Expanded Game Squad for Neurodiverse Youth
Condition: Physical Activity; Mental Health Issue (E.G., Depression, Psychosis, Personality Disorder, Substance Abuse); Health Behavior; Developmental Disorder
MeSH terms: Substance-Related Disorders; Personality Disorders; Developmental Disabilities
Study type: Interventional

Summary: 
      The proposed study will pilot the use of an adapted Game Squad intervention aimed at
      improving physical activity and other important health behaviors (nutrition, sleep hygiene,
      screen time habits) for children and adolescents receiving special education supports for
      behavioral health challenges, or who are served by the Boston Medical Center Developmental
      and Behavioral Pediatrics (BMC-DBP) clinic.
    

Detailed description: 
      The significant health disparities that exist among people with mental health conditions (MH)
      and developmental disabilities (DD), including autism spectrum disorder (ASD), have been
      documented through research and clinical practice. The majority of studies have focused on
      adults with these conditions, but due to the efforts of agencies such as the Maternal Child
      Health Bureau, the health disparities experienced by youth with MH and DD are increasingly
      recognized. These youth are more likely to be overweight and obese than their typically
      developing (TD) counterparts, have higher cardio-metabolic risk factors, and have lower
      levels of health-related fitness. These conditions can be partly attributed to the low
      physical activity levels and poor diet quality that have been observed in these populations.
      Multiple barriers that operate at the individual, community, and societal levels limit
      opportunities for these youth to achieve good health, and thus there is an urgent need for
      health promotion interventions to address these disparities. One novel way to address these
      barriers is to explore the use of virtual methods adapted specifically for this population to
      reach these children and families in their homes, while also investigating viable venues
      through which such interventions can be delivered and supported if necessary.

      This study seeks to pilot a virtual health coaching and exercise program aimed at addressing
      modifiable lifestyle factors that can lead to improved health and well-being for youth with
      MH and DD. The Game Squad Home Exergaming program, originally developed by the Pennington
      Biomedical Research Center, is a theoretically-guided and evidence-based intervention that
      has shown effectiveness at engaging parents and children with overweight/obesity in regular
      physical activity and virtual health counseling. Game Squad utilizes home exergaming consoles
      (i.e., Kinect for Xbox video games that require physical activity for gameplay) for both
      caregiver and child exercise sessions, as well as to deliver virtual health counseling
      sessions to participants. These virtual health counseling sessions were aimed at improving
      non-exergame related physical activity. Importantly, during a recent RCT involving a
      socio-economically and racially diverse population over a six-month period, the intervention
      yielded clinically significant reductions in BMI z-score and cardiovascular disease risk
      factors, as well as increased moderate to vigorous physical activity (MVPA).

      The proposed project seeks to determine whether the Game Squad intervention is acceptable and
      engaging to children and adolescents with MH and DD, adapt the health counseling sessions to
      encompass additional health behaviors and meet the needs of this population, as well as to
      assess feasibility of implementation through both a school-based program and a specialized
      clinic for children with MH/DD. This is achieved through innovative partnerships with several
      key collaborators: Merrimack College; the Pennington Biomedical Research Center; the
      Therapeutic Intervention Designed for Educational Success Program (TIDES) program, a public
      school special education collaborative in several north shore communities in Massachusetts;
      and the developmental-behavioral pediatrics clinic at Boston Medical Center (BMC-DBP), a
      clinical site associated with the MCHB-funded Developmental Pediatrics Research Network
      (DBP-NET).
    

Intervention name(s): NDGameSquad
Intervention type(s): Behavioral
Intervention description(s): The intervention will be delivered within participants' homes. Participants will be provided a gaming console and exergames. Participants will be encouraged to meet a goal of 60 minutes/day of MVPA for the duration of the intervention by playing the exergames at least three times per week and engaging in non-screen based physical activity on other days. Participants will receive a booklet that includes a curriculum for playing weekly challenges. Participants will wear a FitBit during their exergaming sessions. Participants and parents meet bi-weekly with a health coach via video-chat using the exergame console. Sessions will identify and encourage specific physical activity, healthy eating, and healthy sleep habits. At the school site, participants will receive additional check-ins, engagement support, and health curricula from classroom teachers during the first 10 weeks of the intervention.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The project will be carried out in three phases: 1) Formative research to implement the intervention with n=6 youth in order to make any modifications necessary before embarking on the full pilot in both sites in the next phase; 2) The pilot intervention comprised of a randomized wait-list controlled pilot intervention at two sites (school and clinic) during the school year; 3) an unsupported follow up period where participants in the school-based intervention will be offered the intervention during the summer months without school staff support. Wait-listed school site participants will also receive the unsupported intervention in this phase.
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Prevention