Caregiver Needs and Technology Acceptability for Behavioral-Crisis Support in Children With Neurodevelopmental or Behavioral Conditions
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Background
Behavioral crises are common and distressing in children with neurodevelopmental or behavioral conditions, and many escalate to emergency service use. Access to behavioral therapy is often constrained. Smartphone applications, in-home systems, and wearable sensors that could support caregivers during crises at home are in active development, but few studies have asked caregivers what they would accept or want from such tools.
Methods
We conducted a single-center cross-sectional online survey (REDCap) of caregivers of children aged 5–17 years with neurodevelopmental or behavioral conditions, recruited as a convenience sample through flyers, email invitations, and in-person invitations during clinic visits from the neurobehavioral continuum of care at Cincinnati Children’s Hospital Medical Center. The response rate is undetermined due to the open-ended recruitment process. Prior behavioral-crisis experience was not an eligibility requirement. The 24-item instrument covered crisis burden, service utilization, caregiver confidence and training, therapy access and barriers, and technology preferences. Analyses were estimation-first (proportions with Wilson 95% confidence intervals [CIs]; medians with interquartile ranges [IQRs]); three pre-specified bivariate analyses used ordinal methods (Kendall’s tau-b and Jonckheere–Terpstra for ordinal pairs; Friedman for repeated ratings of five support functions). Recruitment closed on July 22, 2026 with 84 respondents (one additional study-team test entry was excluded), exceeding the feasibility-based enrollment target of 75; this full-sample analysis supersedes the interim analysis of the first 55 respondents posted as version 1 of this preprint, and all findings remain hypothesis-generating.
Results
Seventy-eight of 84 responding caregivers (93%; 95% CI 85–97%) reported that their child had ever experienced a behavioral crisis; 43% (95% CI 33–54%) reported crises at least weekly, and 27% (95% CI 19–38%) had ever used 911 or an emergency department for a crisis. Half of caregivers (52%) felt not at all or only a little confident managing crises, and fewer than half (48%; 95% CI 37–58%) had received informal or formal crisis-management training. The most frequent barrier to behavioral therapy was long waitlists (57%; 95% CI 46–67%). Stated openness to hypothetical technology-based crisis support was high, with 60% (95% CI 49–69%) very interested in a smartphone app or in-home support system, 81% (95% CI 71–88%) willing to have their child use a wearable sensor (1 of 84 declined), and 49% (95% CI 39–60%) willing to share video or audio with a future support tool (a further 43% answered “maybe”; 7% declined). The most-valued features were a personalized crisis plan (63%) and safe de-escalation scripts (46%); the most-cited concern was privacy and data security (38%).
Conclusions
In this self-selected, single-center sample, caregivers of children with neurodevelopmental or behavioral conditions reported substantial crisis burden, limited training, and constrained access to therapy, alongside high stated openness to technology-based crisis support; personalization and privacy were their leading priorities. These preliminary, hypothesis-generating findings can inform the design of caregiver-facing crisis-support technologies and larger representative studies.
