Developing an animation-based mental health measure for children and young people

Christodoulides, V. A., Malik, N., Labno, A., Ravaccia, G., Grace, E., Ferguson, A., Obi, O., Khaling, G., Alapati, H. H., Cortina, M. A., McDonnell-Bond, L., Edridge, C., & Edbrooke-Childs, J. (2026). Developing an animation-based mental health measure for children and young people. BMC Psychology, 14(1). https://doi.org/10.1186/s40359-026-04036-0

Publication date: 26 Feb 2026 Added to AutiHub: 5 Jul 2026 Type: Article Article language: English

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1 / 13 (7.7%)

Abstract

BACKGROUND: There is a need to increase the accessibility, inclusivity, and representation of mental health measures for young people, particularly for those who may struggle with traditional text-based formats due to literacy, language, or cognitive barriers. We aimed to develop an animation-based mental health measure for young people. METHODS: This study involved a community-based participatory action research (CBPAR) process, including 10 four-hour in-person workshops with young co-researchers and two rounds of 90-min focus groups with different stakeholders. We also conducted think-aloud interviews with 31 young people to explore comprehension, engagement, and usability of the measure. FINDINGS: The resulting tool, Animi, assesses seven symptoms of depression and anxiety through animated characters. Each scenario is depicted by an animated character (Animi) that indicates whether the symptom is present or absent. Users respond by selecting the animation that most closely matches their experience, using either a multiple-choice or Likert-scale format. In the think-aloud interviews, young people reported they generally understood the animations as intended and described the measure as engaging and easy to use. Feedback identified areas for improvement, like clarifying the instructions and further developing accessibility features (e.g., subtitles, customisation options). Participants also highlighted the tool’s potential relevance for younger children, neurodivergent youth, and those with additional needs. CONCLUSION: Animi represents a promising and innovative approach to mental health measurement that prioritises accessibility and co-production. Future research will revise the instrument based on feedback from the think-aloud interviews, evaluate its psychometric properties, and explore its use across clinical and educational settings. We hope this research can be used by others seeking to increase the accessibility, inclusivity, and representativeness of mental health measures for young people.

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Among occurrences linked to AutiHub author records: 0 / 3 (0.0%). Distinct cited authors identified as autistic: 0 / 196 (0.0%).
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3 / 3 (100.0%)
Among linked cited-author occurrences only. Across all cited-author occurrences: 3 / 201 (1.5%). Distinct linked cited authors not identified as autistic: 3 / 3 (100.0%).
  1. Virginia Braun , Victoria Clarke (2006). Using thematic analysis in psychology . Qualitative Research in Psychology, 3(2), 77-101. Informa UK Limited.
    Crossref OpenAlex
  2. Nurul Shafira Adi , Azizah Othman , Hue San Kuay , Qarem Mohamed Mustafa (2024). A study on the psychological functioning of children with specific learning difficulties and typically developing children . BMC Psychology, 12(1), 725-725. Springer Science and Business Media LLC.
    Crossref OpenAlex
  3. ROBERT GOODMAN (2001). Psychometric Properties of the Strengths and Difficulties Questionnaire . Journal of the American Academy of Child & Adolescent Psychiatry, 40(11), 1337-1345. Elsevier BV.
    Crossref OpenAlex
  4. Erica Afrihyiav , Ernest Chinonso Chianumba , Ashiata Yetunde Mustapha , Opeoluwa Oluwanifemi Akomolafe , Olufunke Omotayo , Adelaide Yeboah Forkuo (2025). Protecting Mental Health Rights in the Digital Space: Legal and Ethical Considerations . Journal of Frontiers in Multidisciplinary Research, 6(1), 205-210. Anfo Publication House.
    Crossref OpenAlex
  5. Caroline Bradbury-Jones , Julie Lounds Taylor (2015). Engaging with children as co-researchers: challenges,counter-challenges and solutions . International Journal of Social Research Methodology, 18(2), 161-173. Informa UK Limited.
    Crossref OpenAlex
  6. González Moreno, Andrés Santiago (2013). Diagnostic and Statistical Manual of Mental Disorders . American Psychiatric Association.
    Crossref OpenAlex
  7. K. Anders Ericsson , Herbert A. Simon (1980). Verbal reports as data. Psychological Review, 87(3), 215-251. American Psychological Association (APA).
    Crossref OpenAlex
  8. Naja Kirstine Andersen , Martin Køster Rimvall , Pia Jeppesen , Mette Bentz , Jens Richardt Møllegaard Jepsen , Lars Clemmensen et al. (2022). A psychometric investigation of the multiple-choice version of Animated Triangles Task to measure Theory of Mind in adolescence . PLOS ONE, 17(3), e0264319. Public Library of Science (PLoS).
    Crossref OpenAlex
  9. Fons J.R. Van De Vijver , Karen Phalet (2004). Assessment in Multicultural Groups: The Role of Acculturation . Applied Psychology, 53(2), 215-236. Wiley.
    Crossref OpenAlex
  10. Laura Lynne Armstrong , Emmalyne Watt , Elizabeth St. John , Stephanie Desson (2022). The interactive symptoms assessment: I.S.A. – development and validation using a knowledge translation-integrated model . Current Psychology, 41(5), 3038-3054. Springer Science and Business Media LLC.
    Crossref OpenAlex
  11. Katharina Manassis , Sandra Mendlowitz , Annie Dupuis , David Kreindler , Charles Lumsden , Suneeta Monga et al. (2013). Mood assessment via animated characters: An instrument to access and evaluate emotions in young children . Open Journal of Psychiatry, 03(01), 149-157. Scientific Research Publishing, Inc..
    Crossref OpenAlex
  12. Elizabeth Benninger , Shereen Naser , Sinéad M. O'Neill (2024). Youth as coresearchers: Social justice means youth as knowledge makers too . School Psychology International, 45(3), 195-214. SAGE Publications.
    Crossref OpenAlex
  13. Elizabeth Charters (2003). The Use of Think-aloud Methods in Qualitative Research An Introduction to Think-aloud Methods . Brock Education Journal, 12(2). Brock University Library.
    Crossref OpenAlex
  14. Carolyn Blair , Paul Best , Patricia Burns , Anne Campbell , Gavin Davidson , Joe Duffy et al. (2022). ‘Getting involved in research’: a co-created, co-delivered and co-analysed course for those with lived experience of health and social care services . Research Involvement and Engagement, 8(1), 20-20. Springer Science and Business Media LLC.
    Crossref OpenAlex
  15. Laura Lundy (2007). ‘Voice’ is not enough: conceptualising Article 12 of the United Nations Convention on the Rights of the Child . British Educational Research Journal, 33(6), 927-942. Wiley.
    Crossref OpenAlex
  16. Lidwine B. Mokkink , Caroline B. Terwee , Donald L. Patrick , Jordi Alonso , Paul W. Stratford , Dirk L. Knol et al. (2010). The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study . Quality of Life Research, 19(4), 539-549. Springer Science and Business Media LLC.
    Crossref OpenAlex
  17. Philip M. Podsakoff , Scott B. MacKenzie , Nathan P. Podsakoff (2012). Sources of Method Bias in Social Science Research and Recommendations on How to Control It . Annual Review of Psychology, 63(1), 539-569. Annual Reviews.
    Crossref OpenAlex
  18. (n.d.). Brown J, Isaacs D. The World Café: shaping our futures through conversations that matter. San Francisco: Berrett-Koehler; 2005.
    Type: Other
    Crossref
  19. Dejan Stevanovic , Peyman Jafari , Rajna Knez , Tomislav Franic , Olayinka Atilola , Nikolina Davidovic et al. (2017). Can we really use available scales for child and adolescent psychopathology across cultures? A systematic review of cross-cultural measurement invariance data . Transcultural Psychiatry, 54(1), 125-152. SAGE Publications.
    Crossref OpenAlex
  20. Christopher Burr , Jessica Morley (2020). Empowerment or Engagement? Digital Health Technologies for Mental Healthcare . In The 2019 Yearbook of the Digital Ethics Lab. Digital Ethics Lab Yearbook (pp. 67-88). Springer International Publishing.
    Crossref OpenAlex
  21. Emily J Ozer (2017). Youth-Led Participatory Action Research: Overview and Potential for Enhancing Adolescent Development . Child Development Perspectives, 11(3), 173-177. Oxford University Press (OUP).
    Crossref OpenAlex
  22. (n.d.). Centre for Social Justice and Community Action & National Coordinating Centre for Public Engagement. Community-based participatory research: a guide to ethical principles and practice. 2022. https://www.durham.ac.uk/media/durham-university/departments-/sociology/Ethical-guidance,-final-version,-Dec-2022.pdf .
    Type: Other
    Crossref
  23. K. Andrew R. Richards , Michael A. Hemphill (2018). A Practical Guide to Collaborative Qualitative Data Analysis . Journal of Teaching in Physical Education, 37(2), 225-231. Human Kinetics.
    Crossref OpenAlex
  24. Emma Claesdotter , Matti Cervin , Sofia Åkerlund , Maria Råstam , Magnus Lindvall (2018). The effects of ADHD on cognitive performance . Nordic Journal of Psychiatry, 72(3), 158-163. Informa UK Limited.
    Crossref OpenAlex
  25. Trishna Chauhan , Charlotte Croft , Dimitrios Spyridonidis (2023). Neutralized, enhanced, tokenistic: The influence of formal employment of service‐users on processes of co‐production . Public Administration, 101(3), 1014-1032. Wiley.
    Crossref OpenAlex
  26. Michelle Farr (2018). Power dynamics and collaborative mechanisms in co-production and co-design processes . Critical Social Policy, 38(4), 623-644. SAGE Publications.
    Crossref OpenAlex
  27. (n.d.). Christodoulides V, Labno A, Ravaccia G, Cortina M, Edridge C, Alapati H, Nisbet K, Jacob J, Edbrooke-Childs J. Using image-based measures to assess mental health and wellbeing: a systematic review. (in press).
    Type: Other
    Crossref
  28. Praveetha Patalay , Daniel Hayes , Miranda Wolpert (2018). Assessing the readability of the self-reported Strengths and Difficulties Questionnaire . BJPsych Open, 4(2), 55-57. Royal College of Psychiatrists.
    Crossref OpenAlex
  29. Tanvir C Turin , Maaz Shahid , Marcua Vaska (2019). Asset Mapping as a Tool for Identifying Resources in Community Health: A Methodological Overview . Journal of Biomedical Analytics, 2(1), 13-25. Biomedical Research Foundation.
    Crossref OpenAlex
  30. Astles, Cariad , Tsaplina, Marina (2020). The Routledge Companion to Health Humanities . Routledge.
    Crossref OpenAlex
  31. (n.d.). Crawford P, Kadetz P. Encyclopedia of Health Humanities. Switzerland: Springer Nature; 2025.
    Type: Other
    Crossref
  32. Alex Reinhart , Ciaran Evans , Amanda Luby , Josue Orellana , Mikaela Meyer , Jerzy Wieczorek et al. (2022). Think-Aloud Interviews: A Tool for Exploring Student Statistical Reasoning . Journal of Statistics and Data Science Education, 30(2), 100-113. Informa UK Limited.
    Crossref OpenAlex
  33. Rodrigo De La Fabián , Alvaro Jiménez‐Molina , Francisco Pizarro Obaid , Jimena Carrasco Madariaga (2025). Healthism and Digital Self‐Tracking: Reinventing the Individualistic Ethos in Chile . Sociology of Health & Illness, 47(8), e70097-e70097. Wiley.
    Crossref OpenAlex
  34. Ola Demkowicz , Emma Ashworth , Rosie Mansfield , Emily Stapley , Helena Miles , Daniel Hayes et al. (2020). Children and young people’s experiences of completing mental health and wellbeing measures for research: learning from two school-based pilot projects . Child and Adolescent Psychiatry and Mental Health, 14(1), 35-35. Springer Science and Business Media LLC.
    Crossref OpenAlex
  35. (n.d.). Futures CFI. Asset mapping webinar guide. 2019. https://independentfutures.com/wp-content/uploads/2019/04/AssetMappingWebinarGuide.pdf .
    Type: Other
    Crossref
  36. Jürgen Sauer , Jürgen Baumgartner , Naomi Frei , Andreas Sonderegger (2021). Pictorial Scales in Research and Practice . European Psychologist, 26(2), 112-130. Hogrefe Publishing Group.
    Crossref OpenAlex
  37. (n.d.). GL Assessment. Read all about it: Why reading is key to GCSE success. Retrieved 10. 10. 2022 from gl-assessment.co.uk/whyreading. n.d.
    Type: Other
    Crossref
  38. Lillian Polanco‐Roman , Regina Miranda (2022). A cycle of exclusion that impedes suicide research among racial and ethnic minority youth . Suicide and Life-Threatening Behavior, 52(1), 171-174. Wiley.
    Crossref OpenAlex
  39. Karolin R. Krause , Jenna Jacob , Péter Szatmári , Daniel Hayes (2022). Readability of Commonly Used Quality of Life Outcome Measures for Youth Self-Report . International Journal of Environmental Research and Public Health, 19(15), 9555. MDPI AG.
    Crossref OpenAlex
  40. Antonia Liguori , Karen Jiyun Sung , Lucy McLaughlin , Jennifer Stuttle (2023). What Digital Storytelling Means to the New Generation of Researchers . Social Sciences, 12(9), 485. MDPI AG.
    Crossref OpenAlex
  41. Briony Lipton , Helen Dickinson , Jodie Bailie , Belinda Hewitt , Anne Kavanagh , Zoe Aitken et al. (2025). Collaborating With Young People: Identifying the Barriers and Facilitators in Co‐Designed Research . Health Expectations, 28(3), e70308-e70308. Wiley.
    Crossref OpenAlex
  42. Tamara L. Morgan , Jensen Pletch , Emma Faught , Michelle S. Fortier , Mary Kate Gazendam , Kelly Howse et al. (2023). Developing and testing the usability, acceptability, and future implementation of the Whole Day Matters Tool and User Guide for primary care providers using think-aloud, near-live, and interview procedures . BMC Medical Informatics and Decision Making, 23(1), 57. Springer Science and Business Media LLC.
    Crossref OpenAlex
  43. Jessica Malloy , Stephanie R Partridge , Joya A Kemper , Andrea Braakhuis , Rajshri Roy (2023). Co-design of digital health interventions with young people: A scoping review . DIGITAL HEALTH, 9(9), 205520762312191. SAGE Publications.
    Crossref OpenAlex
  44. Rachel Milte , Digisie Jemere , Kiri Lay , Claire Hutchinson , Jolene Thomas , Joanne Murray et al. (2023). A scoping review of the use of visual tools and adapted easy-read approaches in Quality-of-Life instruments for adults . Quality of Life Research, 32(12), 3291-3308. Springer Science and Business Media LLC.
    Crossref OpenAlex
  45. Haleh Mehdipour , Marjorie Prokosch , Darien Williams , Abdul-Hai Thomas , Brian Seymour , Jacqueline Conley et al. (2025). The importance of belonging: reflections on a participatory action research project in Jacksonville, Florida . Disaster Prevention and Management: An International Journal, 34(1), 55-74. Emerald.
    Crossref OpenAlex
  46. Maria Michail (2024). Shining a spotlight on youth involvement in mental health research: Challenges and innovations . JCPP Advances, 4(4), e12285-e12285. Wiley.
    Crossref OpenAlex
  47. Philip M. Podsakoff , Nathan P. Podsakoff , Larry J. Williams , Chengquan Huang , Junhui Yang (2024). Common Method Bias: It's Bad, It's Complex, It's Widespread, and It's Not Easy to Fix . Annual Review of Organizational Psychology and Organizational Behavior, 11(1), 17-61. Annual Reviews.
    Crossref OpenAlex
  48. Anett Schumacher , Susan C. Campisi , Anisa F. Khalfan , Kaitlyn Merriman , Tricia S. Williams , Daphne J. Korczak (2024). Cognitive functioning in children and adolescents with depression: A systematic review and meta-analysis . European Neuropsychopharmacology, 79, 49-58. Elsevier BV.
    Crossref OpenAlex
  49. Lisa M. Vaughn (2025). Group Level Assessment Methodology as a Liberating Structure Within Qualitative and Participatory Research . Qualitative Health Research, 35(8), 827-836. SAGE Publications.
    Crossref OpenAlex
  50. (n.d.). Newlove-Delgado T, Marcheselli F, Williams T, Mandalia D, Dennes M, McManus S, Savic M, Treloar W, Croft K, Ford T. Mental health of children and young people in England, 2023. London: NHS England; 2023.
    Type: Other
    Crossref
  51. Carmel Ward , Laura Lundy (2024). Space, Voice, Audience, and Influence: The Lundy Model and Early Childhood . In International Perspectives on Early Childhood Education and Development (pp. 17-28). Springer International Publishing.
    Crossref OpenAlex
  52. Ishrat Shahnaz , Kelly Rose‐Clarke , Daniel Michelson , Petra C. Gronholm (2025). Codesign of Mental Health Interventions With Young People From Racially Minoritised Populations: A Systematic Review of Methods and Outcomes . Health Expectations, 28(2), e70204. Wiley.
    Crossref OpenAlex