Smartphone-based behaviour analysis for challenging behaviour in intellectual and developmental disabilities and autism spectrum disorder - Study protocol for the ProVIA trial

Abstract

Background: Challenging behaviour (CB) comprises various forms of aggressive and problematic behaviours frequently occurring in children with intellectual and developmental disability (IDD) or autism spectrum disorder (ASD). CB often arises from impaired communication or problem solving skills. It is often met with coercive measure due to a lack of alternative strategies on the part of the caregiver, while it also impacts on the caregivers due to the exposure to physical harm and high levels of stress. Within the ProVIA project we developed a smartphone-based tool for caregivers of children with IDD and/or ASD to prevent and modify CB. The ProVIA app systematically helps caregivers to identify specific causes of CB and provides individualised practical guidance to prevent CB and consecutive coercive measures, thus aiming to improve the health and well-being of the children and caregivers.

Methods: In this uncontrolled open trial we will enrol N = 25 caregivers of children aged 3-11 years with a diagnosis of IDD and/or ASD. Participants will use the ProVIA-Kids app for 8 weeks. During the intervention phase, participants will conduct behaviour analyses after each instance of CB. The app will summarise the identified putative causes for the CB in each situation, and provide recommendations regarding the handling and prevention of CB. Furthermore, the app will aggregate data from all available behaviour analyses and identify the most relevant (i.e., most frequently reported) risk factors. Measurement points are at baseline (T0), after the intervention (T1) and 12 weeks after the end of the intervention (follow-up; T2). The primary outcome is the absolute change in parental stress (EBI total scale) between T0 and T1. Further aspects of interest are changes in CB severity and frequency, caregiver mood, satisfaction with the parenting role (EFB-K total scale) and experienced parenting competence (FKE total scale). Pre-post comparisons will be analysed with paired sample t-tests.

Discussion: ProVIA is pioneering structured behaviour analysis via smartphone, assessing predefined causes of CB and providing feedback and recommendations. If this approach proves successful, the ProVIA-Kids app will be a valuable tool for caregivers to prevent CB and improve their own as well as the children's quality of life.

Trial registration: The study is registered at https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_IDDRKS00029039 (registered May 31, 2022).

Keywords: autism spectrum disorder; behaviour analysis; challenging behaviour; cognitive behaviour therapy; intellectual disability; mental health application; parent training; parental stress.

FIGURE 1

ProVIA trial flow.

FIGURE 2

Features of the ProVIA-Kids app (English mock-up, app not yet available in other languages): (A) Home screen, (B) Behaviour analysis algorithm, (C) Graphical display of the frequency of individual contributing factors for CB, (D) Menu for psychoeducational content, (E) Sample from chapter “Hypersensitivity” with recommendations for caregivers, (F) Mood diary. Source: Unsplash: https://unsplash.com/photos/Uu692 wJ0FCY.

FIGURE 3

Features of the ProVIA-Kids app (original German version): (A) Home screen, (B) Behaviour analysis algorithm, (C) Graphical display of the frequency of individual contributing factors for CB, (D) Menu for psychoeducational content, (E) Sample from chapter “Hypersensitivity” with recommendations for caregivers, (F) Mood diary.

FIGURE 4

Schematic architecture and workflow of the ProVIA-Kids app.