Social anxiety disorder (SAD) can have a significant negative impact on children's daily lives, as they often feel intense fear in social situations. Early intervention is crucial and can be highly effective in managing anxiety, but receiving therapy can be difficult due to stigma, costs, and limited access. To overcome these barriers, children need an engaging, accessible, and tangible therapy.

"allie" is a holistic and individually applicable therapeutic system designed for children aged 5 to 9 with social anxiety disorder. It features a customizable hero companion that helps children cope and improve their condition in both the short and long term. By providing stability and enhancing self-confidence during moments of anxiety, the modular system of patches helps to recall learned skills through positive reinforcement. Physicality and personalized, multi-sensorial interactions create an immersive experience and safe environment to provide tangible support. The system also includes individual analog games using the system's components to teach about the condition, triggers, coping mechanisms, relaxation exercises and social skills. At the same time, a digital platform ensures guidance and gives insights for caregivers and the therapist.

"allie" is an accessible and engaging solution to support the process at all stages of SAD therapy, making it a lasting and effective tool for treating children's mental health.

Research

Disorder. Social Anxiety Disorder (SAD) for children manifests as a persistent and intense fear of embarrassment in social situations, rejection, unfamiliar situations, and interactions with authority figures or unknown people. Consequences are often extreme self-consciousness and avoidance of social situations, which are essential for the children's mental and social development. Children with SAD often experience significant impairment in their daily lives, including difficulties with social relationships, academic performance, and emotional and physical well-being.

Prevalence. Taking the US as a representative example, NIMH and other institutions give more accurate figures. According to various studies, SAD affects approximately 2-9% of children. Because prevalence varies by age, gender, culture, therapeutic access and approach, numbers range widely and underreporting may be much higher in many countries. Several studies confirm that 3% of all 4-7-year-olds and 7% of all 7-9-year-olds experience symptoms of SAD. In addition, diagnosed minors are at high risk of developing other mental health conditions (up to 50% of all affected), including depression, other anxiety disorders, and attention-deficit/hyperactivity disorder (ADHD).

Trend. Children's' mental health, particularly SAD, has received increased attention, especially in the current context of COVID-19. Several studies concluded that the pandemic was associated with an increase in symptoms of anxiety and depression among minors (European Child & Adolescent Psychiatry. (2022).). However, even before the pandemic, long-term research showed a steady rise in SAD in children (Costello, E. J. (2003).).

Therapy. Studies indicate that early interventions are crucial to improve the ability of children to handle their anxiety and prevent the condition from worsening with age (Rapee, R. M. (2005).; NIMH. (2023).). Cognitive behavioral therapy (CBT) was particularly effective in reducing symptoms in treated children, with up to 75% experiencing significant improvements (Lyneham et al. (2017).; Hudson et al. (2020).). Nonetheless, studies show that only about 40% of diagnosed children receive therapy (Farmer et al. (2019).; Zhou et al. (2019).).

Conclusion. These high improvement rates show that children can clearly benefit from therapy. However, the access to therapy is often difficult due to cost, stigma, or logistical barriers and is disconnected from the child's everyday life. Children need an engaging, accessible, and tangible therapy intervention that can help overcome these barriers and support them in their daily lives at home, in school or on the go.

Proposal

"allie" is a therapeutic system designed to provide mental support to children between 5 and 9 years suffering from a social anxiety disorder. The game like platform is based on a companion that helps children cope with their symptoms, improve their condition and prevent other accompanying disorders as soon as the first symptoms are detectable. The product is based on two existing therapeutic games, "Hero Companion" and "Safe Space." Together with medical professionals it has been redesigned and expanded into a tangible, physical experience with a customizable and lasting component. It includes tactile, light, and sound feedback to create a holistic therapeutic experience that is engaging, accessible, effective, and individually evolving with the child. "allie" consists of a therapeutically co-created and self-named hero companion. The solution is based on a modular system with personalized, exchangeable, and responsive textile patches. These patches represent the strengths the child has acquired or wants to achieve in therapy to manage their condition. In moments of triggered anxiety, the hero companion provides stability, helps to recall learned skills, enhances self-confidence, and creates a safe environment for the child. "allie" calms, eases the expression of feelings, and encourages communication through positive reinforcement. The companion can be placed on different bases at the therapist's office and at home. Both bases provide situation-based interactions that offer structure and guidance while bringing fun and adventure. In addition to providing acute mental support, "allie" can be used to play therapeutic games. These games are individual and progress-adapted to help children learn about their condition, triggers, coping mechanisms, relaxation exercises, and social skills. This variety and adaptability make the product a long-lasting tool for managing and understanding mental health. "allie" redesigns recurring therapy sessions to make them more exciting and enjoyable for children. The physical product comes together with a digital readout option. This option provides the therapist and caregivers with a holistic view of the child's emotional progress. "allie" can be incorporated into various therapeutical approaches, making it a valuable companion in managing mental health.

Process

The user research methodology involved several steps to identify the needs, behaviors, and problems of the target audience. These research methods included desk research, expert interviews, and prototype testing. Revealed key findings shaped the user-oriented design and development process and ultimately the final product.

Methodology. Desk research was conducted to understand the current literature on mental health conditions in children, particularly social anxiety disorder. The research helped to understand the condition and identify key trends and developments in the field. Several research interviews were held with a clinical therapist who works with children. The expert provided valuable insights into the challenges faced by children with social anxiety, as well as common therapeutic approaches and potential solutions. Interviews with a sound and interaction designer helped to highlight the importance and definition of multisensory interaction.

Key findings. Social anxiety has risen after COVID-19. Children with social anxiety lack an effective coping mechanisms. Therapy is valuable but challenging. Children prefer tangible therapeutic products. Games engage children. Sound and tactile feedback enhance the experience.

Ideation to implementation. Based on the research findings and throughout the concept ideation, the goal became to redesign and develop the two imaginary therapeutic exercises "Super Hero" and "Safe Space" into a concrete physical therapeutic tool. These games should help children manage their social anxiety by allowing them to imagine a hero who possesses all the qualities they would want and by focusing on a personal safe space in tense situations. From originally three designs, one concept emerged within this development phase.

Prototyping. Several prototypes were tested with two children in the respective age group. These tests focused on the physical attributes of the product, such as shape, size and weight, as well as the interaction system, which included sounds and pressing patches. Based on the feedback from all stakeholders in various scenarios, the design was continuously and iteratively improved. Physical features were optimized to provide a better user experience and auditory and tactile feedback adjusted to create a more engaging and immersive experience.

Digital component. A digital component has been added to the product, allowing caregivers and therapists to accompany the child at home and actively participate in the games. The digital component was designed to harmonize with the physical product to provide a cohesive experience.

Conclusion. In conclusion, "allie" is an example of how user-centered, but also holistic and interdisciplinary design can contribute to creating relevant products. The comprehensive design and development process involved multiple stages to ensure that the final product is effective and meets the needs and requirements of the target audience. As a result, the final product has the potential to significantly impact the growing prevalence of mental health issues in children.