Project overview

Digital health tools, including XR-based interventions, are increasingly recognised across UK healthcare policy as essential to addressing growing demands on mental health services and supporting underserved populations [1]. Equitable access remains uneven, with vulnerable young populations facing service gaps and limited routes from research evidence into digital health tools.

Bringing XR-based interventions through software-as-a-medical-device regulatory approval into NHS and community-sector deployment represents a substantial opportunity for the UK's commercial XR/digital health sectors. Translating this opportunity into ethically sound adoption is constrained by underdeveloped understanding of trust, privacy, safety, and security (TPSS):the relational and technical dimensions of the project's research focus.

Objectives and deliverables

The challenge

Neurotech is developing an emerging digital/XR support tool for ADHD-related executive function and emotional regulation difficulties, with current focus on adults. Adapting this tool for neurodivergent young people requires a credible and ethically grounded research foundation: evidence on acceptability and outcomes for the population, a defensible ethics pathway, and the right community and academic partnerships in place for a future effectiveness study.

Three interconnected gaps

The project sits within the team's TIPS research on Trust, Identity, Privacy, Security in emerging technology adoption  [5], which establishes that trust forms not as a dyadic user-platform relationship but as a property of the surrounding social and technical ecosystem — "security breaches, privacy violations, and trust issues... aren't merely technical problems — they're properties of the entire ecosystem." For vulnerable young populations engaging with XR digital health, three operative dimensions need addressing.

First, trust forms across a relational architecture involving the young person, family, community-sector support providers, and clinical contexts, with thresholds shaped by population-specific vulnerability [1, 3]. How trust forms in this context remains underdeveloped in the literature.

Second, safety for vulnerable young populations engaging with XR digital health tools operates in multiple dimensions: psychological and sensory safety in immersive environments for users with executive function and emotional regulation difficulties, safeguarding considerations in community-sector mediated engagement, and the developmental appropriateness of immersive interaction for younger neurodivergent users [2]. Safety considerations are stage-specific across the adoption pathway and require sustained research attention.

Third, privacy and security design for XR digital health tools serving vulnerable young populations is stage-specific and under-theorised. Device-level data minimisation, governance of camera-derived and behavioural data, differentiation of user, feedback, and movement data, and SaMD regulatory compliance require sustained research attention. As the team’s TIPS framework previously establishes, "trust is intrinsically tied to security measures" and emerges from robust privacy and security foundations  [5].

Therefore, this research aims to develop the empirical and methodological infrastructure for an equitable adoption pathway for XR-based digital health tools serving neurodivergent young people, building on the TIPS framework's relational understanding of trust and its emergence from privacy and security foundations.

To achieve this aim, the research objectives are:

(a) develop a framework for the relational architecture of trust formation in vulnerable young populations, using participatory and co-design approaches [4]; early acceptability and outcome evidence is gathered through structured engagement with neurodivergent young people and their families via research relationships the academic team has established with Home-Start Greenwich (HSG), a charity based in the London Borough of Greenwich.

(b) develop infrastructure for the adoption pathway across early-testing, regulatory, and pilot-deployment stages, including the safety considerations specific to vulnerable young populations.

(c) examine privacy and security design including SaMD regulatory considerations and NHS deployment requirements.

Methodology

A mixed-methods approach combining qualitative engagement with HSG-network families, SNA of the relational architecture of trust formation, and a small-scale methodological pilot using iMotions multimodal biosensor instrumentation. The iMotions pilot, undertaken at Greenwich's XR-AI Behavioural Lab, tests the feasibility of measuring psychological responses (facial expression, galvanic skin response, eye tracking) in XR engagement with vulnerable populations. Findings will be presented at the iMotions training and presentation event in Copenhagen in October.

Deliverables

• Research scoping report for Neurotech synthesising findings and recommendations for the adaptation pathway.

• Ethics infrastructure brief documenting research design and safeguarding architecture for future effectiveness work.

• Partnership architecture document mapping the Neurotech-Greenwich-HSG collaboration and follow-on engagement infrastructure.

• Methodological use-case presentation at the iMotions training and presentation event in Copenhagen (October 2026), demonstrating multimodal biosensor pilot work with vulnerable populations in XR research contexts.

• Dissemination workshop hosted at Greenwich's XR-AI Behavioural Lab.

• At least one peer-reviewed publication submitted to Q1 venues (Computers & Security, Journal of Medical Internet Research, Technological Forecasting and Social Change).

• Initial international conference presentations.

• NIHR HealthTech follow-on application work initiated.

References

1. Horvat, S., & Horvat, T. (2025). Artificial intelligence, neurodiversity, and trust: An exploratory overview. Scientia et Fides, 13(1), 215-232.

2. Manuguid, H. M. (2025). Adapting trust-based relational intervention for students with Autism Spectrum Disorder: A systematic qualitative review. International Journal of Studies in Inclusive Education, 2(2), 60-66.

3. Crawford, K. A., & Hamidi, F. (2026). "We Figure It Out Together": A Framework for Relational Communication in Disabled and Neurodivergent LGBTQIA+ Romantic Partnerships. In Proceedings of the 2026 CHI Conference on Human Factors in Computing Systems (pp. 1-24).

4. Rizvi, N. (2025). Data-Driven and Participatory Approaches toward Neuro-Inclusive AI. University of California, San Diego.

5. Vasudevan, S., Piazza, A., Rajendran, L., & Duraivel, S. (2025). Mapping the metaverse minefield: a TIPS framework for security-conscious business adoption. Computers & Security, 104710.