JMIR Publications

ABSTRACT

Background:

Smart rings can unobtrusively capture physiological signals in everyday settings, but their feasibility for adolescents, particularly those with attention-deficit/hyperactivity disorder (ADHD), remains underexamined in real-world classrooms. Although ring-based sensing may offer a low-burden and relatively discreet approach to physiological monitoring in schools, little is known about adoption, feasibility and contextual heart rate (HR) patterns during everyday school routines.

Objective:

This study aimed to examine (1) the feasibility of smart ring use during the school day among adolescents with ADHD and (2) variation in ring-derived HR across classroom activities and time of day

Methods:

We conducted a 5-day in-the-wild feasibility study in a specialized school with 12 adolescents aged 11 to 14 years with ADHD. Participants wore a commercial smart ring during school hours (8:30 AM to 3:00 PM) to passively capture HR. HR samples were cleaned and aligned with classroom schedules to support analyses by activity and 30-minute time blocks. Feasibility was assessed using adherence and data coverage metrics and contextualized through semi-structured student interviews about comfort, discretion, and fit within daily routines. HR differences across activities and time blocks were examined using nonparametric repeated-measures analyses, and standardized effect sizes were reported.

Results:

: Smart rings were feasible for use during everyday classroom routines, with stronger wear and data coverage during structured school activities and lower coverage during transitions, high-movement periods, and later parts of the day. HR patterns varied across classroom contexts and time of day, with higher values generally observed during socially interactive or reinforcement-oriented activities than during core academic instruction. Overall activity- and time-related effects were observed, although many corrected pairwise comparisons did not remain statistically significant. Interview findings suggested that students generally appreciated the ring’s discretion, novelty, and ease of wear, while also reporting occasional issues related to fit, handwashing, and physical activity.

Conclusions:

Smart rings show promise as a feasible form factor for school-based physiological sensing among adolescents with ADHD. Ring-derived HR appeared sensitive to classroom context and daily rhythms, supporting the potential of smart rings for low-burden physiological monitoring in educational settings. These findings can inform the design of future child-centered, privacy-respecting wearable systems for use in schools.