Coulter Helen, Donnelly Mark, Mallett John, Kernohan W George
South Eastern Health and Social Care Trust, County Down, United Kingdom.
Ulster University, Newtownabbey, United Kingdom.
JMIR Form Res. 2022 Aug 26;6(8):e37994. doi: 10.2196/37994.
People with autism spectrum disorder (ASD) frequently experience high levels of anxiety. Despite this, many clinical settings do not provide specialist ASD mental health services, and demand for professional support frequently outstrips supply. Across many sectors of health, investigators have explored digital health solutions to mitigate demand and extend the reach of professional practice beyond traditional clinical settings.
This critical appraisal and pilot feasibility study examines heart rate variability (HRV) biofeedback as an approach to help young people with ASD to manage anxiety symptoms outside of formal settings. The aim is to explore the use of portable biofeedback devices to manage anxiety, while also highlighting the risks and benefits of this approach with this population.
We assessed the feasibility of using home-based HRV biofeedback for self-management of anxiety in young people with ASD. We adopted coproduction, involving people with ASD, to facilitate development of the study design. Next, a separate pilot with 20 participants with ASD (n=16, 80% male participants and n=4, 20% female participants, aged 13-24 years; IQ>70) assessed adoption and acceptability of HRV biofeedback devices for home use over a 12-week period. Data were collected from both carers and participants through questionnaires and interviews; participants also provided single-lead electrocardiogram recordings as well as daily reports through smartphone on adoption and use of their device.
Pre-post participant questionnaires indicated a significant reduction in anxiety in children (t=2.55; P=.04; Cohen d=0.99) as well as adults (t=3.95; P=.006; Cohen d=0.54). Participant age was significantly negatively correlated with all HRV variables at baseline, namely high-frequency heart rate variability (HF-HRV: P=.02), the root mean square of successive differences in normal heartbeat contractions (RMSSD: P=.02) and the variability of normal-to-normal interbeat intervals (SDNN: P=.04). At follow-up, only SDNN was significantly negatively correlated with age (P=.05). Levels of ASD symptoms were positively correlated with heart rate both before (P=.04) and after the intervention (P=.01). The majority (311/474, 65.6%) of reports from participants indicated that the devices helped when used. Difficulties with the use of some devices and problems with home testing of HRV were noted. These initial findings are discussed within the context of the strengths and challenges of remotely delivering a biofeedback intervention for people with ASD.
HRV biofeedback devices have shown promise in this pilot study. There is now a need for larger evaluation of biofeedback to determine which delivery methods achieve the greatest effect for people with ASD.
ClinicalTrials.gov NCT04955093; https://clinicaltrials.gov/ct2/show/NCT04955093.
自闭症谱系障碍（ASD）患者经常经历高度焦虑。尽管如此，许多临床机构并未提供专门的ASD心理健康服务，对专业支持的需求往往超过供给。在许多卫生领域，研究人员探索了数字健康解决方案，以缓解需求并将专业实践的范围扩展到传统临床机构之外。
本批判性评价和试点可行性研究考察心率变异性（HRV）生物反馈作为一种帮助ASD青少年在非正规环境中管理焦虑症状的方法。目的是探索使用便携式生物反馈设备来管理焦虑，同时突出这种方法对该人群的风险和益处。
我们评估了使用家庭式HRV生物反馈进行ASD青少年焦虑自我管理的可行性。我们采用了共同生产的方式，让ASD患者参与其中，以促进研究设计的制定。接下来，对20名ASD参与者（n = 16，80%为男性参与者，n = 4，20%为女性参与者，年龄在13 - 24岁；智商>70）进行了一项单独的试点研究，评估HRV生物反馈设备在12周内用于家庭使用的采用情况和可接受性。通过问卷和访谈从照顾者和参与者那里收集数据；参与者还通过智能手机提供单导联心电图记录以及关于设备采用和使用情况的每日报告。
参与者前后问卷显示，儿童（t = 2.55；P = 0.04；Cohen d = 0.99）和成人（t = 3.95；P = 0.006；Cohen d = 0.54）的焦虑均有显著降低。参与者年龄在基线时与所有HRV变量均呈显著负相关，即高频心率变异性（HF - HRV：P = 0.02）、正常心跳收缩连续差值的均方根（RMSSD：P = 0.02）以及正常到正常心跳间期的变异性（SDNN：P = 0.04）。在随访时，只有SDNN与年龄呈显著负相关（P = 0.05）。ASD症状水平在干预前（P = 0.04）和干预后（P = 0.01）均与心率呈正相关。参与者的大多数报告（311/474，65.6%）表明设备在使用时有所帮助。注意到了一些设备使用方面的困难以及HRV家庭测试的问题。这些初步发现是在为ASD患者远程提供生物反馈干预的优势和挑战的背景下进行讨论的。
HRV生物反馈设备在这项试点研究中显示出了前景。现在需要对生物反馈进行更大规模的评估，以确定哪种交付方式对ASD患者能产生最大效果。
ClinicalTrials.gov NCT04955093；https://clinicaltrials.gov/ct2/show/NCT04955093
