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

ADHD 远程技术和 ADHD 过渡：预测和预防负面结果（ART-过渡）

• 批准号: MR/Y003209/1
• 负责人: Jonna Kuntsi
• 金额: $ 344.63万
• 依托单位: King's College London
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2023
• 资助国家: 英国
• 起止时间: 2023 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FY003209%2F1
• 关键词: ADHD; Remote; Technology; transition; predicting

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

对于患有注意力缺陷多动障碍（ADHD）的年轻人来说，青春期晚期是一个高度挑战性的至关重要时期，可以为分歧成年轨迹奠定基础。许多经常与ADHD共同发生的条件，例如抑郁，拖欠和滥用药物，通常在青春期首次出现。在这个年龄段的重大生活转变，例如离开教育，开始工作或搬出父母的家，导致了多种新需求和可用支持网络的变化，从而进一步增加了ADHD年轻人的脆弱性。这个脆弱的阶段与从儿童和青少年心理保健到成人多动症服务的过渡相吻合，这本身就是当前主要临床关注的重点：新英国的数据表明，尽管对正在进行的治疗需求很大，但大多数ADHD的青年仍未成功转移到成人服务。因此，许多患有多动症的年轻人在可能最需要的时候没有得到适当的干预措施。目前，由于年轻人从临床服务中脱离接触以及我们对现实世界中对更全面干预的现实目标的了解有限，目前尚未完全实现干预的机会。我们提出了一项研究计划，该计划直接解决了这些需求和匹配最近重点介绍的研究重点：（1）2022年对多动症过渡建议的审查突出了缺乏通过过渡和对智能手机应用等现代工具的需求，例如ADHD心理健康保健的一部分； （2）来自ADHD纵向多模式治疗研究（MTA）的2022年出版物表明，ADHD通常是一种“慢性但打蜡和减弱的疾病”，当生物脆弱性导致临床上有重要症状和障碍时，环境因素可能会影响。 MTA研究强调了环境因素和健康行为，可以引发症状和障碍的波动，作为关键研究的重点。远程测量技术（RMT）提供了以下潜力：a）以以前不可能的细节获得持续的，长期的现实世界数据； b）确定包括环境因素和健康行为在内的干预措施的现实目标； c）在多动症过渡期间转变监测，自我管理，个性化治疗以及与临床服务的参与。我们的团队处于独特的位置来推动这些进步，使用我们专门为ADHD开发的RMT（16岁以上）：ADHD远程技术系统。对于患有多动症的人的过渡，我们将解决有关成年过渡的三个核心问题：发生了什么变化，预测它们以及如何防止负面结果并支持健康的生活方式？我们将使用主动监测和被动监控在两年的连续评估期间远程监测250名ADHD的年轻人。主动监视涉及参与者在专用智能手机活动应用程序上完成问卷和语音任务，并在家庭计算机上完成认知任务。被动监视涉及使用可穿戴设备和专用智能手机被动应用程序收集数据（例如，体育锻炼，睡眠，社交互动，相对位置，数字用法）。然后，我们与ADHD的年轻人共同设计，这是新的ADHD转换智能手机应用程序的原型。它的目的是通过促进自我管理，个性化治疗和与成人服务的参与来防止负面结果并支持健康的生活方式。应用程序组件可能包括个性化反馈，个性化的教育组件，提示，警报和与临床医生共享的数据。我们的方法着重于为年轻人与临床医生合作管理多动症的年轻人如何管理自己的多动症，并将重点放在可修改的环境因素和预防负面结果上。