Means to digitally address child mental health

Delivering psychological and behavioural care through digital tools is emerging as an attractive avenue by which to detect mental illness and provide youth-friendly treatment. That said, there are various ways for delivering digital mental health interventions. In this post we draw out some of the ways and discuss what we believe to be important when developing digital health solutions for kids.

As acknowledged, the onset of a vast majority of mental disorders happens during youth [1] which makes targeting prevention towards children and young people important, both in short- and long-term. Moreover, underlying chronic illness has been found to be associated with a heightened risk for psychiatric comorbidities [2], which in turn may result in an increased disease burden [eg 3]. Therefore, it is especially important to systematically monitor pediatric patients with chronic illness to prevent, lessen or treat the potential symptoms of mental disorders, as recognised also by the American Diabetes Association [4] and the joint opinion of Institute of Medicine and American Cancer Society [5].

There is no doubt that digital tools have the potential to offer an alternative to or support traditional mental health care. Although psychological monitoring and support among chronically ill children has been seen as an integral part of comprehensive care, it has not yet been unified across hospitals [6], and this is where digital tools could add value.

Digital mental health interventions

Research in the field of digital mental health interventions is extensive and includes a broad range of ways of delivery - such as evidence-based guided or unguided therapy brought to a session-based web-format, an app to supplement face-to-face therapy (eg therapy homework, tracking mood etc.), text-based SMS or app reminders, fully online chat with mental health specialists or an intervention using gamification serious games, applied games, health games). Depending on the aim of the intervention, different means are used and it takes time to investigate how to best apply the various interventions in the wide healthcare field, its most effective components etc., but we get closer to it day by day.

The best means

Therefore, until there is no such thing as The Best approach, the most important thing to do is to start from what gap the digital solution aims to fill. As target age groups and target aims of the interventions are different, the tool being developed should combine and balance both evidence-based techniques and new digital tools’ enabled approaches. For example, it has been found that personalisation in delivering support, also in digital tools, is important [7] which therefore, could and should be achieved in the digital intervention. Relatedly, engagement with the tool is important [7] which could be achieved, for example, via human support in the context of therapy or also via game-like or personalised approaches [eg 8], especially when targeting children.

We at Triumf believe that play for a child is an activity that cannot be underestimated. It is the way children first learn how to manipulate objects, practice different roles, and also learn about the world and different social situations. When talking about learning about your illness, well-being, solving problems or solutions for different social events, virtual play can become – in addition to play being an inherent skill – a safe place where to practice these skills [9]. This is how, also by using the advantage of gamification, our health game could offer great means for children to acquire new skills and knowledge through relevant and everyday life examples. Game elements also enable to balance the child’s autonomy in choosing the most individually relevant content while still gently directing the child to the content which may be avoided.

To conclude, we at Triumf are constantly working on bringing our digital therapeutics to children, their parents and medical personnel. We believe supporting the behavioural health of children – helping kids develop constructive health behaviours, and providing personalised and timely psychological support – from early on enables more means for prevention. Or if prevention is no longer of help, we are able to timely identify children in need for more systematic help.

References

1. Merikangas KR, He J-P, Burstein M, Swanson SA, Avenevoli S, Cui L, et al. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010;49: 980–989.

2. Hysing M, Elgen I, Gillberg C, Lie SA, Lundervold AJ. Chronic physical illness and mental health in children. Results from a large-scale population study. J Child Psychol Psychiatry. 2007;48: 785–792.

3. Sildorf SM, Breinegaard N, Lindkvist EB, Tolstrup JS, Boisen KA, Teilmann GK, et al. Poor Metabolic Control in Children and Adolescents With Type 1 Diabetes and Psychiatric Comorbidity. Diabetes Care. 2018;41: 2289–2296.

4. Association AD, American Diabetes Association. Standards of Medical Care in Diabetes—2019 Abridged for Primary Care Providers. Clinical Diabetes. 2019. pp. 11–34.

5. Kirch R, Reaman G, Feudtner C, Wiener L, Schwartz LA, Sung L, et al. Advancing a comprehensive cancer care agenda for children and their families: Institute of Medicine Workshop highlights and next steps. CA Cancer J Clin. 2016;66: 398–407.

6. Feudtner C, Womer J, Augustin R, Remke S, Wolfe J, Friebert S, et al. Pediatric Palliative Care Programs in Children’s Hospitals: A Cross-Sectional National Survey. PEDIATRICS. 2013. pp. 1063–1070.

7. Hollis C, Falconer CJ, Martin JL, Whittington C, Stockton S, Glazebrook C, et al. Annual Research Review: Digital health interventions for children and young people with mental health problems - a systematic and meta-review. Journal of Child Psychology and Psychiatry. 2017. pp. 474–503.

8. Swartwout E, El-Zein A, Deyo P, Sweenie R, Streisand R. Use of Gaming in Self-Management of Diabetes in Teens. Curr Diab Rep. 2016;16: 59.

9. Nijhof SL, Vinkers CH, van Geelen SM, Duijff SN, Achterberg EJM, van der Net J, et al. Healthy play, better coping: The importance of play for the development of children in health and disease. Neurosci Biobehav Rev. 2018;95: 421–429.