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FOQUS: A Smartwatch Application for Individuals with ADHD and Mental Health Challenges

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This paper reports on the design of foqus, an app running on a smartwatch to aid adults with mental health conditions like ADHD and mild forms of attention deficiency through two main routes – tools to foster extended focus and tools to reduce anxiety/stress. Using a user-centric design approach, three important features are identified, implemented and evaluated which aim to leverage the benefits of wearable devices: a flexible implementation of the Pomodoro time management technique, a tool for guided meditation, and positive message priming. Initial user test results suggest smartwatch-based interventions as a viable, ubiquitous tool for addressing mental health and stress related conditions.
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FOQUS: A Smartwatch Application for Individuals with
ADHD and Mental Health Challenges
Victor Dibia
IBM T.J. Watson Research Center,
Yorktown, USA
dibiavc@us.ibm.com
ABSTRACT
This paper reports on the design of foqus, an app running on a
smartwatch to aid adults with mental health conditions like ADHD
and mild forms of attention deficiency through two main routes
tools to foster extended focus and tools to reduce anxiety/stress.
Using a user-centric design approach, three important features are
identified, implemented and evaluated which aim to leverage the
benefits of wearable devices: a flexible implementation of the
Pomodoro time management technique, a tool for guided
meditation, and positive message priming. Initial user test results
suggest smartwatch-based interventions as a viable, ubiquitous tool
for addressing mental health and stress related conditions.
Keywords
Wearables, Smartwatches, ADHD, Attention Deficiency, Mental
Health.
1. INTRODUCTION
In the emerging era of wearables and the quantified self, new
opportunities arise for the application of computing technology in
the area of health and wellness. Whilst much work has been done
regarding physical fitness tracking, a less addressed area of inquiry
is the application of wearables to mental health and wellness issues.
Mental health issues such as ADHD, which materialize in the form
of obstacles to sustained task focus and constantly elevated levels
of anxiety, can be a debilitating challenge to adults as well as
children [2]. Unfortunately, the impact of such mental health issues
on the quality of life, are less likely to be observed by the general
public, and not given appropriate attention. In addition, for adults
with mild forms of ADHD and stress, few tools exist that can help
them adopt behavioral change approaches to improving their
condition. To address this, the current study presents a working
prototype (foqus) of a wearable application with feature that assist
a user in improving task focus and reducing stress.
1.1 ADHD and Work
Traditionally, ADHD has been viewed as a childhood disorder
which youngsters outgrow as they get older. However, recent
studies have highlighted ADHD diagnosis within adolescents and
older demographics [2]. Attention deficit problems in the
workplace can cause an individual to exhibit symptoms such as
anxiety, depression and low self-esteem. They appear to be flighty,
edgy, late, disorganized, constantly unable to meet deadlines,
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ASSETS '16, October 23-26, 2016, Reno, NV, USA
ACM 978-1-4503-4124-0/16/10.
http://dx.doi.org/10.1145/2982142.2982207
Figure 1. Interface screenshot for foqus.
prioritize appropriately, fidget and daydream. The work of de Graaf
et al [2] shows that 3.5% of all working adults (age 18 44years, n
= 7075) across 10 countries met the standard (DSM IV) diagnosis
criteria for ADHD. This suggests that a significant percentage of
ADHD cases persist into adulthood, and only a small amount
receive appropriate treatment. Their findings also highlight the
impact of ADHD on job role performance for workers (employed
and self-employed). Specifically, workers with ADHD had an
excess of 8.4 more sickness absence days per year and greater
annualized average excess number of workdays associated with
diminished work quantity (21.7 days) and quality (13.6 days).
Taken together, it is projected that various forms of ADHD are
associated with 143.8 million lost days of productivity each year
[2]. For such adults, there is value in assistive tools that help
manage their conditions.
2. DESIGNING A SOLUTION
Given the neurobehavioral nature of ADHD, this work explores the
design of technology tools that implement behavioral management
techniques (BMT) approaches to ADHD treatment. BMT covers a
range of cognitive behavioral approaches such as cognitive
training, and social skills training which have been identified to be
particularly helpful when patients are unresponsive to medication,
intolerant to medication, when symptoms are mild or where there
are strong ethical or moral objections to medication [5]. Related
work includes interventions where a video game gets harder when
a player’s brainwaves indicate waning attention[6], and a tool that
utilizes skin conductance sensors to estimate stress and offer
positive priming messages [7]. Other recent work in this area
explore the use of smartphones, EEG and heart rate monitors to
track ADHD behavior in children [6]. A drawback of these
approaches is a lack of ubiquity and complexity of their setup that
may limit their effectiveness especially within the workplace.
These drawbacks can be addressed through the use of smartwatches
(as highly ubiquitous and personal devices) while leveraging their
multiple sensors such as heart rate, ambient conditions (light,
pressure, UV) and proximity sensors [1]. To build the proposed
solution, a user-centric design approach was adopted which began
with a user survey (n=27, age 16-40), followed by artifact
prototyping and usability tests (n = 10). Results from the survey
showed that most of the individuals were highly interested in
wearable devices and felt wearable apps were more likely to help
them realize their mental health goals compared to smartphone or
desktop apps. Participants also described their attention deficit
issues mainly as an inability to complete extended tasks and high
levels of stress/anxiety.
3. RESULTS
3.1 System Design
Based on the initial survey, the following app features were
implemented.
Pomodoro: This feature implements the Pomodoro time
management technique (see http://pomodorotechnique.com) which
suggests tasks be broken down into 25 minutes of uninterrupted
work sessions followed by 5 minute breaks. This technique has
been acknowledged to help reduce procrastination, avoid
distraction as well as engender flow and focus. In our
implementation we abide by the tenets of the Pomodoro technique
but allow for a flexible control of work and rest durations to
accommodate users with diverse time schedule granularity. Haptic
feedback (vibration cues) are also used to notify users of focus
milestones and end of sessions.
Mindful Meditation: This feature provides timed visual and haptic
cues which guide users on regulating their breathing pattern as a
meditation session progresses. Users can adjust the inhale/exhale
cycle duration for deeper meditation and vice versa as well as
modify the length of the entire session. Users are then presented
with their average heart rate before and after the session as an
objective measure of its effectiveness. This instant feedback on the
benefit/quality of the completed meditation session, coupled with a
visualization of progress is designed to improve the user’s
motivation and effort.
Message Based Priming: Priming is implemented in two ways
throughout Foqus. First, positive messages (e.g. Awesome job!) are
displayed on successful completion of a Pomodoro or meditation
session. Secondly, there is a dedicated Health Tips screen that
provides mental health tips (adapted from the mental health
foundation).
3.2 Usability Study Results
Figure 2: User test of foqus hi-fi prototype
To evaluate the usability of Foqus, a working prototype (see Figure
1) was developed and deployed on the Samsung Gear 2 smartwatch.
A cognitive walkthrough was performed to ascertain functional
completeness, followed by usability tests (n=10, age=21-30) with
participants who indicated they struggled with attention deficiency
in their daily work. Each was asked to perform at least one focus
and one mindful meditation task over a 7-day period. The focus task
involved the use of the Pomodoro feature in completing 2 hours of
focused work while the meditation task involved completing at
least 3 meditation sessions. They were then asked questions about
the value of the app, its usability and to review the session results.
Findings are summarized as follows:
i.) Users made less interaction mistakes on the interfaces where
functions were disaggregated into multiple screens. E.g. rather than
adding 4 buttons on the screen, a horizontal scroll menu with 4
distinct screens produced better results.
ii.) Context was an important factor for users in constructing the
value of app functions. For example, a user mentioned This app
would be most valuable to me especially during my yoga or
meditation class”.
iii.) While there were concerns regarding the accuracy of the smart
watch heart rate readings, users were excited about the instant
feedback on the effect of their meditation session. A reduction in
measured heartrate made users feel more satisfied with a session.
iv.) 8 users (80%) reported reduced levels of stress/anxiety after
each meditation session.
v.) Inhale/exhale vibration cues helped users remain mindful during
meditation session and was particularly amenable for sessions at
their work desks.
4. CONCLUSION
In this work, a smartwatch app designed to help users improve their
ability to focus on tasks (via a flexible implementation of the
Pomodoro time management technique), reduce their anxiety via
mindful meditation and improve their overall mental health via
positive message priming was designed and implemented. The
intervention provided in this study is put forward as a first step in
designing assistive tools for adults with attention deficiency and
stress challenges in the workplace. In conclusion, the choice of the
wearable platform in this study is timely, given recent investments
in smartwatch development from large technology companies like
Google, Microsoft, Samsung, Asus, Apple as well as fashion and
consumer electronics companies like Withings and Montblanc. As
these firms push the envelope regarding the array and quality of
sensors embedded within smartwatches, design direction from this
work will likely become even more pertinent. Future work will
entail a larger field study and in depth analysis of the efficacy of
Foqus.
5. REFERENCES
[1] Dibia, V. An Affective, Normative and Functional Approach
to Designing User Experiences for Wearables. International
Conference on Information Systems SIGHCI 2014
Proceedings, (2014).
[2] de Graaf, R., Kessler, R.C., Fayyad, J., et al. The prevalence
and effects of adult attention-deficit/hyperactivity disorder
(ADHD) on the performance of workers: results from the
WHO World Mental Health Survey Initiative. Occupational
and environmental medicine 65, 12 (2008), 83542.
[3] Pina, L., Rowan, K., Roseway, A., Johns, P., Hayes, G.R., and
Czerwinsk, M. In Situ Cues for ADHD Parenting Strategies
Using Mobile Technology. International Conference on
Pervasive Computing Technologies for Healthcare, (2014).
[4] Pope, A.T. and Bogart, E.H. Extended Attention Span
Training System: Video Game Neurotherapy for Attention
Deficit Disorder. Child Study Journal 26, 1 (1995), 3950.
[5] Safren, S.A., Otto, M.W., Sprich, S., Winett, C.L., Wilens,
T.E., and Biederman, J. Cognitive-behavioral therapy for
ADHD in medication-treated adults with continued
symptoms. Behaviour research and therapy 43, 7 (2005),
83142.
[6] Sonne, T., Obel, C., and Grønbæk, K. Designing Real Time
Assistive Technologies. Proceedings of the Annual Meeting of
the Australian Special Interest Group for Computer Human
Interaction on -OzCHI ’15, ACM Press (2015), 3438.
... Here, these research projects become legitimised by an unsubstantiated assertion that the family unit is suffering as a result of the ADHD person. Other authors appeal to ADHD's disruption to a person's productivity as a risk to individual success (as in: [1,4,55,80,147]) and imminent threat to national capital (as in: [39,50]). Following from these implications, ADHD thus becomes an urgent societal problem solved only by intervention on the individual, rather than on the society which problematises their embodiment. ...
... Eleven of the 31 papers presenting an intervention or a tool for assisting ADHD people do not explicitly mention a UCD process, nor do they provide any evidence of such a process: only the design rationale and features of a given technology are described (e.g., [42,92,164,182]). One paper mentions plans for future UCD work; three papers claim to have followed a UCD process, but provide no further evidence, or keep participant involvement to an absolute minimum (e.g., conducting a passive survey [39]). ...
... [42]), wristbands combined with e.g. smartphones [49,50,126], belts that measure inhalation or acceleration [59,143], to smartwatches [39] and other wearable devices and sensors; • EEG (4x) ranging from mobile EEG devices for everyday tracking [10], applications for neurofeedback training [113,132] to the use of EEG as an evaluation tool for media consumption [102]; • Smartphones (4x) appear either as general purpose technology [99] or as a platform for time structuring applications [146,148,149]; and • Augmented and Virtual Reality (3x) are used as simulation environments to train specific skills [120], time perception [61] or as an interactive frame for another technology (in this case, a Brain Computer Interface (BCI)) [164]. ...
... Despite effective, this approach relies on co-regulation by depending on another individual to identify the emotion and to aide them to address it. Emotion regulation has been the focus of prior research on technology development [12], [13], yet no prior effort has been dedicated to study in depth and systematically the causes of emotion dysregulation, trigger events, the contexts where it occurs, and approaches commonly and successfully employed to effectively address it in naturalistic settings. ...
... Concerning emotion regulation for neurodiverse individuals, prior work focuses on stress reduction [23], encouraging physical touch [24], task completion [25], [26], time management [27], [28], communication skills [29], expression of affective states [30], proximity awareness [31]- [33], and emotion regulation [34]. More specifically, smartwatches were explored to help in time management using touch and vision [28] and to alleviate anxiety and stress with guided meditation and positive messages [12]. Wearable applications for children with neurodevelopmental disorders were investigated to detect behavior problems and to provide interventions [35], helping users in developing proximity awareness in social settings [31], [32], [36], assisting users in maintaining attention [25], and controlling impulsive speaking [29]. ...
... One limitation that is inherent to reviews is that publications are missed due to the inclusion criteria. Many of these interventions, such as group-based locking of smartphones (Kim, Jung, et al., 2017), using smartwatches (Dibia, 2016) or a physical doll that reminds of excessive usage (Choi et al., 2016), seemed promising or used innovative approaches. We also did not incorporate interviews and other forms of qualitative analysis in this review, which often provide more nuances regarding the intervention and its reception. ...
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