Digital Homework Support Program for Children and AdolescentsWith Attention-Deficit/Hyperactivity Disorder: Protocol for aRandomized Controlled Trial

Background: Attention-deficit/hyperactivity disorder (ADHD) affects 4% to 5% of the general population. Homework sessionsare frequent conflictual moments characterized by increased anxiety in children and stress in their parents, contributing to a lowerfamily quality of life. Children with ADHD experience more severe homework problems than typically developing peers. Pooracademic performance in individuals with ADHD is partly attributed to challenging homework. Psychoeducational and school-basedapproaches are time-consuming and not fully accessible to professionals. Digital tools, such as smartphone and tablet apps, mightoffer an interesting alternative. We present our digital homework support program for children and adolescents, known as"Programme d'Aide Num & eacute;rique aux Devoirs pour Enfant avec TDA-H" (PANDAH), along with the study protocol of our ongoingrandomized controlled trial. Objective: This study aims to test PANDAH's efficacy in improving homework performance and family quality of life. Methods: Individuals aged 9-16 years with an ADHD diagnosis and no comorbid psychiatric disorders are included. This is amulticenter study involving 9 reference centers for ADHD in France. The study comprises (1) a 3-month period with a randomizedcontrolled trial design, where participants are divided into 2 parallel groups (group 1: care as usual or waiting list; group 2:PANDAH app), followed by (2) an extension period of 3 months (months 3-6), during which all participants will have access tothe app. This second phase serves as a crucial incentive for patients initially randomly assigned to group 1. Assessments will beconducted at baseline, month 3, and month 6 for each patient by trained psychologists. The primary end point will be the globalHomework Performance Questionnaire (HPQ), Parent version score at 6 months. The main analysis will adhere to the "intent-to-treatprinciple" (all patient data will be analyzed according to their initial group determined by randomization). We expect (1) HPQscore improvement in individuals using the app during the first 3-month period compared to individuals not using the app; (2)greater HPQ score improvement for individuals using the app for 6 months compared to those using the app for 3 months only;and (3) adherence to the PANDAH program, measured with in-app metrics. Results: Recruitment began in January 2024, and the trial is ongoing. Conclusions: This study contributes to the digital transformation of health care. The use of smartphone apps in self-care andself-management is a societal phenomenon, and its implementation in the field of psychiatry is of particular interest. The app might serve as both valuable support for patients and an opportunity for parents to distance themselves from conflict-ladenhomework sessions. Since the market for smartphone apps in the health care and well-being sector is primarily industry driven,it is crucial to have an academic conception and evaluation of such digital tools.