Mobile Technologies in Child and Adolescent Psychiatry: Pushing for Further Awareness and Research

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Over the past four decades, mobile devices have evolved from the once bulky and expensive cellular phones of the past to the sleek, inexpensive, and omnipresent smartphones of today, which are used by adults and children alike. In the United States nearly 75% of teens either own or have access to a smartphone.1 Family income and place of residence do not appear to change teens’ access to smartphones drastically; 61% of teens in households with income less than $30k have access to smartphones, as do 68% of those living in rural areas.1 This increasing accessibility to smartphones raises important questions about their potential use as a vehicle to deliver improved mental health interventions, particularly in view of the continuing shortage of child and adolescent psychiatrists.2 A better understanding among clinicians of how smartphones can affect treatment is also important because children and adolescents are already using various forms of self-help applications (apps). The purpose of this column is to identify advantages and disadvantages of using mobile technology in the psychiatric treatment of children and adolescents, and also to identify the questions that remain to be answered in this ever growing aspect of child mental health. While the present article is not a comprehensive review of the literature available to date, we draw extensively on that literature to address the above issues concerning mental health treatment using mobile technologies.
A basic function of cell phone technology—texting—has already infiltrated into Child and Adolescent Psychiatry practice. DeJong and Gorrindo3 reviewed the use of texting in patient care and some of the advantages that it offers, which include speed and directness of interaction, accessibility, and portability. Preliminary evidence shows that adolescents are comfortable with integrating text messaging as part of their care, with the only concerns involving cost and privacy.4 One of the most common uses of texting in the therapeutic relationship is coordination of face-to-face appointments.5 Despite the recent advancements in the capabilities of cell phone technology above and beyond texting (e.g., smartphones with apps), however, few studies have looked into how these new features can be used to improve mental health care for children. A review by Donker and colleagues6 looked at adults’ use of mental health smartphone apps for treating various conditions, including depression, anxiety, and substance abuse, and found that they can effectively improve accessibility to care. Their review identified over 3000 apps available, but only 8 of those involved evidence-based interventions, making it difficult to investigate their efficacy.
One of the most important potential advantages of incorporating smartphone technology into child mental health treatment is the possibility of ecological momentary interventions, which are clinical interventions that are delivered in the context of everyday life and in a person’s natural setting.7 For example, a smartphone app could monitor children’s moods in real time and notify their parents, teachers, or mental health providers if their symptoms worsen. These ecological momentary interventions could be particularly important in implementing cognitive-behavioral therapy (CBT), the gold-standard psychotherapeutic approach for treating children’s depression and anxiety. The success of a CBT intervention is based on the participant’s practice of the skills learned during the session in everyday life, but the necessity of practice in between sessions often presents a major challenge in terms of compliance. Use of smartphone technology to enable skills practice may make the concept of CBT homework more attractive for youngsters and therefore increase participation.
One of the few studies to date that has looked at the use of a CBT-based app for children found some promising results.
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