TY - JOUR AU - Atturu, Harini AU - Naraganti, Somasekhar AU - Rao, Rajvir Bugatha PY - 2025/4/28 TI - Effectiveness of Artificial Intelligence?Based Platform in Administering Therapies for Children With Autism Spectrum Disorder: 12-Month Observational Study JO - JMIR Neurotech SP - e70589 VL - 4 KW - autism spectrum disorder KW - neurodevelopmental disorders KW - applied behavior analysis KW - software KW - artificial intelligence N2 - Background: A 12-month longitudinal observational study was conducted on 43 children aged 2?18 years to evaluate the effectiveness of the CognitiveBotics artificial intelligence (AI)?based platform in conjunction with continuous therapy in improving therapeutic outcomes for children with autism spectrum disorder (ASD). Objective: This study evaluates the CognitiveBotics software?s effectiveness in supporting children with ASD through structured, technology-assisted learning. The primary objectives include assessing user engagement, tracking progress, and measuring efficacy using standardized clinical assessments. Methods: A 12-month observational study was conducted on children diagnosed with ASD using the CognitiveBotics AI-based platform. Standardized assessments, include the Childhood Autism Rating Scale (CARS), Vineland Social Maturity Scale, Developmental Screening Test, and Receptive Expressive Emergent Language Test (REEL), were conducted at baseline (T1) and at the endpoint (T2). All participants meeting the inclusion criteria were provided access to the platform and received standard therapy. Participants who consistently adhered to platform use as per the study protocol were classified as the intervention group, while those who did not maintain continuous platform use were designated as the control group. Additionally, caregivers received structured training, including web-based parent teaching sessions, reinforcement strategy training, and home-based activity guidance. Results: Participants in the intervention group demonstrated statistically significant improvements across multiple scales. CARS scores reduced from 33.41 (SD 1.89) at T1 to 28.34 (SD 3.80) at T2 (P<.001). Social age increased from 22.80 (SD 7.33) to 35.76 (SD 9.09; mean change: 12.96, 56.84% increase; P<.001). Social quotient increased from 53.26 (SD 11.84) to 64.75 (SD 16.12; mean change: 11.49, 21.57% increase; P<.001). Developmental age showed an improvement from 30.93 (SD 9.91) to 45.31 (SD 11.20; mean change: 14.38, 46.49% increase; P<.001), while developmental quotient increased from 70.94 (SD 10.95) to 81.33 (SD 16.85; mean change: 10.39, 14.65% increase; P<.001). REEL scores showed substantial improvements, with receptive language increasing by 56.22% (P<.001) and expressive language by 59.93% (P<.001). In the control group, while most psychometric parameters showed some improvements, they were not statistically significant. CARS scores decreased by 10.62% (P=.06), social age increased by 52.27% (P=.06), social quotient increased by 19.62% (P=.12), developmental age increased by 44.88% (P=.06), and developmental quotient increased by 11.23% (P=.19). REEL receptive and expressive language increased by 34.69% (P=.10) and 40.48% (P=.054), respectively. Conclusions: Overall, the platform was an effective supplement in enhancing therapeutic outcomes for children with ASD. This platform holds promise as a valuable tool for augmenting ASD therapies across cognitive, social, and developmental domains. Future development should prioritize expanding the product?s accessibility across various languages, ensuring cultural sensitivity and enhancing user-friendliness. UR - https://neuro.jmir.org/2025/1/e70589 UR - http://dx.doi.org/10.2196/70589 ID - info:doi/10.2196/70589 ER - TY - JOUR AU - Nunes Longhi Aleixo, Daniele AU - Junior Martins de Souza, Daiton AU - Regina Pedroso Vilela Torres de Carvalho, Stela AU - Regina Furlani, Marcia AU - Canato Martins, Cíntia AU - Santos, dos Emerson Roberto AU - Souza Menezes, de João Daniel AU - Querino da Silva, Matheus AU - Maria Maciel Lopes, Sônia AU - Sanches Rodrigues, Marcos AU - Almeida de Arnaldo Silva Rodriguez Castro, Natalia AU - Landim Gonçalves Cristóvão, Helena AU - Ittavo Lamana Faria, Josimerci AU - Maria Sabadoto Brienze, Vânia AU - Regina de Abreu Lima, Alba AU - Silva Fucuta, da Patrícia AU - Cristina Móz Vaz Oliani, Denise AU - Aparecida Micelli Domingos, Neide AU - Cristina Oliveira Santos Miyazaki, Maria AU - Maria de Araújo Filho, Gerardo AU - César André, Júlio PY - 2025/4/24 TI - Mapping the Evidence on Compassion Skills in Applied Behavior Analysis: Protocol for Scoping Review JO - JMIR Res Protoc SP - e66399 VL - 14 KW - compassion KW - applied behavior analysis KW - skills KW - protocol KW - scoping reviews KW - knowledge gaps KW - training program KW - client-centered approach KW - holistic approach N2 - Background: Applied behavior analysis (ABA) is a scientific approach that applies principles of learning and motivation to assess, design, implement, and evaluate social and environmental modifications to produce meaningful changes in human behavior. It has been widely used in various settings, particularly in the treatment of individuals with autism spectrum disorders and other developmental disabilities. Recently, compassion has emerged as a topic of growing scientific interest within ABA. To improve socially relevant behaviors, it is essential to explore how behavior analysts can provide maximum support to clients and promote significant changes through compassionate care. Although compassion skills have been studied by ABA researchers, the literature still presents gaps in understanding how these skills can be effectively integrated into ABA practice. Objective: This study aimed to map, identify, and provide data available in the existing literature on compassion skills and applied behavior analysis. Methods: This scoping review will follow the methodological framework of Arksey and O?Malley with previously proposed refinements. The search strategy will use combinations of descriptors and their synonyms according to the Health Sciences Descriptors and MeSH (Medical Subject Headings) terms, using the PCC (population, concept, and context) mnemonic, combined with the Boolean operators AND Mesh OR. The electronic databases to be searched include Embase, Index Psicologia, Lilacs, PubMed, Scopus, and Web of Science. Studies published between 2020 and 2024 in English, Portuguese, and Spanish will be included. Two independent reviewers will screen titles, abstracts, and full texts, with a third reviewer resolving any disagreements. Results: As this is a protocol, results are pending. The review will synthesize definitions of compassion in ABA, map compassionate skills, analyze existing interventions, and identify outcomes associated with compassionate ABA practice. Conclusions: This scoping review is expected to contribute to the evolution of ABA toward a more compassionate and holistic approach, potentially leading to improved outcomes for clients and practitioners. The findings may inform the development of compassion training programs and influence care policies in ABA. Trial Registration: OSF Registries 10.17605/OSF.IO/F3A6H; https://osf.io/f3a6h International Registered Report Identifier (IRRID): PRR1-10.2196/66399 UR - https://www.researchprotocols.org/2025/1/e66399 UR - http://dx.doi.org/10.2196/66399 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66399 ER - TY - JOUR AU - Meyer, Eric AU - Sauzéon, Hélène AU - Saint-Supery, Isabeau AU - Mazon, Cecile PY - 2025/4/17 TI - Evaluating a Web-Based Application to Facilitate Family-School-Health Care Collaboration for Children With Neurodevelopmental Disorders in Inclusive Settings: Protocol for a Nonrandomized Trial JO - JMIR Res Protoc SP - e63378 VL - 14 KW - neurodevelopmental disorders KW - coeducation KW - whole-school approach KW - family-professional partnership KW - web application KW - inclusive education KW - family-school-health care N2 - Background: An individual education plan (IEP) is a key element in the support of the schooling of children with special educational needs or disabilities. The IEP process requires effective communication and strong partnership between families, school staff, and health care practitioners. However, these stakeholders often report their collaboration as limited and difficult to maintain, leading to difficulties in implementing and monitoring the child?s IEP. Objective: This paper aims to describe the study protocol used to evaluate a technological tool (CoEd application) aiming at fostering communication and collaboration between family, school, and health care in the context of inclusive education. Methods: This protocol describes a longitudinal, nonrandomized controlled trial, with baseline, 3 month, and 6-month follow-up assessments. The intervention consisted of using the web-based CoEd application for 3 months to 6 months. This application is composed of a child?s file in which stakeholders of the support team can share information about the child?s profile, skills, aids and adaptations, and daily events. The control group is asked to function as usual to support the child in inclusive settings. To be eligible, a support team must be composed of at least two stakeholders, including at least one of the parents. Additionally, the pupil had to be aged between 10 years and 16 years, enrolled in secondary school, be taught in mainstream settings, and have an established or ongoing diagnosis of autism spectrum disorder, attention-deficit/hyperactivity disorder, or intellectual disability (IQ<70). Primary outcome measures cover stakeholders? relationships, self-efficacy, and attitudes toward inclusive education, while secondary outcome measures are related to stakeholders? burden and quality of life, as well as children?s school well-being and quality of life. We plan to analyze data using ANCOVA to investigate pre-post and group effects, with a technological skills questionnaire as the covariate. Results: After screening for eligibility, 157 participants were recruited in 37 support teams, composed of at least one parent and one professional (school, health care). In September 2023, after the baseline assessment, the remaining 127 participants were allocated to the CoEd intervention (13 teams; n=82) or control condition (11 teams; n=45). Conclusions: We expect that the CoEd application will improve the quality of interpersonal relationships in children?s IEP teams (research question [RQ]1), will show benefits for the child (RQ2), and improve the well-being of the child and the stakeholders (RQ3). Thanks to the participatory design, we also expect that the CoEd application will elicit a good user experience (RQ4). The results from this study could have several implications for educational technology research, as it is the first to investigate the impacts of a technological tool on co-educational processes. International Registered Report Identifier (IRRID): DERR1-10.2196/63378 UR - https://www.researchprotocols.org/2025/1/e63378 UR - http://dx.doi.org/10.2196/63378 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63378 ER - TY - JOUR AU - Kato, Daigo AU - Okuno, Akiko AU - Ishikawa, Tetsuo AU - Itakura, Shoji AU - Oguchi, Shinji AU - Kasahara, Yoshiyuki AU - Kanenishi, Kenji AU - Kitadai, Yuzo AU - Kimura, Yoshitaka AU - Shimojo, Naoki AU - Nakahara, Kazushige AU - Hanai, Akiko AU - Hamada, Hiromichi AU - Mogami, Haruta AU - Morokuma, Seiichi AU - Sakurada, Kazuhiro AU - Konishi, Yukuo AU - Kawakami, Eiryo PY - 2025/4/4 TI - Multilevel Factors and Indicators of Atypical Neurodevelopment During Early Infancy in Japan: Prospective, Longitudinal, Observational Study JO - JMIR Pediatr Parent SP - e58337 VL - 8 KW - early developmental signs KW - neurodevelopmental screening KW - risk factors KW - prediction KW - early intervention KW - longitudinal study N2 - Background: The early identification of developmental concerns requires understanding individual differences that may represent early signs of neurodevelopmental conditions. However, few studies have longitudinally examined how child and maternal factors interact to shape these early developmental characteristics. Objective: We aim to identify factors from the perinatal to infant periods associated with early developmental characteristics that may precede formal diagnoses and propose a method for evaluating individual differences in neurodevelopmental trajectories. Methods: A prospective longitudinal observational study of 147 mother-child pairs was conducted from gestation to 12 months post partum. Assessments included prenatal questionnaires and blood collection, cord blood at delivery, and postpartum questionnaires at 1, 6, and 12 months. The Modified Checklist for Autism in Toddlers (M-CHAT) was used to evaluate developmental characteristics that might indicate early signs of atypical neurodevelopment. Polychoric or polyserial correlation coefficients assessed relationships between M-CHAT scores and longitudinal variables. L2-regularized logistic regression and Shapley Additive Explanations predicted M-CHAT scores and determined feature contributions. Results: Twenty-one factors (4 prenatal, 3 at birth, and 14 postnatal) showed significant associations with M-CHAT scores (adjusted P values<.05). The predictive accuracy for M-CHAT scores demonstrated reasonable predictive accuracy (area under the receiver operating characteristic curve=0.79). Key predictors included infant sleep status after 6 months (nighttime sleep duration, bedtime, and difficulties falling asleep), maternal Kessler Psychological Distress Scale scores, and Mother-to-Infant Bonding Scale scores after late gestation. Conclusion: Maternal psychological distress, mother-infant bonding, and infant sleep patterns were identified as significant predictors of early developmental characteristics that may indicate emerging developmental concerns. This study advances our understanding of early developmental assessment by providing a novel approach to identifying and evaluating early indicators of atypical neurodevelopment. UR - https://pediatrics.jmir.org/2025/1/e58337 UR - http://dx.doi.org/10.2196/58337 ID - info:doi/10.2196/58337 ER - TY - JOUR AU - Dolón-Poza, María AU - Gabaldón-Pérez, Ana-Marta AU - Berrezueta-Guzman, Santiago AU - López Gracia, David AU - Martín-Ruiz, María-Luisa AU - Pau De La Cruz, Iván PY - 2025/3/14 TI - Enhancing Early Language Disorder Detection in Preschools: Evaluation and Future Directions for the Gades Platform JO - JMIR Hum Factors SP - e60424 VL - 12 KW - developmental language disorder KW - simple language delay KW - adaptive screening system KW - early childhood education KW - pervasive therapy N2 - Background: Language acquisition is a critical developmental milestone, with notable variability during the first 4 years of life. Developmental language disorder (DLD) often overlaps with other neurodevelopmental disorders or simple language delay (SLD), making early detection challenging, especially for primary caregivers. Objective: We aimed to evaluate the effectiveness of the Gades platform, an adaptive screening tool that enables preschool teachers to identify potential language disorders without direct support from nursery school language therapists (NSLTs). Methods: The study took place in a nursery school and an early childhood educational and psychopedagogical center in Madrid, Spain, involving 218 children aged 6 to 36 months, 24 preschool teachers, and 2 NSLTs. Initially, NSLTs conducted informational sessions to familiarize teachers with DLDs and how to identify them. Following this, the teachers used the Gades platform to conduct language screenings independently, without ongoing support from NSLTs. The Gades platform was enhanced to collect detailed profiles of each child and implemented an adaptive screening model tailored to account for variability in language development. This setup allowed preschool teachers, who are not language experts, to observe and assess language development effectively in natural, unsupervised educational environments. The study assessed the platform?s utility in guiding teachers through these observations and its effectiveness in such settings. Results: Gades identified language difficulties in 19.7% (43/218) of the children, with a higher prevalence in boys (29/218, 13.3%) than in girls (14/218, 6.4%). These challenges were most frequently observed in children aged 15 to 27 months. The platform demonstrated a high accuracy rate of 97.41%, with evaluators largely agreeing with its recommendations. Teachers also found Gades to be user friendly and a valuable tool for supporting language development observations in everyday educational settings. Conclusions: Gades demonstrates potential as a reliable and accessible tool for early detection of language disorders, empowering educators to identify DLD and SLD in the absence of NSLTs. However, further refinement of the platform is required to effectively differentiate between DLD and SLD. By integrating Gades into routine preschool assessments, educators can facilitate timely interventions, bridging gaps in early childhood education and therapy. Trial Registration: Pan-African Clinical Trial Registry (PACTR) PACTR202210657553944; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=24051 UR - https://humanfactors.jmir.org/2025/1/e60424 UR - http://dx.doi.org/10.2196/60424 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60424 ER - TY - JOUR AU - Lindhiem, Oliver AU - Tomlinson, S. Claire AU - Kolko, J. David AU - Silk, S. Jennifer AU - Hafeman, Danella AU - Wallace, Meredith AU - Setiawan, Agus I. Made AU - Parmanto, Bambang PY - 2025/3/11 TI - Novel Smartphone App and Supportive Accountability for the Treatment of Childhood Disruptive Behavior Problems: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e67051 VL - 14 KW - mobile health KW - disruptive behaviors KW - parent management training KW - randomized controlled trial KW - externalizing behavior N2 - Background: Although evidence-based treatments have been developed for childhood behavior problems, many families encounter barriers to treatment access and completion (eg, local availability of services, transportation, cost, and perceived stigma). Smartphone apps offer a cost-efficient method to deliver content to families. Objective: The aim of this study is to evaluate the effectiveness of the UseIt! mobile health system as both stand-alone and coach-assisted interventions via a randomized controlled trial. The UseIt! System is designed to reduce disruptive behaviors in young children. Methods: A nationwide sample of parents of children aged 5 years to 8 years with disruptive behaviors (N=324 dyads) are randomly assigned to the stand-alone app (UseIt!; n=108), the coach-assisted app (UseIt! plus supportive accountability; n=108), or the control app (mindfulness app; n=108). The UseIt! App provides parents with tools and troubleshooting to address disruptive behaviors, along with a behavior diary to track behaviors and strategies over time. The coach-assisted condition includes a bachelor?s level paraprofessional who provides weekly phone calls to promote engagement with the app. The control condition is composed of a mindfulness app. The web-based, self-assessed outcome measures (post treatment and 6-month follow-up) include measures of app usage, parenting knowledge (eg, knowledge of parent management training and cognitive behavioral therapy skills), and strategies (use of evidence-based parenting strategies), symptom reduction (eg, behavior problems), and parent mental health (eg, anxiety, stress, and depression). We hypothesize that both intervention conditions will show greater parent knowledge and use of skills along with greater symptom reduction relative to the control condition. Further, we hypothesize that those assigned to the coach assisted condition will report greater knowledge, skill use, and symptom reduction than the stand-alone app. We will use intent-to-treat analyses to regress outcomes on study conditions to evaluate for differences across conditions. Results: Recruitment of study participants began in December of 2022 and is ongoing. We have recruited over half of our intended sample of 324 parent-child dyads (n=214) as of December 2024. These dyads have been randomly allocated to each of the intervention conditions, with 71 assigned to the coach-assisted condition, 72 assigned to the stand-alone app, and 71 assigned to the control app condition. Data collection is projected to be completed by late 2026. Conclusions: The current study aims to address a gap in the literature regarding the feasibility, effectiveness, and utility of a smartphone app that includes a coach-assisted arm. Digital therapeutics have the potential to enhance the reach and scalability of skills-based psychosocial interventions. Findings from this study will advance scientific knowledge and have implications for clinical practice. Trial Registration: ClinicalTrials.gov NCT05647772; https://clinicaltrials.gov/study/NCT05647772 International Registered Report Identifier (IRRID): DERR1-10.2196/67051 UR - https://www.researchprotocols.org/2025/1/e67051 UR - http://dx.doi.org/10.2196/67051 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67051 ER - TY - JOUR AU - Chen, Hao AU - Sun, Yi AU - Luo, Sha AU - Ma, Yingyan AU - Li, Chenshu AU - Xiao, Yingcheng AU - Zhang, Yimeng AU - Lin, Senlin AU - Jia, Yingnan PY - 2025/3/5 TI - Association of Screen Content With Early Development Among Preschoolers in Shanghai: 7-Day Monitoring Study With Auto Intelligent Technology JO - J Med Internet Res SP - e65343 VL - 27 KW - types of screen content KW - screen time KW - intelligent technology KW - early development KW - preschool N2 - Background: It is unclear how exposure to different types of screen content is associated with early development among preschool children. Objective: This study aims to precisely evaluate the screen exposure time across different content types and to explore the associations with the Ages and Stages Questionnaire, Third Edition (ASQ-3) score and 5 capacity domains in children aged 34.5-66 months. Methods: This monitoring study used intelligent technology to collect data on the 7-day screen time and the time spent viewing each content type. The participants were 2 groups of Shanghai kindergarten kids. The data were collected between March 2023 and July 2023. Screen exposure data (total daily time and time for each type of content) were collected from children aged between 34.5 and 66 months. A self-designed questionnaire and the Healthy Screen Viewing for Children intelligent technology app were used to assess screen exposure to all media and tablets. The ASQ-3 was used to assess early development in children aged 34.5-66 months. Results: In the 535-child sample, the results of linear regression analysis indicated that both screen time of more than 60 minutes and exposure to smartphones and tablets were negatively associated with ASQ-3 score. Among 365 participants with data collected by the Healthy Screen Viewing for Children app, median regression showed that the median total ASQ-3 score was negatively associated with screen time for noneducational content (?=?.055; 95% CI ?0.148 to ?0.006; P=.03), screen time for both educational and noneducational content (?=?.042; 95% CI ?0.081 to ?0.007; P=.001), and fast-paced content (?=?.034; 95% CI ?0.062 to ?0.011; P=.049). The median gross motor score was negatively associated with screen time for parental guidance-13?rated content (?=?.015; 95% CI ?0.022 to 0.009; P=.03), educational and noneducational content (?=?.018, 95% CI ?0.038 to ?0.001; P=.02), static content (?=?.022; 95% CI ?0.050 to 0.007; P=.02). This study also revealed that the median fine motor score was negatively associated with screen time for guidance?rated content (?=?.032, 95% CI ?0.057 to ?0.003; P=.006), parental guidance (PG) rated content (?=?.020; 95% CI ?0.036 to ?0.007; P=.004), noneducational content (?=?.026; 95% CI ?0.067 to ?0.003; P=.01), both educational and noneducational content (?=?.020; 95% CI ?0.034 to ?0.001; P<.001), fast-paced content (?=?.022; 95% CI ?0.033 to ?0.014; P<.001), static content (?=?.034; 95% CI ?0.050 to 0.018; P<.001), animated content (?=?.038; 95% CI ?0.069 to ?0.001; P=.004), and screen use during the daytime (?=?.026; 95% CI ?0.043 to 0.005; P=.005). Conclusions: The results indicated that the time spent viewing noneducational, static, fast-paced, and animated content was negatively associated with early development among preschool children. Limiting screen time in relevant aspects is recommended. UR - https://www.jmir.org/2025/1/e65343 UR - http://dx.doi.org/10.2196/65343 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053802 ID - info:doi/10.2196/65343 ER - TY - JOUR AU - Lu, Hsin-Hui AU - Liang, Shih-Yuan AU - Huang, Yi-Chia PY - 2025/2/11 TI - Efficacy, Feasibility, and Acceptability of an Emotional Competence Tele-Intervention for Mandarin-Speaking Children Aged 5 to 7 Years With Developmental Language Disorder: Pilot Study With an Interrupted Time-Series Design JO - JMIR Pediatr Parent SP - e60333 VL - 8 KW - language disorder KW - pediatrics KW - evidence-based intervention KW - telemedicine KW - tele-practice KW - visual support KW - mobile phone N2 - Background: Children with developmental language disorder (DLD) often experience language difficulties that hinder their ability to acquire emotional competence. Poor emotional competence is associated with emotional and behavioral problems in young children. Objective: This research involved two studies focusing on (1) the emotional competence of Mandarin-speaking children aged 5 to 7 years with DLD and (2) the efficacy, feasibility, and acceptability of a tele-intervention designed to enhance their emotional competence in Taiwan. Methods: Five children with DLD from study 1 declined to participate in study 2, the emotional competence tele-intervention, and were excluded from the analysis. We compared the emotional competence of 20 Mandarin-speaking children with DLD to that of 24 children with typical language development (TLD). The children with DLD were, on average, aged 5.79 (SD 0.47) years, whereas the children with TLD were, on average, aged 5.93 (SD 0.31) years. We assessed the children?s emotional competence, nonverbal ability, verbal comprehension, vocabulary acquisition, and expressive language skills. In study 2, all children with DLD included in study 1 engaged in an emotional competence tele-intervention. An interrupted time-series design was used to examine their emotional competence. In total, 20 children with DLD provided data on emotional competence evaluated using the Emotional Lexicon Test. These data were individually collected at 3 time points after study 1 (time 1). These phases included baseline (time 1 to time 2), during the tele-intervention (time 2 to time 3), and follow-up (time 3 to time 4), spanning approximately 18 to 20 weeks from time 1 to time 4. Recruitment, retention, and attendance rates were calculated to evaluate the intervention?s feasibility, and participant mood was evaluated after each session to calculate the intervention?s acceptability. Results: No significant changes in the children?s ability to understand basic or complex emotional terms were observed during the baseline period. However, changes were observed during the tele-intervention period, and these changes remained throughout the follow-up period. With a recruitment rate of 80% (20/25), all participants completed 4 intervention sessions, with retention and attendance rates exceeding 95% (19/20). A total of 90% (18/20) of the participants deemed each session to be acceptable. Conclusions: Mandarin-speaking children aged 5 to 7 years with DLD exhibited lower emotional competence compared with their counterparts with TLD. Tele-interventions are effective in enhancing the emotional competence of children with DLD, demonstrating feasibility and acceptability for these children and their parents in Taiwan. UR - https://pediatrics.jmir.org/2025/1/e60333 UR - http://dx.doi.org/10.2196/60333 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60333 ER - TY - JOUR AU - Zhou, Xuelian AU - Zhang, Xiaochi AU - Bai, Guannan AU - Dong, Guanping AU - Li, Xinyi AU - Chen, Ruimin AU - Chen, Shaoke AU - Zheng, Rongxiu AU - Wang, Chunlin AU - Wei, Haiyan AU - Cao, Bingyan AU - Liang, Yan AU - Yao, Hui AU - Su, Zhe AU - Maimaiti, Mireguli AU - Luo, Feihong AU - Li, Pin AU - Zhu, Min AU - Du, Hongwei AU - Yang, Yu AU - Cui, Lanwei AU - Wang, Jinling AU - Yuan, Jinna AU - Liu, Zhuang AU - Wu, Wei AU - Zhao, Qi AU - Fu, Junfen PY - 2025/2/7 TI - Long-Term Exposure to Fine Particulate Matter (PM2.5) Components and Precocious Puberty Among School-Aged Children: Cross-Sectional Study JO - JMIR Public Health Surveill SP - e62861 VL - 11 KW - fine particulate matter KW - PM2.5 KW - PM2.5 components KW - air pollution KW - precocious puberty KW - children KW - long-term exposure N2 - Background: The increasing incidence of precocious puberty is a major health challenge for Chinese children, while related risk factors remain less well explored. Exposure to ambient fine particulate matter (PM2.5) is a leading environmental hazard in China. Although certain components of PM2.5 have been reported to be endocrine disruptors for sex hormones, population-based evidence is still lacking on the association between PM2.5 exposure and precocious puberty in China. Objective: Based on a cross-sectional survey covering 30 cities in 2017 to 2019, this study was designed to explore the association between long-term exposure to PM2.5 and its 5 major components with precocious puberty in China and to check the potential modifying effects of family-related and personal factors. Methods: We included 34,105 children aged 6 to 9 years. We collected the 5-year average concentrations of PM2.5 and its 5 major components (sulfate, nitrate, ammonium, organic matter, and black carbon) in the area (at a spatial resolution of 0.1° × 0.1°) where each school was located. We used mixed effect logistic regression to estimate the effect sizes of the total mass of PM2.5 and each of its components on precocious puberty, and we examined the modifying effects of family-related and personal factors using an additional interactive term. A weighted quantile sum (WQS) regression model was applied to identify the weights of each component in explaining the effect size of the total mass of PM2.5. Results: We found that the odds ratio (OR) for precocious puberty per IQR increase in the concentration of total PM2.5 mass was 1.27 (95% CI 0.92-1.75) for the whole population, 2.12 (95% CI 1.27-3.55) for girls, and 0.90 (95% CI 0.62-1.30) for boys. Similarly, the effect sizes of the 5 major components were all substantial for girls but minimal for boys. Results of the WQS analysis showed that organic matter could explain the highest proportion of the effect of PM2.5, with the weight of its contribution being 0.71. Modification effects of family income and dietary habits were only observed in certain population subgroups. Conclusions: Long-term exposure to total PM2.5 mass was significantly associated with precocious puberty in girls, with organic matter identified as the major effect contributor. The results add evidence on the detrimental effects of PM2.5 on children?s development and growth. UR - https://publichealth.jmir.org/2025/1/e62861 UR - http://dx.doi.org/10.2196/62861 ID - info:doi/10.2196/62861 ER - TY - JOUR AU - da Rosa, Teixeira André Luiz Schuh AU - da Costa, Barreto Marina Ribeiro AU - Sorato, Bezerra Gabriela AU - Manjabosco, Moura Felipe de AU - de Bem, Bonganhi Érica AU - Dellazari, Lucas AU - Falcão, Bezerra Arthur AU - Cia, Oliveira Lucas de AU - Bezerra, Sorato Olivia AU - Borges, Boff Rogério AU - Rohde, Augusto Luis AU - Graeff-Martins, Soledade Ana PY - 2025/1/30 TI - Clozapine for Treatment-Resistant Disruptive Behaviors in Youths With Autism Spectrum Disorder Aged 10-17 Years: Protocol for an Open-Label Trial JO - JMIR Res Protoc SP - e58031 VL - 14 KW - neurodevelopmental disorders KW - clozapine KW - psychopharmacology KW - antipsychotic medication KW - autism spectrum disorder KW - youth N2 - Background: Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition emerging in early childhood, characterized by core features such as sociocommunicative deficits and repetitive, rigid behaviors, interests, and activities. In addition to these, disruptive behaviors (DB), including aggression, self-injury, and severe tantrums, are frequently observed in pediatric patients with ASD. The atypical antipsychotics risperidone and aripiprazole, currently the only Food and Drug Administration?approved treatments for severe DB in patients with ASD, often encounter therapeutic failure or intolerance. Given this, exploring pharmacological alternatives for more effective management of DB associated with ASD is essential. Clozapine, noted for its unique antiaggressive effects in schizophrenia and in various treatment-resistant neuropsychiatric disorders, independent from its antipsychotic efficacy, remains underexplored in youths with ASD facing severe and persistent DB. Objective: This study aimed to evaluate the efficacy, tolerability, and safety of clozapine for treatment-resistant DB in youths with ASD. Methods: This is a prospective, single-center, noncontrolled, open-label trial. After a cross-titration phase, 31 patients with ASD aged 10-17 years and with treatment-resistant DB received a flexible dosage regimen of clozapine (up to 600 mg/day) for 12 weeks. Standardized instruments were applied before, during, and after the treatment, and rigorous clinical monitoring was performed weekly. The primary outcome was assessed using the Irritability Subscale of the Aberrant Behavior Checklist. Other efficacy measures include the Clinical Global Impression Severity and Improvement, the Swanson, Nolan, and Pelham questionnaire-IV, the Childhood Autism Rating Scale, and the Vineland Adaptive Behavior Scale. Safety and tolerability measures comprised adverse events, vital signs, electrocardiography, laboratory tests, physical measurements, and extrapyramidal symptoms with the Simpsons-Angus Scale. Statistical analysis will include chi-square tests with Monte Carlo simulation for categorical variables, paired t tests or Wilcoxon tests for continuous variables, and multivariate linear mixed models to evaluate the primary outcome, adjusting for confounders. Results: Recruitment commenced in February 2023. Data collection was concluded by April 2024, with analysis ongoing. This article presents the protocol of the initially planned study to provide a detailed methodological description. The results of this trial will be published in a future paper. Conclusions: The urgent need for effective pharmacological therapies in mitigating treatment-resistant DB in pediatric patients with ASD underscores the importance of this research. Our study represents the first open-label trial to explore the anti-aggressive effects of clozapine in this specific demographic, marking a pioneering step in clinical investigation. Adopting a pragmatic approach, this trial protocol aims to mirror real-world clinical settings, thereby enhancing the applicability and relevance of our findings. The preliminary nature of future results from this research has the potential to pave the way for more robust studies and emphasize the need for continued innovation in ASD treatment. Trial Registration: Brazilian Clinical Trials Registry RBR-54j3726; https://ensaiosclinicos.gov.br/rg/RBR-54j3726 International Registered Report Identifier (IRRID): DERR1-10.2196/58031 UR - https://www.researchprotocols.org/2025/1/e58031 UR - http://dx.doi.org/10.2196/58031 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58031 ER - TY - JOUR AU - Shin, Yoomi AU - Park, Ju Eun AU - Lee, Anna PY - 2025/1/17 TI - Early Intervention for Children With Developmental Disabilities and Their Families via Telehealth: Systematic Review JO - J Med Internet Res SP - e66442 VL - 27 KW - developmental disabilities KW - developmental delay KW - early intervention KW - telehealth KW - digital intervention KW - autistic spectrum disorder KW - cerebral palsy KW - family-centered care KW - multidisciplinary care KW - systematic review N2 - Background: Early intervention during the first 3 years of life is crucial for children with developmental disabilities to optimize developmental outcomes. However, access to such services is often limited by geographical distance and resource constraints. Telehealth can be part of a solution for overcoming these barriers, enabling the delivery of early intervention services. However, a comprehensive understanding of the efficacy and implementation of telehealth in early interventions remains elusive, particularly for children aged 0-3 years. Objective: This systematic review aims to synthesize existing research on the effectiveness and implementation of telehealth interventions in infants and toddlers (aged 0?3 years) who are at risk of or diagnosed with developmental disabilities. The primary objective of the study is to evaluate the ways that telehealth compares to conventional in-person interventions in improving developmental outcomes for children and supporting family well-being. Methods: A systematic search was conducted of 4 electronic databases (PubMed, Embase, CINAHL, and Web of Science), focusing on studies published between 2010 and 2024. The inclusion criteria were studies involving telehealth interventions for children aged 0-3 years who were at high risk or had developmental disabilities, which involved active interactions between the providers and the families. Study quality was assessed using the mixed methods appraisal tool, and a narrative synthesis was used to analyze the data. Results: Eighteen studies met the inclusion criteria: 12 single-case designs, 4 randomized controlled trials, and 2 nonequivalent control group designs. All studies involved caregiver-child dyads, with child ages ranging from 5 to 37 months and having or at risk of autistic spectrum disorder (n=10, 56%), cerebral palsy (n=4, 22%), and other conditions (n=4, 22%). Synchronous videoconferencing was the primary modality for caregiver training and coaching (n=17, 94%) while 1 intervention used an Internet of Things system. Outcomes were identified in child communication (n=9, 50%), physical (n=6, 33%), social or emotional (n=6, 33%), and adaptive behavior (n=4, 22%), as well as caregiver implementation (n=12, 66%). Telehealth demonstrated comparable or superior effectiveness to traditional in-person methods in 2 studies. However, the focus on specific conditions and limited research on cognitive development were notable gaps. Conclusions: Telehealth can be a viable alternative to traditional in-person early interventions for young children who have developmental disabilities and their families. It enhances accessibility and interactions between families and providers at a distance while promoting family-centered care. Challenges exist, including those of technological literacy, and the lack of research on cognitive outcomes must be addressed. Future work should explore more comprehensive interventions, including multidisciplinary approaches and expanded family outcomes, to solidify the role that telehealth plays in early intervention. Trial Registration: PROSPERO CRD42024551286; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=551286 UR - https://www.jmir.org/2025/1/e66442 UR - http://dx.doi.org/10.2196/66442 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66442 ER - TY - JOUR AU - Kim, Hyung Do AU - Jeong, Won Joo AU - Kang, Dayoung AU - Ahn, Taekyung AU - Hong, Yeonjung AU - Im, Younggon AU - Kim, Jaewon AU - Kim, Jung Min AU - Jang, Dae-Hyun PY - 2025/1/14 TI - Usefulness of Automatic Speech Recognition Assessment of Children With Speech Sound Disorders: Validation Study JO - J Med Internet Res SP - e60520 VL - 27 KW - speech sound disorder KW - speech recognition software KW - speech articulation tests KW - speech-language pathology KW - child N2 - Background: Speech sound disorders (SSDs) are common communication challenges in children, typically assessed by speech-language pathologists (SLPs) using standardized tools. However, traditional evaluation methods are time-intensive and prone to variability, raising concerns about reliability. Objective: This study aimed to compare the evaluation outcomes of SLPs and an automatic speech recognition (ASR) model using two standardized SSD assessments in South Korea, evaluating the ASR model?s performance. Methods: A fine-tuned wav2vec 2.0 XLS-R model, pretrained on 436,000 hours of adult voice data spanning 128 languages, was used. The model was further trained on 93.6 minutes of children?s voices with articulation errors to improve error detection. Participants included children referred to the Department of Rehabilitation Medicine at a general hospital in Incheon, South Korea, from August 19, 2022, to June 14, 2023. Two standardized assessments?the Assessment of Phonology and Articulation for Children (APAC) and the Urimal Test of Articulation and Phonology (U-TAP)?were used, with ASR transcriptions compared to SLP transcriptions. Results: This study included 30 children aged 3-7 years who were suspected of having SSDs. The phoneme error rates for the APAC and U-TAP were 8.42% (457/5430) and 8.91% (402/4514), respectively, indicating discrepancies between the ASR model and SLP transcriptions across all phonemes. Consonant error rates were 10.58% (327/3090) and 11.86% (331/2790) for the APAC and U-TAP, respectively. On average, there were 2.60 (SD 1.54) and 3.07 (SD 1.39) discrepancies per child for correctly produced phonemes, and 7.87 (SD 3.66) and 7.57 (SD 4.85) discrepancies per child for incorrectly produced phonemes, based on the APAC and U-TAP, respectively. The correlation between SLPs and the ASR model in terms of the percentage of consonants correct was excellent, with an intraclass correlation coefficient of 0.984 (95% CI 0.953-0.994) and 0.978 (95% CI 0.941-0.990) for the APAC and UTAP, respectively. The z scores between SLPs and ASR showed more pronounced differences with the APAC than the U-TAP, with 8 individuals showing discrepancies in the APAC compared to 2 in the U-TAP. Conclusions: The results demonstrate the potential of the ASR model in assessing children with SSDs. However, its performance varied based on phoneme or word characteristics, highlighting areas for refinement. Future research should include more diverse speech samples, clinical settings, and speech data to strengthen the model?s refinement and ensure broader clinical applicability. UR - https://www.jmir.org/2025/1/e60520 UR - http://dx.doi.org/10.2196/60520 UR - http://www.ncbi.nlm.nih.gov/pubmed/39576242 ID - info:doi/10.2196/60520 ER - TY - JOUR AU - Boulton, Ann Kelsie AU - Hilton, Makana AU - Sutton, Emilia AU - Guastella, John Adam PY - 2025/1/1 TI - Apps and Digital Resources for Child Neurodevelopment, Mental Health, and Well-Being: Review, Evaluation, and Reflection on Current Resources JO - J Med Internet Res SP - e58693 VL - 27 KW - digital tools KW - neurodevelopmental conditions KW - mental health KW - digital health KW - implementation KW - digital interventions KW - child neurodevelopment KW - digital technology KW - mobile phone N2 - Background: An increase in the prevalence of neurodevelopmental conditions worldwide, alongside resource constraints within clinical services, has led to increased interest in health information technologies, such as apps and digital resources. Digital tools are often viewed as a solution to bridge this divide and to increase supports for families. There is, however, a paucity of research that has evaluated digital health tools, their potential benefits for child neurodevelopment and associated concerns (eg, mental health, well-being), and their benefit for families. Objective: This study conducted the first review of existing mobile apps and digital resources targeted at supporting the needs of children with developmental concerns or neurodevelopmental conditions. Methods: We identified 3435 separate resources, of which 112 (43 apps and 69 digital resources) met the criteria. These resources were categorized according to their purpose or target and were then reviewed based on their engagement, information quality, and evidence base using the Adapted Mobile App Rating Scale. Results: The most common condition of concern targeted by apps and digital resources was autism (19/112, 17% resources), with retrieved resources focusing on supporting challenging behaviors, promoting speech, language, and social development, and providing options for alternative and assistive communication. Other common areas of concern targeted by apps and digital resources included language and communication (16/112, 14.3%) and attention-deficit/hyperactivity disorder (11/112, 9.8%). Results showed that reviewed resources were engaging, with high levels of accessibility and functionality. Resources had various functions, including developmental or behavioral tasks targeted at children, assistive communication support, scheduling support, journaling, and advice, activities, and strategies for parents. The information quality of resources, such as credibility of source and evidence base was, however, mostly low. Apps and digital resources with good credibility and an existing evidence base were largely developed in partnership with research, health, or government institutions, and were rated significantly higher on overall quality compared with apps and digital resources not developed in partnership with such institutions (apps; t41=?4.35, P<.001; digital resources; t67=?4.95, P<.001). Conclusions: The lack of evidence base across resources means that it is extremely difficult to provide recommendations to families with respect to apps or digital resources that may support their needs. Frameworks for the development of new tools are discussed, highlighting the novel approaches required to demonstrate the efficacy of tools for improving outcomes for children and families. Such a framework requires collaboration with multiple stakeholders (software developers, researchers, regulatory bodies, clinicians, children, and families) and engagement across multiple levels of expertise (app development, implementation, and dissemination within services, policy, and clinical regulations), to harness the potential of digital health for improving outcomes and promoting support in child neurodevelopment, which at this juncture remains largely underdeveloped. UR - https://www.jmir.org/2025/1/e58693 UR - http://dx.doi.org/10.2196/58693 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58693 ER - TY - JOUR AU - Erika, Ayu Kadek AU - Fadilah, Nur AU - Latif, Insani Aulia AU - Hasbiah, Nurhikmawaty AU - Juliaty, Aidah AU - Achmad, Harun AU - Bustamin, Anugrayani PY - 2024/12/17 TI - Stunting Super App as an Effort Toward Stunting Management in Indonesia: Delphi and Pilot Study JO - JMIR Hum Factors SP - e54862 VL - 11 KW - stunting KW - stunting prevention KW - mobile app N2 - Background: Currently, 30 million children are experiencing acute malnutrition, and 8 million children are severely underweight. Objective: This study aimed to develop a stunting super app, a one-stop app designed to prevent and manage stunting in Indonesia. Methods: This study consisted of three stages. Stage 1 used a 3-round Delphi study involving 12 experts. In stage 2, 4 experts and a parent of children with stunted growth created an Android app containing stunting educational materials. In stage 3, a pilot study involving a control group was conducted to evaluate parents? knowledge about stunting prevention through the app and standard interventions. Results: In the Delphi study, 11 consensus statements were extracted; arranged in three major themes, including maternal health education, child health education, and environmental education; and applied in the form of the Sistem Evaluasi Kesehatan Anak Tumbuh Ideal (SEHATI) app. This app was assessed using a content validity index, with a cumulative agreement of ?80% among the 5 individuals. The pilot study showed an increase in the knowledge of mothers of toddlers with stunted growth before and after the educational intervention (P=.001). Conclusions: The SEHATI app provides educational content on stunting prevention that can increase the knowledge of mothers of toddlers with stunted growth. UR - https://humanfactors.jmir.org/2024/1/e54862 UR - http://dx.doi.org/10.2196/54862 ID - info:doi/10.2196/54862 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 - Diaz-Ordoñez, Lorena AU - Duque-Cordoba, Andrea Paola AU - Nieva-Posso, Andrés Daniel AU - Saldarriaga, Wilmar AU - Gutierrez-Medina, David Juan AU - Pachajoa, Harry PY - 2024/11/14 TI - Phenotype-Genotype Correlation in Morquio A Syndrome: Protocol for a Meta-Analysis JO - JMIR Res Protoc SP - e56649 VL - 13 KW - Morquio A syndrome KW - genotype-phenotype associations KW - rare diseases KW - scoping review KW - Mucopolysaccharidosis type IV KW - meta-analysis KW - genotype KW - GALNS gene KW - N-acetylgalactosamine-6-sulfatase KW - pathophysiology KW - laboratories KW - mutations N2 - Background: Mucopolysaccharidosis type IVA (MPS IVA), also known as Morquio A syndrome, is a rare lysosomal storage disease characterized by autosomal recessive inheritance of mutations in the N-acetylgalactosamine-6-sulfatase (GALNS) gene. This leads to a deficiency of the GALNS enzyme, causing the accumulation of glycosaminoglycans in tissues. Morquio A syndrome primarily affects the skeletal system and joints but can also impact various organs, resulting in symptoms such as hearing and vision loss, respiratory issues, spinal cord compression, heart diseases, and hepatomegaly. The genotype-phenotype relationship is diverse, with studies highlighting variants associated with classic, nonclassic, or intermediate phenotypes. Understanding these genetic factors is crucial for predicting disease prognosis and tailoring effective treatment strategies for individuals with Morquio A syndrome. Objective: The aim of this meta-analysis is to comprehend the relationship between the severity of the phenotype and the genotype of patients with MPS IVA, considering factors such as the type of variant and its location in the different domains of the protein. Methods: This meta-analysis will include articles featuring participants of all genders and age groups who have a molecular diagnosis of MPS IVA and a description of the phenotype. Literature published in English, Spanish, and Portuguese will be considered. Exclusion criteria will encompass studies lacking full-text availability and those involving patients with an MPS IVA diagnosis but without phenotype information. The databases to be searched include PubMed, MEDLINE, ScienceDirect, and Scopus. The screening of literature, paper selection, and data extraction will involve 2 independent reviewers, who will conduct the process blindly. In the event of disagreements between the 2 reviewers at any stage, resolution will be sought through discussion or with the involvement of an additional reviewer. The final selection of manuscripts will be based on consensus. The results of the review will be presented using descriptive statistics, and the information will be organized in either diagrammatic or tabular formats, following the guidelines provided by the Joanna Briggs Institute. Genotype-phenotype relationships will be analyzed using IBM SPSS Statistics, using chi-square tests, Fisher exact tests, and regression analysis to interpret the data. Results: A literature search conducted in January 2024 produced 760 results. The review is expected to be completed by the end of 2024. Conclusions: This meta-analysis will gather and analyze information on the phenotype-genotype relationship in patients diagnosed with MPS IVA. The data collection and resulting analyses will make a substantial contribution to understanding the underlying mechanism of the disease, enabling the prediction of the syndrome?s progression and severity. International Registered Report Identifier (IRRID): DERR1-10.2196/56649 UR - https://www.researchprotocols.org/2024/1/e56649 UR - http://dx.doi.org/10.2196/56649 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56649 ER - TY - JOUR AU - Yu, Yanqiu AU - Ng, Hoi-Yuk Joyce AU - Li, Ji-bin AU - Zhang, Jianxin AU - Lau, F. Joseph T. PY - 2024/11/14 TI - Cognitive Mechanisms Between Psychosocial Resources and the Behavioral Intention of Professional Help-Seeking for Internet Gaming Disorder Among Chinese Adolescent Gamers: Cross-Sectional Mediation Study JO - JMIR Public Health Surveill SP - e52478 VL - 10 KW - professional help-seeking KW - behavioral intention KW - internet gaming disorder KW - IGD KW - perception KW - China KW - mental health KW - psychosocial resource KW - secondary school KW - gamer KW - cross-sectional survey N2 - Background: Internet gaming disorder (IGD) is a global public health concern for adolescents due to its potential severe negative consequences. Professional help-seeking is important for early screening, diagnosis, and treatment of IGD. However, research on the factors associated with professional help-seeking for IGD as well as relevant mediation mechanisms among adolescents is limited. Objective: Based on the stress coping theory, the conservation of resource theory, and behavioral change theories, this study investigated the prevalence and factors influencing the behavioral intention of professional help-seeking for internet gaming disorder (BI-PHSIGD). The research also explored the underlying mechanisms, including psychosocial resources like resilience and social support, perceived resource loss due to reduced gaming time, and self-efficacy, in professional help-seeking among adolescent internet gamers. Methods: A cross-sectional survey was conducted among secondary school students who were internet gamers in 2 Chinese cities from October 2019 to January 2020. Data from the full sample (N=1526) and a subsample of 256 IGD cases (according to the 9-item DSM-5 [Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition] IGD Checklist) were analyzed. Multivariate logistic regression analysis was conducted to examine the factors of BI-PHSIGD, while structural equation modeling was performed to test the proposed mediation mechanisms. Results: The prevalence of BI-PHSIGD was 54.3% (829/1526) in the full sample and 40.6% (104/256) in the IGD subsample (vs 708/1239, 57.1% among non-IGD cases). In the full sample, psychosocial resources of resilience (adjusted odds ratio [aOR] 1.03, 95% CI 1.02-1.05) and social support (aOR 1.03, 95% CI 1.02-1.04) as well as self-efficacy in professional help-seeking (aOR 1.64, 95% CI 1.49-1.81) were positively associated with BI-PHSIGD, while perceived resource loss due to reduced gaming time was negatively associated with BI-PHSIGD (aOR 0.97, 95% CI 0.96-0.98); the positive association between psychosocial resources and BI-PHSIGD was fully mediated via 2 single-mediator indirect paths (via self-efficacy in professional help-seeking alone: effect size=53.4%; indirect effect/total effect=0.10/0.19 and via perceived resource loss due to reduced gaming time alone: effect size=17.8%; indirect effect/total effect=0.03/0.19) and one 2-mediator serial indirect path (first via perceived resource loss due to reduced gaming time then via self-efficacy in professional help-seeking: effect size=4.7%; indirect effect/total effect=0.009/0.19). In the IGD subgroup, a full mediation via self-efficacy in professional help-seeking alone but not the other 2 indirect paths was statistically significant. Conclusions: Many adolescent internet gamers, especially those with IGD, were unwilling to seek professional help; as a result, early treatment is often difficult to achieve. To increase BI-PHSIGD, enhancing psychosocial resources such as resilience and social support, perceived resource loss due to reduced gaming time, and self-efficacy in professional help-seeking may be effective. Future longitudinal and intervention studies are needed to confirm and extend the findings. UR - https://publichealth.jmir.org/2024/1/e52478 UR - http://dx.doi.org/10.2196/52478 ID - info:doi/10.2196/52478 ER - TY - JOUR AU - McAlister, L. Kelsey AU - Beatty, C. Clare AU - Smith-Caswell, E. Jacqueline AU - Yourell, L. Jacqlyn AU - Huberty, L. Jennifer PY - 2024/11/4 TI - Social Media Use in Adolescents: Bans, Benefits, and Emotion Regulation Behaviors JO - JMIR Ment Health SP - e64626 VL - 11 KW - adolescent social media KW - social media bans KW - emotion regulation KW - youth KW - adolescent KW - media use KW - social platform KW - social network KW - self-regulation KW - behavioral health KW - mental health KW - digital health KW - technology KW - digital literacy UR - https://mental.jmir.org/2024/1/e64626 UR - http://dx.doi.org/10.2196/64626 ID - info:doi/10.2196/64626 ER - TY - JOUR AU - Garikipati, Anurag AU - Ciobanu, Madalina AU - Singh, Preet Navan AU - Barnes, Gina AU - Dinenno, A. Frank AU - Geisel, Jennifer AU - Mao, Qingqing AU - Das, Ritankar PY - 2024/10/30 TI - Parent-Led Applied Behavior Analysis to Impact Clinical Outcomes for Individuals on the Autism Spectrum: Retrospective Chart Review JO - JMIR Pediatr Parent SP - e62878 VL - 7 KW - applied behavior analysis KW - autism spectrum disorder KW - parent training KW - patient outcomes KW - skill acquisition KW - pediatrics N2 - Background: Autism spectrum disorder (ASD) can have traits that impact multiple domains of functioning and quality of life, which can persevere throughout life. To mitigate the impact of ASD on the long-term trajectory of an individual?s life, it is imperative to seek early and adequate treatment via scientifically validated approaches, of which applied behavior analysis (ABA) is the gold standard. ABA treatment must be delivered via a behavior technician with oversight from a board-certified behavior analyst. However, shortages in certified ABA therapists create treatment access barriers for individuals on the autism spectrum. Increased ASD prevalence demands innovations for treatment delivery. Parent-led treatment models for neurodevelopmental conditions are effective yet underutilized and may be used to fill this care gap. Objective: This study reports findings from a retrospective chart review of clinical outcomes for children that received parent-led ABA treatment and intends to examine the sustained impact that modifications to ABA delivery have had on a subset of patients of Montera, Inc. dba Forta (?Forta?), as measured by progress toward skill acquisition within multiple focus areas (FAs). Methods: Parents received ?40 hours of training in ABA prior to initiating treatment, and patients were prescribed focused (<25 hours/week) or comprehensive (>25?40 hours/week) treatment plans. Retrospective data were evaluated over ?90 days for 30 patients. The clinical outcomes of patients were additionally assessed by age (2-5 years, 6-12 years, 13?22 years) and utilization of prescribed treatment. Treatment encompassed skill acquisition goals; to facilitate data collection consistency, successful attempts were logged within a software application built in-house. Results: Improved goal achievement success between weeks 1?20 was observed for older age, all utilization, and both treatment plan type cohorts. Success rates increased over time for most FAs, with the exception of executive functioning in the youngest cohort and comprehensive plan cohort. Goal achievement experienced peaks and declines from week to week, as expected for ABA treatment; however, overall trends indicated increased skill acquisition success rates. Of 40 unique combinations of analysis cohorts and FAs, 20 showed statistically significant positive linear relationships (P<.05). Statistically significant positive linear relationships were observed in the high utilization cohort (communication with P=.04, social skills with P=.02); in the fair and full utilization cohorts (overall success with P=.03 for the fair utilization cohort and P=.001 for the full utilization cohort, and success in emotional regulation with P<.001 for the fair utilization cohort and P<.001 for the full utilization cohort); and in the comprehensive treatment cohort (communication with P=.001, emotional regulation with P=.045). Conclusions: Parent-led ABA can lead to goal achievement and improved clinical outcomes and may be a viable solution to overcome treatment access barriers that delay initiation or continuation of care. UR - https://pediatrics.jmir.org/2024/1/e62878 UR - http://dx.doi.org/10.2196/62878 ID - info:doi/10.2196/62878 ER - TY - JOUR AU - Lee, JooHyun AU - Lim, JaeHyun AU - Kang, Soyeon AU - Kim, Sujin AU - Jung, Yoon So AU - Hong, Soon-Beom AU - Park, Rang Yu PY - 2024/10/28 TI - Mobile App?Assisted Parent Training Intervention for Behavioral Problems in Children With Autism Spectrum Disorder: Pilot Randomized Controlled Trial JO - JMIR Hum Factors SP - e52295 VL - 11 KW - autism spectrum disorder KW - parent training program KW - parent education KW - behavioral problems KW - child behavior KW - mobile app KW - feasibility KW - mHealth KW - evidence-based parent training N2 - Background: In children with autism spectrum disorder (ASD), problem behaviors play a dysfunctional role, causing as much difficulty with daily living and adjustment as the core symptoms. If such behaviors are not effectively addressed, they can result in physical, economic, and psychological issues not only for the individual but also for family members. Objective: We aimed to develop and evaluate the feasibility of a mobile app?assisted parent training program for reducing problem behaviors in children with ASD. Methods: This open-label, single-center, randomized controlled trial was conducted among parents of children with ASD aged 36-84 months. Participants were recruited from the Department of Psychiatry at Seoul National University Hospital. Participants were randomly assigned (1:1) by a blinded researcher. Randomization was performed using a stratified block randomization (with a block size of 4). Parents in the intervention group completed the mobile app?assisted parent training program at home over a 12-week period. They continued to receive their usual nondrug treatment in addition to the mobile app?assisted parent training program. The control group continued to receive their usual nonpharmaceutical treatment for 12 weeks without receiving the parent training program intervention. The primary outcome measure was the median change in the Korean Child Behavior Checklist (K-CBCL) scores from before to after the intervention. Lower scores on the K-CBCL indicated a decrease in overall problem behavior. Results: Between November 9, 2022, and December 8, 2022, 64 participants were enrolled. Overall, 42 children (intervention group median age: 49, IQR 41-52.5 months; control group median age: 49, IQR 42-58 months) of the participants joined the program. The intervention group included 20 (48%) participants and the control group included 22 (52%) participants. In the intervention group, the K-CBCL total scores showed a decrease after the intervention, with a median difference of ?0.5 (95% CI ?4.5 to 3). Pervasive developmental disorder scores also showed a decrease, with a median difference of ?2.1 (95% CI ?8.5 to 2.5). However, there was no significant difference in Clinical Global Impression?Severity of Illness scores after the intervention for both the control and intervention groups. Scores on the Korean version of the Social Communication Questionnaire showed a further decrease after the intervention in the intervention group (median difference ?2, 95% CI ?4 to 1). Caregivers? stress evaluated using the Korean Parenting Stress Index Fourth Edition?Short Form did not show any significant differences between the control and intervention groups. There were no adverse events related to study participation. Conclusions: The findings demonstrated the feasibility of using mobile devices for evidence-based parent training to reduce problem behaviors in children with ASD. Mobile devices? accessibility and flexibility may provide a viable alternative for offering early intervention for problem behaviors in children with ASD. Trial Registration: CRIS KCT0007841; https://cris.nih.go.kr/cris/search/detailSearch.do?&seq=23112 UR - https://humanfactors.jmir.org/2024/1/e52295 UR - http://dx.doi.org/10.2196/52295 UR - http://www.ncbi.nlm.nih.gov/pubmed/39466295 ID - info:doi/10.2196/52295 ER - TY - JOUR AU - Toki, I. Eugenia AU - Zakopoulou, Victoria AU - Tatsis, Giorgos AU - Pange, Jenny PY - 2024/10/11 TI - Automated Detection of Neurodevelopmental Disorders Using Face-to-Face Mobile Technology Among Typically Developing Greek Children: Randomized Controlled Trial JO - JMIR Form Res SP - e53465 VL - 8 KW - main principles KW - automated detection KW - neurodevelopmental disorders KW - principal component analysis KW - early screening KW - early intervention KW - detection KW - screening KW - assessment KW - digital tool KW - serious game KW - child KW - Greece KW - speech KW - psychomotor KW - cognitive KW - psychoemotional KW - hearing KW - machine learning KW - apps KW - predictions KW - prognosis N2 - Background: Neurodevelopmental disorders (NDs) are characterized by heterogeneity, complexity, and interactions among multiple domains with long-lasting effects in adulthood. Early and accurate identification of children at risk for NDs is crucial for timely intervention, yet many cases remain undiagnosed, leading to missed opportunities for effective interventions. Digital tools can help clinicians assist and identify NDs. The concept of using serious games to enhance health care has gained attention among a growing group of scientists, entrepreneurs, and clinicians. Objective: This study aims to explore the core principles of automated mobile detection of NDs in typically developing Greek children, using a serious game developed within the SmartSpeech project, designed to evaluate multiple developmental domains through principal component analysis (PCA). Methods: A total of 229 typically developing children aged 4 to 12 years participated in the study. The recruitment process involved open calls through public and private health and educational institutions across Greece. Parents were thoroughly informed about the study?s objectives and procedures, and written consent was obtained. Children engaged under the clinician?s face-to-face supervision with the serious game ?Apsou,? which assesses 18 developmental domains, including speech, language, psychomotor, cognitive, psychoemotional, and hearing abilities. Data from the children?s interactions were analyzed using PCA to identify key components and underlying principles of ND detection. Results: A sample of 229 typically developing preschoolers and early school-aged children played the Apsou mobile serious game for automated detection of NDs. Performing a PCA, the findings identified 5 main components accounting for about 80% of the data variability that potentially have significant prognostic implications for a safe diagnosis of NDs. Varimax rotation explained 61.44% of the total variance. The results underscore key theoretical principles crucial for the automated detection of NDs. These principles encompass communication skills, speech and language development, vocal processing, cognitive skills and sensory functions, and visual-spatial skills. These components align with the theoretical principles of child development and provide a robust framework for automated ND detection. Conclusions: The study highlights the feasibility and effectiveness of using serious games for early ND detection in children. The identified principal components offer valuable insights into critical developmental domains, paving the way for the development of advanced machine learning applications to support highly accurate predictions and classifications for automated screening, diagnosis, prognosis, or intervention planning in ND clinical decision-making. Future research should focus on validating these findings across diverse populations integrating additional features such as biometric data and longitudinal tracking to enhance the accuracy and reliability of automated detection systems. Trial Registration: ClinicalTrials.gov NCT06633874; https://clinicaltrials.gov/study/NCT06633874 International Registered Report Identifier (IRRID): RR2-https://doi.org/10.3390/signals4020021 UR - https://formative.jmir.org/2024/1/e53465 UR - http://dx.doi.org/10.2196/53465 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53465 ER - TY - JOUR AU - Zhang, Zeyu AU - Li, Sijia AU - Zhai, Zidan AU - Qiu, Ting AU - Zhou, Yu AU - Zhang, Heng PY - 2024/10/9 TI - Temporal Trends in the Prevalence of Child Undernutrition in China From 2000 to 2019, With Projections of Prevalence in 2030: Cross-Sectional Analysis JO - JMIR Public Health Surveill SP - e58564 VL - 10 KW - child growth failure KW - undernutrition KW - stunting KW - wasting KW - underweight KW - trends KW - projections N2 - Background: Although the problem of malnutrition among children in China has greatly improved in recent years, there is a gap compared to developed countries, and there are differences between provinces. Research on long-term comprehensive trends in child growth failure (CGF) in China is needed for further improvement. Objective: The purpose of this study was to examine trends in stunting, wasting, and underweight among children younger than 5 years in China from 2000 to 2019, and predict CGF till 2030. Methods: We conducted a cross-sectional analysis using data from the local burden of disease (LBD) database. Using Joinpoint Regression Software, we examined trends in CGF among children younger than 5 years in China from 2000 to 2019, and predicted the trends of prevalence in 2030, using the Holt-Winters model with trends but without seasonal components. The assessment was performed with Stata 17 (StataCorp). Data were analyzed from October 17, 2023, to November 22, 2023. Results: In 2019, the prevalences of stunting, wasting, and underweight decreased to 12%, 3%, and 4%, respectively (decreases of 36.9%, 25.0%, and 42.9%, respectively, compared with the values in 2000). The prevalence of CGF decreased rapidly from 2000 to 2010, and the downward trend slowed down after 2010. Most provinces had stagnated processes of trends after 2017. The age group with the highest stunting prevalence was children aged 1 to 4 years, and the highest prevalence of wasting and underweight was noted in early neonatal infants. From 2000 to 2019, the prevalence of CGF declined in all age groups of children. The largest relative decrease in stunting and underweight was noted in children aged 1 to 4 years, and the largest decrease in wasting was noted in early neonatal infants. The prevalences of stunting, wasting, and underweight in China are estimated to decrease to 11.4%, 3.2%, and 4.1%, respectively, by 2030. China has nationally met the World Health Organization?s Global Nutrition Targets for 2030 for stunting but not for wasting. Conclusions: This study provides data on the prevalence and trends of CGF among children younger than 5 years and reports declines in CGF. There remain areas with slow progress in China. Most units have achieved the goal for stunting prevalence but not wasting prevalence. UR - https://publichealth.jmir.org/2024/1/e58564 UR - http://dx.doi.org/10.2196/58564 UR - http://www.ncbi.nlm.nih.gov/pubmed/39382950 ID - info:doi/10.2196/58564 ER - TY - JOUR AU - Murgueitio, Nicolas AU - Tate, Maresa AU - Lurie, Lucy AU - Priddy, Zoe AU - Boda, Sneha AU - Shipkova, Michelle AU - Rodriguez, Micaela AU - Machlin, Laura AU - Furlong, Sarah AU - Mitchell, Amanda AU - McLaughlin, Katie AU - Sheridan, Margaret PY - 2024/9/17 TI - Testing a Conceptual Model of Early Adversity, Neural Function, and Psychopathology: Protocol for a Retrospective Observational Cohort Study JO - JMIR Res Protoc SP - e59636 VL - 13 KW - early adversity KW - psychopathology KW - neurodevelopment KW - adverse childhood events KW - child development N2 - Background: Early adversity, broadly defined as a set of negative exposures during childhood, is extremely common and increases risk for psychopathology across the life span. Previous research suggests that separate dimensions of adversity increase risk through developmental plasticity mechanisms shaping unique neurobiological pathways. Specifically, research suggests that deprivation is associated with deficits in higher order cognition, while threat is associated with atypicality in fear learning and emotion dysregulation. However, most of this research has been conducted in adolescent and adult samples, long after exposure to adversity occurs and far from periods of peak developmental plasticity. Objective: The Wellness Health and Life Experiences (WHALE) study examines the neurobiological and behavioral mechanisms by which deprivation, threat, and unpredictability increase risk for psychopathology in early childhood (age 4-7 years) directly following periods of peak developmental plasticity. The objective of this study is to describe the study rationale and aims, the research design and procedures, and the analytical plan to test the study hypotheses. Methods: This is a retrospective cohort study that examines associations between exposure to deprivation and threat and their hypothesized neurobiological mechanisms, how these neurobiological mechanisms link early adversity and psychopathology, and associations between unpredictability, reward learning, and psychopathology. The sample was a convenience sample of children (aged 4-7 years) and their families, identified through flyers, email blasts to listserves, school-based advertising, and involvement in community events. Data were collected during a home visit, a subsequent laboratory visit, and a final neuroimaging visit. Planned analyses include linear regression, path analyses, and functional magnetic resonance imaging analyses to explore the role of neural function in the association between early adversity and psychopathology. Results: Participants (N=301) have been recruited into the study, and data collection has commenced. The expected results will be available in 2024. Conclusions: The findings of this study will help elucidate the neurobiological mechanisms by which early adversity increases risk for psychopathology in early childhood. This study represents the earliest test of an influential theory of biological embedding of early adversity. International Registered Report Identifier (IRRID): DERR1-10.2196/59636 UR - https://www.researchprotocols.org/2024/1/e59636 UR - http://dx.doi.org/10.2196/59636 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59636 ER - TY - JOUR AU - Tahmasebi, Neda AU - Zarifian, Talieh AU - Ashtari, Atieh AU - Biglarian, Akbar PY - 2024/4/19 TI - Telepractice Parent Training of Enhanced Milieu Teaching With Phonological Emphasis (EMT+PE) For Persian-Speaking Toddlers With Nonsyndromic Cleft Palate: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e54426 VL - 13 KW - telepractice KW - cleft palate KW - language intervention KW - parent training KW - Phonological Emphasis KW - Enhanced Milieu Teaching KW - Persian-speaking toddlers KW - toddler KW - toddlers KW - children KW - child KW - cleft lip KW - language development KW - speech sound disorders KW - speech sound disorder KW - effectiveness KW - parent-based KW - intervention KW - speech KW - therapy N2 - Background: Children born with a cleft palate with or without a cleft lip (CP/L) are at increased risk for delayed language development and speech sound disorders. Enhanced Milieu Teaching with Phonological Emphasis (EMT+PE) is a recommended naturalistic intervention for toddlers with CP/L. The parents? role in providing naturalistic interventions is critical and they need training based on learning principles to implement these interventions. Telepractice is an appropriate method for training parents and children with various speech-related disorders. Objective: This study aims to determine and compare the effectiveness of telepractice and the parent-implemented EMT+PE intervention on language and speech measures in toddlers with CP/L with usual interventions and determine the effectiveness maintenance of the intervention. Methods: A randomized controlled trial (RCT) will assess the efficacy of telepractice and the parent-implemented EMT+PE intervention in enhancing speech and language measures in toddlers with CP/L. Eligible participants will be randomly assigned to one of 2 groups: the conventional intervention group and the EMT+PE intervention group. Participants? speech and language measures will be evaluated remotely by trained raters before and after the intervention and 2 months after the intervention. Parents of participants in the intervention group will receive 3 months of training in speech and language supportive strategies from trained therapists using telehealth fidelity scales. Parents of participants in the control group will receive the conventional speech and language intervention by cleft team therapists. Study outcomes will include language variables (mean length of utterance) and speech production variables (percent correct consonants). Results: The protocol was approved by the Research Ethics Committee of the University of Social Welfare and Rehabilitation Sciences in February 2022. The selection process of participants, as well as training therapists and raters, commenced in January 2022, the therapy and follow-up period ended in June 2023, and pre- and postintervention assessments have been conducted. Data analysis is ongoing, and we expect to publish our results by the summer of 2024. Funding is yet to be received. Conclusions: The results of this study may help us develop a speech and language intervention with a different delivery model for toddlers with CP/L, and the cleft team care can use these results in service delivery. Consistent with our hypothesis, speech and language measures are expected to improve. International Registered Report Identifier (IRRID): DERR1-10.2196/54426 UR - https://www.researchprotocols.org/2024/1/e54426 UR - http://dx.doi.org/10.2196/54426 UR - http://www.ncbi.nlm.nih.gov/pubmed/38640014 ID - info:doi/10.2196/54426 ER - TY - JOUR AU - Chun, Sulim AU - Jang, Sooyoung AU - Kim, Yong Jin AU - Ko, Chanyoung AU - Lee, JooHyun AU - Hong, JaeSeong AU - Park, Rang Yu PY - 2024/2/21 TI - Comprehensive Assessment and Early Prediction of Gross Motor Performance in Toddlers With Graph Convolutional Networks?Based Deep Learning: Development and Validation Study JO - JMIR Form Res SP - e51996 VL - 8 KW - child development KW - digital health KW - artificial intelligence KW - gross KW - motor KW - movement KW - development KW - developmental KW - machine learning KW - pediatric KW - pediatrics KW - paediatric KW - paediatrics KW - toddler KW - toddlers KW - child KW - children KW - limb KW - limbs KW - algorithm KW - algorithms KW - kinesiology KW - GCN KW - graph convolutional networks KW - convolutional network N2 - Background: Accurate and timely assessment of children?s developmental status is crucial for early diagnosis and intervention. More accurate and automated developmental assessments are essential due to the lack of trained health care providers and imprecise parental reporting. In various areas of development, gross motor development in toddlers is known to be predictive of subsequent childhood developments. Objective: The purpose of this study was to develop a model to assess gross motor behavior and integrate the results to determine the overall gross motor status of toddlers. This study also aimed to identify behaviors that are important in the assessment of overall gross motor skills and detect critical moments and important body parts for the assessment of each behavior. Methods: We used behavioral videos of toddlers aged 18-35 months. To assess gross motor development, we selected 4 behaviors (climb up the stairs, go down the stairs, throw the ball, and stand on 1 foot) that have been validated with the Korean Developmental Screening Test for Infants and Children. In the child behavior videos, we estimated each child?s position as a bounding box and extracted human keypoints within the box. In the first stage, the videos with the extracted human keypoints of each behavior were evaluated separately using a graph convolutional networks (GCN)?based algorithm. The probability values obtained for each label in the first-stage model were used as input for the second-stage model, the extreme gradient boosting (XGBoost) algorithm, to predict the overall gross motor status. For interpretability, we used gradient-weighted class activation mapping (Grad-CAM) to identify important moments and relevant body parts during the movements. The Shapley additive explanations method was used for the assessment of variable importance, to determine the movements that contributed the most to the overall developmental assessment. Results: Behavioral videos of 4 gross motor skills were collected from 147 children, resulting in a total of 2395 videos. The stage-1 GCN model to evaluate each behavior had an area under the receiver operating characteristic curve (AUROC) of 0.79 to 0.90. Keypoint-mapping Grad-CAM visualization identified important moments in each behavior and differences in important body parts. The stage-2 XGBoost model to assess the overall gross motor status had an AUROC of 0.90. Among the 4 behaviors, ?go down the stairs? contributed the most to the overall developmental assessment. Conclusions: Using movement videos of toddlers aged 18-35 months, we developed objective and automated models to evaluate each behavior and assess each child?s overall gross motor performance. We identified the important behaviors for assessing gross motor performance and developed methods to recognize important moments and body parts while evaluating gross motor performance. UR - https://formative.jmir.org/2024/1/e51996 UR - http://dx.doi.org/10.2196/51996 UR - http://www.ncbi.nlm.nih.gov/pubmed/38381519 ID - info:doi/10.2196/51996 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 - Liang, Haiyan AU - Wang, Xi AU - An, Ruopeng PY - 2023/11/13 TI - Influence of Pokémon GO on Physical Activity and Psychosocial Well-Being in Children and Adolescents: Systematic Review JO - J Med Internet Res SP - e49019 VL - 25 KW - Pokémon GO KW - artificial intelligence KW - physical activity KW - psychosocial well-being KW - children KW - adolescent N2 - Background: Pokémon GO, an augmented reality game with widespread popularity, can potentially influence players? physical activity (PA) levels and psychosocial well-being. Objective: This review aims to systematically examine the scientific evidence regarding the impact of Pokémon GO on PA and psychosocial well-being in children and adolescents. Methods: Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework, we conducted keyword and reference searches in the PubMed, CINAHL, Web of Science, and Scopus databases. We performed title and abstract screening, full-text review, evidence synthesis, and identified research gaps. Results: Our review included 10 studies that explored the effect of Pokémon GO on PA or psychosocial well-being among children and adolescents. These studies used diverse designs across multiple countries and regions. Pokémon GO use measures encompassed frequency, experience, adherence, and motivation. PA assessment methods ranged from self-reported questionnaires to technology-based evaluations and qualitative approaches. Psychosocial well-being measures included emotional intelligence, personal well-being, self-control, emotionality, and sociability. In general, the estimated impact of Pokémon GO on PA was positive, with gaming elements and engagement correlating with increased PA levels. However, the effect on psychosocial well-being presented mixed results, with positive associations for sociability but a complex relationship involving well-being and internet gaming disorder. The limitations of these studies comprised the absence of randomized controlled trials, heterogeneity in study designs and outcome measures, and potential confounding bias. Conclusions: Overall, Pokémon GO tends to positively affect PA levels, while the impact on psychosocial well-being remains complex and requires further investigation. Future research should investigate the mechanisms connecting Pokémon GO use with PA and psychosocial well-being and the potential risks of excessive gameplay. These findings can help inform public health interventions to harness gaming technologies for promoting PA and enhancing well-being among the younger generation. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42023412032; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=412032 UR - https://www.jmir.org/2023/1/e49019 UR - http://dx.doi.org/10.2196/49019 UR - http://www.ncbi.nlm.nih.gov/pubmed/37955949 ID - info:doi/10.2196/49019 ER - TY - JOUR AU - Kim, Seong-Yeol AU - Song, Minji AU - Jo, Yunju AU - Jung, Youngjae AU - You, Heecheon AU - Ko, Myoung-Hwan AU - Kim, Gi-Wook PY - 2023/10/11 TI - Effect of Voice and Articulation Parameters of a Home-Based Serious Game for Speech Therapy in Children With Articulation Disorder: Prospective Single-Arm Clinical Trial JO - JMIR Serious Games SP - e49216 VL - 11 KW - articulation disorder KW - home-based therapy KW - serious game KW - children KW - speech KW - voice N2 - Background: Articulation disorder decreases the clarity of language and causes a decrease in children?s learning and social ability. The demand for non?face-to-face treatment is increasing owing to the limited number of therapists and geographical or economic constraints. Non?face-to-face speech therapy programs using serious games have been proposed as an alternative. Objective: The aim of this study is to investigate the efficacy of home therapy on logopedic and phoniatric abilities in children with articulation disorder using the Smart Speech game interface. Methods: This study is a prospective single-arm clinical trial. Children with articulation disorders, whose Urimal Test of Articulation and Phonology (U-TAP) was ?2 SDs or less and the Receptive and Expressive Vocabulary Test score was ?1 SD or more, were enrolled. A preliminary evaluation (E0) was conducted to check whether the children had articulation disorders, and for the next 4 weeks, they lived their usual lifestyle without other treatments. Prior to the beginning of the training, a pre-evaluation (E1) was performed, and the children trained at home for ?30 minutes per day, ?5 times a week, over 4 weeks (a total of 20 sessions). The Smart Speech program comprised oral exercise training, breathing training, and speech training; the difficulty and type of the training were configured differently according to the participants? articulation error, exercise, and vocal ability. After the training, postevaluation (E2) was performed using the same method. Finally, 8 weeks later, postevaluation (E3) was performed as a follow-up. A voice evaluation included parameters such as maximum phonation time (MPT), fundamental frequency (F0), jitter, peak air pressure (relative average perturbation), pitch, intensity, and voice onset time. Articulation parameters included a percentage of correct consonants (PCC; U-TAP word-unit PCC, U-TAP sentence-unit PCC, and three-position articulation test) and alternate motion evaluation (diadochokinesis, DDK). Data obtained during each evaluation (E1-E2-E3) were compared. Results: A total of 13 children with articulation disorders aged 4-10 years were enrolled in the study. In voice parameters, MPT, jitter, and pitch showed significant changes in repeated-measures ANOVA. However, only MPT showed significant changes during E1-E2 (P=.007) and E1-E3 (P=.004) in post hoc tests. Other voice parameters did not show significant changes. In articulation parameters, U-TAP, three-position articulation test (TA), and DDK showed significant changes in repeated-measures ANOVA. In post hoc tests, U-TAP (word, sentence) and TA showed significant changes during E1-E2 (P=.003, .04, and .01) and E1-E3 (P=.001, .03, and .003), and DDK showed significant changes during E1-E2 only (P=.03). Conclusions: Home-based serious games can be considered an alternative treatment method to improve language function. Trial Registration: Clinical Research Information Service KCT0006448; https://cris.nih.go.kr/cris/search/detailSearch.do/20119 UR - https://games.jmir.org/2023/1/e49216 UR - http://dx.doi.org/10.2196/49216 UR - http://www.ncbi.nlm.nih.gov/pubmed/37819707 ID - info:doi/10.2196/49216 ER - TY - JOUR AU - Kostyrka-Allchorne, Katarzyna AU - Chu, Petrina AU - Ballard, Claire AU - Lean, Nancy AU - French, Blandine AU - Hedstrom, Ellen AU - Byford, Sarah AU - Cortese, Samuele AU - Daley, David AU - Downs, Johnny AU - Glazebrook, Cristine AU - Goldsmith, Kimberley AU - Hall, L. Charlotte AU - Kovshoff, Hanna AU - Kreppner, Jana AU - Sayal, Kapil AU - Shearer, James AU - Simonoff, Emily AU - Thompson, Margaret AU - Sonuga-Barke, S. Edmund J. PY - 2023/9/11 TI - Remote Recruitment Strategy and Structured E-Parenting Support (STEPS) App: Feasibility and Usability Study JO - JMIR Pediatr Parent SP - e47035 VL - 6 KW - parenting intervention KW - mobile app KW - attention-deficit/hyperactivity disorder KW - ADHD KW - behavior problems KW - mobile health KW - mHealth KW - children KW - usability KW - mobile phone N2 - Background: The Structured E-Parenting Support (STEPS) app provides support for parents of children with elevated hyperactivity, impulsivity, inattention, and conduct problems who are awaiting clinical assessment. STEPS will be evaluated in a randomized controlled trial (RCT) within the Online Parent Training for the Initial Management of ADHD Referrals (OPTIMA) research program in the United Kingdom. Phase 1 of the OPTIMA tested the feasibility of participants? recruitment and the app?s usability. Objective: This study aimed to adapt a digital routine clinical monitoring system, myHealthE, for research purposes to facilitate waitlist recruitment; test using remote methods to screen and identify participants quickly and systematically; pilot the acceptability of the recruitment and assessment protocol; and explore the usability of STEPS. Methods: myHealthE was adapted to screen patients? data. Parents? and clinicians? feedback on myHealthE was collected, and information governance reviews were conducted in clinical services planning to host the RCT. Potential participants for the observational feasibility study were identified from new referrals using myHealthE and non-myHealthE methods. Descriptive statistics were used to summarize the demographic and outcome variables. We estimated whether the recruitment rate would meet the planned RCT sample size requirement (n=352). In addition to the feasibility study participants, another group of parents was recruited to assess the STEPS usability. They completed the adapted System Usability Scale and responded to open-ended questions about the app, which were coded using the Enlight quality construct template. Results: Overall, 124 potential participants were identified as eligible: 121 (97.6%) via myHealthE and 3 (2.4%) via non-myHealthE methods. In total, 107 parents were contacted, and 48 (44.9%) consented and were asked if, hypothetically, they would be willing to participate in the OPTIMA RCT. Of the 28 feasibility study participants who provided demographic data, 21 (75%) identified as White. Their children had an average age of 8.4 (SD 1.7) years and 65% (31/48) were male. During the primary recruitment period (June to July 2021) when 45 participants had consented, 38 (84%) participants agreed hypothetically to take part in the RCT (rate of 19/mo, 95% CI 13.5-26.1), meeting the stop-go criterion of 18 participants per month to proceed with the RCT. All parents were satisfied or very satisfied with the study procedures. Parents (n=12) recruited to assess STEPS? usability described it as easy to navigate and use and as having an attractive combination of colors and visual design. They described the content as useful, pitched at the right level, and sensitively presented. Suggested improvements included adding captions to videos or making the recorded reflections editable. Conclusions: Remote recruitment and study procedures for testing a parenting intervention app are feasible and acceptable for parents. The parents felt that STEPS was a useful and easy-to-use digital parenting support tool. International Registered Report Identifier (IRRID): RR2-10.1186/s40814-021-00959-0 UR - https://pediatrics.jmir.org/2023/1/e47035 UR - http://dx.doi.org/10.2196/47035 UR - http://www.ncbi.nlm.nih.gov/pubmed/37695667 ID - info:doi/10.2196/47035 ER - TY - JOUR AU - Mills-Koonce, Roger William AU - Willoughby, T. Michael AU - Short, J. Sarah AU - Propper, B. Cathi PY - 2022/6/29 TI - The Brain and Early Experience Study: Protocol for a Prospective Observational Study JO - JMIR Res Protoc SP - e34854 VL - 11 IS - 6 KW - poverty KW - executive functioning KW - parenting KW - language KW - sleep KW - neurological development N2 - Background: Children raised in conditions of poverty (or near poverty) are at risk for nonoptimal mental health, educational, and occupational outcomes, many of which may be precipitated by individual differences in executive function (EF) skills that first emerge in early childhood. Objective: The Brain and Early Experience study considers prenatal and postnatal experiences that may mediate the association between poverty and EF skills, including neural substrates. This paper described the study rationale and aims; research design issues, including sample size determination, the recruitment strategy, and participant characteristics; and a summary of developmental assessment points, procedures, and measures used to test the study hypotheses. Methods: This is a prospective longitudinal study examining multiple pathways by which poverty influences normative variations in EF skills in early childhood. It is funded by the National Institute of Child Health and Human Development and approved by the institutional review board. Results: Recruitment is complete with a sample of 203 participants, and data collection is expected to continue from September 2018 to February 2024. Of those recruited as low socioeconomic status (SES), 71% (55/78) reported income-to-needs (ITN) ratios of <2.0, and 35% (27/78) reported ITN ratios of <1.0. Among participants recruited into the not-low SES stratum, only 8.8% (11/125) reported ITN ratios of <2.0, and no participant reported ITN ratios of <1.0. The average ITN ratio for participants recruited into the low-income stratum was significantly lower than the average for the high-income recruitment cell (P<.001). Comparable recruitment outcomes were observed for both Black and non-Black families. Overall, the sample has adequate diversity for testing proposed hypotheses, with 13.3% (27/203) of participants reporting ITN ratios of <1 and >32.5% (66/203) reporting ratios of <2.0. Conclusions: Preliminary results indicate that the recruitment strategy for maximizing variation in family SES was successful, including variation within race. The findings of this study will help elucidate the complex interplay between prenatal and postnatal risk factors affecting critical neurocognitive developmental outcomes in early childhood. International Registered Report Identifier (IRRID): DERR1-10.2196/34854 UR - https://www.researchprotocols.org/2022/6/e34854 UR - http://dx.doi.org/10.2196/34854 UR - http://www.ncbi.nlm.nih.gov/pubmed/35767351 ID - info:doi/10.2196/34854 ER - TY - JOUR AU - Davidson, Rosemary AU - Randhawa, Gurch PY - 2022/5/20 TI - The Sign 4 Big Feelings Intervention to Improve Early Years Outcomes in Preschool Children: Outcome Evaluation JO - JMIR Pediatr Parent SP - e25086 VL - 5 IS - 2 KW - language development KW - sign language KW - early years outcomes KW - well-being N2 - Background: Any delays in language development may affect learning, profoundly influencing personal, social, and professional trajectories. The effectiveness of the Sign 4 Big Feelings (S4BF) intervention was investigated by measuring changes in early years outcomes (EYOs) after a 3-month period. Objective: This study aims to determine whether children?s well-being and EYOs significantly improve (beyond typical, expected development) after the S4BF intervention period and whether there are differences between boys and girls in progress achieved. Methods: An evaluation of the S4BF intervention was conducted with 111 preschool-age children in early years settings in Luton, United Kingdom. Listening, speaking, understanding, and managing feelings and behavior, in addition to the Leuven well-being scale, were assessed in a quasi-experimental study design to measure pre- and postintervention outcomes. Results: Statistically and clinically significant differences were found for each of the 7 pre- and postmeasures evaluated: words understood and spoken, well-being scores, and the 4 EYO domains. Gender differences were negligible in all analyses. Conclusions: Children of all abilities may benefit considerably from S4BF, but a language-based intervention of this nature may be transformational for children who are behind developmentally, with English as an additional language, or of lower socioeconomic status. Trial Registration: ISRCTN Registry ISRCTN42025531; https://doi.org/10.1186/ISRCTN42025531 UR - https://pediatrics.jmir.org/2022/2/e25086 UR - http://dx.doi.org/10.2196/25086 UR - http://www.ncbi.nlm.nih.gov/pubmed/35594062 ID - info:doi/10.2196/25086 ER - TY - JOUR AU - Zapolski, Tamika AU - Whitener, MacKenzie AU - Khazvand, Shirin AU - Crichlow, Queenisha AU - Revilla, Rebecca AU - Salgado, F. Eduardo AU - Aalsma, Matthew AU - Cyders, Melissa AU - Salyers, Michelle AU - Wu, Wei PY - 2022/5/12 TI - Implementation of a Brief Dialectical Behavioral Therapy Skills Group in High Schools for At-Risk Youth: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e32490 VL - 11 IS - 5 KW - dialectical behavioral therapy KW - adolescents KW - high school KW - intervention KW - teenagers KW - risk-taking behavior KW - impulsivity KW - emotion dysregulation KW - social and emotional learning KW - youth N2 - Background: Adolescence is a developmental period marked by engagement in risk-taking behaviors, especially among impulsive or emotionally dysregulated youth. Thus, interventions that teach skills to reduce the risk of negative outcomes associated with emotional dysregulation are required. Social and emotional learning (SEL) programs have been developed to address both adolescent emotional dysregulation and risk-taking behaviors; however, current programs have mostly been implemented among younger youth and are used as a tier 1 universal intervention rather than a targeted tier 2 intervention for youth identified with emotional regulation difficulties. Objective: This study aimed to address the need for SEL programming that can be delivered in schools, particularly for older youth who have difficulties with emotional or behavioral dysregulation, to reduce the risk of health-risk behaviors among this population. Methods: Here, we outline the implementation of an SEL intervention titled Going 4 Goals, a 9-session adaptation of the Dialectical Behavioral Therapy for Adolescents (DBT-A) program delivered to at-risk high school students in a school setting. The primary objectives of the study are to test whether participating in the skills group intervention produces significant increases in the core DBT-A skills of mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness, while also producing significant decreases in substance use and risky behaviors. These primary outcomes are based on changes in participant scores between baseline and after the intervention and follow-ups at 1, 3, and 6 months compared with a control group of youth participating in the school?s health curriculum at the same time points. Qualitative interviews will also be conducted with intervention participants and school staff to examine acceptability and facilitators of and barriers to the intervention. Results: A total of 171 participants across 13 groups had been enrolled in the intervention, with data collection ending December 2021. Data analysis will begin in the spring of 2022, with expected results to be published in the spring of 2023. Conclusions: This paper describes the protocol of the 9-session school-based adaptation of the DBT-A intervention and discusses the strengths and limitations of the study and future directions. International Registered Report Identifier (IRRID): DERR1-10.2196/32490 UR - https://www.researchprotocols.org/2022/5/e32490 UR - http://dx.doi.org/10.2196/32490 UR - http://www.ncbi.nlm.nih.gov/pubmed/35551054 ID - info:doi/10.2196/32490 ER - TY - JOUR AU - Washington, Peter AU - Kalantarian, Haik AU - Kent, John AU - Husic, Arman AU - Kline, Aaron AU - Leblanc, Emilie AU - Hou, Cathy AU - Mutlu, Cezmi Onur AU - Dunlap, Kaitlyn AU - Penev, Yordan AU - Varma, Maya AU - Stockham, Tyler Nate AU - Chrisman, Brianna AU - Paskov, Kelley AU - Sun, Woo Min AU - Jung, Jae-Yoon AU - Voss, Catalin AU - Haber, Nick AU - Wall, Paul Dennis PY - 2022/4/8 TI - Improved Digital Therapy for Developmental Pediatrics Using Domain-Specific Artificial Intelligence: Machine Learning Study JO - JMIR Pediatr Parent SP - e26760 VL - 5 IS - 2 KW - computer vision KW - emotion recognition KW - affective computing KW - autism spectrum disorder KW - pediatrics KW - mobile health KW - digital therapy KW - convolutional neural network KW - machine learning KW - artificial intelligence N2 - Background: Automated emotion classification could aid those who struggle to recognize emotions, including children with developmental behavioral conditions such as autism. However, most computer vision emotion recognition models are trained on adult emotion and therefore underperform when applied to child faces. Objective: We designed a strategy to gamify the collection and labeling of child emotion?enriched images to boost the performance of automatic child emotion recognition models to a level closer to what will be needed for digital health care approaches. Methods: We leveraged our prototype therapeutic smartphone game, GuessWhat, which was designed in large part for children with developmental and behavioral conditions, to gamify the secure collection of video data of children expressing a variety of emotions prompted by the game. Independently, we created a secure web interface to gamify the human labeling effort, called HollywoodSquares, tailored for use by any qualified labeler. We gathered and labeled 2155 videos, 39,968 emotion frames, and 106,001 labels on all images. With this drastically expanded pediatric emotion?centric database (>30 times larger than existing public pediatric emotion data sets), we trained a convolutional neural network (CNN) computer vision classifier of happy, sad, surprised, fearful, angry, disgust, and neutral expressions evoked by children. Results: The classifier achieved a 66.9% balanced accuracy and 67.4% F1-score on the entirety of the Child Affective Facial Expression (CAFE) as well as a 79.1% balanced accuracy and 78% F1-score on CAFE Subset A, a subset containing at least 60% human agreement on emotions labels. This performance is at least 10% higher than all previously developed classifiers evaluated against CAFE, the best of which reached a 56% balanced accuracy even when combining ?anger? and ?disgust? into a single class. Conclusions: This work validates that mobile games designed for pediatric therapies can generate high volumes of domain-relevant data sets to train state-of-the-art classifiers to perform tasks helpful to precision health efforts. UR - https://pediatrics.jmir.org/2022/2/e26760 UR - http://dx.doi.org/10.2196/26760 UR - http://www.ncbi.nlm.nih.gov/pubmed/35394438 ID - info:doi/10.2196/26760 ER - TY - JOUR AU - Baumert, O. Brittney AU - Fiedler, Nancy AU - Prapamontol, Tippawan AU - Suttiwan, Panrapee AU - Naksen, Warangkana AU - Panuwet, Parinya AU - Sittiwang, Supattra AU - Dokjunyam, Chayada AU - Smarr, M. Melissa AU - Marsit, J. Carmen AU - Ryan, Barry P. AU - Siriwong, Wattasit AU - Robson, G. Mark AU - Barr, Boyd Dana PY - 2022/2/7 TI - Investigation of Prenatal Pesticide Exposure and Neurodevelopmental Deficits in Northern Thailand: Protocol for a Longitudinal Birth Cohort Study JO - JMIR Res Protoc SP - e31696 VL - 11 IS - 2 KW - birth cohort KW - farmworker KW - neurodevelopment KW - organophosphate KW - pesticide KW - pregnant women KW - Thailand N2 - Background: Prenatal exposure to pesticides has been linked to adverse neurodevelopmental outcomes. Gaps exist in the current literature about the timing and magnitude of exposures that result in these adverse outcomes. Objective: The Study of Asian Women and their Offspring?s Development and Environmental Exposures (SAWASDEE) cohort was established to investigate the impact of prenatal exposure to pesticides on early indicators of cognitive and motor skills, inhibitory control, emotion regulation, and memory that have been found to be important in the development of subsequent neurobehavioral and neurodevelopmental diseases. The overarching goal is to find earlier predictors of potential adverse neurologic outcomes in order to enable earlier interventions that could result in better outcome prognoses. Methods: Recruitment of this prospective, longitudinal birth cohort began in July 2017 and was completed in June 2019 in Chom Thong and Fang, 2 farming districts in Chiang Mai Province in northern Thailand. Follow-up of the study participants is ongoing. During pregnancy, 7 questionnaires were administered. Time-resolved biospecimen samples were collected monthly (for urine) and during each trimester (for blood) during antenatal care visits. Medical records were abstracted. Infants were administered the NICU Network Neurobehavioral Scale (NNNS) test at 1 month of age. A total of 322 mother-child pairs completed the NNNS test. All children will be followed until 3 years of age and undergo a series of neurodevelopmental tests. We will complete several additional exposure related analyses. Results: A total of 1298 women were screened, and of those, 394 (30.35%) women were enrolled. The mean gestational age at enrollment was 9.9 weeks (SD 2.6). Differences in literacy were observed between Chom Thong and Fang participants. In Fang, about 54 of 105 (51.4%) participants reported being able to read in Thai compared to about 206 of 217 (94.9%) participants in Chom Thong. The percentages were comparable for reporting to be able to write in Thai. Conclusions: This longitudinal birth cohort study will inform risk assessment standards for pregnant women in Thailand and other countries. Building awareness of how insecticide exposure during specific windows of pregnancy affects the neurodevelopmental trajectories of children in developing countries is a specific need recognized by the World Health Organization. International Registered Report Identifier (IRRID): DERR1-10.2196/31696 UR - https://www.researchprotocols.org/2022/2/e31696 UR - http://dx.doi.org/10.2196/31696 UR - http://www.ncbi.nlm.nih.gov/pubmed/35129451 ID - info:doi/10.2196/31696 ER - TY - JOUR AU - Tennant, Ryan AU - Allana, Sana AU - Mercer, Kate AU - Burns, M. Catherine PY - 2022/1/5 TI - Exploring the Experiences of Family Caregivers of Children With Special Health Care Needs to Inform the Design of Digital Health Systems: Formative Qualitative Study JO - JMIR Form Res SP - e28895 VL - 6 IS - 1 KW - children KW - caregiver KW - digital health KW - home care KW - qualitative research KW - technology N2 - Background: Family caregivers of children with special health care needs (CSHCN) are responsible for managing and communicating information regarding their child?s health in their homes. Although family caregivers currently capture information through nondigital methods, digital health care applications are a promising solution for supporting the standardization of information management in complex home care across their child?s health care team. However, family caregivers continue to use paper-based methods where the adoption of digital health care tools is low. With the rise in home care for children with complex health care needs, it is important to understand the caregiving work domain to inform the design of technologies that support child safety in the home. Objective: The aim of this study is to explore how family caregivers navigate information management and communication in complex home care for CSHCN. Methods: This research is part of a broader study to explore caregivers? perspectives on integrating and designing digital health care tools for complex home care. The broader study included interviews and surveys about designing a voice user interface to support home care. This formative study explored semistructured interview data with family caregivers of CSHCN about their home care situations. Inductive thematic analysis was used to analyze the information management and communication processes. Results: We collected data from 7 family caregivers in North America and identified 5 themes. First, family caregivers were continuously learning to provide care. They were also updating the caregiver team on their child?s status and teaching caregivers about their care situation. As caregiving teams grew, they found themselves working on communicating with their children?s educators. Beyond the scope of managing their child?s health information, family caregivers also navigated bureaucratic processes for their child?s home care. Conclusions: Family caregivers? experiences of caring for CSHCN differ contextually and evolve as their child?s condition changes and they grow toward adulthood. Family caregivers recorded information using paper-based tools, which did not sufficiently support information management. They also experienced significant pressure in summarizing information and coordinating 2-way communication about the details of their child?s health with caregivers. The design of digital health care systems and tools for complex home care may improve care coordination if they provide an intuitive method for information interaction and significant utility by delivering situation-specific insights and adapting to unique and dynamic home care environments. Although these findings provide a foundational understanding, there is an opportunity for further research to generalize the findings. UR - https://formative.jmir.org/2022/1/e28895 UR - http://dx.doi.org/10.2196/28895 UR - http://www.ncbi.nlm.nih.gov/pubmed/34989692 ID - info:doi/10.2196/28895 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 - Kuczy?ski, Wojciech AU - Wibowo, Erik AU - Hoshino, Tetsuro AU - Kudrycka, Aleksandra AU - Ma?olepsza, Aleksandra AU - Karwowska, Urszula AU - Pruszkowska, Milena AU - Wasiak, Jakub AU - Kuczy?ska, Aleksandra AU - Spa?ka, Jakub AU - Pruszkowska-Przybylska, Paulina AU - Mokros, ?ukasz AU - Bia?as, Adam AU - Bia?asiewicz, Piotr AU - Sasanabe, Ryujiro AU - Blagrove, Mark AU - Manning, John PY - 2021/10/6 TI - Understanding the Associations of Prenatal Androgen Exposure on Sleep Physiology, Circadian Proteins, Anthropometric Parameters, Hormonal Factors, Quality of Life, and Sex Among Healthy Young Adults: Protocol for an International, Multicenter Study JO - JMIR Res Protoc SP - e29199 VL - 10 IS - 10 KW - digit ratio KW - sleep KW - sex hormones KW - testosterone KW - estrogen KW - circadian proteins KW - circadian rhythm KW - chronotype KW - miRNA N2 - Background: The ratio of the second finger length to the fourth finger length (2D:4D ratio) is considered to be negatively correlated with prenatal androgen exposure (PAE) and positively correlated with prenatal estrogen. Coincidentally, various brain regions are sensitive to PAE, and their functions in adults may be influenced by the prenatal actions of sex hormones. Objective: This study aims to assess the relationship between PAE (indicated by the 2D:4D ratio) and various physiological (sex hormone levels and sleep-wake parameters), psychological (mental health), and sexual parameters in healthy young adults. Methods: This study consists of two phases. In phase 1, we will conduct a survey-based study and anthropometric assessments (including 2D:4D ratio and BMI) in healthy young adults. Using validated questionnaires, we will collect self-reported data on sleep quality, sexual function, sleep chronotype, anxiety, and depressive symptoms. In phase 2, a subsample of phase 1 will undergo polysomnography and physiological and genetic assessments. Sleep architecture data will be obtained using portable polysomnography. The levels of testosterone, estradiol, progesterone, luteinizing hormone, follicle-stimulating hormone, prolactin, melatonin, and circadian regulatory proteins (circadian locomotor output cycles kaput [CLOCK], timeless [TIM], and period [PER]) and the expression levels of some miRNAs will be measured using blood samples. The rest and activity cycle will be monitored using actigraphy for a 7-day period. Results: In Poland, 720 participants were recruited for phase 1. Among these, 140 completed anthropometric measurements. In addition, 25 participants joined and completed phase 2 data collection. Recruitment from other sites will follow. Conclusions: Findings from our study may help to better understand the plausible role of PAE in sleep physiology, mental health, and sexual quality of life in young adults. International Registered Report Identifier (IRRID): DERR1-10.2196/29199 UR - https://www.researchprotocols.org/2021/10/e29199 UR - http://dx.doi.org/10.2196/29199 UR - http://www.ncbi.nlm.nih.gov/pubmed/34612837 ID - info:doi/10.2196/29199 ER - TY - JOUR AU - Khodyakov, Dmitry AU - Jilani, M. Shahla AU - Dellva, Stephanie AU - Faherty, J. Laura PY - 2021/9/7 TI - Informing the Development of a Standardized Clinical Definition of Neonatal Abstinence Syndrome: Protocol for a Modified-Delphi Expert Panel JO - JMIR Res Protoc SP - e25387 VL - 10 IS - 9 KW - Delphi KW - ExpertLens KW - expert panel KW - neonatal abstinence syndrome KW - neonatal opioid withdrawal syndrome KW - neonatal withdrawal KW - neonatal KW - neonates KW - opioid KW - opioids KW - withdrawal KW - infants KW - clinical KW - newborn KW - newborns KW - perinatal KW - postnatal N2 - Background: Neonatal abstinence syndrome (NAS) is a postnatal withdrawal syndrome that most commonly results from prenatal opioid exposure. Every 15 minutes, an infant is born in the United States with signs of NAS. The field lacks a standardized clinical definition of NAS, complicating discussions on programmatic and policy development to support opioid-exposed mothers and infants. Objective: The goal of this paper is to describe a protocol for a systematic expert panel process to inform the development of a clinical definition of NAS. Methods: We will conduct two three-round online modified-Delphi panels using the ExpertLens system and will follow the recommendations for Conducting and REporting of DElphi Studies (CREDES). One panel will focus on developing key components of a clinical definition of NAS, and the second panel will focus on neonatal opioid withdrawal syndrome (NOWS), which is a term that has come into use to differentiate opioid-exposed infants from infants exposed to other substances in utero. However, there is lack of agreement on the precise clinical definition of NOWS and how it is distinct from or overlaps with NAS. Each panel will complete two rating rounds and a discussion round using a similar protocol. We will analyze all rating data descriptively and determine the presence of agreement within and between the two panels. We will also perform thematic analysis of the qualitative comments to contextualize the panel findings. Results: The panels were convened between October 29 and December 17, 2020. Their results were disseminated and discussed at a national conference on NAS that took place on March 17-18, 2021. Conclusions: A standardized clinical definition of NAS will help to better characterize NAS incidence and to design effective clinical, public health, and policy interventions to support opioid-exposed mother-infant dyads. International Registered Report Identifier (IRRID): DERR1-10.2196/25387 UR - https://www.researchprotocols.org/2021/9/e25387 UR - http://dx.doi.org/10.2196/25387 UR - http://www.ncbi.nlm.nih.gov/pubmed/34491203 ID - info:doi/10.2196/25387 ER - TY - JOUR AU - So, Lydia AU - Miller, Erin AU - Eastwood, John PY - 2021/8/31 TI - Exploring Mothers? Experience of a Linguistic Feedback Technology for Children at Risk of Poor Language Development: Qualitative Pilot Study JO - JMIR Pediatr Parent SP - e27049 VL - 4 IS - 3 KW - language development KW - technology KW - feedback KW - socioeconomic factors N2 - Background: The early language environment is important for language development and a child?s life-course trajectory. Risk factors associated with poor language development outcomes in children include maternal anxiety and depression, low educational attainment, substance misuse, and low socioeconomic status. Language Environment Analysis (LENA) is a wearable technology designed to promote caregivers? engagement in supporting their children?s language development. LENA provides quantitative linguistic feedback, which has been shown to improve caregiver language output, thus enhancing a child?s language environment. There is limited research on the uptake of this technology by families with developmentally at-risk children. Objective: This qualitative study aims to explore the conditions under which mothers with children at risk of poor developmental outcomes are willing to adopt the use of LENA to monitor and improve caregiver language output. Methods: Using a qualitative interpretive design, semistructured, in-depth interviews were conducted with 8 mothers. Participants were recruited purposively to select the maximal variation of socioeconomic and ethnodemographic backgrounds. The transcribed interview data were analyzed thematically and interpretatively. Themes were mapped abductively to an extended Unified Theory of Acceptance and Use of Technology, which included contextual factors for LENA acceptance. Results: Factors that influenced the intention to use LENA included both technology-specific acceptance factors and contextual factors. Technology acceptance themes included reassurance, feeling overwhelmed, and trust. These themes were mapped to performance expectancy, effort expectancy, and social influence. Contextual themes included emergent success and the intrusion of past difficulties. These were mapped to parenting self-efficacy and perceived risk. The theme of building on success described behavioral intention. Mothers were more likely to adopt LENA when the technology was viewed as acceptable, and this was influenced by parenting self-efficacy and perceived risk. Conclusions: LENA is a technology that is acceptable to mothers with children who are at risk of poor language development outcomes. Further studies are needed to establish LENA?s effectiveness as an adjunct to strategies to enrich a child?s early language environment. UR - https://pediatrics.jmir.org/2021/3/e27049 UR - http://dx.doi.org/10.2196/27049 UR - http://www.ncbi.nlm.nih.gov/pubmed/34463633 ID - info:doi/10.2196/27049 ER - TY - JOUR AU - Alsafadi, Danyah AU - Ezzat, Aly AU - Altamimi, Fatima AU - ElBagoury, Marwan AU - Olfat, Mohammed AU - Saleh, Mohammed AU - Roushdy, Sherif AU - Aktham, Yahia PY - 2021/8/31 TI - Mucopolysaccharidosis Type I Disease Prevalence Among Patients With Idiopathic Short Stature in Saudi Arabia: Protocol for a Multicenter Cross-sectional Study JO - JMIR Res Protoc SP - e28619 VL - 10 IS - 8 KW - mucopolysaccharidosis KW - lysosomal storage disorders KW - epidemiology KW - Saudi Arabia N2 - Background: Since the underlying cause of idiopathic short stature can indeed be undiagnosed mucopolysaccharidosis type I, it is critical to identify patients with mucopolysaccharidosis type I among screened patients with idiopathic short stature. Objective: The primary objective of this study is to determine the prevalence of mucopolysaccharidosis type I disease in a high-risk group (ie, patients with idiopathic short stature). Methods: We plan to perform a multicenter, cross-sectional screening study to primarily assess the prevalence of mucopolysaccharidosis type I disease in patients with idiopathic short stature. All eligible patients will be tested after obtaining written informed consent from their parents and guardians. Eligible patients will be recruited over 18 months from specialty care centers for pediatrics and genetics. Results: This protocol was approved by the Institutional Review Board of King Fahd Medical City and funded by Sanofi Genzyme Saudi Arabia. We expect to collect data from ?800 patients, as determined by our sample size calculation. Conclusions: Saudi Arabia is the largest country in the Arabian Peninsula; it has a population of more than 28 million people. To date, there are no reliable data regarding the incidence and prevalence of mucopolysaccharidosis type I in Saudi Arabia; therefore, future multicenter studies will be needed. Further, the prevalence of an attenuated form of mucopolysaccharidosis type I is largely underestimated in Saudi Arabia due to the absence of an effective newborn screening program. Therefore, the implementation of a nationwide newborn screening program is essential for the accurate estimation of the burden of mucopolysaccharidosis and the early diagnosis of patients. International Registered Report Identifier (IRRID): PRR1-10.2196/28619 UR - https://www.researchprotocols.org/2021/8/e28619 UR - http://dx.doi.org/10.2196/28619 UR - http://www.ncbi.nlm.nih.gov/pubmed/34463634 ID - info:doi/10.2196/28619 ER - TY - JOUR AU - Louw, Gidion Jacobus AU - van Heerden, Alastair AU - Olivier, Leana AU - Lambrechts, Tersius AU - Broodryk, Mandi AU - Bunge, Liska AU - Vosloo, Martlé AU - Tomlinson, Mark PY - 2021/7/2 TI - Executive Function After Prenatal Alcohol Exposure in Children in a South African Population: Cross-sectional Study JO - JMIR Form Res SP - e20658 VL - 5 IS - 7 KW - fetal alcohol spectrum disorders KW - FASD KW - cognitive KW - executive function KW - experimental games KW - brain drug effects KW - child development KW - serious games KW - games KW - alcohol KW - training N2 - Background: Alcohol is a teratogen; its consumption during pregnancy can lead to negative birth outcomes, collectively referred to as fetal alcohol spectrum disorders. Neurodevelopmental delays in higher-order cognitive functions that affect development of executive functions are a common feature. Studies on executive function in children have focused on children diagnosed with fetal alcohol spectrum disorder, and there is a lack of information on the impact on children not diagnosed with fetal alcohol spectrum disorder but who had been exposed to alcohol. Objective: The aim of this study was to compare the development of executive function in children between 4 and 6 years of age with and without prenatal exposure to alcohol. Methods: Children both exposed and not exposed to alcohol were recruited as part of a feasibility RCT evaluating a computer-based cognitive training program for improving executive function development. The study was conducted in a low?socioeconomic status community in South Africa with a high prevalence of fetal alcohol spectrum disorder. Neurodevelopment was assessed in participating children; NEPSY-II standardized scores for executive function domains were compared using a multivariate analysis of variance with group membership as the predictor variable. Results: No significant differences in executive functions assessments (P=.39) were found between children in the alcohol-exposed group (n=76) and those in the nonexposed group (n=40). Both groups showed moderate to severe delays in domains. In all but one subtest, the average score for both groups was below the 25th percentile of expected norms. Conclusions: We expected that alcohol exposure would have a measurable impact on executive function development. The lack of differences highlights the prevalence of developmental delays in low?socioeconomic status communities in South Africa and suggests that children are exposed to various threats to cognitive development. International Registered Report Identifier (IRRID): RR2-10.2196/14489 UR - https://formative.jmir.org/2021/7/e20658 UR - http://dx.doi.org/10.2196/20658 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255647 ID - info:doi/10.2196/20658 ER - TY - JOUR AU - Stoodley, Cathy AU - McKellar, Lois AU - Ziaian, Tahereh AU - Steen, Mary AU - Gwilt, Ian AU - Fereday, Jenny PY - 2021/6/10 TI - Using Co-design to Explore How Midwives Can Support the Emerging Mother-Infant Relationship During the Early Postnatal Period: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e29770 VL - 10 IS - 6 KW - mother-infant relationship KW - mother-infant relations KW - mother-infant bonding KW - infant development KW - midwife KW - early postnatal KW - co-design KW - mixed methods N2 - Background: The postnatal period can be a challenging time for women, with mothers experiencing a range of emotions. As a woman transitions to motherhood, she adjusts to a new sense of self and forms a new relationship with her infant. Becoming a mother is a complex cognitive and social process that is unique for each woman and is influenced and shaped by culture. The emerging mother-infant relationship is a significant factor in maternal well-being and infant development, with the bond between the mother and her baby being critical to the development of secure attachment. It has been recognized that the strength of this relationship is the main predictor of how well a child will do throughout life. There has been a global focus on the importance of the first 1000 days, with Australia identifying this as a national priority. Midwives are ideally placed to support mothers during the development of the mother-infant relationship, providing care through the early postnatal period, which has been identified as a sensitive period for the development of the mother-infant relationship. Objective: The aim of this study is to explore how midwives can support the emerging mother-infant relationship in the context of cultural diversity and develop an appropriate co-designed intervention in the early postnatal period. Methods: This study will use a mixed method approach, specifically the exploratory sequential design (intervention development variant). This study will be undertaken in 3 phases: 1 qualitative phase, which is followed by 2 quantitative phases. Phase 1 will include a scoping review to explore interventions that have influenced the development of the mother-infant relationship, and then, interviews will be undertaken with women exploring their early experiences of motherhood, followed by 3 co-design workshops. The workshops will engage with multilevel stakeholder representatives where, through partnership and participation, they will propose and develop an intervention to support the emerging mother-infant relationship. Phase 2 will develop and pilot 2 purpose-designed evaluation surveys to evaluate the co-designed intervention from the perspective of both mothers and midwives. Phase 3 will implement and evaluate the co-designed intervention using pre- and postmeasures and feedback from the purpose-designed surveys. Results: Phase 1 has commenced and is expected to be completed by August 2021. Phase 2 is expected to be completed by September 2021, with phase 3 commencing in October 2021. The study will be completed by March 2023. Conclusions: The results of this study will be shared with a variety of audiences and will contribute to the body of knowledge on the mother-infant relationship, potentially improving the understanding of this relationship for women and midwives. This may result in improved strategies for care, with mothers benefiting from enhanced experience and satisfaction during the early postnatal period. UR - https://www.researchprotocols.org/2021/6/e29770 UR - http://dx.doi.org/10.2196/29770 UR - http://www.ncbi.nlm.nih.gov/pubmed/34110301 ID - info:doi/10.2196/29770 ER - TY - JOUR AU - Kim, Heon Ho AU - An, Il Jae AU - Park, Rang Yu PY - 2021/6/4 TI - A Prediction Model for Detecting Developmental Disabilities in Preschool-Age Children Through Digital Biomarker-Driven Deep Learning in Serious Games: Development Study JO - JMIR Serious Games SP - e23130 VL - 9 IS - 2 KW - developmental delay KW - diagnosis prediction KW - deep learning KW - serious games KW - digital health KW - digital phenotyping KW - digital biomarkers N2 - Background: Early detection of developmental disabilities in children is essential because early intervention can improve the prognosis of children. Meanwhile, a growing body of evidence has indicated a relationship between developmental disability and motor skill, and thus, motor skill is considered in the early diagnosis of developmental disability. However, there are challenges to assessing motor skill in the diagnosis of developmental disorder, such as a lack of specialists and time constraints, and thus it is commonly conducted through informal questions or surveys to parents. Objective: This study sought to evaluate the possibility of using drag-and-drop data as a digital biomarker and to develop a classification model based on drag-and-drop data with which to classify children with developmental disabilities. Methods: We collected drag-and-drop data from children with typical development and developmental disabilities from May 1, 2018, to May 1, 2020, via a mobile application (DoBrain). We used touch coordinates and extracted kinetic variables from these coordinates. A deep learning algorithm was developed to predict potential development disabilities in children. For interpretability of the model results, we identified which coordinates contributed to the classification results by applying gradient-weighted class activation mapping. Results: Of the 370 children in the study, 223 had typical development, and 147 had developmental disabilities. In all games, the number of changes in the acceleration sign based on the direction of progress both in the x- and y-axes showed significant differences between the 2 groups (P<.001; effect size >0.5). The deep learning convolutional neural network model showed that drag-and-drop data can help diagnose developmental disabilities, with an area under the receiving operating characteristics curve of 0.817. A gradient class activation map, which can interpret the results of a deep learning model, was visualized with the game results for specific children. Conclusions: Through the results of the deep learning model, we confirmed that drag-and-drop data can be a new digital biomarker for the diagnosis of developmental disabilities. UR - https://games.jmir.org/2021/2/e23130 UR - http://dx.doi.org/10.2196/23130 UR - http://www.ncbi.nlm.nih.gov/pubmed/34085944 ID - info:doi/10.2196/23130 ER - TY - JOUR AU - Siddiqui, Ayat AU - Ladak, Akbar Laila AU - Kazi, Momin Abdul AU - Kaleem, Sidra AU - Akbar, Fizza AU - Kirmani, Salman PY - 2021/6/3 TI - Assessing Health-Related Quality of Life, Morbidity, and Survival Status for Individuals With Down Syndrome in Pakistan (DS-Pak): Protocol for a Web-Based Collaborative Registry JO - JMIR Res Protoc SP - e24901 VL - 10 IS - 6 KW - Down syndrome KW - registry KW - web-based registry KW - health-related quality of life KW - lower-middle income country KW - mobile health KW - patient-reported outcome N2 - Background: Down syndrome is the most common chromosomal disorder, with a global incidence of 1 in 700 live births. However, the true prevalence, associated morbidities, and health-related quality of life (HRQOL) of these individuals and their families are not well documented, especially in low- and middle-income countries such as Pakistan. Disease-specific documentation in the form of a collaborative registry is required to better understand this condition and the associated health outcomes. This protocol paper describes the aims and processes for developing the first comprehensive, web-based collaborative registry for Down syndrome in a Pakistani cohort. Objective: This study aims to assess the HRQOL, long-term survival, and morbidity of individuals with Down syndrome by using a web-based collaborative registry. Methods: The registry data collection will be conducted at the Aga Khan University Hospital and at the Karachi Down Syndrome Program. Data will be collected by in-person interviews or virtually via telephone or video interviews. Participants of any age and sex with Down syndrome (trisomy 21) will be recruited. After receiving informed consent and assent, a series of tablet-based questionnaires will be administered. The questionnaires aim to assess the sociodemographic background, clinical status, and HRQOL of the participants and their families. Data will be uploaded to a secure cloud server to allow for real-time access to participant responses by the clinicians to plan prompt interventions. Patient safety and confidentiality will be maintained by using multilayer encryption and unique coded patient identifiers. The collected data will be analyzed using IBM SPSS Statistics for Windows, Version 22.0 (IBM Corporation), with the mean and SD of continuous variables being reported. Categorical variables will be analyzed with their percentages being reported and with a P value cutoff of .05. Multivariate regression analysis will be conducted to identify predictors related to the HRQOL in patients with Down syndrome. Survival analysis will be reported using the Kaplan-Meier survival curves. Results: The web-based questionnaire is currently being finalized before the commencement of pilot testing. This project has not received funding at the moment (ethical review committee approval reference ID: 2020-3582-11145). Conclusions: This registry will allow for a comprehensive understanding of Down syndrome in low- and middle-income countries. This can provide the opportunity for data-informed interventions, which are tailored to the specific needs of this patient population and their families. Although this web-based registry is a proof of concept, it has the potential to be expanded to national, regional, and international levels. International Registered Report Identifier (IRRID): PRR1-10.2196/24901 UR - https://www.researchprotocols.org/2021/6/e24901 UR - http://dx.doi.org/10.2196/24901 UR - http://www.ncbi.nlm.nih.gov/pubmed/34081014 ID - info:doi/10.2196/24901 ER - TY - JOUR AU - Yildirim, Oguzcan AU - Surer, Elif PY - 2021/5/31 TI - Developing Adaptive Serious Games for Children With Specific Learning Difficulties: A Two-phase Usability and Technology Acceptance Study JO - JMIR Serious Games SP - e25997 VL - 9 IS - 2 KW - serious games KW - adaptive games KW - specific learning difficulty KW - usability KW - system usability scale KW - technology acceptance model KW - training KW - development KW - adaptation KW - gaming KW - learning disability KW - children KW - education KW - teacher N2 - Background: Specific learning difficulties (SpLD) include several disorders such as dyslexia, dyscalculia, and dysgraphia, and the children with these SpLD receive special education. However, the studies and the educational material so far focus mainly on one specific disorder. Objective: This study?s primary goal is to develop comprehensive training material for different types of SpLD, with five serious games addressing different aspects of the SpLD. The second focus is measuring the impact of adaptive difficulty level adjustment in the children?s and their educators? usability and technology acceptance perception. Receiving feedback from the children and their educators, and refining the games according to their suggestions have also been essential in this two-phase study. Methods: A total of 10 SpLD educators and 23 children with different types of SpLD tested the prototypes of the five serious games (ie, Word game, Memory game, Category game, Space game, and Math game), gave detailed feedback, answered the System Usability Scale and Technology Acceptance Model (TAM) questionnaires, and applied think-aloud protocols during game play. Results: The games? standard and adaptive versions were analyzed in terms of average playtime and the number of false answers. Detailed analyses of the interviews, with word clouds and player performances, were also provided. The TAM questionnaires? average and mean values and box plots of each data acquisition session for the children and the educators were also reported via System Usability Scale and TAM questionnaires. The TAM results of the educators had an average of 8.41 (SD 0.87) out of 10 in the first interview and an average of 8.71 (SD 0.64) out of 10 in the second interview. The children had an average of 9.07 (SD 0.56) out of 10 in the first interview. Conclusions: Both the educators and the children with SpLD enjoyed playing the games, gave positive feedback, and suggested new ways for improvement. The results showed that these games provide thorough training material for different types of SpLD with personalized and tailored difficulty systems. The final version of the proposed games will become a part of the special education centers? supplementary curriculum and training materials, making new enhancements and improvements possible in the future. UR - https://games.jmir.org/2021/2/e25997 UR - http://dx.doi.org/10.2196/25997 UR - http://www.ncbi.nlm.nih.gov/pubmed/34057415 ID - info:doi/10.2196/25997 ER - TY - JOUR AU - McMaughan, Jones Darcy AU - Lin, Sherry AU - Ozmetin, Jennifer AU - Beverly, Gayle Judith AU - Brog, Joshua AU - Naiser, Emily PY - 2021/5/25 TI - A Provider-Facing eHealth Tool for Transitioning Youth With Special Health Care Needs From Pediatric to Adult Care: Mixed Methods, User-Engaged Usability Study JO - JMIR Form Res SP - e22915 VL - 5 IS - 5 KW - youth with special health care needs KW - health care transitions KW - eHealth KW - usability KW - concurrent think aloud method N2 - Background: There is a need for medical education on health care transitions for youth with special health care needs. The Texas Transition Toolkit (the tool) supports providers through a one-stop shop for researching literature on care transitions, a catalog of care transition tools, and guides for developing care transition programs. Objective: This study aims to assess the functionality and usability of the tool with providers working with transition-aged children and youth with special health care needs (representative users). Methods: The tool was evaluated using a triangulated mixed methods case study approach consisting of a concurrent think-aloud phase, a satisfaction survey, and a survey of problem relevance and task performance to operationalize and capture functionality and usability. Our mixed methods deep dive into the functionality and usability of the tool focused on 10 representative users from one medical home in Texas and 5 website design experts. Results: Representative users found the tool to be highly relevant, as demonstrated by the satisfaction score for relevance (138/150, 92%). According to the users, the tool provided comprehensive information related to health care transitions for youth with special health care needs, with a satisfaction score of 87.3% (131/150) for comprehensive. Overall satisfaction with the tool was high at 81.92% (1065/1300) with a cutoff score of 73.33% (953.4/1300) indicating high satisfaction, but users reported relatively lower satisfaction with search (114/150, 76%) and navigation (ease of use: 114/150, 76%; hyperlinks: 163/200, 81.5%; structure: 159/200, 79.5%). They experienced search- and navigation-related problems (total problems detected: 21/31, 68%) and, based on quality checks, had a relatively low task completion rate for tasks involving finding information (60/80, 75%), which required searching and navigation. The problems identified around search and navigation functionality were relevant (relevance scores ranging from 14.5 to 22, with a cutoff score of 11.7 indicating relevance). Conclusions: The tool may help bridge the gaps in training on health care transitions for youth with special health care needs in US medical education. The tool can be used to create structured protocols to help improve provider knowledge, collaboration across pediatric and adult care providers, and the continuity of care as youth with special health care needs transition from pediatric to adult care. The results provided a road map for optimizing the tool and highlighted the importance of evaluating eHealth technologies with representative users. UR - https://formative.jmir.org/2021/5/e22915 UR - http://dx.doi.org/10.2196/22915 UR - http://www.ncbi.nlm.nih.gov/pubmed/34032579 ID - info:doi/10.2196/22915 ER - TY - JOUR AU - Dimitri, Paul AU - Fernandez-Luque, Luis AU - Banerjee, Indraneel AU - Bergadá, Ignacio AU - Calliari, Eduardo Luis AU - Dahlgren, Jovanna AU - de Arriba, Antonio AU - Lapatto, Risto AU - Reinehr, Thomas AU - Senniappan, Senthil AU - Thomas-Teinturier, Cécile AU - Tsai, Meng-Che AU - Anuar Zaini, Azriyanti AU - Bagha, Merat AU - Koledova, Ekaterina PY - 2021/5/20 TI - An eHealth Framework for Managing Pediatric Growth Disorders and Growth Hormone Therapy JO - J Med Internet Res SP - e27446 VL - 23 IS - 5 KW - eHealth tools KW - pediatric growth disorders KW - referral and diagnosis KW - growth hormone therapy KW - adherence to treatment KW - workshop discussions KW - eHealth KW - pediatrics KW - growth failure KW - growth hormone N2 - Background: The use of technology to support health and health care has grown rapidly in the last decade across all ages and medical specialties. Newly developed eHealth tools are being implemented in long-term management of growth failure in children, a low prevalence pediatric endocrine disorder. Objective: Our objective was to create a framework that can guide future implementation and research on the use of eHealth tools to support patients with growth disorders who require growth hormone therapy. Methods: A total of 12 pediatric endocrinologists with experience in eHealth, from a wide geographical distribution, participated in a series of online discussions. We summarized the discussions of 3 workshops, conducted during 2020, on the use of eHealth in the management of growth disorders, which were structured to provide insights on existing challenges, opportunities, and solutions for the implementation of eHealth tools across the patient journey, from referral to the end of pediatric therapy. Results: A total of 815 responses were collected from 2 questionnaire-based activities covering referral and diagnosis of growth disorders, and subsequent growth hormone therapy stages of the patient pathway, relating to physicians, nurses, and patients, parents, or caregivers. We mapped the feedback from those discussions into a framework that we developed as a guide to integration of eHealth tools across the patient journey. Responses focused on improved clinical management, such as growth monitoring and automation of referral for early detection of growth disorders, which could trigger rapid evaluation and diagnosis. Patient support included the use of eHealth for enhanced patient and caregiver communication, better access to educational opportunities, and enhanced medical and psychological support during growth hormone therapy management. Given the potential availability of patient data from connected devices, artificial intelligence can be used to predict adherence and personalize patient support. Providing evidence to demonstrate the value and utility of eHealth tools will ensure that these tools are widely accepted, trusted, and used in clinical practice, but implementation issues (eg, adaptation to specific clinical settings) must be addressed. Conclusions: The use of eHealth in growth hormone therapy has major potential to improve the management of growth disorders along the patient journey. Combining objective clinical information and patient adherence data is vital in supporting decision-making and the development of new eHealth tools. Involvement of clinicians and patients in the process of integrating such technologies into clinical practice is essential for implementation and developing evidence that eHealth tools can provide value across the patient pathway. UR - https://www.jmir.org/2021/5/e27446 UR - http://dx.doi.org/10.2196/27446 UR - http://www.ncbi.nlm.nih.gov/pubmed/34014174 ID - info:doi/10.2196/27446 ER - TY - JOUR AU - Remmele, Julia AU - Helm, Christian Paul AU - Oberhoffer-Fritz, Renate AU - Bauer, MM Ulrike AU - Pickardt, Thomas AU - Ewert, Peter AU - Tutarel, Oktay PY - 2021/5/13 TI - A National Comparative Investigation of Twins With Congenital Heart Defects for Neurodevelopmental Outcomes and Quality of Life (Same Same, but Different?): Protocol for a Prospective Observational Study JO - JMIR Res Protoc SP - e26404 VL - 10 IS - 5 KW - congenital heart defect KW - twin siblings with CHD KW - twin study KW - neurodevelopmental outcome KW - same same KW - cardiology KW - heart defect KW - twin N2 - Background: Due to the increased survival rates of patients with congenital heart defects (CHD), associated disorders are an increasing focus of research. Existing studies figured out an association between CHD and its treatment, and neurodevelopmental outcomes including motor competence impairments. All these studies, however, compared their test results with reference values or results of healthy control groups. This comparison is influenced by socioeconomic and genetic aspects, which do have a known impact on neurodevelopmental outcomes. Objective: This study protocol describes a setting that aims to find out the role of CHD and its treatments on neurodevelopmental outcomes, excluding socioeconomic and genetic aspects. Only a twin comparison provides the possibility to exclude these confounding factors. Methods: In a German-wide prospective cohort study, 129 twin siblings registered in the National Register for Congenital Heart Defects will undergo testing on cognitive function (Wechsler Intelligence Tests age-dependent: Wechsler Adult Intelligence Scale, fourth edition; Wechsler Intelligence Scale for Children, fifth edition; and Wechsler Preschool and Primary Scale of Intelligence, fourth edition) and motor competence (Movement Assessment Battery for Children, second edition). Additionally, the self-reported health-related quality of life (KINDL-R for children, Short Form 36 for adults) and the parent-reported strength and difficulties of the children (Strength and Difficulties Questionnaire, German version) will be assessed by standardized questionnaires. CHD data on the specific diagnosis, surgeries, transcatheter procedures, and additional medical information will be received from patient records. Results: The approval of the Medical Ethics Committee Charité Mitte was obtained in June 2018. After getting funded in April 2019, the first enrollment was in August 2019. The study is still ongoing until June 2022. Final results are expected in 2022. Conclusions: This study protocol provides an overview of the study design?s technical details, offering an option to exclude confounding factors on neurodevelopmental outcomes in patients with CHD. This will enable a specific analysis focusing on CHD and clinical treatments to differentiate in terms of neurodevelopmental outcomes of patients with CHD compared to twin siblings with healthy hearts. Finally, we aim to clearly define what is important to prevent patients with CHD in terms of neurodevelopmental impairments to be able to develop targeted prevention strategies for patients with CHD. Trial Registration: German Clinical Trials Register DRKS00021087; https://tinyurl.com/2rdw8w67 International Registered Report Identifier (IRRID): DERR1-10.2196/26404 UR - https://www.researchprotocols.org/2021/5/e26404 UR - http://dx.doi.org/10.2196/26404 UR - http://www.ncbi.nlm.nih.gov/pubmed/33983133 ID - info:doi/10.2196/26404 ER - TY - JOUR AU - Sezgin, Emre AU - Noritz, Garey AU - Lin, Simon AU - Huang, Yungui PY - 2021/5/11 TI - Feasibility of a Voice-Enabled Medical Diary App (SpeakHealth) for Caregivers of Children With Special Health Care Needs and Health Care Providers: Mixed Methods Study JO - JMIR Form Res SP - e25503 VL - 5 IS - 5 KW - children with special health care needs KW - care management KW - care coordination KW - voice-enabled mobile app KW - health information technology KW - voice assistant KW - voice interaction KW - mobile phone N2 - Background: Children with special health care needs (CSHCN) require more than the usual care management and coordination efforts from caregivers and health care providers (HCPs). Health information and communication technologies can potentially facilitate these efforts to increase the quality of care received by CSHCN. Objective: In this study, we aim to assess the feasibility of a voice-enabled medical diary app (SpeakHealth) by investigating its potential use among caregivers and HCPs. Methods: Following a mixed methods approach, caregivers of CSHCN were interviewed (n=10) and surveyed (n=86) about their care management and communication technology use. Only interviewed participants were introduced to the SpeakHealth app prototype, and they tested the app during the interview session. In addition, we interviewed complex care HCPs (n=15) to understand their perception of the value of a home medical diary such as the SpeakHealth app. Quantitative data were analyzed using descriptive statistics and correlational analyses. Theoretical thematic analysis was used to analyze qualitative data. Results: The survey results indicated a positive attitude toward voice-enabled technology and features; however, there was no strong correlation among the measured items. The caregivers identified communication, information sharing, tracking medication, and appointments as fairly and highly important features of the app. Qualitative analysis revealed the following two overarching themes: enablers and barriers in care communication and enablers and barriers in communication technologies. The subthemes included parent roles, care communication technologies, and challenges. HCPs found the SpeakHealth app to be a promising tool for timely information collection that could be available for sharing information with the health system. Overall, the findings demonstrated a variety of needs and challenges for caregivers of CSHCN and opportunities for voice-enabled, interactive medical diary apps in care management and coordination. Caregivers fundamentally look for better information sharing and communication with HCPs. Health care and communication technologies can potentially improve care communication and coordination in addressing the patient and caregiver needs. Conclusions: The perspectives of caregivers and providers suggested both benefits and challenges in using the SpeakHealth app for medical note-taking and tracking health events at home. Our findings could inform researchers and developers about the potential development and use of a voice-enabled medical diary app. UR - https://formative.jmir.org/2021/5/e25503 UR - http://dx.doi.org/10.2196/25503 UR - http://www.ncbi.nlm.nih.gov/pubmed/33865233 ID - info:doi/10.2196/25503 ER - TY - JOUR AU - Al Azdi, Zunayed AU - Islam, Khaleda AU - Khan, Amir Muhammad AU - Khan, Nida AU - Ejaz, Amna AU - Khan, Ahmar Muhammad AU - Warraitch, Azza AU - Jahan, Ishrat AU - Huque, Rumana PY - 2021/5/4 TI - Effectiveness of an Integrated Care Package for Refugee Mothers and Children: Protocol for a Cluster Randomized Controlled Trial JO - JMIR Res Protoc SP - e25047 VL - 10 IS - 5 KW - mental health KW - refugee health KW - early childhood development KW - Rohingya KW - Bangladesh KW - community health care KW - community health worker N2 - Background: Thousands of Rohingya refugee mothers at the world?s largest refugee camp located in Bangladesh are at risk of poor mental health. Accordingly, their children are also vulnerable to delayed cognitive and physical development. Objective: The aim of this study is to evaluate the effectiveness of an integrated care package in reducing the prevalence of developmental delays among children aged 1 year and improving their mothers? mental health status. Methods: This is a parallel, two-arm, single-blind, cluster randomized controlled trial (cRCT). A total of 704 mother-child dyads residing at the Kutupalong refugee camp in Cox?s Bazar, Bangladesh, will be recruited from 22 clusters with 32 mother-child dyads per cluster. In the intervention arm, an integrated early childhood development and maternal mental health package will be delivered every quarter to mothers of newborns by trained community health workers until the child is 1 year old. Our primary outcome is a reduction in the prevalence of two or more childhood developmental delays of infants aged 1 year compared to the usual treatment. The secondary outcomes include reduced stunting among children and the prevalence of maternal depression. We will also assess the cost-effectiveness of the integrated intervention, and will further explore the intervention?s acceptability and feasibility. Results: At the time of submission, the study was at the stage of endpoint assessment. The data analysis started in December 2020, and the results are expected to be published after the first quarter of 2021. Conclusions: This study will address the burden of childhood developmental delays and poor maternal mental health in a low-resource setting. If proven effective, the delivery of the intervention through community health workers will ensure the proposed intervention?s sustainability. Trial Registration: ISRCTN Registry ISRCTN10892553; https://www.isrctn.com/ISRCTN10892553 International Registered Report Identifier (IRRID): DERR1-10.2196/25047 UR - https://www.researchprotocols.org/2021/5/e25047 UR - http://dx.doi.org/10.2196/25047 UR - http://www.ncbi.nlm.nih.gov/pubmed/33944793 ID - info:doi/10.2196/25047 ER - TY - JOUR AU - Brons, Annette AU - de Schipper, Antoine AU - Mironcika, Svetlana AU - Toussaint, Huub AU - Schouten, Ben AU - Bakkes, Sander AU - Kröse, Ben PY - 2021/4/22 TI - Assessing Children?s Fine Motor Skills With Sensor-Augmented Toys: Machine Learning Approach JO - J Med Internet Res SP - e24237 VL - 23 IS - 4 KW - motor development KW - fine motor function KW - gamification KW - playful KW - motor skill assessment KW - Movement ABC (MABC) KW - machine learning KW - motor function KW - motor skills KW - toys KW - children KW - game KW - movement assessment N2 - Background: Approximately 5%-10% of elementary school children show delayed development of fine motor skills. To address these problems, detection is required. Current assessment tools are time-consuming, require a trained supervisor, and are not motivating for children. Sensor-augmented toys and machine learning have been presented as possible solutions to address this problem. Objective: This study examines whether sensor-augmented toys can be used to assess children?s fine motor skills. The objectives were to (1) predict the outcome of the fine motor skill part of the Movement Assessment Battery for Children Second Edition (fine MABC-2) and (2) study the influence of the classification model, game, type of data, and level of difficulty of the game on the prediction. Methods: Children in elementary school (n=95, age 7.8 [SD 0.7] years) performed the fine MABC-2 and played 2 games with a sensor-augmented toy called ?Futuro Cube.? The game ?roadrunner? focused on speed while the game ?maze? focused on precision. Each game had several levels of difficulty. While playing, both sensor and game data were collected. Four supervised machine learning classifiers were trained with these data to predict the fine MABC-2 outcome: k-nearest neighbor (KNN), logistic regression (LR), decision tree (DT), and support vector machine (SVM). First, we compared the performances of the games and classifiers. Subsequently, we compared the levels of difficulty and types of data for the classifier and game that performed best on accuracy and F1 score. For all statistical tests, we used ?=.05. Results: The highest achieved mean accuracy (0.76) was achieved with the DT classifier that was trained on both sensor and game data obtained from playing the easiest and the hardest level of the roadrunner game. Significant differences in performance were found in the accuracy scores between data obtained from the roadrunner and maze games (DT, P=.03; KNN, P=.01; LR, P=.02; SVM, P=.04). No significant differences in performance were found in the accuracy scores between the best performing classifier and the other 3 classifiers for both the roadrunner game (DT vs KNN, P=.42; DT vs LR, P=.35; DT vs SVM, P=.08) and the maze game (DT vs KNN, P=.15; DT vs LR, P=.62; DT vs SVM, P=.26). The accuracy of only the best performing level of difficulty (combination of the easiest and hardest level) achieved with the DT classifier trained with sensor and game data obtained from the roadrunner game was significantly better than the combination of the easiest and middle level (P=.046). Conclusions: The results of our study show that sensor-augmented toys can efficiently predict the fine MABC-2 scores for children in elementary school. Selecting the game type (focusing on speed or precision) and data type (sensor or game data) is more important for determining the performance than selecting the machine learning classifier or level of difficulty. UR - https://www.jmir.org/2021/4/e24237 UR - http://dx.doi.org/10.2196/24237 UR - http://www.ncbi.nlm.nih.gov/pubmed/33885371 ID - info:doi/10.2196/24237 ER - TY - JOUR AU - Fernandes, Magela Geraldo AU - Motta, Felipe AU - Sasaki, Paravidine Lizandra Moura AU - Silva, Da Ângelo Pereira AU - Miranda, Monforte Andreza AU - Carvalho, De Aleida Oliveira AU - Gomides, Monteiro Ana Paula AU - Soares, Munhoz Alexandre Anderson De Sousa AU - Santos Jr, Dos Agenor De Castro Moreira AU - Alves, Oliveira Caroline De AU - Gomes, Martins Ciro AU - Siracusa, De Clara Correia AU - Araújo Jr, De David Alves AU - Mendonça-Silva, Lane Dayde AU - Jesus, De José Alfredo Lacerda AU - Costa, Nascimento Karina AU - Castro, De Maria Eduarda Canellas AU - Kurizky, Shu Patricia AU - França, Sérgio Paulo AU - Tristão, Rosana AU - Pereira, Ribeiro Yacara AU - Castro, De Luiz Claudio Gonçalves AU - Zaconeta, Moreno Alberto AU - Albuquerque, De Cleandro Pires AU - Mota, Da Licia Maria Henrique PY - 2021/4/20 TI - Pregnancy Outcomes and Child Development Effects of SARS-CoV-2 Infection (PROUDEST Trial): Protocol for a Multicenter, Prospective Cohort Study JO - JMIR Res Protoc SP - e26477 VL - 10 IS - 4 KW - SARS-CoV-2 KW - COVID-19 KW - pregnancy KW - neonate KW - children KW - outcome KW - development KW - prospective KW - cohort KW - women KW - fetus KW - baby KW - implication N2 - Background: A growing body of evidence suggests that SARS-COV-2 infection during pregnancy may affect maternal-fetal outcomes and possibly result in implications for the long-term development of SARS-CoV-2?exposed children. Objective: The PROUDEST (Pregnancy Outcomes and Child Development Effects of SARS-CoV-2 Infection Study) is a multicenter, prospective cohort study designed to elucidate the repercussions of COVID-19 for the global health of mothers and their children. Methods: The PROUDEST trial comprises 2 prospective, sequential substudies. The PREGNANT substudy will clinically assess the effects of SARS-CoV-2 infection on pregnancy, childbirth, and puerperium from a mechanistic standpoint to elucidate the pregnancy-related inflammatory and immunological phenomena underlying COVID-19. Pregnant women aged 18-40 years who have been exposed (proven with laboratory tests) to SARS-CoV-2 (group A; n=300) will be compared to control subjects with no laboratory evidence of in-pregnancy exposure to the virus (group B; n=300). Subjects exposed to other infections during pregnancy will be excluded. The BORN substudy is a long-term follow-up study that will assess the offspring of women who enrolled in the prior substudy. It will describe the effects of SARS-CoV-2 exposure during pregnancy on children?s growth, neurodevelopment, and metabolism from birth up to 5 years of age. It includes two comparison groups; group A (exposed; n=300) comprises children born from SARS-CoV-2?exposed pregnancies, and group B (controls; n=300) comprises children born from nonexposed mothers. Results: Recruitment began in July 2020, and as of January 2021, 260 pregnant women who were infected with SARS-CoV-2 during pregnancy and 160 newborns have been included in the study. Data analysis is scheduled to start after all data are collected. Conclusions: Upon completion of the study, we expect to have comprehensive data that will provide a better understanding of the effects of SARS-CoV-2 infection and related inflammatory and immunological processes on pregnancy, puerperium, and infancy. Our findings will inform clinical decisions regarding the care of SARS-CoV-2?exposed mothers and children and support the development of evidence-based public health policies. Trial Registration: Brazilian Register of Clinical Trials RBR65QXS2; https://ensaiosclinicos.gov.br/rg/RBR-65qxs2 International Registered Report Identifier (IRRID): DERR1-10.2196/26477 UR - https://www.researchprotocols.org/2021/4/e26477 UR - http://dx.doi.org/10.2196/26477 UR - http://www.ncbi.nlm.nih.gov/pubmed/33793409 ID - info:doi/10.2196/26477 ER - TY - JOUR AU - Koumarela, Christina AU - Kokkinaki, Theano AU - Giannakakis, Giorgos AU - Koutra, Katerina AU - Hatzidaki, Eleftheria PY - 2021/4/12 TI - Autonomic Nervous System Maturation and Emotional Coordination in Interactions of Preterm and Full-Term Infants With Their Parents: Protocol for a Multimethod Study JO - JMIR Res Protoc SP - e28089 VL - 10 IS - 4 KW - preterm infants KW - heart rate variability KW - emotional coordination KW - developmental outcomes N2 - Background: There is limited knowledge on the physiological and behavioral pathways that may affect the developmental outcomes of preterm infants and particularly on the link between autonomic nervous system maturation and early social human behavior. Thus, this study attempts to investigate the way heart rate variability (HRV) parameters are related to emotional coordination in interactions of preterm and full-term infants with their parents in the first year of life and the possible correlation with the developmental outcomes of infants at 18 months. Objective: The first objective is to investigate the relationship between emotional coordination and HRV in dyadic full-term infant?parent (group 1) and preterm infant?parent (group 2) interactions during the first postpartum year. The second objective is to examine the relationship of emotional coordination and HRV in groups 1 and 2 in the first postpartum year with the developmental outcomes of infants at 18 months. The third objective is to investigate the effect of maternal and paternal postnatal depression on the relation between emotional coordination and HRV in the two groups and on developmental outcomes at 18 months. The fourth objective is to examine the effect of family cohesion and coping on the relation between emotional coordination and HRV in the two groups and on developmental outcomes at 18 months. Methods: This is an observational, naturalistic, and longitudinal study applying a mixed method design that includes the following: (1) video recordings of mother-infant and father-infant interactions at the hospital, in the neonatal period, and at home at 2, 4, 6, 9, and 12 months of the infants? life; (2) self-report questionnaires of parents on depressive symptoms, family cohesion, and dyadic coping of stress; (3) infants? HRV parameters in the neonatal period and at each of the above age points during and after infant-parent video recordings; and (4) assessment of toddlers? social and cognitive development at 18 months through an observational instrument. Results: The study protocol has been approved by the Research Ethics Committee of the University of Crete (number/date: 170/September 18, 2020). This work is supported by the Special Account for Research Funds of the University of Crete (grant number: 10792-668/08.02.2021). All mothers (with their partners) of full-term and preterm infants who give birth between March 2021 and January 2022 at the General University Hospital of Crete (northern Crete, Greece) will be invited to participate. The researcher will invite the parents of infants to participate in the study 1 to 2 days after birth. Data collection is expected to be completed by March 2023, and the first results will be published by the end of 2023. Conclusions: Investigating the regulatory role of HRV and social reciprocity in preterm infants may have implications for both medicine and psychology. International Registered Report Identifier (IRRID): PRR1-10.2196/28089 UR - https://www.researchprotocols.org/2021/4/e28089 UR - http://dx.doi.org/10.2196/28089 UR - http://www.ncbi.nlm.nih.gov/pubmed/33843606 ID - info:doi/10.2196/28089 ER - TY - JOUR AU - Weijers, Miriam AU - Feron, Frans AU - van der Zwet, Jonne AU - Bastiaenen, Caroline PY - 2021/3/16 TI - Evaluation of a New Personalized Health Dashboard in Preventive Child Health Care: Protocol for a Mixed Methods Feasibility Randomized Controlled Trial JO - JMIR Res Protoc SP - e21942 VL - 10 IS - 3 KW - child health services KW - prevention KW - control KW - personalized health care KW - international classification of functioning KW - disability KW - health KW - patient KW - access to records KW - personalized KW - child KW - feasibility N2 - Background: A new dashboard, the 360ºCHILD-profile, was developed to adopt personalized health care within preventive child health care. On this profile, holistic health data are visualized in a single image to provide parents, adolescents, and caregivers direct access to a manageable résumé of a child?s medical record. Theoretical ordering, conforming to ?International Classification of Functioning, Disability and Health for Children and Youth?, guides clinical reasoning toward the biopsychosocial concept of health. It is yet unknown if and how this promising tool functions in practice, and a variety of feasibility questions must be addressed. Objective: This paper describes the design and methods of a feasibility randomized controlled trial (RCT), with the aim of evaluating the RCT?s feasibility (recruitment, response, measure completion, and intervention allocation) and 360ºCHILD-profile?s feasibility (usability and potential effectiveness). Methods: A pragmatic mixed methods study design was chosen, starting with an RCT to measure feasibility and health literacy in 2 parallel groups (1:1). Qualitative research will then be used to understand and explain quantitative findings and to explore the stakeholders' perspectives on the potential of the 360ºCHILD-profile. Participants will include child health care professionals (n?30), parents (n?30), and caregivers (n?10) of children who experience developmental problems (age 0-16 years). Children will only be able to participate if they are older than 11 years (adolescents, n?10). The 2 groups included in the study will receive standard care. The experimental group will additionally receive personalized 360ºCHILD-profiles. Results: After an intervention period of 6 months, quantitative outcomes will be measured, analyzed (descriptive feasibility statistics and preliminary between-group differences) and used to purposively sample for semistructured interviews. Conclusions: Study results will provide knowledge for building theory on the 360ºCHILD-profile and designing future (effect) studies. Trial Registration: Netherlands Trial Register NTR6909; https://www.trialregister.nl/trial/6731 International Registered Report Identifier (IRRID): DERR1-10.2196/21942 UR - https://www.researchprotocols.org/2021/3/e21942 UR - http://dx.doi.org/10.2196/21942 UR - http://www.ncbi.nlm.nih.gov/pubmed/33724191 ID - info:doi/10.2196/21942 ER - TY - JOUR AU - Leal Neto, Onicio AU - Haenni, Simon AU - Phuka, John AU - Ozella, Laura AU - Paolotti, Daniela AU - Cattuto, Ciro AU - Robles, Daniel AU - Lichand, Guilherme PY - 2021/3/5 TI - Combining Wearable Devices and Mobile Surveys to Study Child and Youth Development in Malawi: Implementation Study of a Multimodal Approach JO - JMIR Public Health Surveill SP - e23154 VL - 7 IS - 3 KW - child development KW - wearables KW - participatory surveillance KW - proximity sensors KW - mobile surveying N2 - Background: Multimodal approaches have been shown to be a promising way to collect data on child development at high frequency, combining different data inputs (from phone surveys to signals from noninvasive biomarkers) to understand children?s health and development outcomes more integrally from multiple perspectives. Objective: The aim of this work was to describe an implementation study using a multimodal approach combining noninvasive biomarkers, social contact patterns, mobile surveying, and face-to-face interviews in order to validate technologies that help us better understand child development in poor countries at a high frequency. Methods: We carried out a mixed study based on a transversal descriptive analysis and a longitudinal prospective analysis in Malawi. In each village, children were sampled to participate in weekly sessions in which data signals were collected through wearable devices (electrocardiography [ECG] hand pads and electroencephalography [EEG] headbands). Additionally, wearable proximity sensors to elicit the social network were deployed among children and their caregivers. Mobile surveys using interactive voice response calls were also used as an additional layer of data collection. An end-line face-to-face survey was conducted at the end of the study. Results: During the implementation, 82 EEG/ECG data entry points were collected across four villages. The sampled children for EEG/ECG were 0 to 5 years old. EEG/ECG data were collected once a week. In every session, children wore the EEG headband for 5 minutes and the ECG hand pad for 3 minutes. In total, 3531 calls were sent over 5 weeks, with 2291 participants picking up the calls and 984 of those answering the consent question. In total, 585 people completed the surveys over the course of 5 weeks. Conclusions: This study achieved its objective of demonstrating the feasibility of generating data through the unprecedented use of a multimodal approach for tracking child development in Malawi, which is one of the poorest countries in the world. Above and beyond its multiple dimensions, the dynamics of child development are complex. It is the case not only that no data stream in isolation can accurately characterize it, but also that even if combined, infrequent data might miss critical inflection points and interactions between different conditions and behaviors. In turn, combining different modes at a sufficiently high frequency allows researchers to make progress by considering contact patterns, reported symptoms and behaviors, and critical biomarkers all at once. This application showcases that even in developing countries facing multiple constraints, complementary technologies can leverage and accelerate the digitalization of health, bringing benefits to populations that lack new tools for understanding child well-being and development. UR - https://publichealth.jmir.org/2021/3/e23154 UR - http://dx.doi.org/10.2196/23154 UR - http://www.ncbi.nlm.nih.gov/pubmed/33536159 ID - info:doi/10.2196/23154 ER - TY - JOUR AU - Tanaka, Masanori AU - Saito, Manabu AU - Takahashi, Michio AU - Adachi, Masaki AU - Nakamura, Kazuhiko PY - 2021/2/4 TI - Interformat Reliability of Web-Based Parent-Rated Questionnaires for Assessing Neurodevelopmental Disorders Among Preschoolers: Cross-sectional Community Study JO - JMIR Pediatr Parent SP - e20172 VL - 4 IS - 1 KW - neurodevelopmental disorders KW - web-based questionnaire KW - preschoolers KW - parents KW - interformat reliability N2 - Background: Early detection and intervention for neurodevelopmental disorders are effective. Several types of paper questionnaires have been developed to assess these conditions in early childhood; however, the psychometric equivalence between the web-based and the paper versions of these questionnaires is unknown. Objective: This study examined the interformat reliability of the web-based parent-rated version of the Autism Spectrum Screening Questionnaire (ASSQ), Attention-Deficit/Hyperactivity Disorder Rating Scale (ADHD-RS), Developmental Coordination Disorder Questionnaire 2007 (DCDQ), and Strengths and Difficulties Questionnaire (SDQ) among Japanese preschoolers in a community developmental health check-up setting. Methods: A set of paper-based questionnaires were distributed for voluntary completion to parents of children aged 5 years. The package of the paper format questionnaires included the ASSQ, ADHD-RS, DCDQ, parent-reported SDQ (P-SDQ), and several additional demographic questions. Responses were received from 508 parents of children who agreed to participate in the study. After 3 months, 300 parents, who were among the initial responders, were randomly selected and asked to complete the web-based versions of these questionnaires. A total of 140 parents replied to the web-based format and were included as a final sample in this study. Results: We obtained the McDonald ? coefficients for both the web-based and paper formats of the ASSQ (web-based: ?=.90; paper: ?=.86), ADHD-RS total and subscales (web-based: ?=.88-.94; paper: ?=.87-.93), DCDQ total and subscales (web-based: ?=.82-.94; paper: ?=.74-.92), and P-SDQ total and subscales (web-based: ?=.55-.81; paper: ?=.52-.80). The intraclass correlation coefficients between the web-based and paper formats were all significant at the 99.9% confidence level: ASSQ (r=0.66, P<.001); ADHD-RS total and subscales (r=0.66-0.74, P<.001); DCDQ total and subscales (r=0.66-0.71, P<.001); P-SDQ Total Difficulties and subscales (r=0.55-0.73, P<.001). There were no significant differences between the web-based and paper formats for total mean score of the ASSQ (P=.76), total (P=.12) and subscale (P=.11-.47) mean scores of DCDQ, and the P-SDQ Total Difficulties mean score (P=.20) and mean subscale scores (P=.28-.79). Although significant differences were found between the web-based and paper formats for mean ADHD-RS scores (total: t132=2.83, P=.005; Inattention subscale: t133=2.15, P=.03; Hyperactivity/Impulsivity subscale: t133=3.21, P=.002), the effect sizes were small (Cohen d=0.18-0.22). Conclusions: These results suggest that the web-based versions of the ASSQ, ADHD-RS, DCDQ, and P-SDQ were equivalent, with the same level of internal consistency and intrarater reliability as the paper versions, indicating the applicability of the web-based versions of these questionnaires for assessing neurodevelopmental disorders. UR - https://pediatrics.jmir.org/2021/1/e20172 UR - http://dx.doi.org/10.2196/20172 UR - http://www.ncbi.nlm.nih.gov/pubmed/33455899 ID - info:doi/10.2196/20172 ER - TY - JOUR AU - Jeong, Seung-Hyun AU - Lee, Rim Tae AU - Kang, Bae Jung AU - Choi, Mun-Taek PY - 2020/11/23 TI - Analysis of Health Insurance Big Data for Early Detection of Disabilities: Algorithm Development and Validation JO - JMIR Med Inform SP - e19679 VL - 8 IS - 11 KW - early detection of disabilities KW - health insurance KW - big data KW - feature selection KW - classification N2 - Background: Early detection of childhood developmental delays is very important for the treatment of disabilities. Objective: To investigate the possibility of detecting childhood developmental delays leading to disabilities before clinical registration by analyzing big data from a health insurance database. Methods: In this study, the data from children, individuals aged up to 13 years (n=2412), from the Sample Cohort 2.0 DB of the Korea National Health Insurance Service were organized by age range. Using 6 categories (having no disability, having a physical disability, having a brain lesion, having a visual impairment, having a hearing impairment, and having other conditions), features were selected in the order of importance with a tree-based model. We used multiple classification algorithms to find the best model for each age range. The earliest age range with clinically significant performance showed the age at which conditions can be detected early. Results: The disability detection model showed that it was possible to detect disabilities with significant accuracy even at the age of 4 years, about a year earlier than the mean diagnostic age of 4.99 years. Conclusions: Using big data analysis, we discovered the possibility of detecting disabilities earlier than clinical diagnoses, which would allow us to take appropriate action to prevent disabilities. UR - http://medinform.jmir.org/2020/11/e19679/ UR - http://dx.doi.org/10.2196/19679 UR - http://www.ncbi.nlm.nih.gov/pubmed/33226352 ID - info:doi/10.2196/19679 ER - TY - JOUR AU - Dui, Greta Linda AU - Lunardini, Francesca AU - Termine, Cristiano AU - Matteucci, Matteo AU - Stucchi, Adolfo Natale AU - Borghese, Alberto Nunzio AU - Ferrante, Simona PY - 2020/10/22 TI - A Tablet App for Handwriting Skill Screening at the Preliteracy Stage: Instrument Validation Study JO - JMIR Serious Games SP - e20126 VL - 8 IS - 4 KW - serious game KW - tablet KW - isochrony KW - homothety KW - speed-accuracy tradeoff KW - steering law KW - writing KW - prevention N2 - Background: Difficulties in handwriting, such as dysgraphia, impact several aspects of a child?s everyday life. Current methodologies for the detection of such difficulties in children have the following three main weaknesses: (1) they are prone to subjective evaluation; (2) they can be administered only when handwriting is mastered, thus delaying the diagnosis and the possible adoption of countermeasures; and (3) they are not always easily accessible to the entire community. Objective: This work aims at developing a solution able to: (1) quantitatively measure handwriting features whose alteration is typically seen in children with dysgraphia; (2) enable their study in a preliteracy population; and (3) leverage a standard consumer technology to increase the accessibility of both early screening and longitudinal monitoring of handwriting difficulties. Methods: We designed and developed a novel tablet-based app Play Draw Write to assess potential markers of dysgraphia through the quantification of the following three key handwriting laws: isochrony, homothety, and speed-accuracy tradeoff. To extend such an approach to a preliteracy age, the app includes the study of the laws in terms of both word writing and symbol drawing. The app was tested among healthy children with mastered handwriting (third graders) and those at a preliterate age (kindergartners). Results: App testing in 15 primary school children confirmed that the three laws hold on the tablet surface when both writing words and drawing symbols. We found significant speed modulation according to size (P<.001), no relevant changes to fraction time for 67 out of 70 comparisons, and significant regression between movement time and index of difficulty for 44 out of 45 comparisons (P<.05, R2>0.28, 12 degrees of freedom). Importantly, the three laws were verified on symbols among 19 kindergartners. Results from the speed-accuracy exercise showed a significant evolution with age of the global movement time (circle: P=.003, square: P<.001, word: P=.001), the goodness of fit of the regression between movement time and accuracy constraints (square: P<.001, circle: P=.02), and the index of performance (square: P<.001). Our findings show that homothety, isochrony, and speed-accuracy tradeoff principles are present in children even before handwriting acquisition; however, some handwriting-related skills are partially refined with age. Conclusions: The designed app represents a promising solution for the screening of handwriting difficulties, since it allows (1) anticipation of the detection of alteration of handwriting principles at a preliteracy age and (2) provision of broader access to the monitoring of handwriting principles. Such a solution potentially enables the selective strengthening of lacking abilities before they exacerbate and affect the child?s whole life. UR - http://games.jmir.org/2020/4/e20126/ UR - http://dx.doi.org/10.2196/20126 UR - http://www.ncbi.nlm.nih.gov/pubmed/33090110 ID - info:doi/10.2196/20126 ER - TY - JOUR AU - Davidson, Rosemary AU - Randhawa, Gurch PY - 2020/6/30 TI - The Sign 4 Little Talkers Intervention to Improve Listening, Understanding, Speaking, and Behavior in Hearing Preschool Children: Outcome Evaluation JO - JMIR Pediatr Parent SP - e15348 VL - 3 IS - 1 KW - sign language KW - early years KW - intervention KW - disadvantage N2 - Background: Gaining age-appropriate proficiency in speech and language in the early years is crucial to later life chances; however, a significant proportion of children fail to meet the expected standards in these early years outcomes when they start school. Factors influencing the development of language and communication include low income, gender, and having English as an additional language (EAL). Objective: This study aimed to determine whether the Sign 4 Little Talkers (S4LT) program improves key developmental outcomes in hearing preschool children. S4LT was developed to address gaps in the attainment of vocabulary and communication skills in preschool children, identified through routine monitoring of outcomes in early years. Signs were adapted and incorporated into storybooks to improve vocabulary, communication, and behavior in hearing children. Methods: An evaluation of S4LT was conducted to measure key outcomes pre- and postintervention in 8 early years settings in Luton, United Kingdom. A total of 118 preschool children were tested in 4 early years outcomes domains?listening, speaking, understanding, and managing feelings and behavior?as well as Leuven well-being scales and the number of key words understood and spoken. Results: Statistically significant results were found for all measures tested: words spoken (P<.001) and understood (P<.001), speaking (P<.001), managing feelings and behavior (P<.001), understanding (P<.001), listening and attention (P<.001), and well-being (P<.001). Approximately two-thirds of the children made expected or good progress, often progressing multiple steps in educational attainment after being assessed as developmentally behind at baseline. Conclusions: The findings reported here suggest that S4LT may help children to catch up with their peers at a crucial stage in development and become school ready by improving their command of language and communication as well as learning social skills. Our analysis also highlights specific groups of children who are not responding as well as expected, namely boys with EAL, and who require additional, tailored support. UR - https://pediatrics.jmir.org/2020/1/e15348 UR - http://dx.doi.org/10.2196/15348 UR - http://www.ncbi.nlm.nih.gov/pubmed/32452813 ID - info:doi/10.2196/15348 ER - TY - JOUR AU - Zhang, Donglan AU - Jin, Lan AU - Liang, Di AU - Geng, Ruijin AU - Liu, Yun AU - Ling, Yu AU - Jiang, Fan AU - Zhang, Yunting PY - 2020/5/28 TI - Assessing Feasibility of an Early Childhood Intervention Using Mobile Phones Among Low-Income Mothers of Newborns: Qualitative Interview Study JO - JMIR Form Res SP - e17179 VL - 4 IS - 5 KW - mobile health KW - interview KW - health belief model KW - early child development N2 - Background: Many children aged younger than 5 years living in low- and middle-income countries are at risk for poor development. Early child development (ECD) programs are cost-effective strategies to reduce poverty, crime, school dropouts, and socioeconomic inequality. With the spread of low-cost mobile phones and internet access in low- and middle-income countries, new service delivery models such as mobile phone?aided interventions have a great potential to improve early childhood development. Objective: This study aimed to identify the beliefs on importance of ECD, feasibility of a proposed intervention using mobile phones and factors that may affect the usability of the intervention among mothers of newborns in a poverty-stricken area in southwestern China. Methods: We conducted an in-depth, semistructured interview study of 25 low-income mothers of newborns recruited from two county hospitals in Yunnan Province. We applied the health belief model and cultural competence theories to identify the facilitators, barriers, and preferences among the target population for parenting knowledge. Results: The results showed that the participants had low health literacy and high perceived needs for learning ECD knowledge. At the same time, they experienced several barriers to learning parenting information and following evidence-based instructions including having limited time, limited financial resources, and different opinions on childcare among family members. Many participants preferred to receive personalized messages tailored to their specific needs and preferred videos or graphics to text only in the messages. Many favored a separate module to support postpartum mental health. Conclusions: The study assessed the acceptability of an early childhood intervention using mobile phones to meet the needs of the target population based on their beliefs, traits, and preferences and provided suggestions to refine the intervention to improve its usability. UR - http://formative.jmir.org/2020/5/e17179/ UR - http://dx.doi.org/10.2196/17179 UR - http://www.ncbi.nlm.nih.gov/pubmed/32463374 ID - info:doi/10.2196/17179 ER - TY - JOUR AU - Baker, Jess AU - Kohlhoff, Jane AU - Onobrakpor, Se-Inyenede AU - Woolfenden, Sue AU - Smith, Rebecca AU - Knebel, Constanze AU - Eapen, Valsamma PY - 2020/4/23 TI - The Acceptability and Effectiveness of Web-Based Developmental Surveillance Programs: Rapid Review JO - JMIR Mhealth Uhealth SP - e16085 VL - 8 IS - 4 KW - public health surveillance KW - mass screening KW - developmental disabilities KW - neurodevelopmental disorders KW - review literature as topic KW - health care disparities N2 - Background: Web-based developmental surveillance programs may be an innovative solution to improving the early detection of childhood developmental difficulties, especially within disadvantaged populations. Objective: This review aimed to identify the acceptability and effectiveness of web-based developmental surveillance programs for children aged 0 to 6 years. Methods: A total of 6 databases and gray literature were searched using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses?informed protocol. Data extraction included variables related to health equity. Results: In total, 20 studies were identified. Most papers implemented web-based versions of the Modified Checklist for Autism in Toddlers, Revised with Follow-Up screener for autism spectrum disorder or Parent Evaluation of Developmental Status screeners for broad developmental delay. Caregivers and practitioners indicated a preference for web-based screeners, primarily for user-friendliness, improved follow-up accuracy, time, and training efficiencies. Conclusions: Although evidence is limited as to the necessity of web- versus face-to-face?based developmental screening, there are clear efficiencies in its use. Trial Registration: PROSPERO CRD42019127894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=127894 UR - http://mhealth.jmir.org/2020/4/e16085/ UR - http://dx.doi.org/10.2196/16085 UR - http://www.ncbi.nlm.nih.gov/pubmed/32324149 ID - info:doi/10.2196/16085 ER - TY - JOUR AU - Hsu, Chen-Fang AU - Chien, Tsair-Wei AU - Chow, Chi Julie AU - Yeh, Yu-Tsen AU - Chou, Willy PY - 2020/4/16 TI - An App for Identifying Children at Risk for Developmental Problems Using Multidimensional Computerized Adaptive Testing: Development and Usability Study JO - JMIR Pediatr Parent SP - e14632 VL - 3 IS - 1 KW - computer adaptive testing KW - developmental delay KW - multidimensional KW - mobile phone KW - screening N2 - Background: The use of multidomain developmental screening tools is a viable strategy for pediatric professionals to identify children at risk for developmental problems. However, a specialized multidimensional computer adaptive testing (MCAT) tool has not been developed to date. Objective: We developed an app using MCAT, combined with Multidimensional Screening in Child Development (MuSiC) for toddlers, to help patients and their family members or clinicians identify developmental problems at an earlier stage. Methods: We retrieved 75 item parameters from the MuSiC literature item bank for 1- to 3-year-old children, and simulated 1000 person measures from a normal standard distribution to compare the efficiency and precision of MCAT and nonadaptive testing (NAT) in five domains (ie, cognitive skills, language skills, gross motor skills, fine motor skills, and socioadaptive skills). The number of items saved and the cutoff points for the tool were determined and compared. We then developed an app for a Web-based assessment. Results: MCAT yielded significantly more precise measurements and was significantly more efficient than NAT, with 46.67% (=(75-40)/75) saving in item length when measurement differences less than 5% were allowed. Person-measure correlation coefficients were highly consistent among the five domains. Significantly fewer items were answered on MCAT than on NAT without compromising the precision of MCAT. Conclusions: Developing an app as a tool for parents that can be implemented with their own computers, tablets, or mobile phones for the online screening and prediction of developmental delays in toddlers is useful and not difficult. UR - http://pediatrics.jmir.org/2020/1/e14632/ UR - http://dx.doi.org/10.2196/14632 UR - http://www.ncbi.nlm.nih.gov/pubmed/32297867 ID - info:doi/10.2196/14632 ER -