Challenging Behaviors in Children with Nonverbal Autism: A Questionnaire to Guide the Design of a Wearable Device for Biomarker Recording

Highlights: Approximately 25% of individuals affected with ASD exhibit severe language impairments and are more likely to have challenging behavioral issues. Recent research focuses on early detection and prevention of crises by utilizing biomarkers measuring stress signals before the onset of the crisis. Regarding design requirements, the trunk appears to be the preferred location for wearable devices in this population. The arm and wrist can be an alternative with encouraging results. These locations offer interesting prospects for integrating devices into clothing or connected bracelets. The utilization of wires should be discouraged in the design of wearable devices for this specific population. Acceptance could be improved through prior desensitization. What are the main findings? A total of 67.5% of respondents support a wearable stress detection device for nmvASD children, preferably integrated into clothing, placed on the trunk, and be wireless. What is the implication of the main finding? These findings guide the development of tailored tools to improve behavioral management in this population. Children with non- or minimally verbal autism (nmvASD) commonly display sensory and emotional dysregulations leading to extremely stressful situations that trigger challenging behaviors which are often difficult to treat. Nonetheless, this population remains rarely studied in clinical research. Recent methods use electrophysiological biomarkers as diagnostic tools to detect stress signals, which may be useful in anticipating situations or conditions leading to challenging behaviors in nmvASD. A specific questionnaire was created in order to identify the characteristics of nmvASD children and gather the opinions of future users (parents and caregivers) on the design of a wearable device able to collect stress-related electrophysiological data. The results indicate that approximately 67.5% of respondents (n = 40) would be interested in such a device, both in outpatient and inpatient settings. In 70% of cases, prolonged contact with an object on the trunk is always well accepted by the child. This location was also preferentially chosen by 57.5% of respondents for such a wearable device. The presence of wires could be problematic in 82.5% of cases. About 65% of respondents find it far better to integrate these wearable devices directly into the clothing. These results will help in the development of devices specifically developed for the nmvASD population to enhance their care for behavioral disorders and based on user-center design.