Julia Carbone
Holland Bloorview Kids Rehabilitation Hospital

Dr. Marlee Vandewouw
Holland Bloorview Kids Rehabilitation Hospital

Harshit Bokadia
Holland Bloorview Kids Rehabilitation Hospital

Tithi Paul
Holland Bloorview Kids Rehabilitation Hospital

Aleena Walji
Holland Bloorview Kids Rehabilitation Hospital

Kamran Niroomand
Holland Bloorview Kids Rehabilitation Hospital

Dr. Azadeh Kushki
Holland Bloorview Kids Rehabilitation Hospital 

Heightened emotion is sometimes difficult to recognize before escalation. These emotions may manifest into challenging behaviours such as aggression, self-injury, and outburst. By using markers of physiological arousal as early signs of escalation behaviors, the onset of challenging behaviors can be detected and de-escalation strategies can be initiated. holly™ is a Bloorview Research Institute patented algorithm that uses heart rate measurements to provide a visual display of emotional arousal level, a technology developed to detect anxiety and empower self-awareness and management for better outcomes—especially for those with Austim Spectrum Disorder. The BRI team evaluated holly™ in naturalistic settings with children and youth to learn how we could enhance the technology’s usability in pediatric therapeutic and educational settings. The results of this trial indicated high satisfaction and acceptability, and identified some usability challenges as well.