PROJECT SUMMARY The project will develop and pilot test a personalized medicine mobile health application, KeepCalm, that incorporates physiological stress measurement to support evidence-based practices for reducing challenging behavior in children on the autism spectrum. As much as 80% of children on the autism spectrum 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 on the autism spectrum 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 on the autism spectrum. In order to tailor KeepCalm 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 on the autism spectrum and challenging behaviors, by conducting interviews with teachers of children on the autism spectrum, parents of children on the autism spectrum and school administrators, and conducting structured in-class observations with teachers. Through the activities of Aim 2, we will improve KeepCalm, building on our initial app prototype, in collaboration with our established technology partner, Alevio, 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 on the autism spectrum, 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 20 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 on the autism spectrum, using evidence-based strategies. These activities will lay the foundation for an R...