specific aberrations. Such aberrations may also exist for patients suffering from bipolar disorder. Objective: In this study, we will examine whether the method of brainstem audiometry can be used as a diagnostic tool for patients suffering from schizophrenia, ADHD, and bipolar disorder. Methods: The method includes three steps: (1) auditory stimulation with specific sound stimuli, (2) simultaneous measurement of brainstem activity, and (3) automated interpretation of the resulting brain stem audiograms with data-based signal analysis. We will compare three groups of 12 individuals with confirmed diagnoses of schizophrenia, ADHD, or bipolar disorder with 12 healthy subjects under blinded conditions for a total of 48 participants. The extent to which the method can be used to reach the correct diagnosis will be investigated. Results: The project is now in a recruiting phase. When all patients and controls have been recruited and the measurements have been performed, the data will be analyzed according to a previously arranged algorithm. We expect the recruiting phase and measurements to be completed in early 2015, the analyses to be performed in mid-2015, and the results of the study to be published in early 2016. Conclusions: If the results support previous findings, this will lend strength to the idea that brainstem audiometry can offer objective diagnostic support for patients suffering from schizophrenia, ADHD, and bipolar disorder. A positive result from the study could imply that brainstem audiometry could become an important supportive tool for clinicians in their efforts to diagnose patients with these disorders in a timely and accurate manner. Trial Registration: ClinicalTrials.gov NCT01629355; https://clinicaltrials.gov/ct2/show/NCT01629355 (Archived by WebCite at http://www.webcitation.org/6VBfTwx5H). UR - http://www.researchprotocols.org/2015/1/e16/ UR - http://dx.doi.org/10.2196/resprot.3880 UR - http://www.ncbi.nlm.nih.gov/pubmed/25679914 ID - info:doi/10.2196/resprot.3880 ER - TY - JOUR AU - Hanson, L. Carl AU - Burton, H. Scott AU - Giraud-Carrier, Christophe AU - West, H. Josh AU - Barnes, D. Michael AU - Hansen, Bret PY - 2013/04/17 TI - Tweaking and Tweeting: Exploring Twitter for Nonmedical Use of a Psychostimulant Drug (Adderall) Among College Students JO - J Med Internet Res SP - e62 VL - 15 IS - 4 KW - Adderall KW - Twitter KW - social media KW - prescription drug abuse N2 - Background: Adderall is the most commonly abused prescription stimulant among college students. Social media provides a real-time avenue for monitoring public health, specifically for this population. Objective: This study explores discussion of Adderall on Twitter to identify variations in volume around college exam periods, differences across sets of colleges and universities, and commonly mentioned side effects and co-ingested substances. Methods: Public-facing Twitter status messages containing the term ?Adderall? were monitored from November 2011 to May 2012. Tweets were examined for mention of side effects and other commonly abused substances. Tweets from likely students containing GPS data were identified with clusters of nearby colleges and universities for regional comparison. Results: 213,633 tweets from 132,099 unique user accounts mentioned ?Adderall.? The number of Adderall tweets peaked during traditional college and university final exam periods. Rates of Adderall tweeters were highest among college and university clusters in the northeast and south regions of the United States. 27,473 (12.9%) mentioned an alternative motive (eg, study aid) in the same tweet. The most common substances mentioned with Adderall were alcohol (4.8%) and stimulants (4.7%), and the most common side effects were sleep deprivation (5.0%) and loss of appetite (2.6%). Conclusions: Twitter posts confirm the use of Adderall as a study aid among college students. Adderall discussions through social media such as Twitter may contribute to normative behavior regarding its abuse. UR - http://www.jmir.org/2013/4/e62/ UR - http://dx.doi.org/10.2196/jmir.2503 UR - http://www.ncbi.nlm.nih.gov/pubmed/23594933 ID - info:doi/10.2196/jmir.2503 ER - TY - JOUR AU - Hirsch, Oliver AU - Hauschild, Franziska AU - Schmidt, H. Martin AU - Baum, Erika AU - Christiansen, Hanna PY - 2013/03/21 TI - Comparison of Web-Based and Paper-Based Administration of ADHD Questionnaires for Adults JO - J Med Internet Res SP - e47 VL - 15 IS - 3 KW - computers KW - Attention-Deficit/Hyperactivity Disorder KW - questionnaires KW - Internet KW - psychometrics N2 - Background: Satisfactory psychometric properties in offline questionnaires do not guarantee the same outcome in Web-based versions. Any construct that is measured online should be compared to a paper-based assessment so that the appropriateness of online questionnaire data can be tested. Little research has been done in this area regarding Attention-Deficit/Hyperactivity Disorder (ADHD) in adults. Objective: The objective was to simultaneously collect paper-based and Web-based ADHD questionnaire data in adults not diagnosed with ADHD in order to compare the two data sources regarding their equivalence in raw scores, in measures of reliability, and in factorial structures. Methods: Data from the German versions of the Connors Adult ADHD Rating Scales (CAARS-S), the Wender Utah Rating Scale (WURS-k), and the ADHD Self Rating Scale (ADHS-SB) were collected via online and paper questionnaires in a cross-sectional study with convenience sampling. We performed confirmatory factor analyses to examine the postulated factor structures in both groups separately and multiple group confirmatory factor analyses to test whether the postulated factor structures of the questionnaires were equivalent across groups. With Cronbach alpha, we investigated the internal consistency of the postulated factors in the different questionnaires. Mann-Whitney U tests with the effect size ?Probability of Superiority (PS)? were used to compare absolute values in the questionnaires between the two groups. Results: In the paper-based sample, there were 311 subjects (73.3% female); in the online sample, we reached 255 subjects (69% female). The paper-based sample had a mean age of 39.2 years (SD 18.6); the Web-based sample had a mean age of 30.4 years (SD 10.5) and had a higher educational background. The original four factor structure of the CAARS-S could be replicated in both samples, but factor loadings were different. The Web-based sample had significantly higher total scores on three scales. The five-factor structure of the German short form of the WURS-k could be replicated only in the Web-based sample. The Web-based sample had substantially higher total scores, and nearly 40% of the Web-based sample scored above the clinically relevant cut-off value. The three-factor structure of the ADHS-SB could be replicated in both samples, but factor loadings were different. Women in the Web-based sample had substantially higher total scores, and 30% of the Web-based sample scored above the clinically relevant cut-off value. Internal consistencies in all questionnaires were acceptable to high in both groups. Conclusions: Data from the Web-based administration of ADHD questionnaires for adults should not be used for the extraction of population norms. Separate norms should be established for ADHD online questionnaires. General psychometric properties of ADHD questionnaires (factor structure, internal consistency) were largely unaffected by sampling bias. Extended validity studies of existing ADHD questionnaires should be performed by including subjects with a diagnosis of ADHD and by randomizing them to Web- or paper-based administration. UR - http://www.jmir.org/2013/3/e47/ UR - http://dx.doi.org/10.2196/jmir.2225 UR - http://www.ncbi.nlm.nih.gov/pubmed/23518816 ID - info:doi/10.2196/jmir.2225 ER -