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Evaluation of a Telehealth ABA Program for Caregivers of Children with ASD

Stephanie Gerow https://orcid.org/0000-0001-9578-6189 stephanie.gerow@unlv.edu, Marie Kirkpatrick, […], Kristina McGinnis, Tracey N. Sulak, Tonya N. Davis https://orcid.org/0000-0002-9349-0736, and Stephanie Fritz+3View all authors and affiliations

Volume 47, Issue 2

https://doi.org/10.1177/01454455221130001

Abstract

Children with autism spectrum disorder (ASD) often experience skill deficits that can negatively affect long-term outcomes. Interventions based on applied behavior analysis (ABA) yield improvements in targeted skills. However, families often have difficulty accessing ABA services. The purpose of this study was to evaluate the efficacy of a caregiver coaching program delivered via telehealth. Thirty children with ASD and their caregivers (e.g., parents, grandparents) participated in all phases of the study. The program consisted of therapists providing coaching in English or Spanish to caregivers of children with ASD via synchronous video call telehealth visits, typically provided one to two times per week. Caregivers received coaching in interventions (e.g., functional communication training, discrete trial teaching, total task chaining, and naturalistic teaching) to address individualized goals. We collected data on caregiver treatment fidelity and child outcomes (i.e., Vineland-3, observation, and analysis of time series data). Caregivers implemented intervention procedures with 95% accuracy on average. The single-case effect sizes calculated based on the time series baseline and intervention data yielded medium, large, or very large improvements for 85% of goals addressed. Results indicated that the children improved on appropriate engagement (measured via observation), but there was no statistically significant improvement for the remaining pre-post measures. These results, along with the results of previous studies, provide preliminary support for the use of telehealth to provide ABA services. However, there is a need for additional research evaluating the efficacy of these types of programs.

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References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Author. https://doi.org/10.1176/appi.books.9780890425596

American Telemedicine Association. (2020). Telehealth basics. https://www.americantelemed.org/resource/why-telemedicine/

Ballaban-Gil K., Rapin I., Tuchman R., Shinnar S. (1996). Longitudinal examination of the behavioral, language, and social changes in a population of adolescents and young adults with autistic disorder. Pediatric Neurology, 15(3), 217–223. https://doi.org/10.1016/s0887-8994(96)00219-6

Bearss K., Burrell T. L., Challa S. A., Postorino V., Gillespie S. E., Crooks C., Scahill L. (2018). Feasibility of parent training via telehealth for children with autism spectrum disorder and disruptive behavior: A demonstration pilot. Journal of Autism and Developmental Disorders, 48(4), 1020–1030. https://doi.org/10.1007/s10803-017-3363-2

Behavior Analyst Certification Board. (2020). Ethics code for behavior analysts. https://bacb.com/wp-content/ethics-code-for-behavior-analysts/

Boisvert M., Lang R., Andrianopoulos M., Boscardin M. L. (2010). Telepractice in the assessment and treatment of individuals with autism spectrum disorders: A systematic review. Developmental Neurorehabilitation, 13(6), 423–432. https://doi.org/10.3109/17518423.2010.499889

Boutain A. R., Sheldon J. B., Sherman J. A. (2020). Evaluation of a telehealth parent training program in teaching self-care skills to children with autism. Journal of Applied Behavior Analysis, 53(3), 1259–1275. https://doi.org/10.1002/jaba.743

Bradshaw J., Koegel L. K., Koegel R. L. (2017). Improving functional language and social motivation with a parent-mediated intervention for toddlers with autism spectrum disorder. Journal of Autism and Developmental Disorders, 47(8), 2443–2458. https://doi.org/10.1007/s10803-017-3155-8

Brown K. A., Wacker D. P., Derby K. M., Peck S. M., Richman D. M., Sasso G. M., Knutson C. L., Harding J. W. (2000). Evaluating the effects of functional communication training in the presence and absence of establishing operations. Journal of Applied Behavior Analysis, 33(1), 53–71. https://doi.org/10.1901/jaba.2000.33-53

Centers for Disease Control and Prevention. (2021). Autism spectrum disorder: Signs and symptoms. https://www.cdc.gov/ncbddd/autism/signs.html

Cohen H., Amerine-Dickens M., Smith T. (2006). Early intensive behavioral treatment: Replication of the UCLA model in a community setting. Journal of Developmental and Behavioral Pediatrics, 27(2), S145–S155. https://doi.org/10.1097/00004703-200604002-00013

Cooper J. O., Heron T. E., Heward W. L. (2020). Applied behavior analysis (3rd ed.). Pearson.

Craig E. A., Dounavi K., Ferguson J. (2021). Telehealth to train interventionists teaching functional living skills to children with autism spectrum disorder. Journal of Applied Behavior Analysis, 54(2), 511–529. https://doi.org/10.1002/jaba.834

Davis T. N., Gerow S., Wicker M., Cosottile D., Exline E., Swensson R., Lively P. (2022). Using telehealth to coach parents to implement trial-based functional analysis and treatment. Journal of Behavioral Education. Advance online publication. https://doi.org/10.1007/s10864-022-09468-3

U.S Department of Health and Human Services. (2017). Report to congress: Young adults and transitioning youth with autism spectrum disorder. https://www.hhs.gov/sites/default/files/2017Aut

Faul F., Erdfelder E., Lang A.-G., Buchner A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191. https://doi.org/10.3758/bf03193146

Fisher W. W., Kuhn D. E., Thompson R. H. (1998). Establishing discriminative control of responding using functional and alternative reinforcers during functional communication training. Journal of Applied Behavior Analysis, 31(4), 543–560. https://doi.org/10.1901/jaba.1998.31-543

Gerow S., Davis T. N., Radhakrishnan S., Gregori E., Rivera G. (2018). Functional communication training: The strength of evidence across disabilities. Exceptional Children, 85(1), 86–103. https://doi.org/10.1177/0014402918793399

Gerow S., Radhakrishnan S., Akers J. S., McGinnis K., Swensson R. (2021). Telehealth parent coaching to improve daily living skills for children with ASD. Journal of Applied Behavior Analysis, 54(2), 566–581. https://doi.org/10.1002/jaba.813

Gerow S., Radhakrishnan S., Davis T. N., Zambrano J., Avery S., Cosottile D. W., Exline E. (2021). Parent-implemented brief functional analysis and treatment with coaching via telehealth. Journal of Applied Behavior Analysis, 54(1), 54–69. https://doi.org/10.1002/jaba.801

Hagopian L. P., Hardesty S. L., Gregory M. (2020). Overview and summary of scientific support for applied behavior analysis. The Kennedy Krieger Institute. https://www.kennedykrieger.org/sites/default/files/library/documents/patient-care/centers-and-programs/down-syndrome-clinic-and-research-center/aba-scientific-support-9-2015.pdf

Horner R. H., Carr E. G., Halle J., McGee G., Odom S., Wolery M. (2005). The use of single-subject research to identify evidence-based practice in special education. Exceptional Children, 71(2), 165–179. https://doi.org/10.1177/001440290507100203

Howard J. S., Stanislaw H., Green G., Sparkman C. R., Cohen H. G. (2014). Comparison of behavior analytic and eclectic early interventions for young children with autism after three years. Research in Developmental Disabilities, 35(12), 3326–3344. https://doi.org/10.1016/j.ridd.2014.08.021

IBM Corp. (2020). IBM SPSS statistics for windows (Version 27.0) [Computer software]. IBM Corp (Released 2020).

Institute of Medicine (IOM). (2012). The role of telehealth in an evolving health care environment: Workshop summary. National Academy Press.

Jahr E. (2001). Teaching children with autism to answer novel wh- questions by utilizing a multiple exemplar strategy. Research in Developmental Disabilities, 22(5), 407–423. https://doi.org/10.1016/S0891-4222(01)00081-6

Jones E. A., Feeley K. M., Takacs J. (2007). Teaching spontaneous responses to young children with autism. Journal of Applied Behavior Analysis, 40(3), 565–570. https://doi.org/10.1901/jaba.2007.40-565

Kelley M. E., Shillingsburg M. A., Castro M. J., Addison L. R., LaRue R. H. (2007). Further evaluation of emerging speech in children with developmental disabilities: Training verbal behavior. Journal of Applied Behavior Analysis, 40(3), 431–445. https://doi.org/10.1901/jaba.2007.40-431

Lindgren S., Wacker D., Suess A., Schieltz K., Pelzel K., Kopelman T., Lee J., Romani P., Waldron D. (2016). Telehealth and autism: Treating challenging behavior at lower cost. Pediatrics, 137 (Suppl 2), S167–S175. https://doi.org/10.1542/peds.2015-2851O

Lovaas O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55(1), 3–9. https://doi.org/10.1037//0022-006x.55.1.3

Machalicek W., Lequia J., Pinkelman S., Knowles C., Raulston T., Davis T., Alresheed F. (2016). Behavioral telehealth consultation with families of children with autism spectrum disorder. Behavioral Interventions, 31(3), 223–250. https://doi.org/10.1002/bin.1450

Matson J. L., Turygin N. C., Beighley J., Rieske R., Tureck K., Matson M. L. (2012). Applied behavior analysis in autism spectrum disorders: Recent developments, strengths, and pitfalls. Research in Autism Spectrum Disorders, 6(1), 144–150. https://doi.org/10.1016/j.rasd.2011.03.014

Meadan H., Snodgrass M. R., Palomo I., Amenta C. G., Halle J. W. (2017). A framework for defining contextual features of training and coaching practices. Exceptionality, 25(4), 253–269.

Mills G. E., Gay L. R. (2019). Educational research: Competencies for analysis and applications. Pearson.

National Association for the Education of Young Children & National Association of Child Care Resource and Referral Agencies (NAEYC & NACCRRA). (2011). Early childhood education professional development: Training and technical assistance glossary. https://www.naeyc.org/sites/default/files/globally-shared/downloads/PDFs/our-work/public-policy-advocacy/glossarytraining_ta.pdf

Neely L., Rispoli M., Gerow S., Hong E. R., Hagan-Burke S. (2017). Fidelity outcomes for autism-focused interventionists coached via telepractice: A systematic literature review. Journal of Developmental and Physical Disabilities, 29(6), 849–874. https://doi.org/10.1007/s10882-017-9550-4

Parker R. I., Vannest K. J., Davis J. L., Sauber S. B. (2012). Combining nonoverlap and trend for single-case research: Tau-U. Behavior Therapy, 42(2), 284–299. https://doi.org/10.1016/j.beth.2010.08.006

Patterson S. Y., Smith V., Mirenda P. (2012). A systematic review of training programs for parents of children with autism spectrum disorders: Single subject contributions. Autism: The International Journal of Research and Practice, 16(5), 498–522. https://doi.org/10.1177/136231311413398

Postorino V., Sharp W. G., McCracken C. E., Bearss K., Burrell T. L., Evans A. N., Scahill L. (2017). A systematic review and meta-analysis of parent training for disruptive behavior in children with autism spectrum disorder. Clinical Child and Family Psychology Review, 20(4), 391–402. https://doi.org/10.1007/s10567-017-0237-2

Reichow B., Volkmar F. R., Cicchetti D. V. (2008). Development of the evaluative method for evaluating and determining evidence-based practices in autism. Journal of Autism and Developmental Disorders, 38(7), 1311–1319. https://doi.org/10.1007/s10803-007-0517-7

Robertson, R. E., Sobeck E. E., Wynkoop K., Schwartz R. (2017). Participant diversity in special education research: Parent-implemented behavior interventions for children with autism. Remedial and Special Education, 38(5), 259–271. https://doi.org/10.1177/0741932516685407

Roux A. M., Rast J. E., Anderson K. A., Shattuck P. T. (2017). National autism indicators report: Developmental disability services and outcomes in adulthood. Life Course Outcomes Research Program, A.J. Drexel Autism Institute, Drexel University.

Rush D., Shelden M. (2011). The Early Childhood Coaching Handbook. Brookes Publishing.

Siperstein G. N., Parker R. C., Drascher M. (2013). National snapshot of adults with intellectual disabilities in the labor force. Journal of Vocational Rehabilitation, 39(3), 157–165. https://doi.org/10.3233/JVR-130658

Smith T., Groen A. D., Wynn J. W. (2000). Randomized trial of intensive early intervention for children with pervasive developmental disorder. American Journal of Mental Retardation, 105(4), 269–285.

Sparrow S. S., Cicchetti D. V., Saulnier C. A. (2016). Vineland Adaptive Behavior Scales. (3rd ed.). Pearson.

Steege M. W., Mace F. C., Perry L., Longenecker H. (2007). Applied behavior analysis: Beyond discrete trial teaching. Psychology in the Schools, 44(1), 91–99. https://doi.org/10.1002/pits.20208

Steinbrenner J. R., Hume K., Odom S. L., Morin K. L., Nowell S. W., Tomaszewski B., Szendrey S., McIntyre N. S., Yücesoy-Özkan S., Savage M. N. (2020). Evidence-based practices for children, youth, and young adults with Autism. The University of North Carolina at Chapel Hill, Frank Porter Graham Child Development Institute, National Clearinghouse on Autism Evidence and Practice Review Team.

Tomlinson S. R. L., Gore N., McGill P. (2018). Training individuals to implement applied behavior analytic procedures via telehealth: A systematic review of the literature. Journal of Behavioral Education, 27(2), 172–222. https://doi.org/10.1007/s10864-018-9292-0

Tsami L., Lerman D., Toper-Korkmaz O. (2019). Effectiveness and acceptability of parent training via telehealth among families around the world. Journal of Applied Behavior Analysis, 52(4), 1113–1129. https://doi.org/10.1002/jaba.645

Ura S. K., Liao C.-Y., Ganz J. B., Stein K., Clark S. (2021). Parent-coaching telehealth intervention for youth with autism spectrum disorder: A pilot program. Child & Family Behavior Therapy, 43(2), 86–102. https://doi.org/10.1080/07317107.2021.1894719

U.S. Census Bureau. (2015). Detailed languages spoken at home and ability to speak English for the population 5 years and over: 2009-2013. [Data file]. https://www.census.gov/data/tables/2013/demo/2009-2013-lang-tables.html

U. S. Census Bureau. (2020). About race. https://www.census.gov/topics/population/race/about.html

U.S. Department of Education. (2020). IDEA section 618 state part b child count and educational environments. [Data file]. https://data.ed.gov/dataset/idea-section-618-state-part-b-child-count-and-educational-environments/resources

Vannest K. J., Ninci J. (2015). Evaluating intervention effects in single-case research designs. Journal of Counseling & Development, 93(4), 403–411. https://doi.org/10.1002/jcad.12038

VSee. (2013). VSee vs. Skype: Three key differences. https://vsee.com/blog/vsee-vs-skype-telemedicine/

VSee. (2020). HIPAA and VSee video conferencing. https://vsee.com/hipaa

Wacker D. P., Lee J. F., Dalmau Y. C. P., Kopelman T. G., Lindgren S. D., Kuhle J., Pelzel K. E., Waldron D. B. (2013). Conducting functional analyses of problem behavior via telehealth. Journal of Applied Behavior Analysis, 46(1), 31–46. https://doi.org/10.1002/jaba.29

Wainer A. L., Ingersoll B. R. (2015). Increasing access to an ASD imitation intervention via a telehealth parent training program. Journal of Autism and Developmental Disorders, 45(12), 3877–3890. https://doi.org/10.1007/s10803-014-2186-7

Wong C., Odom S. L., Hume K. A., Cox A. W., Fettig A., Kucharczyk S., Brock M. E., Plavnick J. B., Fleury V. P., Schultz T. R. (2015). Evidence-based practices for children, youth, and young adults with autism spectrum disorder: A comprehensive review. Journal of Autism and Developmental Disorders, 45(7), 1951–1966. https://doi.org/10.1007/s10803-014-2351-z

Biographies

Stephanie Gerow, PhD, BCBA-D., is a Research Associate at the University of Nevada, Las Vegas. Her research interests include parent-implemented interventions, interventions for young children with developmental disabilities, and applied behavior analysis.

Marie Kirkpatrick, PhD, BCBA-D, is an Assistant Professor in the Department of Educational Psychology, College of Education and Human Development, at The University of Texas at San Antonio. Dr. Kirkpatrick’s research focuses on use of behavior analytic interventions in schools to support students with autism and developmental disabilities, use of technology-based interventions to support areas of skill acquisition, and teacher/staff training in evidence-based practices.

Kristina McGinnis, BCBA, LBA, is a doctoral student at Baylor University and a supervisor on Baylor’s Caregiver Coaching team. She is also a licensed special education teacher in Texas and Arizona. Kristina’s research interests include evidence-based practices for individuals with ASD, telehealth service delivery, social validity, and caregiver-implemented interventions.

Dr. Tracey N. Sulak serves as Clinical Associate faculty in Baylor University’s Department of Educational Psychology. Her research includes teacher training and STEM talent development.

Dr. Tonya N. Davis serves as a Professor in Baylor University’s Department of Educational Psychology. Her research includes interventions to reduce challenging behavior and supporting practitioners to implement evidence-based practices for children with developmental disabilities.

Stephanie Fritz is a doctoral level educational psychology graduate student at Baylor University. She is also a Board Certified Behavior Analyst. She is currently completing a doctoral level internship within a public school in Goodyear, AZ.

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