Using Digital Health Technology In Addressing Children's Behavioral Health

Parents, clinicians, teachers, and child health advocates want to ensure children develop vital physical and mental health. In today's post-pandemic world, digital health technology is working to improve family access to behavioral care, resources, and support. Not only can digital health improve access timeliness and help maximize existing clinical staff coverage, but it can radically enhance care delivery in pediatric mental health.

Here, we highlight the benefits and potential limitations of digital behavioral health, encompassing mental health and substance use treatment, tools for improving patient outcomes and health equity for youth. We also share examples of where digital health, including digital therapeutics, is supporting behavioral health access for children.

Youth mental health crisis calls for new technology, tools, and services to improve access

Since the US Surgeon General issued an advisory to address the nation's youth mental health crisis in 2021, digital health services and tools have proliferated in the behavioral health space to address this pressing need.

According to the World Health Organization, about 20% of children and adolescents have a mental health condition, nearly double that of the general population. It's reported that under 25% of these children will receive treatment. These numbers grew during the pandemic and paint a picture where timely prevention, assessment, and intervention are essential.

What is the size and scale of youth behavioral health conditions?

The increasing behavioral health diagnoses are compounded by a lack of adequate access and/or time-to-treatment. A 2019 journal article in Digital Medicine highlighted the scope of insufficient access to care:

“For example, only 1 in 5 people from high-income countries and only 1 in 27 people from low- and middle-income countries receive minimally adequate treatment for depression. This is particularly the case for youth who, despite the high prevalence of mental disorders, face major difficulties in accessing appropriate treatment. This is partly due to the “gap" in care between child and adult mental health services as well as to a reluctance to seek help, stigma, and negative attitudes towards professionals. As a result, less than 1 in 5 adolescents with disorders of youth onset (anxiety, substance use disorders) received care."

Digital mental health tools and services have attracted commercial attention and investment

Digital health startups aimed at children and youth behavioral health grew exponentially during the pandemic, raising $5.1 billion in 2021 alone, outpacing investment in all other digital health clinical areas by $3.3 billion.

Despite this growth, the market is still emerging and in the throes of shifts and change. Many digital health startups have launched and are being supported by investment, but economic forces and the need to prove ROI and effectiveness require developers to pivot for sustainability. Even some promising organizations, like Brightline, are contracting at the moment.

Youth behavioral health presents a critical need and an opportunity to curb future adult conditions

More than 50% of all mental illnesses start before age 18, with the peak age for onset at 14.5 years. Yet the average time to receive a correct diagnosis is 11 years plus time-to-treatment. Not only can the use of digital mental health tools support access, but they can support diagnosis and interventions within the critical windows when children's behavioral issues can become ingrained and harder to treat by adulthood.

According to a 2020 editorial in the Journal of Child Psychology and Psychiatry, "Digital mental health interventions and tools have the potential to… go beyond simply replicating traditional face-to-face interventions online by providing interventions that are more effective, more accessible, and more cost-effective."

As complex disorders of the nervous system are indicated by behavioral or mental patterns that cause significant distress or impairment of a young person's functioning, early treatment of behavioral health conditions is critical. The Journal of Medical Internet Research – Mental Health – published research from 2020 which found that “the early emergence of psychopathology contributes to a lifelong course of challenges across a broad set of functional domains, so addressing this early in the life course is essential."

For example, focusing on critical windows of neurodevelopment as children age offers outset improvements and fewer long-term exacerbations. Studies have shown that early diagnosis and treatment enable 75% of individuals living with autism to participate in mainstream education instead of special education classrooms and schools. Plus, 25% of patients who receive early intervention can function at a level beyond their original diagnosis.

Digital health has demonstrated promising outcomes for mental health

Digital health for youth behavioral health treatment is still in its infancy as technology-enabled healthcare. However, growing and varied research shows exciting results, as indicated in these recent journal articles.

Frontiers of Digital Health: The organization published research into game-based digital therapeutics for children and adolescents, demonstrating sustained therapeutic effects in treating or preventing mental health problems like attention deficit disorders or depression.

Also, research based on thematic analysis showed that “the increased affordability of digital mental health tools in comparison to face-to-face consultations combined with limited dependence of these systems on geographical constraints may facilitate access to mental healthcare." Digital mental health technologies have been shown to increase youth autonomy and sense of empowerment, encourage patients to take a more active role in treatment, seek support to control difficult situations, and practice new coping strategies outside therapy.

JMIR Mental Health: Five focus groups conducted with clinicians who work with young people using digital tools like web-based videos and mood-tracking apps found that these tools helped “young people build skills, facilitate learning, and monitor symptoms." Clinicians reported better engagement with adolescents.

A systematic review and meta-analyses found evidence of the effectiveness of computerized cognitive behavioral therapy on anxiety and depression, notably when treatment included an in-person element with a professional, peer, or parent. Another systematic review explored 51 digital interventions using various delivery methods to address primarily depression, anxiety, and stress. Nearly half of the interventions were associated with at least one positive outcome after the intervention compared with the control group.

Four other reviews found no significant difference in the effectiveness between cognitive behavioral therapy (CBT) delivered through a digital platform or standard face-to-face therapy.

Nature Partner Journals – Digital Medicine: Published research points to how “digital health and tools can also help monitor recovery, provide early warning signs of risk or relapse, and offer novel information on functional outcomes." A particular value is providing digital phenotyping, which is the moment-by-moment quantification of individual-level metrics using data from personal digital devices. Digital health tools can capture symptoms, for example, when a young person hallucinates or has suicidal ideation, along with clues from the environment, social context, and even autonomic response surrounding the experience.

One study demonstrated technology's ability to “predict relapse in patients with psychosis through applying anomaly detection to captured personal changes in mobility, socialness, and self-reported symptoms up to 2 weeks before clinical relapse."

Association for Child and Adolescent Mental Health: Ten studies looked at 7 digital mental health interventions, uncovering findings that suggest a moderate but limited effect in improving mental health outcomes for youth.

Other research found that chatbots could be effective for adolescent depression treatment. Over half of the participants completed the entire intervention and provided user experience feedback, indicating that 64.3% would use a chatbot in the future. Patients pointed to symptom improvement (61.1%) and availability (52.8%) as the most positive aspects.

These publications highlight the need for ongoing research into digital mental health tools for safety, effectiveness, usability, and acceptance by young people and their parents. Building on this information, we look at the types of tools that show the most promise and examples of solutions that are being used in the space.

Types of digital mental health tools & real-world technology solutions to address youth behavioral health needs

Six main types of digital health intervention (DHI) tools are being used for youth behavioral health, including:

1. Telehealth and virtual care
2. Applications
3. Gaming
4. Robots and digital devices
5. Virtual reality
6. Digital educational resources and website

Technology-enabled care can augment, complement, and enhance existing services and expertise, delivering on the promise of better prevention, earlier intervention, and faster time-to-treatment.

Engaging children and youth through digital mental health requires an understanding of child development, tool use, and expectations of technology. This ensures confidence with parents and practitioners as well as builds trust and reliability with young individuals. DHIs have the opportunity to couple convenience and confidence with privacy to help protect against social stigma.

Digital mental health programs and products for youth

Two academic sources have curated a list of high-quality digital mental health products:

1. Children's Health Council: The organization's list includes tools that can be used independently or with parental supervision and others that would be a valuable complement to professional care. The organization provides digital tools for parents, children, teens, and young adults that cover various issues, from self-harm and -care to mindfulness and CBT.

2. University of Texas: Digital Resources for Mental Health: The institution curated a list of products grouped into 7 categories broken down by age groups – ages 2-10, 11-17, and 18+):

1. Mood improvement
2. Stress
3. Mood disorders
4. Self-image
5. Mindfulness
6. Addiction recovery
7. Grief and bereavement

Listed are digital health products that support specific behavioral health issues like grief, eating disorder management, anxiety and depression, aggression, and autism spectrum disorders.

WonderLab at NYU Langone: The WonderLab team is developing apps to help parents understand and manage young children's challenging behaviors, develop strategies to support their children's mental health, and know when to seek clinical help. "When to Wonder: Picky Eating" is the Lab's first app that uses games, questionnaires, and facial recognition technology to build knowledge about food preferences and emotions around eating.

Cognoa: Its first device helps diagnose autism in children as young as 18 months, receiving FDA Breakthrough Device Designations. The second FDA- approved device offered by the company is a mobile app addressing the underlying cause of autistic actions in 3 to 8-year-olds.

Limbix: Spark is a CBT treatment for adolescent depression revolving around value-based accomplishments.

Manatee: A therapy app with a parent and patient portal, allowing the family to track, remind, and adjust settings to pursue collective treatment goals.

Akili Interactive: EndeavorRx is a prescription video game approved by the FDA to treat ADHD and attention function, using gamification to make treatment more fun while tracking insights in a clinical dashboard for parents and clinicians. Patients ages 8-12 use the tool for 25 minutes a day 5 days a week for 4 weeks.

Digital health tools seek to close gaps in time-to-diagnosis, expanding access to behavioral health treatment options

Digital health tools for youth living with behavioral health issues and conditions provide a new and hopeful pathway to addressing symptoms of distress sooner, complementing existing services, and maximizing clinical expertise. While researchers and the FDA will need to closely monitor these tools' safety and efficacy, parents, schools, and clinicians seek powerful ways to prevent illness and support faster diagnosis and treatment.

RTI Health Advance helps vet and assess behavioral health tools and programs

Our team comprises clinical, health policy, population health, digital therapeutics, data science, quality, and health equity experts. Together, we can assess behavioral health digital tools that should enhance clinical programming, align with patient or member populations, and streamline operations to achieve better health outcomes. Contact us.