Improvement of Attention-Deficit/Hyperactivity Disorder Symptoms in School-Aged Children, Adolescents, and Young Adults With Autism via a Digital Smartglasses-Based Socioemotional Coaching Aid: Short-Term, Uncontrolled Pilot Study

Abstract

BackgroundPeople with autism spectrum disorder (ASD) commonly experience symptoms related to attention-deficit/hyperactivity disorder (ADHD), including hyperactivity, inattention, and impulsivity. One-third of ASD cases may be complicated by the presence of ADHD. Individuals with dual diagnoses face greater barriers to accessing treatment for ADHD and respond less positively to primary pharmacologic interventions. Nonpharmacologic technology-aided tools for hyperactivity and inattention in people with ASD are being developed, although research into their efficacy and safety remains limited.ObjectiveThe objective of this preliminary study was to describe the changes in ADHD-related symptoms in children, adolescents, and young adults with ASD immediately after use of the Empowered Brain system, a behavioral and social communication aid for ASD running on augmented reality smartglasses.MethodsWe recruited 8 children, adolescents, and young adults with ASD (male to female ratio of 7:1, mean age 15 years, range 11.7-20.5 years) through a Web-based research signup form. The baseline score on the hyperactivity subscale of the Aberrant Behavioral Checklist (ABC-H), a measure of hyperactivity, inattention, and impulsivity, determined their classification into a high ADHD-related symptom group (n=4, ABC-H≥13) and a low ADHD-related symptom group (n=4, ABC-H<13). All participants received an intervention with Empowered Brain, where they used smartglasses-based social communication and behavioral modules while interacting with their caregiver. We then calculated caregiver-reported ABC-H scores at 24 and 48 hours after the session.ResultsAll 8 participants were able to complete the intervention session. Postintervention ABC-H scores were lower for most participants at 24 hours (n=6, 75%) and for all participants at 48 hours (n=8, 100%). At 24 hours after the session, average participant ABC-H scores decreased by 54.9% in the high ADHD symptom group and by 20% in the low ADHD symptom group. At 48 hours after the session, ABC-H scores compared with baseline decreased by 56.4% in the high ADHD symptom group and by 66.3% in the low ADHD symptom group.ConclusionsThis study provides initial evidence for the possible potential of the Empowered Brain system to reduce ADHD-related symptoms, such as hyperactivity, inattention, and impulsivity, in school-aged children, adolescents, and young adults with ASD. This digital smartglasses intervention can potentially be targeted at a broader array of mental health conditions that exhibit transdiagnostic attentional and social communication deficits, including schizophrenia and bipolar disorder. Further research is required to understand the clinical importance of these observed changes and to conduct longitudinal studies on this intervention with control groups and larger sample sizes.

Improved Socio-Emotional and Behavioral Functioning in Students with Autism Following School-Based Smartglasses Intervention: Multi-Stage Feasibility and Controlled Efficacy Study

“…Prior research into the Empowered Brain has provided evidence for its feasibility [ 54 ], usability [ 55 ], desirability [ 56 ], smartglasses sensor accuracy [ 73 ], and potential impact on behavioral symptoms [ 54 , 58 , 59 , 60 ] (See Table 1 ). Many individuals with ASD also present with sensory challenges, either hyper- or hypo-reactivity to sensory input [ 1 ].…”

“…We have previously described one such technology, referred to in this study as the Empowered Brain, and demonstrated preliminary evidence of its feasibility [ 54 ], usability [ 55 ], desirability [ 56 ], and safety in ASD populations [ 57 ]. Additionally, pilot data found the technology to be associated with improvement in social communication, decreased irritability and ADHD symptoms in people with ASD [ 58 ]. Early school-based studies have shown some early evidence of feasibility, usability, and efficacy [ 59 , 60 ].…”

“…The ABC-I subscale consists of 16 items and includes assessment of physical aggression, temper tantrums, yelling, screaming, and self-injurious behaviors (see review [ 68 ]). The hyperactivity subscale of the ABC (ABC-H) has been used in ADHD-symptom treatment studies in ASD using pharmacological [ 69 ], dietary [ 70 ], and technology-related interventions [ 58 ]. Similarity, the social withdrawal/lethargy subscale (ABC-L/SW) has been used to measure the impact of treatment in ASD-related social impairment [ 71 ].…”

Updates in technology-based interventions for attention deficit hyperactivity disorder

“…Monitoring sensors such as accelerometer and technology such as smartglassees were previously studied [ 98 ]. Sluiter et al [ 99 ] used a timer to regularly remind seven students with ADHD in a special needs classroom to monitor their on-task behaviour.…”

Case Study of a Digital Augmented Reality Intervention for Autism in School Classrooms: Associated With Improved Social Communication, Cognition, and Motivation via Educator and Parent Assessment

“…User performance is measured through graphs of rewards, events, and attention data. The socio-emotional coaching apps of the Empowered Brain have been previously found to be well-tolerated (Keshav et al, 2017), feasible to use (Liu et al, 2017), free from adverse effects in people with ASD (Sahin et al, 2018), and associated with improvements in the symptoms of ASD (Liu et al, 2017) and attention deficit hyperactivity disorder (Vahabzadeh et al, 2018). These studies were, however, conducted in controlled research settings, utilizing the caregivers of participants with ASD, and were based on a single intervention session.…”