# Reducing Challenging Behaviors In Children With Autism Through Digital Health

> **NIH NIH K01** · UNIVERSITY OF PENNSYLVANIA · 2021 · $179,874

## Abstract

PROJECT SUMMARY
The project will develop and pilot test a personalized medicine mobile health EMOtion REgulation application
(m-health EMORE app) that incorporates physiological stress measurement to support evidence-based
practices for reducing challenging behavior in children with autism spectrum disorder (ASD). As much as 80%
of children with ASD exhibit challenging behaviors that can have a devastating impact on personal and family
well-being, contribute to teacher burnout and require frequent hospitalization. Evidence-based practices for
reducing these behaviors emphasize uncovering triggers, yet parents and teachers often report that challenging
behaviors surface without warning. Challenging behaviors caused by emotion dysregulation can be the most
difficult to predict, as children with ASD often have difficulty communicating their distress before it results in
challenging behavior. Exciting recent advances in digital technology now allow measurement of momentary
emotion dysregulation, using physiological indices. Our pilot data from four separate samples demonstrate that
increased heart rate predicts onset of challenging behavior in children with ASD. In order to tailor the m-health
EMORE app to end users and avoid potential barriers to its adoption, in Aim 1, we will evaluate the acceptability,
feasibility, and appropriateness of app, and the needs of educational teams in managing stress in children with
ASD and challenging behaviors, by conducting interviews with teachers of children with ASD, parents of children
with ASD and school administrators, and conducting structured in-class observations with teachers. Through the
activities of Aim 2, we will improve our m-health EMORE app, building on our initial app prototype, in
collaboration with our established research partner, the Translational Informatics Unit, Children’s Hospital of
Philadelphia, and our established community partner, the School District of Philadelphia. We will do this through
1) exploratory work on the specificity of heart rate increase to challenging behavior, on app clinical decision
support timing, and on the association of app false positives and negatives to movement or child factors; 2)
monthly advisory board meetings with expert stakeholders for app development guidance, and; 3) rapid-cycle
prototyping of the app with 10 educational teams (i.e. 1-2 children with ASD, and their teacher and classroom
aide, if they have one). This will allow for iterative improvement based on each user’s experience. Through Aim
3, we will test the app for usability, acceptability, feasibility and appropriateness, as well as preliminary
effectiveness with 30 educational teams in a randomized waitlist field trial over a 3-month period. Successful
completion of these aims will result in a novel m-health app designed to help teachers support emotion regulation,
and reduce or prevent challenging behavior in children with ASD, using evidence-based strategies. These
activities will lay th...

## Key facts

- **NIH application ID:** 10217987
- **Project number:** 5K01MH120509-02
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Heather J Nuske
- **Activity code:** K01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $179,874
- **Award type:** 5
- **Project period:** 2020-07-17 → 2024-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10217987

## Citation

> US National Institutes of Health, RePORTER application 10217987, Reducing Challenging Behaviors In Children With Autism Through Digital Health (5K01MH120509-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10217987. Licensed CC0.

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