ADHD Remote Technology (ART)
Research type
Research Study
Full title
ADHD Remote Technology (ART)
IRAS ID
278126
Contact name
Jonna Kuntsi
Contact email
Sponsor organisation
King's College London
Duration of Study in the UK
0 years, 7 months, 1 days
Research summary
Research Summary
Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders and is often associated with additional mental-health problems such as anxiety, depression, emotional instability, antisocial behaviour, and autism spectrum disorders. A better understanding of predictors and markers of different long-term ADHD outcomes is needed. Remote measurement technology (RMT) is changing the way in which many conditions are assessed and managed, shifting the focus from 'diagnose and treat' to 'predict and prevent'. The purpose of this study is to develop and pilot a novel remote assessment system for ADHD that incorporates active and passive monitoring using mobile and web technologies. Active monitoring (completing questionnaires and cognitive tasks) and passive monitoring (using smartphones and activity monitors) will be carried out over a 10-week period. The long-term vision for this project is to establish a remote assessment and monitoring system for adults and adolescents with ADHD that can be applied to both research and clinical long-term monitoring of symptoms, impairments and health-related behaviours, with the ultimate aim to support self-management and clinician decision-making, and improve outcomes. RMT can help to overcome current research and clinical limitations.The project benefits from the RADAR-base platform developed at King’s College London. The development and initial testing phase will be guided by existing service user feedback on remote assessments for ADHD from previous pilot studies as well as on feedback by a new group of service users. The remote battery will be comprised of: smartphone and web-based self- and informant-report versions of questionnaires on DSM-5 ADHD diagnostic symptoms and functional impairments, co-occurring symptoms and health service use; a wristband activity measure to collect data on physical activity and sleep; and self-administration versions of cognitive tasks sensitive to ADHD and its long-term outcomes, using a computer at home.
Summary of Results
Attention deficit hyperactivity disorder (ADHD) is a common psychiatric disorder, with a prevalence among adults of 2.5%. The disorder is diagnosed based on impairing levels of inattentive, hyperactive and impulsive behaviours. Most adults with ADHD present with additional mental health problems. People with ADHD are usually assessed in a clinic or a research centre. In the future, it may be possible to carry out some of the assessments or follow-ups remotely, using wearable and web-based technologies. This could help researchers and clinicians obtain more detailed information, more often, about the wellbeing and behaviours of people with ADHD in their everyday lives. For people with ADHD, it could help them feel more involved with the assessments and, longer term, smartphone apps could also be designed to give individual feedback and advice. Benefiting from an existing ‘RADAR-base’ mobile-health platform(https://eur03.safelinks.protection.outlook.com/?url=http%3A%2F%2Furl6570.hra.nhs.uk%2Fls%2Fclick%3Fupn%3DXv3JSvJ-2B3M71ppf7N9agbQSi652RliXcUPf70PWLr8aVg09U-2BIEuIf0Eu7k2RdXfWeX6_E1aO2-2BZlVOSJJV-2FajQqskegTd6IRomHYTi-2Fbt8SH3YKsnZWBvhkSDRMRuvrXW7krChMugE2r-2BvotK-2BzbKvVayjEci2BobWXmKxVEH9cNQNJgj3aK-2BgDB0CRpMIhOEg4qCudzI6Qf8NEzXrhSL0VmGkz-2BxbAP96-2F-2B-2F-2FCFO461-2Fwpk4rIkeaVMUqqF3DVGGDu4vfXZLTys-2BR2mFu3Qpgo9jA-3D-3D&data=04%7C01%7Capprovals%40hra.nhs.uk%7C1f829d9eafed436be26608da0e69fe72%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C637838145645798554%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000&sdata=L1JH11m4EBv%2F7XizYLWhdABuZ4OUS%2F4ZLe7evry8IZc%3D&reserved=0
We have taken the first step in this process and have developed a set of remote measures for adolescents and adults with ADHD: the ADHD Remote Technology (‘ART’) system. The ART system uses remote measurement technology (RMT) which includes active (questionnaires and computer-based tasks) and passive (smartphone and a wearable device) monitoring.
20 individuals with ADHD and 20 individuals in the comparison group took part in the ART pilot study. Participants first attended two virtual sessions with a member of the research team and then were monitored remotely using RMT over a 10-week period, using the new ART remote measures. Participants were also invited to complete an interview at the end of the 10-weeks, to provide feedback on ART system. ADHD diagnosis was confirmed by the Diagnostic Interview for ADHD in adults at baseline. Participants did not take ADHD medication. Participants were aged between 16 to 39 years, and 75% of our participants were female.
Summary of Key Results
So far, compared to our comparison group, we have found that individuals with ADHD:
• Experienced more variable sleep duration (time spent asleep)
• Also spent slightly less time in bed (this includes all sleep stages: deep, light, REM and awake)
• Reported more feelings of anxiety and depression
• Spent less time daily on health and fitness apps
• Showed some difficulties with focused attention on the computer-based tasks
• With a new twist, we asked our participants to also administer the tasks at home by themselves. The results show that this worked well: we saw the same differences between the groups as when a researcher administered the tasksDuring the interviews, we asked for feedback on the study. Our participants said:
“The overall experience was very easy because there wasn't really anything I had to to do other than wear the Fitbit and do the questionnaires [..] it was really easy 'cause I was just carrying on with my normal life”
“I thought it was really good, yeah, there was a lot of support throughout. I knew that I could email about any questions I had, and you’d get back to me. [..] I thought it was very well run and the devices, there were never any issues with them”
“Yeah, the tasks definitely, especially if it’s a year [long]. I wouldn't really want to be doing [the computer-based tasks] every like 2 weeks or something“ “Yeah, I think if you're doing it for a much longer period, I would definitely say needs to be a longer gap between them”Thank you to those who provided feedback! For future studies, based on feedback about the computer-based tasks, we have:
• Increased the time between computer-based tasks
• Reduced the number of computer-based tasks during the study periodThis study gave us important information about how well the new remote measures capture the symptoms of ADHD and changes over time, and how the individuals with ADHD and the individuals in the comparison group found these measures.
What’s next for the ART research programme?
In 2021 we received funding from the European Commission for a new, large clinical study called ADHD Remote Technology study of cardiometabolic risk factors and medication adherence (ART-CARMA). We will be recruiting 300 adults with ADHD from adult ADHD clinic waiting lists in the UK and in Spain, and will follow them over 12 months. We will be using the measures from the ART pilot study as well as some new ones.We would like to say a big thank you to everyone who took part in our study.
To find out more information about ART, please go to: https://eur03.safelinks.protection.outlook.com/?url=http%3A%2F%2Furl6570.hra.nhs.uk%2Fls%2Fclick%3Fupn%3DXv3JSvJ-2B3M71ppf7N9agbRQfkyl3EStCrOxRFWcrNo9-2FOehCGp7Es66B8shyMRP8NcnB2K7Y9epiY1aytXsMyeB9LcRT7aGtdpF6Oni11e0-3Dr_Ud_E1aO2-2BZlVOSJJV-2FajQqskegTd6IRomHYTi-2Fbt8SH3YKsnZWBvhkSDRMRuvrXW7krweyUMm9JdDJMvUuHYEOLOn0aZ2Nq0TyPj2NUiHu-2FstI9hwg6Zc7ooQP2gMi8MFbqSgS5PsMiTeGS1BDCZpp1xYBagdxthtSvZrqN2kTJQ0L-2BnCyN0UEl4-2FM1cUtfF09uhrV1nwaZI70hoGd2OxdoCg-3D-3D&data=04%7C01%7Capprovals%40hra.nhs.uk%7C1f829d9eafed436be26608da0e69fe72%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C637838145645798554%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000&sdata=5LAR2kuOfJEJ03E1OW0brAa6hxvK0mXmP9ieI%2BAxeGM%3D&reserved=0 or follow us on Twitter at @ADHD_RemoteTech. You can also contact the research team on ART@kcl.ac.uk
The ART pilot study was supported by a King’s Together Strategic Grant. The co-sponsors were King’s College London and South London and Maudsley NHS Trust.
REC name
North East - Tyne & Wear South Research Ethics Committee
REC reference
20/NE/0034
Date of REC Opinion
26 Feb 2020
REC opinion
Further Information Favourable Opinion