iBehavior - A Smartphone-Based Ecological Momentary Assessment Tool for the Assessment of Behavior Change in Neurodevelopmental Disorders

Dakopolos, Andrew; Glassman, Dana; Scott, Haleigh; Bass, Michael; Hessl, David · 2023 · Crossref

DOI: 10.21203/rs.3.rs-2787281/v1

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Summary

This study introduces and evaluates iBehavior, a smartphone-based electronic ecological momentary assessment (eEMA) tool designed to track behavior change in individuals with intellectual and developmental disabilities (IDDs). The research addresses methodological limitations inherent in traditional retrospective proxy-report questionnaires, which are prone to recall bias, rater bias, and lack of contextual specificity. By enabling caregivers to record behaviors in near-real-time across daily contexts, iBehavior aims to provide more valid and reliable behavioral outcome measures for clinical trials and diagnostic assessments. The pilot study involved ten parents of children (ages 8–17) diagnosed with fragile X syndrome (n=7) or Down syndrome (n=3). Caregivers received one-onone training via videoconference, including calibration interviews to align their understanding of specific behaviors with the app’s definitions. Participants used the iBehavior app to rate their child’s behavior once daily for 14 days across four domains: aggression and irritability, avoidant and fearful behavior, restricted and repetitive behaviors, and social initiation. Each rating required assessing frequency and intensity, guided by specific anchoring text. At the end of the observation period, parents completed traditional validation measures—the Aberrant Behavior Checklist–Community (ABC-C), Behavior Rating Inventory of Executive Function 2 (BRIEF-2), and Conners 3—as well as a user feedback survey. Results demonstrated high feasibility, with a 94% response rate (13.3 of 14 days completed on average) and 100% completion of items for logged observations. The study found preliminary evidence of convergent validity between iBehavior domains and traditional scales. Significant correlations were observed between iBehavior aggression frequency and ABC-C irritability (r = .735, p = .015) and BRIEF-2 emotional control (r = .868, p = .001). Similarly, iBehavior repetitive behavior intensity correlated significantly with ABC-C stereotypy (r = .742, p = .014), and BRIEF-2 shifting correlated with repetitive behavior frequency (r = .817, p = .003) and intensity (r = .835, p = .004). User feedback indicated high overall satisfaction with the app, though technical issues with SMS reminders slightly lowered satisfaction scores for that specific feature. The authors conclude that iBehavior is a feasible and preliminarily valid tool for assessing behavioral outcomes in IDDs. They hypothesize that eEMA methods can reduce expectancy bias and placebo responding in clinical trials by capturing behaviors closer to their occurrence. This approach may improve statistical power, reveal dynamic behavioral changes, and enhance measurement accuracy. Future studies, including a larger feasibility trial and a placebo-controlled crossover study, are planned to further validate reliability and assess the tool’s impact on clinical trial outcomes.

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• telematics ubi feedback