An In Situ, Child-Led Intervention to Promote Emotion Regulation Competence in Middle Childhood: Protocol for an Exploratory Randomized Controlled Trial

Petr Slovak, Brett Q Ford, Sherri Widen, Claudia Daudén Roquet, Nikki Theofanopoulou, James J Gross, Benjamin Hankin, Predrag Klasnja, Petr Slovak, Brett Q Ford, Sherri Widen, Claudia Daudén Roquet, Nikki Theofanopoulou, James J Gross, Benjamin Hankin, Predrag Klasnja

Abstract

Background: Emotion regulation is a key transdiagnostic risk factor for a range of psychopathologies, making it a prime target for both prevention and treatment interventions in childhood. Existing interventions predominantly rely on workshops or in-person therapy-based approaches, limiting the ability to promote emotion regulation competence for children in everyday settings and at scale. Purrble is a newly developed, inexpensive, socially assistive robot-in the form of an interactive plush toy-that uses haptic feedback to support in-the-moment emotion regulation. It is accessible to children as needed in their daily lives, without the need for a priori training. Although qualitative data from previous studies show high engagement in situ and anecdotal evidence of the robot being incorporated into children's emotion regulation routines, there is no quantitative evidence of the intervention's impact on child outcomes.

Objective: The aim of this study is to examine the efficacy of a new intervention model for child-led emotion regulation-Purrble-that can be deployed across prevention and treatment contexts.

Methods: Overall, 134 children aged 8 to 10 years will be selected from an enriched nonclinical North American population; for inclusion, the cutoff for the parents' rating of child dysregulation will be ≥10 points in the total difficulties score on the Strengths and Difficulties Questionnaire. This cutoff was selected to obtain a measurable, but not necessarily clinical, level of the child's emotion regulatory difficulties. The selected families will be randomly assigned with .5 probability to receive either a Purrble or an active control (noninteractive plush toy). The primary outcome will be a daily ecological momentary assessment measure of child emotion regulation capability (as reported by parents) over a period of 4 weeks. Exploratory analyses will investigate the intervention impact on secondary outcomes of child emotion regulation, collected weekly over the same 4-week period, with follow-ups at 1 month and 6 months postdeployment. Quantitative data will be analyzed on an intent-to-treat basis. A proportion of families (approximately 30% of the sample) will be interviewed after deployment as part of the process analysis.

Results: The study is funded by the UKRI Future Leaders Fellowship (MR/T041897/1) and an in-kind contribution from the Committee for Children. This study received ethical approval from the Pearl institutional review board (#18-CFC-101). Participant recruitment started in February 2021, with the 1-month deployment in April-May 2021. The results of this analysis will be published in 2022.

Conclusions: This study will be the first quantitative evaluation of the efficacy of an innovative, proof-of-concept intervention model for an in situ, child-led emotion regulation intervention. Insights into the trajectory of daily changes, complemented with weekly questionnaire batteries and postdeployment interviews, will result in an in-depth understanding of whether and how the hypothesized intervention logic model works, leading to further intervention optimization.

Trial registration: ClinicalTrials.gov NCT04810455; https://ichgcp.net/clinical-trials-registry/NCT04810455.

International registered report identifier (irrid): PRR1-10.2196/28914.

Keywords: children; efficacy; emotion; emotion regulation; exploratory; in situ intervention; intervention; model; prevention; protocol; randomized controlled trial; risk factor; treatment.

Conflict of interest statement

Conflicts of Interest: PS is one of the designers of the Purrble intervention, in a research consultancy agreement with the Committee for Children (Seattle, WA).

©Petr Slovak, Brett Q Ford, Sherri Widen, Claudia Daudén Roquet, Nikki Theofanopoulou, James J Gross, Benjamin Hankin, Predrag Klasnja. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 09.11.2021.

Figures

Figure 1
Figure 1
Assessment design. EMA: ecological momentary assessment; ERC: Emotion Regulation Checklist; SDQ: Strengths and Difficulties Questionnaire; TWEETS: Twente Engagement With eHealth Technologies Scale.
Figure 2
Figure 2
Participant selection flowchart.
Figure 3
Figure 3
Purrble plush toy.
Figure 4
Figure 4
On the left, an image of the Hedgehog toy for the active control group. On the right, an image of Purrble for the intervention.
Figure 5
Figure 5
Rating of the questions regarding the appeal of Purrble versus the active control unit, and the likelihood of recommending Purrble versus the active control unit to another parent.

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