Ongoing Research Projects
LemurDx - Objectivity, Precision, and Clinical Utility in Hyperactivity Measurement for Childhood ADHD Using Smartwatches and Machine Learning Algorithms.
Grant Number: 1R41MH119644 (MPI: Goel/Lindhiem/Shaaban)
Funding Period: 2018-2019
Role: Principal Investigator
Project Coordinator: Jordan L. Harris
Grant Number: 1R41MH119644 (MPI: Goel/Lindhiem/Shaaban)
Funding Period: 2018-2019
Role: Principal Investigator
Project Coordinator: Jordan L. Harris
ADHD is the most common behavioral diagnosis in early childhood, affecting around 5% of all American children. Although hyperactivity is a core symptom of ADHD, there are no objective measures that are widely used in practice settings. LemurDx is a concept for a software system for smartwatches and mobile tablets, optimized for clinical use, that uses state-of-the-art, yet relatively low-cost, sensor technology to measure hyperactivity, with the clinical goal of differentiating children with ADHD-hyperactive presentation or ADHD combined presentation from children with typical levels of activity. LemurDx will passively collect data from smartwatch sensors. Clinicians will ask a child to wear a smartwatch with the LemurDx application for one day and then collect the de-identified data. The data will be transmitted to a HIPAA-compliant secure server. Machine learning (ML) algorithms will be used to differentiate children with clinical levels of hyperactivity from those with typical levels of activity, providing clinicians with immediate results. LemurDx is superior to research-focused tools such as traditional actigraphy in a number of ways. Along with the improved precision afforded by modern smartwatch sensors (many of which are not available on actigraphy devices) and machine learning (ML) algorithms, the team is carefully designing a complete system based on the unique needs of clinicians. This includes a comprehensive system of secure HIPAA-compliant servers, automated state-of-the- art ML algorithms, pre-programmed mobile tablets and smartwatches for clinical use, a secure and de-identified data architecture, and a simple user interface that eliminates any technological burden on clinicians. Aim 1 of the project is to develop a commercial grade prototype of LemurDx following principles of user- centered design, with feedback from focus groups including children, parents, and clinicians. Aim 2 of the project is to test the feasibility of collecting, storing, and analyzing data from 30 children (ages 6-11) who will wear a smartwatch with LemurDx technology for one day. Aim 3 of the project is to test and refine several ML algorithms to achieve a high level of sensitivity and specificity to accurately classify children with and without ADHD. LemurDx is significant as there is no objective and commercially available measure of hyperactivity to assist in the diagnosis of ADHD, despite a great need in settings including pediatric primary-care practices, children’s hospitals, and behavioral health clinics. The project is consistent with NICHD’s mission to ensure, “that all children have the chance to achieve their full potential for healthy and productive lives.” Innovations include a combination of reliable, inexpensive measurement technology combined with accurate ML algorithms to consistently and objectively measure hyperactivity in a system that is designed for clinical users. We will show that LemurDx has commercialization potential by demonstrating accuracy, cost effectiveness, and user adherence, and will lay the foundation for the development of a scalable clinical delivery system.
Funding Source: National Institute of Mental Health (NIMH)
The Center for Enhancing Triage and Utilization for Depression and Emergent Suicidality (ETUDES) in Pediatric Primary Care - Study 1: Screening Guru
Grant Number: 1P50MH115838 (PI: Brent)
Funding Period: 2018-2019
Role: Co-Investigator; Study 1 Leader
Grant Number: 1P50MH115838 (PI: Brent)
Funding Period: 2018-2019
Role: Co-Investigator; Study 1 Leader
The adolescent suicide rate has increased by more than 20% in the past decade and is now the second leading cause of death for adolescents. Depression is the single most important contributor to suicidal ideation, attempt, and death by suicide among adolescents aged 12-17.11. Screening for mental health problems in general, and for depression and suicidality in particular, is a national priority. Even when routine screening is implemented, initiation of treatment is low. One critical barrier to starting depression treatment is whether adolescents and their parent(s) perceive a need for mental health treatment. Perceived need for mental health care services is a known predictor of service use, but may be low when depression is not the presenting concern but rather is identified on a routine screening questionnaire. This project seeks to increase the rate of appropriate referrals by primary care providers and treatment initiation among adolescents who screen positive for depression or suicidal ideation by: 1) assessing adolescents’ and their parents’ barriers to following through with clinician-recommended care prior to the start of treatment; and 2) providing clinicians with decision- support recommendations that are personalized to the adolescent’s clinical presentation, treatment preferences, and barriers. This will be accomplished through three specific aims. Aim 1 is to develop an automated decision-support system (DSS) that will guide primary care providers in making personalized treatment recommendations to adolescents presenting with symptoms of depression and risk for suicide at the time of the office encounter. Aim 2 is to test the effectiveness of the DSS, using a stepped wedge design, at increasing primary care providers’ rate of personalized referrals in a pilot trial (N = 120) of adolescents aged 12-17.11 years who screen positive for depression and/or suicidality during a routine primary care visit. Aim 3 is to explore the impact of the DSS on service utilization and symptom reduction. This project is innovative because there currently is no support tool for PCPs assessing depressed adolescents, the tool integrates information about suicidal risk using an adaptive screen, severity of depression, and patient and parent motivation, barriers, and treatment preferences to provide the PCP with a personalized recommendation for the patient. The study has the potential to improve care following depression screening by reducing variability in PCPs’ treatment recommendations, and increasing PCPs’ awareness of potential barriers to care so as to provide a referral that reflects the patient’s clinical needs and also increases patients’ engagement with recommended care.
Funding Source: National Institute of Mental Health (NIMH)
Completed Research Projects
Improving Access to Care via mHealth Technology
Funding Period: 2015-2017
Role: Principal Investigator
Project Coordinator: Charles Bennett, Jordan L. Harris
Improving Access to Care via mHealth Technology
Funding Period: 2015-2017
Role: Principal Investigator
Project Coordinator: Charles Bennett, Jordan L. Harris
Although evidence-based treatments (EBTs) have been developed for childhood disruptive behavior problems, many families do not have access to these services. Barriers to access include local availability of services, transportation, cost, and perceived stigma. This project will collect preliminary data on a smartphone-based mobile health (mHealth) system called UseIt! (Understanding Skill-use to Enhance the Impact of Treatment) as a standalone intervention to promote the use of parent management training (PMT) skills and cognitive-behavioral therapy (CBT) skills. The UseIt! system consists of parent and child smartphone apps that include both content and features to promote and measure the use of specific PMT skills and CBT skills in day-to-day life including, 1) a digital library of skills, 2) an interactive trouble-shooting guide, 3) an electronic diary, 4) a digital reward bank, and 5) a skill-use reminder alarm. The project will consist of a pilot randomized-controlled trial (RCT) comparing the effects of the UseIt! mHealth system to a waitlist control condition.
Funding Source: The Klingenstein Third Generation Foundation
Funding Source: The Klingenstein Third Generation Foundation
Using Smartphones to Enhance Skill Development in Brief CBT for Child Anxiety
Grant Number: 1R34MH102666 (PI: Silk)
Funding Period: 2014-2016
Role: Co-Investigator
Grant Number: 1R34MH102666 (PI: Silk)
Funding Period: 2014-2016
Role: Co-Investigator
Anxiety disorders affect as many as 1 in 5 youth and contribute to problems in social and academic functioning, as well as the development of chronic depression and substance abuse in adolescence and adulthood. This study develops a mobile health intervention that has the potential to make psychosocial treatments for child anxiety disorders more personalized, interactive, and efficacious. The refinement of mobile technologies to support skills practice and patient-therapist engagement also has wider relevance to improving care delivery and reducing healthcare costs for other child psychiatric disorders and a broad array of chronic conditions across the lifespan.
Funding Source: National Institute of Mental Health (NIMH)
Screening Tool for Pediatric Bipolar Disorder in Primary Care
Grant Number: 1R43MH108178 (PIs: DeRosier/Lindhiem)
Funding Period: 2015-2016
Role: Co-Principal Investigator
Screening Tool for Pediatric Bipolar Disorder in Primary Care
Grant Number: 1R43MH108178 (PIs: DeRosier/Lindhiem)
Funding Period: 2015-2016
Role: Co-Principal Investigator
Unlike most medical conditions, mental health disorders have no definitive diagnostic or screening tools (e.g., blood tests, x-rays) to verify their presence or absence. In primary care settings, pediatricians and family medicine doctors often lack confidence in their ability to screen for significant mental health problems such as pediatric bipolar disorder, and refer out for most mental and behavioral health concerns. Unfortunately, many patients either do not follow through on referrals or do not receive appropriate referrals. As a result, both under-referrals and over-referrals are all too common in primary care settings. Over-referrals cause inefficiency while under-referrals result in prolonged patient suffering, burden on family members, and a huge cost to society. The Posterior Probability of Diagnosis (PPOD) Index has recently been proposed as a unique step towards solving these problems. The PPOD Index is a Bayesian method that quantifies the probability that a patient meets or exceeds a diagnostic threshold for a particular disorder. The goal of this SBIR project is to develop and test a Bayesian screening tool using PPOD Index software for tablets. In Phase I, we will focus prototype development and testing on pediatric (ages 5-17) bipolar disorder, a disorder that is particularly likely to be misdiagnosed, resulting in tremendous costs for the person and society. The proposed software system will enhance screening to improve the precision and quality of referrals for pediatric bipolar disorder in primary- care settings. We envision a final product (Phase II) that will include modules for other mental health disorders such as ADHD, Autism, and PTSD. By improving the efficiency and screening of mental health problems in primary-care settings, we can significantly improve the mental health outcomes of children and their families, alleviating suffering, burden on families, and cost to society.
Funding Source: National Institute of Mental Health (NIMH)
Skill Acquisition/Utilization During Treatment for Childhood Behavior Problems
Grant Number: K01MH093508
Funding Period: 2011-2016
Role: Principal Investigator
Project Coordinator: Charles Bennett
This federally-funded research project seeks to improve rates of response to evidence-based psychosocial treatments for childhood disruptive behavior disorders (Oppositional Defiant Disorder and Conduct Disorder) by focusing on the acquisition and utilization of specific skills (parent-management skills and cognitive-behavioral skills) learned during the course of treatment. Aim 1 is to develop measures and a methodology for assessing skill acquisition and skill utilization during the course of treatment, using performance based assessments and ecological assessment (electronic diary) strategies. Aim 2 is to assess determinates, correlates, and sequelae of skill acquisition and utilization. Aim 3 is to develop a pilot protocol for enhancing skill utilization by augmenting existing evidence-based treatments for childhood disruptive behavior disorders through the use of interactive health technologies. The research aims of this proposal are consistent with Strategic Objective 3 of the NIMH Strategic Plan, which is to, "develop new and better interventions for mental disorders that incorporate the diverse needs and circumstances of people with
mental illness."
mental illness."
Promoting Skill Utilization to Enhance Treatment for Childhood Behavior Problems
Grant Number: 1R34MH106619
Funding Period: 2016-2018
Role: Principal Investigator
Project Coordinator: Jordan L. Harris
Grant Number: 1R34MH106619
Funding Period: 2016-2018
Role: Principal Investigator
Project Coordinator: Jordan L. Harris
Although existing treatments benefit many families of children with disruptive behavior problems, a substantial proportion do not respond to treatment. A better understanding of treatment mechanisms will illuminate reasons for nonresponse and point to strategies for improving treatment. To achieve this goal, systematic research on specific treatment targets (not just symptom reduction) is needed. This research study focuses on skill acquisition and utilization as specific treatment targets or hypothesized mechanisms of therapeutic action for cognitive behavioral therapy (CBT) for childhood disruptive behavior problems. Specifically, this project consists of a small pilot randomized-controlled trial (RCT) to examine target engagement and validation (acquisition and utilization of specific CBT skills) of a smartphone based mobile health (mHealth) system called UseIt! (Understanding Skill-use to Enhance the Impact of Treatment). The project will also establish the feasibility of this novel research protocol and refine the smartphone apps and secure online clinician portal. The parent and child UseIt! apps include both content and features to promote the use of CBT skills in day-to-day life. The project will also establish the feasibility of incorporating recently developed measures of skill acquisition (Skill Acquisition Measure [SAM]) and skill utilization (Skill-use Internet Diary [SID]) into a treatment trial. Children with significant disruptive behavior problems (ages 8-12) and their parents will be recruited directly from partnering community agencies. Aim 1 of the project is to assess target engagement and validation in the context of a preliminary RCT comparing CBT + UseIt! protocol (N=30) to CBT only (N=15). Aim 2 is to assess the feasibility of a future full-scale effectiveness RCT comparing these treatments, and incorporating measures of skill acquisition and skill utilization into a treatment trial. Aim 3 is to refine the UseIt! apps and clinician portal, and to integrate the technology seamlessly with treatment delivery, based on feedback obtained from clinicians and families.
Funding Source: National Institute of Mental Health (NIMH)
Effective parenting is a critical component of healthy child development and deficits in parenting skills have been implicated as both pathogenic and maintaining factors for childhood disruptive behavior problems and subsequent behavioral and emotional problems extending into adulthood. Parenting measures are still needed that are brief, low-cost, have strong psychometrics and established norms, are bias free, and are sensitive to change. We have recently developed a set of measures to address these limitations. The Skill Acquisition Measure (SAM), a measure of parenting knowledge and skill acquisition, is a computerized assessment during which respondents answer questions in response to video-clip vignettes of both common and challenging parenting scenarios. The Skill-use Internet Diary (SID), a measure of parenting skill utilization, is an internet- based diary used to document the use of various parenting behaviors in daily life. Both measures focus specifically on the domains of parenting that are known to be associated with childhood disruptive behavior problems. The measures cover content including, age-appropriate expectations, effective communication, planned ignoring, rewards, consequences, time-outs, attending to positive behavior, and praise. This project will allow us to evaluate the psychometric properties of these two measures and establish norms and optimal clinical cut-scores using a using a large, nationally representative sample (N = 1,000). This project will result in psychometric and normative data for a set of promising new parenting measures that will contribute to both developmental research and intervention research. Aim 1 is to examine the reliability and validity of the SAM and SID using data obtained from a nationally representative sample. Aim 2 is to establish norms and optimal clinical cut-off scores for the SAM and SID using data from a nationally representative sample. Aim 3 is to use item response theory (IRT) to establish a brief (10-item) and unbiased version of the SAM (no differential item functioning [DIF] for any of the items) of the SAM that will enhance its utility as a research tool for both longitudinal and early-intervention research.