blanchflower, tj

system model development

The system model I am developing is divided in two—expert, and young adult ADHD patients. The expert area is inaccessible to patients, but the patient area is fully accessible to the expert. This allows the expert to collect information, such as behavioral patterns, annotations, schedules, and goals created by the patient and regulate the system behaviors, functions, and aesthetics. Initially, the expert has complete control over the system, and as a reward, a patient may be afforded control. The patient area is represented in two moments—Phase 01 and Phase 02, which are not necessarily distinct, but are necessary to illustrate the system shift from developing Awareness to Awareness and Training. In phase 01, the patient generates seemingly arbitrary data toward the development of patterns they believe are problematic. These patterns are developed through the Mobile Interactive Media Experience (MIME) and visualized for reflection in the Less Mobile Interactive Media Experience (L MIME). When enough data has been generated, visualized, annotated, and synthesized by the expert and patient, the two of them, in partnership, begin developing and implementing strategies around an agent, or impaired executive function, commencing phase 02. In phase 02, These strategies are stored in a library, accessible to the patient at all times unless the expert decides otherwise and shuts off access to them for one reason or another.

Initially, the system is adaptable—the expert can integrate and remove strategies, and regulate system behaviors, functions, and aesthetics. As a patient progresses toward their goals, they gain more control, allowing them to adapt the system as they see fit, paralleling their improvement. The system is also adaptive, meaning it acts as a third, artificial user within the experience. The system, in terms of a complex adaptive system, is alive, co-evolving with the user, changing on the fly. As a user inputs data over time, the system learns, gaining intelligence. This may be evident in the interface. For example, if specific agents have been implemented, but do not correspond to new patient data, the interface may change to accommodate the patient. This may be the removal and/or integration of strategies or in the form of new visual and/or auditory notifications, such as alarms, queries, depth of field, color change, scale, composition, etc.

expert interviews

The last few days I have been interviewing experts in the field of ADHD. The goal of my interviews was to narrow down Brown’s impaired executive functions, or what I will be referring to as ADHD agents, and gained a better understanding of technology’s role in their daily workload and treatment regimes.

The first interview was with a Counselor in the student counseling center here at NC State. To actually get an interview I had to schedule a counseling session under false pretenses because they would not respond to my emails, phone calls, and the messages I left as a walk-in. Once in front of the counselor, I was open about why I was there, but the counselor, under protocol, maintained the structure of an initial meeting, or intake interview, significantly shorting my interview time. The good news is the counselor agreed to have a second meeting to explicitly discuss my research. After moving through the red-tape, and with only a couple of minutes left in the session, the counselor came around, touching lightly on technology’s role in his daily work, and the main reason ADHD students come to counseling. Technology, in this particular counseling space, exists only between counselors and administrative staff, i.e. scheduling of patients and emailing. The counselor explained that there is no direct digital line from counselors to patients because they would be inundated with correspondence. I hope for elaboration on this response in our next meeting, because there is most likely greater reasoning for the communication break. When asked what problems ADHD students come to counseling for the most, the counselor, responding quickly, said MOTIVATION. Motivation specifically in relation to deadlines. Alluding to procrastination and organization issues as symptomatic of motivation, the counselor discussed the initial strategy—to get a student to see the difference between emotional and behavioral motivation—stating that the majority of motivation problems are favor emotional and not behavioral response. An interesting approach, the counselor asked students to observe those students who they believe to be motivated,VISUALIZING themselves as the motivated student. Motivation was furthered described as a growing plant in need of specific conditions, i.e. water, sunlight, etc. Once the conditions are met, the plant begins to bloom. In the counselor’s metaphor, conditions are behaviors and blooming is emotion. Once the conditions or behaviors are met, the plant or person can bloom or have feelings. Again, I hope to have this notion explicated in our next meeting.

The second interview took place in a casual setting, a coffee shop, with a certified ADHD Coach. A less formal setting, and no protocol to abide by, allowed this interview to take on the format of a conversation. In our discussion we touched on technology’s, the coach’s, and the patient’s roles, highlighting problems and strategies along the way.

Technology currently plays a minimal role in coaching treatment . Although patients do have email contact with their coaches, the coach acknowledged problems of inundation. There are various notifying, disruptive, unrewarding applications available for mobile and desktop use, but they have not been aggregated into a space designed for the ADHD brain. Reward is something the coach identified as necessary for progress in any ADHD treatment program, and current technologies, whether mobile or not, are not providing the empathetic partnership patients need. Instead, these systems are identified as the apathetic machines they are, and subsequently are easily ignored. The coach favored mobile technology, but did warn of the ease of becoming engrossed in the waterfall of information they make accessible. The coach’s role was defined as an individual in a developing partnership. Essential to their role, a coach should only guide a patient, have no agenda, and remain unbiased. The coach should be viewed as a mirror, providing the patient with feedback, and enabling the discovery of problems on their own. As the coach opens a patient’s perspective of their own world, a patient must learn to comprise with themselves, working toward the self-coaching model. A constant and critical concern of coaches is making sure they remain professional, and avoid acting parental when guiding patients. The patient’s role in the coaching model is to dedicate themselves to action, committing to the regime they develop and decide upon. Along the way they should keep track of their successes and failures, referencing them continually as they develop, with the expert and eventually without, improved behaviors and more focused strategies.

The major problems faced by ADHD patients are societies difference in acknowledging the disorder, patients keeping with the pace of society, the complexity of systems, and understanding long-term impacts of behavior. ADHD is not the worst mental disorder to have, but being that is low on the totem pole, societal acceptance is less than par. This alone keeps many patients from owning their ADHD, and instead, they keep it bottled up and continually struggle with daily functioning. According to the coach, the requirements in many job applications to not play to the strengths of the ADHD brain, maintaining patients, visible, struggles on the job, and sustaining society’s perspective on ADHD. Complexity was alluded to as a problem for the ADHD brain when memory was discussed in terms of comprehension, communication, and interaction. Working memory is problematic for patients and oft times this problem feeds a patient’s perception of themselves when in social settings. Not being able to hold definitions of words in their memory long enough to understand the word in the context of a sentence, book, or lecture, keeping up with the of dialogue in conversations, and being overwhelmed with too much information when interacting with current technologies all feed insufficient feelings and thoughts in an ADHD brain. ADHD patients do not always think before the act, resulting in long-term ramifications of actions and behaviors they may not even recall. Poor dietary and spending patterns often exist that a patient may never consider until it is too late, resulting in long-term health and financial issues.

Not far from the above problems are the parsing of information, tasks, and time into accessible parts, a lack of accountability, comorbidity, leaps in thought. Patients have trouble seeing either the forest for the trees or trees for the forest, becoming overwhelmed and failing to complete their tasks. In terms of motivation, accountability is problematic. Patients do not motivate when there is not another person to hold them accountable. In coaching, this is resolved by developing a partnership with the coach. A significant amount of ADHD patients suffer from comorbidity, meaning they exhibit symptoms of other, often more intense, disorders, such as depression. Seasonal affective disorder (SAD), or winter depression is seen in cases of patients who are not medicated. SAD leads to feelings of aloneness and isolation, and can be exacerbated and/or alleviated by technology. Many times, according to the coach, patients try to treat their ADHD when they should be seeking the help of a psychologist. Frustration is paramount in patients, oft times because they do not think anyone understands them, leading them to question their intelligence. The coach suggests this is because patients, when communicating, have leaps in thought, leaving out details they believe are evident in their words but are not.

Coaches use various strategies to collect patient information, such as questionnaires, self-assessment tests, information interviews, and various types of journals. The coach discussed strategies for narrowing issues and facilitating tasks by working toward understanding the parts to the whole. For staying on schedule, on task, and organized the coach suggested utilizing analog and digital notifications, such as alarms, post-its, and digital calendar reminders. In addition to notifications, the coach talked about relying on a system that the patient cannot control, but reiterated that the system should not exhibit characteristics of parental control, or the patient would not fully engage. For long-term projects, it was recommended that patients should develop a system to simplify tasks, breaking time and effort into parts. Also, a strategic system must keep track of successes and failures, allowing patients to quickly contextualize their behaviors. For the impulsive types, the strategy pertained to effort—the more effort it takes to go through with something, the more time they have to reflect on their actions, enabling the understanding of cause and effect in behavior. A strategy the coach spoke highly of was accountability, specifically in the form of person-to-person. It was noted that ADHD patients tend to fail if they are not held accountable by another person, or in a public setting. In other words, fear of failure can be seen as a strategy. Authentic feedback is critical to patients, particularly in partnership, and when being held accountable. In terms of memory, strategies should be implemented that negate disenchantment of ideas, projects, and tasks. Meaning, even though a patient understands and can visualize the idea, project, or task, the strategy must keep the patient moving forward to finish what they are doing. This is where the strategy of reward comes in. The ultimate reward for an ADHD patient is success. Strategies of reward are used to sustain motivation. In some systems, the reward is more control over the system. In others, reward is the completion of work. At times, for an ADHD patient, credit for doing the right thing is enough reward. The coach harped on immediate gratification as well. Suggesting that the ADHD brain moves too quickly and is too scattered to wait for delayed gratification. So for the reward to be success, there must be immediate gratification along the way to completion.

After synthesizing the interviews, both interviewees discussed motivation, whether in terms of starting or finishing an idea, project, or task as the most frequent problem for patients. In Brown’s model, motivation, in various forms, is inherent throughout, which does not necessarily help me narrow down agents. Also, the interviews reaffirmed the interconnectedness of Brown’s agents, making it difficult to select one or two of them. I believe motivation is more explicit in Brown’s (01) ACTIVATION, (02) FOCUS, (03) EFFORT, (06) ACTION agents, and I will begin my design investigations from here with the hopes of narrowing my focus through the making process.

diffusion of innovation theory: everett rogers

In Everett Rogers’ book, Diffusion of Innovations, he discusses categories of adopters in social systems and the innovation-decision process. In five (5) stages: (1) KNOWLEDGE, (2) PERSUASION, (3) DECISION, (4) IMPLEMENTATION, and (5) CONFIRMATION, Rogers’ temporal innovation-decision model shows how an individual moves from finding out about an innovation, to forming an opinion about an innovation, to adopting or rejecting an innovation, to deploying an innovation, and, for some, affirming their decision. In this model, everyone enters the process with their Previous practice, Felt needs / problems, Innovativeness, and Social system norms. The factors contribute to how an individual identifies with innovations, and is identified in the categories of adopters: Innovators, Early Adopters, Early Majority, Late Majority, and Laggards.

In the diagrams above, I have extended Rogers models to provide an in-depth understanding of the innovative-decision process phases, and types of adopters.