Designing a Clinical Decision Support System for

Recommending Computerized Cognitive

Rehabilitation Programs: the Experience of

Attention Deficit Hyperactivity Disorder

1st Azadeh Bashiri

Health Information management department

2nd Marjan Ghazisaeedi

Health Information management department

3th Leila Shahmoradi*

(Corresponding Author) Health Information management

department Shiraz University of Medical Sciences Shiraz, Iran

a-bashiri@alurnnus.tums.ac.ir

Tehran University of Medical Sciences Tehran, Iran

ghazimar@tums. ac.ir

Tehran University of Medical Sciences Tehran, Iran

Lshahmoradi@tums. ac. ir

4rd Behrouz Alizadeh Savareh Health Information management

department Shahid Beheshti University of Medical

Sciences Tehran, Iran

5'h Hamid Beigy Computer engineering department

Sharif University of Technology

Tehran, Iran beigy@sharif.edu

61h Sharareh Rostam Niakan kalhori Health Information management

department Tehran University of Medical Sciences

Tehran, Iran niakan2@gmail.com

alizade. behruz@gmail. com

7th Masoud Nosratabadi

Clinical psychology department University of Social Welfare &

Rehabilitation Sciences Tehran, Iran

masoudnosratabadi@gmail. com

8th Mahnaz Estaki

Psychology department

Islamic Azad University Tehran, Iran

p. esteki@gmail. com

Abstract-According to the American Psychiatry Association, Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in the childhood Considering the importance of cognitive approaches to rehab such a disorder, the purpose of the present study is to design a clinical decision support system to propose suitable computerized cognitive rehabilitation programs. At first, the scores of parameters of attention and response control in the IV A test were extracted Then, by interviewing with experts and analyzing the results, a set of computerized coguitive rehabilitation programs (Captain Log, Lumosity, Maghzine) to empower attention and response control parameters were selected, modeled and implemented as if-then rules. To design and implement the system, the MATLAB (2016 b) programming environment was used Designed clinical decision support system was able to provide computerized cognitive rehabilitation programs with regard to defective attention and response control parameters. It could help therapists and psychiatrists to improve the symptoms and rehab the children aud adolescents with Attention deficit hyperactivity disorder.

Keywords- Attention deficit hyperactivity disorder,

IV A-CPT, Computerized Cognitive Rehabilitation Programs, Clinical Decision Support System

978-1-7281-1114-8/18/$31.00 ©2018 IEEE

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I. INTRODUCTION

According to the American Psychiatry Association, Attention deficit hyperactivity disorder is one of the most common neurodevelopmental disorders in the childhood. This developmental disorder is diagnosed in the 3-7(%) of school-age children [1-3]. Regarding the International Classification of Mental and Behavioral Disorders- lOth revision (lCD- 10) and Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), nature, duration and frequency changes of behavioral symptoms such as attention and response control are the main diagnostic criteria in the ADHD [2, 4-6]. Recently, one of the Continuous Performance Tests is called Integrated Visual and Auditory (IV A) is a psychological computerized test, which has been designed to measure and evaluate behavioral symptoms in the Attention deficit hyperactivity disorder [4, 7, 8]. It can help psychologist to make a correct diagnosis in the individuals aged 6 years and up with ADHD. IVA-CPT measures different kinds of attention and response control parameters in the visual and auditory status separately. They include speed, vigilance, focus, consistency, prudence, and stamina [4, 9-13]. Cognitive rehabilitation methods have been developed because of the Neuro-plasticity. Due to this characteristic,

the human brain can repair some of its injuries by using specific and continuous exercises. Such exercises improve cognitive functions in humans, such as emotions, memory, attention, and learning, and so, can improve the rehabilitation of the ADHD subject faster [6, 9]. Considering the importance of cognitive approaches to rehab such a disorder, the objective of the present study is to design a clinical decision support system to propose suitable computerized cognitive rehabilitation programs.

II. RELATED WORKS

ADHD by imposing social, economic, educational and health care costs affects the persons, families, and society, negatively. Computerized decision support strategies are the best hope for equipping pediatric psychiatrists and GPs to treat and manage the attention deficit hyperactivity disorder effectively [14, 15] . Considering the new presence of decision support systems in psychiatry, there are a few studies to provide such systems for computerized cognitive rehabilitation of attention deficit hyperactivity disorder and most of them focused on the developing of CDSS in prognosis, differential diagnosis

and, drug therapy [16-19] . One of the most relevant studies was done in 2013 by Wang and Huang [20]. They developed a computerized game-oriented system for pre­school children. Their system has gathered different educational exercise to empower various aspects of attention (focused, sustained, selective, alternating and divided attention). The collection of exercises that gathered in this system provided a mechanism for the development and training of users.

III. METHODOL Y

A. Participants

95 ADHD subjects (7-18 years old) were participating in this study. They referred to the Parand and Aren centers in from 2013 to 2016. They met the diagnostic criteria of ADHD according to the clinical evaluation of psychologists based on the DSM-IV [21] . Also, the subjects with the history of head injury, neurological disorders, and other condition were excluded. The demographic information of participants based on the ADHD type, gender and age have shown in tablel .

TABLE I. T HE CHARACTERISTICS OF ADIID PARTICIPANTS

B. Data Collection

In the present study, after investigating the IVA reports, the parameters of response control and attention of

participants were considered. All of these parameters were extracted in both visual and auditory dimensions. Finally, 28 parameters were gathered and stored for each ADHD participant (Table 2).

TABLE I I. T HE IVA-CPT PARATMETERS

C. Processing Based on the IV A -CPT test guide, it was cleared that, in each parameter the score below 90 means there is the defect in it. We organized each IV A -CPT parameter as follow: . {1, if TV A - CPT parameters .2: 90 newpnnt= .

O,l f TV A - CPT parameters < 90

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Eql. IVA-CPT parameters Binarization

Relying on the literature review, a semi-structured interview was done with psychologist and neuroscience experts to select suitable computerized cognitive rehabilitation programs. The results of the interview were analyzed in terms of content and then summarized by the research team. In the final, Lumosity, Captain's log, and Maghzine programs were selected and confirmed as recommended programs. Each program includes game-

oriented exercises. These exercises were classified into 7 categories. Finally, If-then rules were defined according to the IV A manual for each category in the form of PDF and implemented in the MATLAB environment (2016/ b version). As well, the entire process of modeling the CDSS was done by this software. To design and create Graphical User Interfaces, a set of functions implemented in the MATLAB environment to produce graphical forms.

IVA-CPT parameters. According to this figure, it is clear that from the 28 IV A -CPT parameters, 16 parameters are defective. And so, the system should propose the computerized cognitive rehabilitation exercises for each of them. In this study, the Captain Log, Lumosity and Maghzine Rehabilitation Package as a native program, were suggested. Figure 2 reveals a sample of suggested cognitive exercises for selective attention. According to this figure, the name and description of the program, as well as an illustration of its interface is presented to the therapists. The name of the programs was considered as a hyperlink, so, the therapist can click on it to open the application's program or, in the case of online programs, go to the website of it.

IV. R ESULTS

In the current study, the designed system enables therapists to enter IVA-CPT parameters for each ADHD subject and receive a set of cognitive exercises based on the defect in each IVA-CPT parameter. Table 3 shows the recommended exercises by the proposed system. Also, the figure 1 shows the GUI of output results related to the

TABLE I I I. T HE RECOMMENDED EXERCISES FOR IV A PARAMETERS

IV A parameters Recommended Exercises

The Great Hun, Match Point, Cat's Play, Watchdog, Red Light, Green Light, Total Recall, Tower Power, Max's Match, What's Next, Conceptor, Figure It Out, What's Missing, Bits And Pieces, City Lights, Counting Critters, Great Escape, Darts!, On The

Road, Code Cracker, Tricky Tracks, Puzzle Power, Remember The Alamo, Match Play,

Full scale attention/ visual attention/ auditory attention Racing Robots, Bingo Discovery, Eureka!, Touchdown!, A Day At The Races, Where's My Car?, Forget Something?, Birds of a Feather, Lost And Found, Don't Be Late, Bird

watching, Top Chimp, Space Junk, Playing Koi, Eagle Eye, Observation Tower, Lost in

Migration, Train of Thought, Star Search, Trouble Brewing, Rhythm Revolution, <hil>

�. Y-3k; f�l, ccW f�l, "3r' '3;f, "'} J"

Full scale response control! visual response control/ Darts!, Cat's Play, Mouse Hunt, Target Practice, Red Light, Green Light, Pick Quick,

auditory response control Match Point, �), ), ,� , ol;f)j!

Visual focused attention/ Audio focused attention Drum Signals, Happy Hunter, Target Practice, Domino Dynamite, Eagle Eye, Pick And

Pop, Musical Pairs, Pop-N-Zap, c.Sj4 }bi

Visual alternating attention/ Audio alternating attention Match Maker, Red Light-Green Light, Mouse Hunt, Great Escape, c.s'�JY'• o3r' o3;f, �4 o�;?, <tj_Jjy>

Visual sustained attention/ Audio sustained attention Pop-N-Zap, Mouse Hunt, Target Practice, c.Sj� }bi

Visual divided attention, Audio divided attention Hide and Seek, On The Road, Mystery Messages, c.s'IJ�)

Visual selective attention/ Audio selective attention Smart Detective, Match Maker, Happy Trails, Target Practice, c.s'�JY'• Y-3La:; fr.Jl, fr.ll wl.il, 4J.) J,) o�, '-:-'4 o�;?, oi_}Jj·b <\..i}JA

Fig. I. The GUJ of entering IVA -CPT parameters Fig.2. The GUJ of proposed exercises foe selective attention

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V. DISCUSSION �\c'JD CONCLUSION

Attention deficit hyperactivity disorder is a condition that the only one therapeutic intervention isn't sufficient for its rehabilitation. And so, it has an urgent need for new, innovative, cost-effective, and person-centered therapies [22, 23]. Studies have shown that the regular and planned exercises will be able to enhance brain functions over time. In the recent years, the growth of knowledge to produce computerized softwares has made it possible to design and implement exercises based on the initial capabilities of different persons to accelerate the progress of brain functions improvement [22, 24]. According to the American Academy of Pediatrics, the behavioral approaches should be considered as the first treatment line in the attention deficit hyperactivity disorder before prescribing any drug. Computerized cognitive programs as a subtype of behavioral approaches are developed to help the damaged brain or other cognitive impaim1ents to restore their normal functions. So, these programs are used to treat and improve psychiatric disorders such as attention deficit hyperactivity disorder [22. 24-27]. These training programs along with game-based elements aim to improve the self-control in the individuals with ADHD. They can be combined with other drug and supportive therapies to be effective and safe tools in the rehabilitation of this disorder [28]. Many studies have emphasized that computerized cognitive programs such as Captain Log, Pay Attention, Computerized Attention Training (CAT), Cogmed RM, Academy of Math. Braingame brain, C8 Sciences' ACTIVATE, and Atten Focus have positive impacts on the rehabilitation of cogmtiVe functions such as working memory, concentration and attention in ADHD [28-32]. Each of these programs delivers a vast range of exercises to improve cognitive skills and so, it is necessary for therapists to select the exact exercises for each case. The clinical decision support systems have developed to help the healthcare providers for making the best decision in the real-time. They integrate and analyze the health evidence and suggest the optimum choice for diagnosis and treatment. The clinical decision support systems are useful in the management of clinical data and experiences, saving the time and cost, and reducing the errors in medical activities. According to the recent tendencies to use CDSS in the psychiatry domain [17, 33-36], the present study introduces a CDSS for recommending computerized cognitive rehabilitation programs in the attention deficit hyperactivity disorder. Designed system was able to provide a set of computerized cognitive exercises \vith regard to defective attention and response control parameters. It could help therapists and psychiatrists to improve the symptoms and rehab the children and adolescents with ADHD.

ACK.'JOWLEDGMEI\T

The present study was done with the financial support of the Tehran University of Medical Sciences and

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extracted from the Ph.D. thesis in the Health lnfornmtion Management of the Azadeh Bashiri.

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