From the Lab to the Real World

New Tool Measures Anxiety in Children with Autism Spectrum Disorder, Could Lead to New Treatments

Researchers at Holland Bloorview have developed a new and wearable device that detects states of anxiety in children with ASD, and helps these kids manage their symptoms. New treatments may evolve from this innovative tool that’s on the eve of commercialization.

Researchers led by Dr. Azadeh Kushki, an engineer in the Autism Research Centre at Holland Bloorview Kids Rehabilitation Hospital, have developed a new device: the Anxiety Meter. It’s an app that detects states of anxiety in children with Autism Spectrum Disorder (ASD) by measuring the heart rate and visually providing the information to the children through a mobile phone or tablet.

For the child, it means greater self-awareness and response to biofeedback. “We are hoping that this device can provide a visual feedback mechanism for the children so that they can better manage their anxiety levels,” Kushki explains. “We know anxiety has a negative impact on physical and mental health. It can increase the risk of other psychiatric disorders like depression or substance abuse and cause difficulties in school and increase social isolation,” she adds.

It is hoped that this new device, very nearly commercialized, will lead to new treatments for autism.

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Dr. Azadeh Kushki, Holland Bloorview Kids Rehabilitation Hospital. Photograph courtesy of Holland Bloorview.

There is a connection between autism and anxiety. In 2011, researchers at the University of Amsterdam reviewed 31 studies that focused on the presence of anxiety disorders in children under 18 years old with ASD, and concluded that about 40% of these kids had at least one diagnosed anxiety disorder. “There is considerable evidence that children and adolescents with ASDs are at increased risk of anxiety and anxiety disorders,” the study concluded.

The prevalence of specific anxiety disorders in youth with ASD was found in the Amsterdam study at the following rates:

  • specific phobia: 30%;
  • obsessive-compulsive disorder: 17%;
  • social anxiety disorder/agoraphobia: 17%;
  • generalized anxiety disorder: 15%;
  • separation anxiety disorder: 9%; and
  • panic disorder: 2%.

Given this evidence, this new device, created at Holland Bloorview, clearly fills a need, especially since children with autism may have more difficulty recognizing the symptoms of anxiety, such as racing heart, shortness of breath, feelings of dread and hyper-vigilance; or communicating how they feel to others.

Wearable Device Works with Mobile Phone or Tablet

The Anxiety Meter is an app that connects to sensors on the chest. The wearable sensors measure physiological signals in real time ‒ mainly, the heart rate, which is one of the most consistent markers of anxiety.

This information is then translated into a visual but language-free display on a mobile phone or tablet. This way, children can track changes in their heart rate based on the movement of a white bar: When the bar sits in the green range, this signifies relaxation. As it moves into the red area, it identifies arousal and signals the need for the child to apply a calming strategy.

Interestingly, Kushki hopes that the arm band component will be replaced by a “smart fabric” shirt at some point in the future.

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Dr. Azadeh Kushki, Holland Bloorview Kids Rehabilitation Hospital (left), fitting client with the Anxiety Meter. Photograph courtesy of Holland Bloorview.

The Anxiety Meter is intended to complement the delivery of behavioural therapy in ASD by:

  • informing children of their anxiety level and prompting self-awareness;
  • prompting children with guidelines to manage anxiety symptoms as needed; and
  • reducing anxiety through biofeedback.

The Anxiety Meter will provide further support for the children outside of the clinical setting and away from their caregivers, during their time spent at school or in the community. In this way, it may allow the children to be more confident and capable in everyday activities, which will lead to indirect benefits for the parents and caregivers of these children.

Commercialization and Job Creation in the Works

Kushki is testing the device through a study funded by the Ontario Brain Institute and through the Holland Bloorview’s Facing Your Fears program for youth with autism. She hopes to be able to deliver this technology directly into the hands of individuals and families with ASD for use in their daily lives.

Commercialization will make this possible, and more: It will facilitate getting this new technology into the hands of trained professionals across Ontario and Canada.

The first step to commercialization is already in process: Working with MaRS Innovation, Holland Bloorview is discussing licensing terms for the Anxiety Meter with an Ontario-based start-up company named Dymaxia, founded by entrepreneur Asim Siddiqi. It is anticipated that in 2015, the commercialization of the Anxiety Meter will support two full-time jobs at Dymaxia.

The Ontario Brain Institute provided over $415,000 in funding for the Anxiety Meter. Additionally, Facing Your Fears was given a $1 million donation from RBC Royal Bank.

To read more about the Anxiety Meter, go here: and here: To read the scientific article by researchers from the University of Amsterdam, in Clinical Child and Family Psychology Review, go here: