FedHealthIT’s President, Susan Sharer, recently sat down with Sara Singh M.D, FAPA, Founder and President of A Square Group (ASG) and its COO Mandeep Singh, to learn more about the company’s recent awards and efforts with the National Institutes of Health, National Institute for Mental Health (NIMH) around mobile application, Data Collection and Analytics platforms. She also had the opportunity to dig into the clinical side with Melissa A. Brotman, Ph.D. Assistant Clinical Investigator and Director of NIH’s Neuroscience and Novel Therapeutics Unit (NNT).

The Agency’s Goal

Brotman says at the macro level, there is a goal to develop non-pharmacological treatment for kids with severe irritability, specifically those with Disruptive Mood Dysregulation Disorder (DMDD). “Irritability is one of the key reasons youth are referred for care and it has a profound public health impact. We know that early severe irritability in youth is associated with numerous problems into adulthood including Major Depressive Disorder, suicidality and socioeconomic problems.”

While over the past two years there has been an increased understanding of the issue, no standard treatment yet exists. A fundamental question, says Brotman has been how to leverage technology to work with children and youth impacted. “If you think about a clinical assessment, the clinician typically interviews the child and parent or they complete forms; there is an inherent flaw in that these require a retrospective report. These can be biased by recall, and often by emotions at the time they are being completed.”

The Challenge for A Square Group

A Square Group brings to the table a clinical knowledge (Sara) who is dual board physician in Psychiatry and Internal Medicine and technical knowledge (Mandeep) and through the combined expertise, bring a focused perspective. While much of the team’s prior work has involved adult mental health, its efforts with NIH have been focused on developing and integrating treatment for children and adolescents .

The challenge NIMH was facing was that the data collection they had been receiving was not objective and the Institute was looking to drive evidence-based research with an output of data that was real time and could be tuned accordingly. That is a challenge when you consider the population of interest was between (seven) 7 and 17 (seventeen) years old.

There was also an idea that if data could be collected in real time and in small increments in a variety of settings, there would be an opportunity to gain a better understanding of triggers and responses.

The Solution

The technology solution developed by A Square Group leveraged the use of mobile phones and built a mobile application, since many people in this age group have phones and actively use them on a daily basis. From the perspective of the users, they are simply playing a video game but, in the background, the application is collecting data and an AI and machine learning component is then modifying the game according to the parameters set for the individual user and the responses received from that user.

The game can be set for a variety of patient types, customized according to the capabilities of the individual. Game inputs and tactical responses received from the wearable device, are fed to an Analytics platform with NIMH research models helping the research team to measure and record  key behavioral markers.

The Clinical Aspect

From a clinical perspective, there is an understanding that certain physiological parameters in the body change based on how one is feeling emotionally. Through this technology, there is an opportunity to measure these parameters and monitor the gradual progress of the individual over time based on the changes in these parameters and thus know how individual is responding to the treatment.

The objective is to help the patient without the need to use medicines, to help them learn to manage their emotions and the use of technology, in turn, helps to self-control behavior and measures their success. Rather than a formal therapy session that is controlled by an adult, in a different setting than what child is comfortable in creating an awkward situation for the child, the game is something the child enjoys to play, with the added benefit of their home environment without the presence of a stranger (therapist).

Translating Concept into Reality

Brotman explains that one component for those suffering with DMDD is the impulse towards a physical motor response to frustration and a clinical understanding that those areas of the brain influencing such activity have different patterns for those with extreme irritability. The game has been designed to require a certain pattern of response, and to introduce mildly frustrating triggers that will force the user to surpress that impulse in order to succeed at the game. “We know that behavioral interventions for anxiety can be extremely effective and since the circuitry for fear and anger overlap, considering similar behavioral interventions for anger control is an avenue we are currently pursuing.”

What’s Next?

Research has been going on in a small sample and it will be opening to larger number of patients and we’re working on a next release of the application. Brotman says it was important that the technology be tested in a scientific way, first using children involved at NIH. “We want to be sure there is a connection between the triggers and then proposed treatment, that we are validating the results and that the intervention is meeting the target.”

She says that testing until now has involved the more extreme cases of the disorder but that, if the technology can be proven, it can be offered to those with less severity, those who may struggle to find appropriate treatment.

There is also an opportunity to collect data from the device to make it available to the clinicians so that they can see the patterns of behavior and then work with the patient and parent and, as appropriate, an education professional  to better support the child and drive real behavioral change.

About A Square Group (ASG)

A Square Group (ASG) is a leading provider of Healthcare, technology, and management consulting services to the Federal and state governments as well as the private sector. A Square Group is dedicated to better Healthcare outcomes for patients through compassionate care delivery enabled through technology. Part of ASG’s mission focus is to help people with behavioral health disorders overcome their challenges and help them gain the freedom to live functional and productive lives.

About Sara Singh

Sara Singh, M.D., FAPA is Founder and President of A Square Group (ASG), a recognized leader in clinical and Healthcare solutions. She is responsible for the overall health of the company and leads ASG management with an emphasis on identifying new strategic markets and leveraging relationships with customers and partners.

About Mandeep Singh

Mandeep Singh is COO with ASG. As a results driven, certified CIO (Chief Information Officer) from GSA (General Services Administration) CIO University, Mr. Singh is a PMP (Project Management Professional), CISM (Certified Information Security Manager), ITIL (Information Technology Infrastructure Library) – certified professional who has influenced with progressive solutions, and led large, national and multinational organizations toward a modern and more efficient business environment within an industry that has seen declining cost but still having the need for increased revenue.

About Dr. Melissa Brotman

Melissa A. Brotman, Ph.D., is the Assistant Clinical Investigator of the Neuroscience and Novel Therapeutics Unit (NNT) in the Emotion and Development Branch at the National Institute of Mental Health (NIMH) Intramural Research Program (IRP). Currently, her neurodevelopmental, translational research integrates basic and clinical approaches to the study of mood disorders in children and adolescents. Specifically, she uses affective neuroscience techniques to understand the brain-based mechanisms underlying severe irritability in youth and leverages pathophysiological knowledge to guide the development of novel targeted interventions.



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