Neurodevelopmental conditions such as attention deficit hyperactivity disorder (ADHD) and autism affect about one in ten children . These conditions impact development, behaviour and wellbeing.
Authors
- Kelsie Boulton
Senior Research Fellow in Child Neurodevelopment, Brain and Mind Centre, University of Sydney
- Adam Guastella
Professor and Clinical Psychologist, Michael Crouch Chair in Child and Youth Mental Health, University of Sydney
But children with these conditions and their caregivers often can't get the support they need. Families report difficulties accessing health-care providers and experience long wait lists to receive care.
Digital tools, such as apps and websites, are often viewed as a solution to these gaps. With a single click or a download, families might be able to access information to support their child.
There are lots of digital tools available, but it's hard to know what is and isn't useful. Our new study evaluated freely available digital resources for child neurodevelopment and mental health to understand their quality and evidence base.
We found many resources were functional and engaging. However, resources often lacked evidence for the information provided and the claimed positive impact on children and families.
This is a common problem in the digital resource field, where the high expectations and claims of impact from digital tools to change health care have not yet been realised .
What type of resources?
Our study identified 3,435 separate resources, of which 112 (43 apps and 69 websites) met our criteria for review. These resources all claimed to provide information or supports for child neurodevelopment, mental health or wellbeing.
Resources had to be freely available, in English and have actionable information for children and families.
The most common focus was on autism, representing 17% of all resources. Resources suggested they provided strategies to promote speech, language and social development, and to support challenging behaviours.
Other common areas included language and communication (14%), and ADHD (10%).
Resources had various purposes, including journalling and providing advice, scheduling support, and delivering activities and strategies for parents. Resources delivered information interactively, with some apps organising content into structured modules.
Resources also provided options for alternative and assistive communication for people with language or communication challenges.
Most apps were functional and accessible
Our first question was about how engaging and accessible the information was. Resources that are hard to use aren't used frequently , regardless of the information quality.
We evaluated aesthetics, including whether digital tools were easy to use and navigate, stylistically consistent, with clean and appealing graphics for users.
Most resources were rated as highly engaging, with strong accessibility and functionality.
But many lacked quality information
We ranked resources on various features from 1 (inadequate) to 5 (excellent), with a ranking of 3 considered acceptable. These ratings looked at how credible the resource was and whether there was evidence supporting it.
Despite their functionality, 37% of reviewed apps did not meet the minimum acceptable standards for information quality. This means many apps could not be recommended. Most websites fared better than apps.
There also wasn't a lot of scientific evidence to suggest using either apps or digital resources actually helped families. Studies show long-term engagement with digital tools is rare, and downloads don't correspond to frequent usage or benefits.
Digital tools are often viewed as a panacea to health-care gaps, but the evidence is yet to show they fill such gaps. Digital health is a fast-moving field and resources are often made available before they have been properly evaluated .
What should you look for in digital resources?
We found the highest quality resources were developed in collaboration with institutions, such as health, university or government groups.
One highly rated resource was the Raising Children's Network and the associated app, Raising Healthy Minds . These are co-developed with a university and hospital, and by people with appropriate qualifications.
This resource provides information to support children's overall health, development and wellbeing, with dedicated sections addressing neurodevelopmental needs and concerns.
Our research shows parents can assess whether digital resources are high quality by checking they are:
factually correct. Look for where the app or resource is getting its information. Does the author have the qualifications and training to provide the information? Are they a registered health expert who is accountable to a regulatory body (such as AHPRA, the Australian Health Practitioners Regulation Agency ) for providing information that does not cause harm?
consistent across multiple credible sources, such as health institutions.
linked to supporting information. Look for reliable links to reputable institutions. Links to peer-reviewed scientific journals are often helpful as those articles will also usually describe the limitations of the research presented.
up-to-date. Apps should be frequently updated. For websites, dates of update are usually found on the homepage or at the bottom of individual pages.
Beware of red flags
Some things to watch out for are:
testimonials and anecdotes without evidence and scientific links to back the anecdotes up. If it sounds too good to be true, it probably is.
no information provided about conflicts of interest. Organisations gain when you click on their links or take their advice (financial, reputation and brand development). Think about what they gain when you use their information to help keep a balanced perspective.
Remember, the app's star rating doesn't mean it will contain factual information from a reliable source or be helpful for you and your child.
The role of digital tools
Digital tools won't usually replace a health professional, but they can support care in many different ways. They may be used to help to educate and prepare for meetings, and to collaborate with health providers.
They may also be used to collect information about daily needs. Studies show reporting on sleep in children can be notoriously difficult, for example. But tracking sleep behaviour with actigraphy , where movement and activity patterns are measured using a wearable device, can provide information to support clinical care. With the promise of artificial intelligence, there will also be new opportunities to support daily living .
Our findings reflect a broader problem for digital health, however. Much investment is often made in developing products to drive use, with spurious claims of health benefits.
What's needed is a system that prioritises the funding, implementation and evaluation of tools to demonstrate benefits for families. Only then may we realise the potential of digital tools to benefit those who use them.
Kelsie Boulton receives funding from the National Health and Medical Research Council and the Cerebral Palsy Alliance Research Foundation for research into neurodevelopmental conditions.
Adam Guastella receives funding from the National Health and Medical Research Council and Australian Research Council for research into neurodevelopmental conditions. He is director of the Clinic for Autism and Neurodevelopmental Research and scientific chair of Neurodevelopment Australia, a scientific group seeking to improve the knowledge and supports for all people with neurodevelopmental conditions.
