The CoolCraig App: Promoting Health by Improving Self-Regulation in Adolescents with ADHD

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A wearable digital healthcare intervention to promote self-regulation among children with attention deficit hyperactivity disorder and their parents is a promising method to support adherence to treatment.

Project Details -
Completed

Attention deficit hyperactivity disorder (ADHD) is the most prevalent childhood psychiatric condition and has profound public health, personal, and family impacts. A lifelong condition, it requires maintenance and substantial self-regulation to support treatment gains. Despite success in clinical interventions, long-term treatment adherence can be challenging. Providing support and reinforcement via simple technology integrated into a smartwatch and smart phone may be one mechanism to improve adherence to treatment.

This research developed and piloted CoolCraig, a wearable and connected system combining a smartwatch, mobile phone application, and web portal that delivers, reinforces, and sustains treatment for adolescents with ADHD.

The specific aims of the research were the following:

  • Establish key design principles for the support of adolescents with ADHD and implement these principles in the CoolCraig system.
  • Evaluate the feasibility and acceptability of CoolCraig.

A series of design workshops with 24 children, eight teachers, and eight parents were held where participants discussed wearable technology, self-regulation strategies, and potential features for the smartwatch app, as well as giving children the opportunity to sketch prototypes. Fourteen design sessions were conducted to develop, present, and discuss provisional scenarios to inform design. These workshops and design sessions informed the development of a prototype system.

Prior to the start of the feasibility and acceptability trial, however, COVID-19 impacted the original research plan. The research was quickly adapted to study how it might support mental health treatment during COVID-19-related stay at home orders. New features were added to the prototype, including personalized calendars that synchronized across devices with distance learning schedules. Three pilot trials were completed, with the prototype revised for each subsequent pilot.

The research showed that children can successfully wear and use the watch daily for 6 weeks or more. Parents indicated that the intervention was helpful and pointed to the support it gave their children in the development of organizational skills. The research was able to show how the use of smartwatches can support daily organization and task completion in children with ADHD, particularly during periods of distance learning. Finally, the research produced guidelines for designing interventions using technology in supporting this population.

Hanging Out with CoolCraig: Self-Regulation for Youth with Attention Deficit Hyperactivity Disorder

Theme:
Engaging and Empowering Patients and Caregivers
Subtheme:
Using Digital Healthcare Tools in Chronic Disease Self-Management

A wearable digital healthcare intervention to promote selfregulation among children with attention deficit hyperactivity disorder and their parents is a promising method to support adherence to treatment.

Treatment support between clinic visits

Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatric conditions among adolescents and requires treatment continuity to support lifelong gains. Traditionally, treatment for ADHD includes behavioral intervention and, often, daily medication. While effective, long-term adherence with this model can be challenging for both the child and the parent, related to limited support outside the clinical setting. Dr. Kimberley Lakes and Dr. Gillian Hayes, a psychologist and computer scientist, respectively, paired their expertise to design technology that would address this gap in care by maintaining treatment for youth with ADHD outside of visits to the doctor’s office.

A solution on your wrist

The research team developed and piloted CoolCraig, a system consisting of a smartwatch, mobile phone application, and web portal to deliver self-regulating interventions to both the youth wearing the device and their parents. Dr. Lakes and Dr. Hayes and their team designed the technology with the input of users, hosting design workshops with youth, parents, teachers, and clinicians. With the overall goal to improve ADHD treatment adherence, the team made sure that adolescents had their voices heard and incorporated features to support behavioral change. The team evaluated the usability and feasibility of this intervention in a 20-participant pilot study, observing participant’s self-regulation and parent’s coregulation techniques acquired from wearing the technology.

“This can be a really meaningful way to help support yourself, and to build the self-efficacy and the independent agency in being able to know what you need to manage yourself and to regulate emotions and behavior on a day-to-day basis.”
- Dr. Kimberley Lakes

A feasible approach

This research illustrated the value of both co- and self-regulation for children with ADHD, and the role digital healthcare interventions can have in this model. During the COVID-19 pandemic with school provided by distance learning, CoolCraig provided structured support during challenging times. Drs. Lakes and Hayes gained a better understanding of designing technological interventions to enhance the support of CoolCraig users and plan to expand the prototype for promising future research.

This Research is Featured in
Principal Investigator
Lakes, Kimberley
Organization
University of California Riverside
Research Profile
Funded Amount
378705
Research Type
Completed
This Research is Featured in
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