Leveraging technology to probe mechanisms of psychopathology: A proof of concept study of inhibitory control

Abstract

Objective: Quantifying relevant behavioral mechanisms has relied on rigorous, time-consuming tools restricted to laboratory settings and inaccessible to the clinical community. Advances in technology provide an opportunity to develop more accessible platforms. Here, we developed CALM-IT, a novel mobile-application to experimentally assess inhibitory control in vivo.

Method: In a transdiagnostic sample of 200 youth aged 8-20, we (i) apply knowledge from canonical inhibitory control tasks in the methodological design of the mobile application, (ii) establish feasibility and engagement with CALM-IT, (iii) assess test-retest reliability of CALM-IT, (iv) investigate the convergent validity of CALM-IT with behavioral and neural responses to laboratory-based tasks, and (v) probe clinical relevance via associations with clinical symptoms.

Results: First, we provide evidence that our novel inhibitory control mobile application, CALM-IT, was accessible, feasible, and engaging. Second, we found performance was reliable over time. Third, we found CALM-IT performance was associated with established measures of inhibitory control and activation in the bilateral inferior frontal gyrus. Associations with brain but not behavior survived after controlling for age. Finally, we found evidence linking impaired CALM-IT performance to increased levels of co-occurring anxiety, irritability, and attention deficit hyperactivity disorder (ADHD) symptoms.

Conclusion: Validation of this neuroscience-informed mobile application represents a critical first step in bridging precise, mechanism-driven research and community-based assessment of childhood psychopathology. The present work lays the groundwork for future research that could provide researchers and clinicians with a multifaceted tool to measure clinically-relevant behaviors in an engaging and accessible manner.

Fig 1. Leveraging mobile-technology in the development of clinically-relevant tools to bridge the granularity of neuroscience-informed assessments of behavior and the accessibility and easily disseminated format of mobile devices.

Fig 2. Roadmap for the development and validation of accessible and clinically-relevant tools for experimentally assessing behavior in vivo.

Fig 3. Screenshots depicting CALM-IT gameplay.

(A) Tutorial screen with instructions, (B) In-level play depicting stars (yellow) and targets, (C) Explosion and negative point indicator feedback in response to swiping a star, (D) End of level cumulative score display.