skip to main content
US FlagAn official website of the United States government
dot gov icon
Official websites use .gov
A .gov website belongs to an official government organization in the United States.
https lock icon
Secure .gov websites use HTTPS
A lock ( lock ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.


Title: Wearables and behavioral coding show promise for measuring and predicting severe emotional outbursts in children
Introduction. Temper tantrums are common in early childhood. Severe emotional outbursts, however, are transdiagnostic, disruptive, and difficult to measure across settings, highlighting the need for better methods to identify and predict these components of emotion dysregulation. To address major methodological gaps, we propose a multimodal approach combining a retrospective electronic health record (EHR) analysis (Study 1) and a pilot wearable feasibility study (Study 2) to explore new ways of predicting and quantifying emotional outbursts in children enrolled in a therapeutic day program (TDP). Methods. In Study 1, we explored retrospective data collected from the EHR (historical patient data and hourly behavioral observations), trying to understand which variables might predict an outburst. In Study 2, wearable technology was employed to characterize outbursts leveraging free-living data collected during a typical day at a TDP. Moreover, we used these data to assess the future of possible outburst predictions among a clinical sample by analyzing the feasibility of such a technology. Results. An EHR analysis of 45 patients aged 4–8 years revealed that observed rough behaviors at the beginning of the day were associated with an increased likelihood of subsequent outbursts (p<.001), from 6% for those with zero rough behaviors to 68% for those with two or more such behaviors. Wearable sensor data demonstrated high tolerability (all four children assented each of 3–5 days of participation for 5 h of wear) and minimal data loss (<4%). Case studies of wearable-derived heart rate, heart rate variability, and skin temperature suggested that these factors might serve as promising indicators for detecting distress and outbursts. Discussion. Our results suggest that behavioral observation has the potential of predicting outbursts, and that wearable sensors are tolerable and feasible for children to wear. Overall, multiple methodologies should be studied concurrently and may be required to predict outbursts in the future.  more » « less
Award ID(s):
2046440 2422226
PAR ID:
10671673
Author(s) / Creator(s):
; ; ; ; ; ; ; ; ; ; ;
Publisher / Repository:
Frontiers
Date Published:
Journal Name:
Frontiers in Digital Health
Volume:
7
ISSN:
2673-253X
Format(s):
Medium: X
Sponsoring Org:
National Science Foundation
More Like this
  1. Background/Objectives: Nurses are at high risk for burnout. Identification of biomarkers associated with early manifestations of distress is essential to support effective intervention efforts. Methods: Fifty nurses from a large hospital system participated in a 30-day study of biopsychosocial factors that may contribute to burnout. Nurses wore an Oura ring that collected behavioral data and they completed a self-report burnout questionnaire at baseline and the end of the study period. Machine learning models were developed to evaluate whether objective measures could predict burnout states and changes at the end of the study period. Analyses were exploratory and hypothesis-generating for future work. Results: Data for 45 participants were included in the analyses. Participants with burnout had significantly higher sleep variability. Sleep measures provided 75.75% accuracy in ability to discriminate between burnout states. Heart rate-based measures better modeled changes in symptomatic components of burnout (Emotional Exhaustion, Depersonalization) over time. Heart rate-based measures provided a R-squared value of 0.13 (p < 0.05) (RMSE of 7.41) in a regression model of changes in Emotional Exhaustion evaluated in a leave-one-participant-out cross-validation. Conclusions: Sleep measures’ association with a state of burnout may reflect the longer-term manifestations of chronic exposure to workplace stress. Short-term changes in burnout symptoms are associated with disturbances in heart rate measures. Wearable technology may support monitoring/early identification of those at risk for burnout. 
    more » « less
  2. Importance Autism detection early in childhood is critical to ensure that autistic children and their families have access to early behavioral support. Early correlates of autism documented in electronic health records (EHRs) during routine care could allow passive, predictive model-based monitoring to improve the accuracy of early detection. Objective To quantify the predictive value of early autism detection models based on EHR data collected before age 1 year. Design, Setting, and Participants This retrospective diagnostic study used EHR data from children seen within the Duke University Health System before age 30 days between January 2006 and December 2020. These data were used to train and evaluate L2-regularized Cox proportional hazards models predicting later autism diagnosis based on data collected from birth up to the time of prediction (ages 30-360 days). Statistical analyses were performed between August 1, 2020, and April 1, 2022. Main Outcomes and Measures Prediction performance was quantified in terms of sensitivity, specificity, and positive predictive value (PPV) at clinically relevant model operating thresholds. Results Data from 45 080 children, including 924 (1.5%) meeting autism criteria, were included in this study. Model-based autism detection at age 30 days achieved 45.5% sensitivity and 23.0% PPV at 90.0% specificity. Detection by age 360 days achieved 59.8% sensitivity and 17.6% PPV at 81.5% specificity and 38.8% sensitivity and 31.0% PPV at 94.3% specificity. Conclusions and Relevance In this diagnostic study of an autism screening test, EHR-based autism detection achieved clinically meaningful accuracy by age 30 days, improving by age 1 year. This automated approach could be integrated with caregiver surveys to improve the accuracy of early autism screening. 
    more » « less
  3. Objective: Children and adolescents with intellectual and developmental disabilities (IDD), particularly those with autism spectrum disorder, are at increased risk of challenging behaviors such as self-injury, aggression, elopement, and property destruction. To mitigate these challenges, it is crucial to focus on early signs of distress that may lead to these behaviors. These early signs might not be visible to the human eye but could be detected by predictive machine learning (ML) models that utilizes real-time sensing. Current behavioral assessment practices lack such proactive predictive models. This study developed and pilot-tested real-time early agitation capture technology (REACT), a real-time multimodal ML model to detect early signs of distress, termed “agitations.” Integrating multimodal sensing, ML, and human expertise could make behavioral assessments for people with IDD safer and more efficient. Methods: We leveraged wearable technology to collect behavioral and physiological data from three children with IDD aged 6 to 9 years. The effectiveness of the REACT system was measured using F1 score, assessing its usefulness at the time of agitation to 20s prior. Results: The REACT system was able to detect agitations with an average F1 score of 78.69% at the time of agitation and 68.20% 20s prior. Conclusion: The findings support the use of the REACT model for real-time, proactive detection of agitations in children with IDD. This approach not only improves the accuracy of detecting distress signals that are imperceptible to the human eye but also increases the window for timely intervention before behavioral escalation, thereby enhancing safety, well-being, and inclusion for this vulnerable population. We believe that such technological support system will enhance user autonomy, self-advocacy, and self-determination. 
    more » « less
  4. The quality of parent-child interactions at an early age has been linked to children's social-emotional development, executive function, and risk for behavior problems. As such, parent-child interactions in naturalistic settings could present a unique opportunity to screen for at-risk behavior in young children, enabling timely and targeted interventions. In this work, we validate the feasibility of using structured at-home play sessions, completed via the Tandem smartphone app, to enable highly accurate and scalable behavioral assessments. We demonstrate that audio and physiological signals recorded during the play session can be used to capture key markers of parent-child interaction dynamics, which are more indicative of at-risk behavior compared to features from each individual alone. We propose novel audio-based dyadic interaction features that significantly outperform conventional speech features at predicting risk for behavior problems, achieving an F1 score of 0.87. Furthermore, we show that dyadic physiological synchrony features, extracted from privacy-preserving wearable sensor data, can classify at-risk behavior with an F1 score of 0.91. Tandem thus sets the stage for automated at-home behavior assessment tools for young children that balance screening accuracy with practical deployment considerations. 
    more » « less
  5. Abstract Study Objectives Examine the ability of a physiologically based mathematical model of human circadian rhythms to predict circadian phase, as measured by salivary dim light melatonin onset (DLMO), in children compared to other proxy measurements of circadian phase (bedtime, sleep midpoint, and wake time). Methods As part of an ongoing clinical trial, a sample of 29 elementary school children (mean age: 7.4 ± .97 years) completed 7 days of wrist actigraphy before a lab visit to assess DLMO. Hourly salivary melatonin samples were collected under dim light conditions (<5 lx). Data from actigraphy were used to generate predictions of circadian phase using both a physiologically based circadian limit cycle oscillator mathematical model (Hannay model), and published regression equations that utilize average sleep onset, midpoint, and offset to predict DLMO. Agreement of proxy predictions with measured DLMO were assessed and compared. Results DLMO predictions using the Hannay model outperformed DLMO predictions based on children’s sleep/wake parameters with a Lin’s Concordance Correlation Coefficient (LinCCC) of 0.79 compared to 0.41–0.59 for sleep/wake parameters. The mean absolute error was 31 min for the Hannay model compared to 35–38 min for the sleep/wake variables. Conclusion Our findings suggest that sleep/wake behaviors were weak proxies of DLMO phase in children, but mathematical models using data collected from wearable data can be used to improve the accuracy of those predictions. Additional research is needed to better adapt these adult models for use in children. Clinical Trial The i Heart Rhythm Project: Healthy Sleep and Behavioral Rhythms for Obesity Prevention https://clinicaltrials.gov/ct2/show/NCT04445740. 
    more » « less