Examining the effect of a wearable, anxiety detection technology on improving the awareness of anxiety signs in autism spectrum disorder: a pilot randomized controlled trial

Jenny Nguyen, Robyn E Cardy, Evdokia Anagnostou, Jessica Brian, Azadeh Kushki, Jenny Nguyen, Robyn E Cardy, Evdokia Anagnostou, Jessica Brian, Azadeh Kushki

Abstract

Background: Anxiety is prevalent in autism spectrum disorder (ASD) and can negatively impact physical and mental health. Self-awareness of anxiety signs is a key barrier to success of anxiety interventions for many children.

Methods: To address this, we conducted a randomized controlled trial to assess whether the Anxiety Meter, a wearable, real-time anxiety detection technology, can improve awareness of anxiety symptoms and the initiation of relaxation techniques in children with ASD. Twenty-eight children with ASD were trained on the use of the Anxiety Meter and taught a diaphragmatic breathing relaxation technique over three visits. On the fourth visit, participants were randomized to either receive feedback of their anxiety level or no feedback from the Anxiety Meter while completing a stress-eliciting task (public speaking) and asked to engage in deep breathing if anxious.

Results: Feedback from the Anxiety Meter was associated with increased likelihood of initiating deep breathing in response to anxiety.

Limitations: Limitations include the small sample size, imbalanced group matching for IQ and sex, and the controlled-laboratory settings which limit the statistical power and generalizability of the results to real-world settings.

Conclusions: Although these results are limited by the relatively small sample size, they support the feasibility of using a wearable device and real-time feedback to improve anxiety symptom awareness. Trial Registration ClinicalTrials.gov Identifier: NCT02160691, registration date: 06/05/2014.

Keywords: ASD; Anxiety; Autism; Intervention; Wearables.

Conflict of interest statement

AK and EA hold two patents for the Anxiety Meter, are involved in its commercialization, and will benefit financially from its sales.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Schematic outline of protocol for visit 4. WASI-II: Wechsler Abbreviated Scale of Intelligence, Second Edition; CASI-5: Child and Adolescent Symptom Inventory-5; STAI: State-Trait Anxiety Inventory; ECG: electrocardiogram
Fig. 2
Fig. 2
Consolidated Standards of Reporting Trials (CONSORT) flow diagram from enrolment to analysis. HR: heart rate; bpm: beats per minute; Δ: change
Fig. 3
Fig. 3
Group–event interaction effect for all signals measured. Error bars = standard deviation

References

    1. Davis TE, Hess JA, Moree BN, Fodstad JC, Dempsey T, Jenkins WS, et al. Anxiety symptoms across the lifespan in people diagnosed with autistic disorder. Res Autism Spectr Disord. 2011;5(1):112–118. doi: 10.1016/j.rasd.2010.02.006.
    1. van Steensel FJA, Bögels SM, Perrin S. Anxiety disorders in children and adolescents with autistic spectrum disorders: a meta-analysis. Clin Child Fam Psychol Rev. 2011;14(3):302–317. doi: 10.1007/s10567-011-0097-0.
    1. MacNeil BM, Lopes VA, Minnes PM. Anxiety in children and adolescents with autism spectrum disorders. Res Autism Spectr Disord. 2009;3(1):1–21. doi: 10.1016/j.rasd.2008.06.001.
    1. Blakeley-Smith A, Reaven J, Ridge K, Hepburn S. Parent–child agreement of anxiety symptoms in youth with autism spectrum disorders. Res Autism Spectr Disord. 2012;6(2):707–716. doi: 10.1016/j.rasd.2011.07.020.
    1. Gosch EA, Flannery-Schroeder E, Mauro CF, Compton SN. Principles of cognitive-behavioral therapy for anxiety disorders in children. J Cogn Psychother. 2006;20(3):247–262. doi: 10.1891/jcop.20.3.247.
    1. Helverschou SB, Martinsen H. Anxiety in people diagnosed with autism and intellectual disability: recognition and phenomenology. Res Autism Spectr Disord. 2011;5(1):377–387. doi: 10.1016/j.rasd.2010.05.003.
    1. Garfinkel SN, Tiley C, O’Keeffe S, Harrison NA, Seth AK, Critchley HD. Discrepancies between dimensions of interoception in autism: implications for emotion and anxiety. Biol Psychol. 2016;114:117–126. doi: 10.1016/j.biopsycho.2015.12.003.
    1. Lord C, Risi S, Lambrecht L, Cook EH, Leventhal BL, DiLavore PC, et al. The autism diagnostic observation schedule—generic: a standard measure of social and communication deficits associated with the spectrum of autism. J Autism Dev Disord. 2000;30(3):205–223. doi: 10.1023/A:1005592401947.
    1. Lord C, Rutter M, Le Couteur A. Autism diagnostic interview-revised: a revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. J Autism Dev Disord. 1994;24(5):659–685. doi: 10.1007/BF02172145.
    1. Burns A, Greene BR, McGrath MJ, O’Shea TJ, Kuris B, Ayer SM, et al. SHIMMERTM—a wireless sensor platform for noninvasive biomedical research. IEEE Sens J. 2010;10(9):1527–1534. doi: 10.1109/JSEN.2010.2045498.
    1. Shimmer. ECG User Guide Revision 1.12 [Internet]. Real Time Technologies Ltd; 2018 [cited 2021 Jul 28].
    1. Pan J, Tompkins WJ. A real-time QRS detection algorithm. IEEE Trans Biomed Eng. 1985;3:230–236. doi: 10.1109/TBME.1985.325532.
    1. Puli A, Kushki A. Toward automatic anxiety detection in autism: a real-time algorithm for detecting physiological arousal in the presence of motion. IEEE Trans Biomed Eng. 2020;67(3):646–657. doi: 10.1109/TBME.2019.2919273.
    1. Reaven J, Blakeley-Smith A, Nichols S, Hepburn S. Facing your fears: group therapy for managing anxiety in children with high-functioning autism spectrum disorders. Baltim MD Brookes. 2011.
    1. Boutcher YN, Boutcher SH. Cardiovascular response to Stroop: Effect of verbal response and task difficulty. Biol Psychol. 2006;73(3):235–241. doi: 10.1016/j.biopsycho.2006.04.005.
    1. Kushki A, Brian J, Dupuis A, Anagnostou E. Functional autonomic nervous system profile in children with autism spectrum disorder. Mol Autism. 2014;5(1):1–10. doi: 10.1186/2040-2392-5-39.
    1. Spielberger CD. State-trait anxiety inventory. Corsini Encycl Psychol. 2010;1–1.
    1. Wechsler D. WASI-II: Wechsler abbreviated scale of intelligence. PsychCorp. 2011.
    1. Gadow K, Sprafkin J. Child and adolescent symptom inventory-5. 2013
    1. Khodadad D, Nordebo S, Müller B, Waldmann A, Yerworth R, Becher T, et al. Optimized breath detection algorithm in electrical impedance tomography. Physiol Meas. 2018;39(9):094001. doi: 10.1088/1361-6579/aad7e6.
    1. Roth WT. Physiological markers for anxiety: panic disorder and phobias. Int J Psychophysiol. 2005;58(2–3):190–198. doi: 10.1016/j.ijpsycho.2005.01.015.
    1. Kirschbaum C, Pirke K-M, Hellhammer DH. The ‘Trier Social Stress Test’—a tool for investigating psychobiological stress responses in a laboratory setting. Neuropsychobiology. 1993;28(1–2):76–81. doi: 10.1159/000119004.
    1. Corbett BA, Muscatello RA, Baldinger C. Comparing stress and arousal systems in response to different social contexts in children with ASD. Biol Psychol. 2019;140:119–130. doi: 10.1016/j.biopsycho.2018.12.010.

Source: PubMed

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