The Interactive Child Distress Screener: Development and Preliminary Feasibility Testing

Background: Early identification of child emotional and behavioral concerns is essential for the prevention of mental health problems; however, few suitable child-reported screening measures are available. Digital tools offer an exciting opportunity for obtaining clinical information from the child's perspective.

Objective: The aim of this study was to describe the initial development and pilot testing of the Interactive Child Distress Screener (ICDS). The ICDS is a Web-based screening instrument for the early identification of emotional and behavioral problems in children aged between 5 and 12 years.

Methods: This paper utilized a mixed-methods approach to (1) develop and refine item content using an expert review process (study 1) and (2) develop and refine prototype animations and an app interface using codesign with child users (study 2). Study 1 involved an iterative process that comprised the following four steps: (1) the initial development of target constructs, (2) preliminary content validation (face validity, item importance, and suitability for animation) from an expert panel of researchers and psychologists (N=9), (3) item refinement, and (4) a follow-up validation with the same expert panel. Study 2 also comprised four steps, which are as follows: (1) the development of prototype animations, (2) the development of the app interface and a response format, (3) child interviews to determine feasibility and obtain feedback, and (4) refinement of animations and interface. Cognitive interviews were conducted with 18 children aged between 4 and 12 years who tested 3 prototype animated items. Children were asked to describe the target behavior, how well the animations captured the intended behavior, and provide suggestions for improvement. Their ability to understand the wording of instructions was also assessed, as well as the general acceptability of character and sound design.

Results: In study 1, a revised list of 15 constructs was generated from the first and second round of expert feedback. These were rated highly in terms of importance (mean 6.32, SD 0.42) and perceived compatibility of items (mean 6.41, SD 0.45) on a 7-point scale. In study 2, overall feedback regarding the character design and sounds was positive. Children's ability to understand intended behaviors varied according to target items, and feedback highlighted key objectives for improvements such as adding contextual cues or improving character detail. These design changes were incorporated through an iterative process, with examples presented.

Conclusions: The ICDS has potential to obtain clinical information from the child's perspective that may otherwise be overlooked. If effective, the ICDS will provide a quick, engaging, and easy-to-use screener that can be utilized in routine care settings. This project highlights the importance of involving an expert review and user codesign in the development of digital assessment tools for children.