Attention deficit hyperactivity disorder (ADHD) is the most prevalent childhood psychiatric condition and has profound public health, personal, and family impacts. A lifelong condition, it requires maintenance and substantial self-regulation to support treatment gains. Despite success in clinical interventions, long-term treatment adherence can be challenging. Providing support and reinforcement via simple technology integrated into a smartwatch and smart phone may be one mechanism to improve adherence to treatment.

This research developed and piloted CoolCraig, a wearable and connected system combining a smartwatch, mobile phone application, and web portal that delivers, reinforces, and sustains treatment for adolescents with ADHD.

The specific aims of the research were the following:

• Establish key design principles for the support of adolescents with ADHD and implement these principles in the CoolCraig system.
• Evaluate the feasibility and acceptability of CoolCraig.

A series of design workshops with 24 children, eight teachers, and eight parents were held where participants discussed wearable technology, self-regulation strategies, and potential features for the smartwatch app, as well as giving children the opportunity to sketch prototypes. Fourteen design sessions were conducted to develop, present, and discuss provisional scenarios to inform design. These workshops and design sessions informed the development of a prototype system.

Prior to the start of the feasibility and acceptability trial, however, COVID-19 impacted the original research plan. The research was quickly adapted to study how it might support mental health treatment during COVID-19-related stay at home orders. New features were added to the prototype, including personalized calendars that synchronized across devices with distance learning schedules. Three pilot trials were completed, with the prototype revised for each subsequent pilot.

The research showed that children can successfully wear and use the watch daily for 6 weeks or more. Parents indicated that the intervention was helpful and pointed to the support it gave their children in the development of organizational skills. The research was able to show how the use of smartwatches can support daily organization and task completion in children with ADHD, particularly during periods of distance learning. Finally, the research produced guidelines for designing interventions using technology in supporting this population.