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Bravo A, Ibañez LV, Scott S, Dick C, Carpentier P, Stone WL. Telehealth Delivery in Part C Early Intervention: Provider and Caregiver Perspectives. J Autism Dev Disord 2023; 53:4545-4559. [PMID: 36153443 PMCID: PMC9510265 DOI: 10.1007/s10803-022-05734-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/29/2022]
Abstract
Telehealth is a promising modality for Part C early intervention (EI), services typically implemented face-to-face in home and community settings. Barriers to telehealth in EI reported prior to COVID-19 included lack of training and access to reliable internet. The abrupt telehealth shift at the onset of the pandemic did not permit a phased adoption approach. This mixed-methods study aimed to characterize perspectives of service changes resulting from the telehealth transition. Providers (n = 39) and caregivers (n = 11) completed surveys about perceptions towards the telehealth switch. All providers indicated at least one aspect of services had changed. Approximately half of caregivers reported satisfaction with services decreased and half that satisfaction remained the same. Implications for telehealth in EI beyond the pandemic are discussed.
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Affiliation(s)
- Alice Bravo
- College of Education, University of Washington, Seattle, WA, 98115, USA.
| | - Lisa V Ibañez
- Department of Psychology, University of Washington, Seattle, WA, 98115, USA
| | - Sabine Scott
- Department of Psychology, University of Washington, Seattle, WA, 98115, USA
| | - Catherine Dick
- Department of Psychology, University of Washington, Seattle, WA, 98115, USA
| | - Pascale Carpentier
- Department of Psychology, University of Washington, Seattle, WA, 98115, USA
| | - Wendy L Stone
- Department of Psychology, University of Washington, Seattle, WA, 98115, USA
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Kolb RL, McComas JJ, Girtler SN, Simacek J, Dimian AF, Unholz-Bowden EK, Shipchandler AH. Teaching Requesting to Individuals with Rett Syndrome Using Alternative Augmentative Communication (AAC) Through Caregiver Coaching via Telehealth. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2023; 35:1063-1090. [PMID: 38053943 PMCID: PMC10697698 DOI: 10.1007/s10882-023-09894-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 12/07/2023]
Abstract
Rett syndrome is a severe neurodevelopmental disorder that results in both motor and language skill regression with a wide range of severity in symptom presentation. Communication intervention may be particularly challenging for this population due to the decline in speech, motor skills, and motor planning difficulties that characterize the disorder (Townend et al., 2020), often resulting in the need for augmentative and alternative communication (AAC) technology. Very limited research has evaluated communication interventions for individuals with Rett syndrome and even fewer have targeted expressive communication, an important skill required for improved autonomy and quality of life (Sigafoos et al., 2009; Townend et al., 2020). The current study sought to systematically replicate the Simacek et al. (2017) mand training procedures to teach three girls with Rett Syndrome to use AAC to make requests through caregiver coaching by researchers via telehealth. Results suggest that mand training was successful in increasing AAC use for all three participants. Barriers to intervention for this population and implications of results for future research and clinical practice are discussed.
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Affiliation(s)
- Rebecca L. Kolb
- Department of Educational Psychology, The University of Minnesota, 56 River Rd E., Minneapolis, MN 55414, USA
| | - Jennifer J. McComas
- Department of Educational Psychology, The University of Minnesota, 56 River Rd E., Minneapolis, MN 55414, USA
| | - Shawn N. Girtler
- Department of Educational Psychology, The University of Minnesota, 56 River Rd E., Minneapolis, MN 55414, USA
| | - Jessica Simacek
- Institute on Community Integration, University of Minnesota, 2025 E River Pkwy, Minneapolis, MN 55414, USA
| | - Adele F. Dimian
- Institute on Community Integration, University of Minnesota, 2025 E River Pkwy, Minneapolis, MN 55414, USA
| | - Emily K. Unholz-Bowden
- Department of Educational Psychology, The University of Minnesota, 56 River Rd E., Minneapolis, MN 55414, USA
| | - Alefyah H. Shipchandler
- Department of Educational Psychology, The University of Minnesota, 56 River Rd E., Minneapolis, MN 55414, USA
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Kane CL, DeBar RM. A Descriptive Review of Telehealth for Individuals With Autism Spectrum Disorder. Behav Modif 2023; 47:504-546. [PMID: 36113035 DOI: 10.1177/01454455221121085] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Since the early 2000s, telehealth has been used to provide behavior analytic intervention to individuals with autism spectrum disorder (ASD). Evaluating evidence supporting telehealth remains valuable, especially as there has been increased accessibility since the COVID-19 pandemic. Although there is empirical support for telehealth as an effective service-delivery option, important variables (e.g., costs, implementer training) remain unknown. Despite potential roles in telehealth service-delivery models, a careful review of participant prerequisite skills, implementer characteristics (e.g., experience, education), technology variables (e.g., HIPAA compliance), and skill(s) targeted (i.e., mastered or untrained skills) have not been considered. Therefore, we aimed to extend prior telehealth literature reviews by evaluating current research across variables important for telehealth service-delivery involving individuals with ASD. We found thorough descriptions of participants and implementers, implementer training, and social validity evaluations. Limitations of telehealth literature include exclusion of teen and adult participants, limited description of prerequisite skills and evaluations of direct telehealth interventions. Future research areas were identified.
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Gerow S, Kirkpatrick M, McGinnis K, Sulak TN, Davis TN, Fritz S. Evaluation of a Telehealth ABA Program for Caregivers of Children with ASD. Behav Modif 2023; 47:349-379. [PMID: 36317793 DOI: 10.1177/01454455221130001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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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Preas E, Carroll RA, Van Den Elzen G, Halbur M, Harper M. Evaluating the Use of Video Modeling With Voiceover Instructions to Train Therapists to Deliver Caregiver Training Through Telehealth. Behav Modif 2023; 47:402-431. [PMID: 35850543 DOI: 10.1177/01454455221111988] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Caregiver training is an important component of behavioral intervention; however, many barriers exist for in-person training. Alternatively, behavioral therapists may use telehealth as a service delivery method. To effectively train caregivers through telehealth, therapists should receive explicit training, but there has been limited research on effective methods for teaching this skill. The purpose of the current study was to evaluate video modeling with voice-over instruction (VMVO) to train therapists to implement 11 component skills of caregiver training through telehealth to teach confederate caregivers to implement a guided compliance procedure. We measured the therapist's implementation of the component skills during a scripted role-play before and after video-model training within a multiple baseline design across participants. We also conducted maintenance and generalization probes to a novel skill. All seven therapists learned the skill, but three therapists required a feedback component in addition to the VMVO. The results suggest that VMVO may be an efficient and effective method for training therapists to conduct caregiver training via telehealth. Furthermore, results indicate that component skill analyses may be valuable to monitor skills that require remediation.
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Affiliation(s)
- Elizabeth Preas
- University of Nebraska Medical Center's Munroe-Meyer Institute, Omaha, USA
| | - Regina A Carroll
- University of Nebraska Medical Center's Munroe-Meyer Institute, Omaha, USA
| | | | - Mary Halbur
- University of Nebraska Medical Center's Munroe-Meyer Institute, Omaha, USA
| | - Megan Harper
- University of Nebraska Medical Center's Munroe-Meyer Institute, Omaha, USA
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Hacker RE, Meadan H, Terol AK. Siblings Supporting the Social Interactions of Children Who Use Augmentative and Alternative Communication. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:201-215. [PMID: 36548981 DOI: 10.1044/2022_ajslp-22-00072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE The purpose of this study was to examine the effectiveness of a training and coaching program aimed to increase the use of the aided language modeling (ALM) strategy by siblings to support the social interactions of children with disabilities who use augmentative and alternative communication (AAC) in the natural environment. METHOD A single-case, multiple-probe design that included a training and coaching intervention was implemented to teach four typically developing siblings to use the ALM strategy with high fidelity with their sibling who used AAC. In addition, a second research question investigated the rate at which siblings used the ALM strategy with the child. RESULTS Results revealed that the sibling training and coaching was (a) effective in increasing high fidelity of the siblings' implementation of the ALM strategy and (b) participants and family members found the intervention to be impactful and meaningful. CONCLUSIONS The changes observed throughout this study demonstrate the need for more sibling- and family-centered training to increase the use of AAC in the natural environment. Families were satisfied with the goals, procedures, and outcomes; however, they also expressed their need for additional support.
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Affiliation(s)
- Rebecca E Hacker
- Juniper Gardens Children's Project, The University of Kansas, Kansas City
| | - Hedda Meadan
- Department of Special Education, University of Illinois Urbana-Champaign, Champaign
| | - Adriana Kaori Terol
- Department of Special Education, University of Illinois Urbana-Champaign, Champaign
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Larsen A, Schieltz KM, Barrett A, O'Brien MJ. A Retrospective Analysis of Therapists' Coaching Behavior When Directing Parents to Conduct Behavioral Assessments and Treatments Via Telehealth. Behav Modif 2023; 47:154-184. [PMID: 35730524 PMCID: PMC11019754 DOI: 10.1177/01454455221106127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Research on the delivery of behavioral assessment and treatment via telehealth has focused largely on child outcomes and parent procedural fidelity. By contrast, the behavior of the therapists coaching parents to conduct assessment and treatment has garnered little research consideration. In this study, we conducted a retrospective analysis of behavior therapists' coaching behaviors when directing parents to conduct functional analysis (FA) and functional communication training (FCT) with their young children with autism via telehealth. Coaching behaviors for five experienced behavior therapists across seven parent-child dyads were scored using a combination of standardized and novel behavior codes. Therapists displayed more social engagement behaviors than any other type of behavior throughout the study, and rates of antecedent and consequence behaviors shifted across the FA and FCT phases. Results are discussed in relation to therapists' goals during behavioral assessment and treatment and the implications for training behavioral therapists to coach parents via telehealth.
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Traube DE, Taylor A, Cederbaum JA, Naish L, Rau A. Strategies for implementation of virtual home visitation in the United States. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2118-e2126. [PMID: 34791751 DOI: 10.1111/hsc.13650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 06/13/2023]
Abstract
Utilising telepractice videoconferencing technology to offer home visitation services has the potential to provide access and parenting support through a high-tech and high-touch service delivery option. Families can receive evidence-based, family support intervention from their home via videoconferencing technology, removing the need for the provider to be physically in the home. While the expansion of telehealth and telepractice services for families is essential for meeting the needs of both parents and their children, well-documented engagement barriers to digital health/computer-mediated interventions exist across treatment modalities and technology platforms. Semi-structured interviews with 15 providers were conducted and analysed to identify engagement strategies utilised to sustain families in a home visitation model offered through live videoconferencing technology on a telehealth platform. Analysis revealed four themes that were deemed essential for successfully attracting and maintaining families in a telepractice-based home visitation programme: (a) engagement strategies to encourage families to participate; (b) clinical skills used within sessions; (c) articulation of benefits to the family; and (d) exploration of rationale for ending services. This study was able to identify strategies for engagement and sustained involvement of families in telehealth-based home visitation. Findings include evidence that providers should be able to move between telehealth and on-ground service provision with relative ease.
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Affiliation(s)
- Dorian E Traube
- USC Suzanne Dworak-Peck School of Social Work, Los Angeles, California, USA
| | - Amanda Taylor
- USC Suzanne Dworak-Peck School of Social Work, Los Angeles, California, USA
| | - Julie A Cederbaum
- USC Suzanne Dworak-Peck School of Social Work, Los Angeles, California, USA
| | - Lauren Naish
- USC Suzanne Dworak-Peck School of Social Work, Los Angeles, California, USA
| | - Angela Rau
- Parents as Teachers National Center, St. Louis, Missouri, USA
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Akers JS, Davis TN, McGinnis K, Swensson RM. Effectiveness of Remote Delayed Performance Feedback on Accurate Implementation of Caregiver Coaching. JOURNAL OF BEHAVIORAL EDUCATION 2022; 33:1-24. [PMID: 35971548 PMCID: PMC9365676 DOI: 10.1007/s10864-022-09487-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 06/15/2023]
Abstract
The supervision of field experiences is an indispensable component of Board-Certified Behavior Analyst (BCBA®) training. During the supervised field experience, supervisors regularly provide performance feedback to trainees for the purpose of improving fidelity of implementation of various assessments and interventions. Emerging evidence supports the efficacy of using telehealth to train teachers and parents to implement interventions, but no study has evaluated the effectiveness of the remote delayed performance feedback among individuals completing BCBA® training. We used videoconference equipment and software to deliver remote delayed performance feedback to seven participants enrolled in a graduate program and completing supervised field experience. Remote delayed performance feedback was provided regarding participants' implementation of caregiver coaching. The results indicate that delayed performance feedback provided remotely increased the correct implementation of caregiver coaching. These preliminary results indicate the efficacy of remote supervision and delayed performance feedback.
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Affiliation(s)
- Jessica S. Akers
- Department of Educational Psychology, Baylor University, One Bear Place #97301, Waco, TX 76798 USA
| | - Tonya N. Davis
- Department of Educational Psychology, Baylor University, One Bear Place #97301, Waco, TX 76798 USA
| | - Kristina McGinnis
- Department of Educational Psychology, Baylor University, One Bear Place #97301, Waco, TX 76798 USA
| | - Remington M. Swensson
- Department of Educational Psychology, Baylor University, One Bear Place #97301, Waco, TX 76798 USA
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Chen Y, Zhou Z, Cao M, Liu M, Lin Z, Yang W, Yang X, Dhaidhai D, Xiong P. Extended Reality (XR) and telehealth interventions for children or adolescents with autism spectrum disorder: Systematic review of qualitative and quantitative studies. Neurosci Biobehav Rev 2022; 138:104683. [PMID: 35523302 DOI: 10.1016/j.neubiorev.2022.104683] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/15/2022] [Accepted: 04/29/2022] [Indexed: 12/17/2022]
Abstract
World Health Organization reported that almost one in 100 children is diagnosed with autism spectrum disorder (ASD) worldwide. Extended Reality (XR) and Telehealth interventions are evident to be effective for ASD treatments. While there is no comprehensive systematic review to summarize and evaluate the evidence for promoting the accessibility of different technology-based treatment regiments. This paper aims to verify the efficacy and validity of XR and Telehealth interventions for children and adolescents with ASD. We reviewed 112 studies from databases of PubMed, Web of Science and Cochrane Library, published in English between January 2010 to April 1st, 2022. We found that after interventions, positive improvements for ASD participants were observed in social interaction, acceptance, and engagement, communication and speech, emotion recognition and control, daily living skill, problem behavior reduction, attention, cost reduction, anxiety symptom reduction, pretend play, contextual processing, match to sample skill, and insomnia control. Our findings provide a solid and positive evidence of XR and Telehealth interventions in improving the treatment outcomes for children and adolescents with ASD. In the future, more research with RCTs and standardized outcome measurements are required to establish the therapeutic efficiency of the two interventions independently or combined.
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Affiliation(s)
- Yuhan Chen
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Zhuoren Zhou
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Min Cao
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Min Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Zhihao Lin
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Weixin Yang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Xiao Yang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Denzel Dhaidhai
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Peng Xiong
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China.
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Witte AL, Schumacher RE, Sheridan SM. The Effectiveness of Technology-Delivered Conjoint Behavioral Consultation: Addressing Rural Student and Family Needs. JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 2022. [DOI: 10.1080/10474412.2022.2083624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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King HC, Wu S, Bloomfield BS, Fischer AJ, Martone LE. A Practical Guide on Problem-Solving Teleconsultation in Schools. JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 2022. [DOI: 10.1080/10474412.2022.2070495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pompa-Craven P, Tierman E, Martino J, Lotfizadeh AD. Caregiver Satisfaction with Delivery of Telehealth Autism Services. ADVANCES IN NEURODEVELOPMENTAL DISORDERS 2022; 6:196-205. [PMID: 35531083 PMCID: PMC9058747 DOI: 10.1007/s41252-022-00256-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The purpose of this study was to assess satisfaction with telehealth interventions for a large nonprofit organization that transitioned interventions for individuals with autism spectrum disorder (ASD) to telehealth during a pandemic. Services provided via telehealth included applied behavior analysis (ABA), speech and language, and occupational therapies. A secondary survey evaluated reasons for declining telehealth services. METHODS A survey was administered to 10,567 families who were receiving autism interventions. A total of 440 respondents answered all the questions on the survey, and their results were included in this study. A secondary survey was administered to 223 individuals who declined to have telehealth autism interventions. RESULTS There was not a clinically meaningful difference in satisfaction across service types. Although all ratings were in the high range, caregivers ranked speech therapists as more dependable than ABA therapists, and this difference was statistically significant. The findings suggested that the majority of caregivers were generally satisfied with services provided in a telehealth format. For those who declined services, the majority indicated a discomfort with the use of technology. CONCLUSIONS The participants of telehealth autism interventions reported high general satisfaction and indicated an improvement in their quality of life. Results provide suggestive evidence that increased satisfaction of telehealth services may allow for further acceptability and access for participants. Future research should evaluate participant and clinician satisfaction with telehealth versus in-person interventions.
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Affiliation(s)
- Paula Pompa-Craven
- Autism Services, Easterseals Southern California, 1063 McGaw Avenue, Irvine, CA 92614 USA
| | - Emily Tierman
- Autism Services, Easterseals Southern California, 1063 McGaw Avenue, Irvine, CA 92614 USA
| | - Joelle Martino
- Autism Services, Easterseals Southern California, 1063 McGaw Avenue, Irvine, CA 92614 USA
| | - Amin D. Lotfizadeh
- Autism Services, Easterseals Southern California, 1063 McGaw Avenue, Irvine, CA 92614 USA
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Aranki J, Wright P, Pompa-Craven P, Lotfizadeh AD. Acceptance of Telehealth Therapy to Replace In-Person Therapy for Autism Treatment During COVID-19 Pandemic: An Assessment of Patient Variables. Telemed J E Health 2022; 28:1342-1349. [PMID: 35119331 DOI: 10.1089/tmj.2021.0397] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Importance: Children with autism achieve improved behavioral outcomes with applied behavior analytic (ABA) interventions. Typically, ABA is delivered in a participant's home or in a clinic setting. At the onset of COVID-19, treatment in these environments was not available due to health exposure concerns. A large social service organization in California rapidly pivoted to the delivery of ABA intervention through telehealth. Access disparity for telehealth has been a historical concern in health care delivery, particularly for disenfranchised populations within the autistic participant population. Objective: This study evaluated the demographic and behavioral variables associated with the acceptance or declination of telehealth by the pediatric participants' caregivers at the onset of the pandemic. Design, Setting, Participants: A non-experimental design was used, and archival data were compared for a random sample of 100 participants with autism who accepted telehealth interventions with 100 participants who declined it. Main Outcomes and Measures: Socioeconomic data, gender, age, ethnicity, language, and household size were compared. Clinical data were compared for treatment dosage, standardized Vineland Adaptive Behavior Scales scores, and Verbal Behavior Milestones Assessment and Placement Program scores. Results: None of the demographic variables were statistically significant in a participant's acceptance or declination of telehealth, but there were moderate differences in treatment dosage across the groups. Conclusions: It is concerning that a large portion of participants initially declined intervention via telehealth, resulting in these participants experiencing a gap in intervention during the pandemic. As intervention is imperative for pediatric autism participants, it is untenable that ∼40% of the population initially declined telehealth at the start of the pandemic.
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Affiliation(s)
- Jenna Aranki
- Autism Services Division, Easterseals Southern California, Irvine, California, USA
| | | | - Paula Pompa-Craven
- Autism Services Division, Easterseals Southern California, Irvine, California, USA
| | - Amin D Lotfizadeh
- Autism Services Division, Easterseals Southern California, Irvine, California, USA
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Drew CM, Machalicek W, Crowe B, Glugatch L, Wei Q, Erturk B. Parent-Implemented Behavior Interventions via Telehealth for Older Children and Adolescents. JOURNAL OF BEHAVIORAL EDUCATION 2022; 32:1-20. [PMID: 35035202 PMCID: PMC8741557 DOI: 10.1007/s10864-021-09464-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 06/14/2023]
Abstract
Children and adolescents with intellectual and developmental disabilities (IDD) are more likely to engage in challenging and interfering behavior than their typically developing peers, which has been linked to many negative outcomes. The most effective interventions to address challenging and interfering behavior incorporate function-based assessments, which are used to develop individualized behavior interventions. Functional communication training (FCT) is an evidence-based practice to decrease challenging and interfering behavior that can be taught to parents using behavioral parent training (BPT); however, there are limited skilled professionals who can develop interventions and train parents. Telehealth can enable greater access to these professionals. This study used withdrawal designs to determine whether high parent treatment fidelity resulted in decreased challenging and interfering behavior and increased appropriate replacement behavior. Three participants (8-17 years) were included in the study, and their parents served as interventionists during mealtime, toothbrushing, and room cleaning. Data were analyzed using visual analysis. Each parent achieved high treatment fidelity with one session of BPT and bug-in-ear coaching. All participants had a decrease in challenging and interfering behavior and an increase in functional communication responses (FCRs) upon the introduction of the intervention with reliable reversals. All parents reported high social validity. Results and implications for practice and future research are discussed.
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Affiliation(s)
- Christine M. Drew
- Department of Special Education, Rehabilitation, and Counseling, Auburn University, Haley Center 2084, Auburn, AL 36849 USA
| | - Wendy Machalicek
- Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR USA
| | - Becky Crowe
- Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR USA
| | - Lindsay Glugatch
- Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR USA
| | - Qi Wei
- Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR USA
| | - Buket Erturk
- Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR USA
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Bloomfield BS, Fischer AJ, Dove M, Clark RR, Fife M. Parent Teleconsultation to Increase Bites Consumed: A Demonstration Across Foods for a Child With ARFID and ASD. Behav Anal Pract 2021; 14:913-926. [PMID: 34868807 DOI: 10.1007/s40617-021-00586-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 11/30/2022] Open
Abstract
Children with autism spectrum disorder (ASD) experience feeding dysfunction at a substantially higher proportion than their neurotypical peers. Feeding concerns can provide considerable challenges for parents, and as such, helping parents of children with ASD provide effective mealtime interventions for interfering behavior is critical, especially if parents have individual circumstances that affect their ability to effectively implement these feeding interventions. This study contributes to the parent-implemented feeding-intervention literature by demonstrating that a parent with ASD can implement a pediatric feeding intervention in the home with their child with ASD, despite contributing mental health factors. To address family needs, we developed a socially valid and individualized intervention, which we delivered over telehealth. The intervention resulted in an increase in the consumption of previously nonpreferred foods, while the caregiver maintained adequate levels of procedural fidelity. Practical considerations and implications are discussed.
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Traube DE, Cederbaum JA, Taylor A, Naish L, Rau A. Telehealth Training and Provider Experience of Delivering Behavioral Health Services. J Behav Health Serv Res 2021; 48:93-102. [PMID: 32596804 DOI: 10.1007/s11414-020-09718-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The exclusion of telehealth training and education in behavioral health degree programs contributes to the challenges in telehealth delivery. This qualitative study was designed to assess the impact of telehealth training during a behavioral health degree program on perceptions of providing telehealth services. Fifteen interviews were conducted using a semi-structured interview guide. A narrative inquiry approach was employed, allowing for the participants to use narrative story to describe and discuss experiences. Analysis revealed three themes: (1) facilitators for delivering telehealth services; (2) challenges encountered when delivering telehealth service; and (3) overall satisfaction with delivering telehealth services. Key facilitators for delivering telehealth services include training, intervention curriculum, and ongoing telehealth supervision. Barriers to telehealth service delivery included issues of telehealth operations and technology. Making telehealth training widely accessible, as opposed to a continuing education option, is essential to promoting the utilization of the treatment modality.
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Affiliation(s)
- Dorian E Traube
- USC Suzanne Dworak Peck School of Social Work, 669 W 34th Street, Los Angeles, CA, 90089-0411, USA.
| | - Julie A Cederbaum
- USC Suzanne Dworak Peck School of Social Work, 669 W 34th Street, Los Angeles, CA, 90089-0411, USA
| | - Amanda Taylor
- USC Suzanne Dworak Peck School of Social Work, 669 W 34th Street, Los Angeles, CA, 90089-0411, USA
| | - Lauren Naish
- USC Suzanne Dworak Peck School of Social Work, 669 W 34th Street, Los Angeles, CA, 90089-0411, USA
| | - Angela Rau
- Parents as Teachers National Center, St. Louis, MO, USA
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Shire SY, Worthman LB, Arbuckle S. A Technology-Enabled Adaptation of Face-to-Face Caregiver-Mediated JASPER Intervention: Preliminary Examination of Video Conferenced Caregiver Coaching. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 126:421-434. [PMID: 34428271 DOI: 10.1352/1944-7558-126.5.421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 01/19/2021] [Indexed: 06/13/2023]
Abstract
Family-centered practices that involve direct participation of caregivers as part of intervention is critical to effective early intervention. However, regularly scheduled, in person service delivery is not always possible in remote communities, prompting a need for adaptations to the delivery of services, such as the use of live video conferencing to coach caregivers in strategies to promote their children's development. In this study, caregivers and their children ages 2-9 with autism who were living in rural and remote Canadian communities were included. A concurrent multiple baseline design across participants was applied to examine the effects of live video conference caregiver coaching on children's time jointly engaged with caregivers and caregivers' intervention strategy implementation. Results indicated that all children demonstrated greater time jointly engaged and caregivers demonstrated greater use of strategies in comparison to baseline. The results of this study offer preliminary evidence of the effectiveness of real time video conference coaching for caregivers engaging their children with ASD in play.
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Ellison KS, Guidry J, Picou P, Adenuga P, Davis TE. Telehealth and Autism Prior to and in the Age of COVID-19: A Systematic and Critical Review of the Last Decade. Clin Child Fam Psychol Rev 2021; 24:599-630. [PMID: 34114135 PMCID: PMC8191715 DOI: 10.1007/s10567-021-00358-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2021] [Indexed: 01/20/2023]
Abstract
There has been growing interest in the use of telehealth; however, the COVID-19 pandemic and the subsequent isolation and restrictions placed on in-person services have fast-tracked implementation needs for these services. Individuals with autism spectrum disorder (ASD) have been particularly affected due to the often-intensive service needs required by this population. As a result, the aim of this review was to examine the evidence base, methodology, and outcomes of studies that have used telehealth for assessment and/or intervention with children and adolescents with ASD as well as their families over the last decade. Further, the goal is to highlight the advances in telehealth and its use with this special population. A systematic search of the literature was undertaken, with 55 studies meeting inclusion criteria and quality analysis. Specified details were extracted from each article, including participant characteristics, technology, measures, methodology/study design, and clinical and implementation outcomes. Services provided via telehealth included diagnostic assessments, preference assessments, early intervention, applied behavior analysis (ABA), functional assessment and functional communication training, and parent training. Findings, although still emerging, encouragingly suggested that services via telehealth were equivalent or better to services face-to-face. Results support the benefits to using telehealth with individuals with ASD. Future research should continue to explore the feasibility of both assessments and interventions via telehealth with those having ASD to make access to assessment services and interventions more feasible for families, while acknowledging the digital divide it could create.
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Affiliation(s)
- Kimberly S Ellison
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Jerrica Guidry
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Paige Picou
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Paige Adenuga
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Thompson E Davis
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA.
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20
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Andersen AS, Hansen BA, Hathaway KL, Elson LA. A Demonstration of Caregiver-Implemented Functional Analysis of Inappropriate Mealtime Behavior via Telehealth. Behav Anal Pract 2021; 14:1067-1072. [PMID: 34257832 PMCID: PMC8265283 DOI: 10.1007/s40617-021-00615-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 11/30/2022] Open
Abstract
Treatment for pediatric feeding disorders is imperative, so clinicians should alter the assessment and treatment process, making it is possible for caregivers to deliver via telehealth. Clinicians must first demonstrate that caregivers can conduct initial assessments in this format. We extended the literature on functional analysis of inappropriate mealtime behavior by demonstrating that caregivers can implement functional analysis procedures via telehealth to identify maintaining variables of inappropriate mealtime behavior. Clinicians determined that escape, attention, and tangibles and escape maintained inappropriate mealtime behavior during solids and liquids meals, respectively.
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Affiliation(s)
- Ashley S Andersen
- University of Nebraska Medical Center, Munroe-Meyer Institute, 444 South 44th Street, Omaha, NE 68105 USA
| | - Bethany A Hansen
- University of Nebraska Medical Center, Munroe-Meyer Institute, 444 South 44th Street, Omaha, NE 68105 USA
| | - Kristin L Hathaway
- University of Nebraska Medical Center, Munroe-Meyer Institute, 444 South 44th Street, Omaha, NE 68105 USA
| | - Lindsey A Elson
- University of Nebraska Medical Center, Munroe-Meyer Institute, 444 South 44th Street, Omaha, NE 68105 USA
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21
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King HC, Bloomfield BS, Wu S, Fischer AJ. A Systematic Review of School Teleconsultation: Implications for Research and Practice. SCHOOL PSYCHOLOGY REVIEW 2021. [DOI: 10.1080/2372966x.2021.1894478] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kunze MG, Machalicek W, Wei Q, St. Joseph S. Coaching via Telehealth: Caregiver-Mediated Interventions for Young Children on the Waitlist for an Autism Diagnosis Using Single-Case Design. J Clin Med 2021; 10:1654. [PMID: 33924440 PMCID: PMC8070073 DOI: 10.3390/jcm10081654] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 11/16/2022] Open
Abstract
Years can elapse between parental suspicion of a developmental delay and a diagnostic assessment, ultimately delaying access to medically necessary, autism-specific intervention. Using a single-case, concurrent multiple baseline design, autism spectrum disorder symptomology (i.e., higher-order restrictive and repetitive behaviors and interests; higher-order RRBIs) was targeted in toddlers (21-35 months) waiting for a diagnostic appointment. Caregivers were coached via telehealth to mediate early intervention to decrease interfering, inflexible higher-order RRBIs during play using four evidence-based applied behavior analytic strategies: modeling, prompting, differential reinforcement of appropriate behaviors, and response interruption and redirection. Six mother-child dyads were recruited from pediatrician offices and early intervention service districts in the United States. All families were considered under-served, under-resourced, or living in rural locations. A visual analysis of the data combined with Tau-U revealed a strong basic effect between the intervention package and parent strategy use and child flexible and inflexible behavior. Findings were consistent across participants with one exception demonstrating a moderate effect for flexible behaviors yet a strong effect for inflexible behaviors. Standardized mean difference was beyond zero for all participants. Implications for science and practice include support for early intervention of higher-order RRBIs for young children with and at risk for ASD.
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Affiliation(s)
- Megan G. Kunze
- Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR 97403, USA; (W.M.); (Q.W.); (S.S.J.)
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23
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Leyser M, Schieltz K, Strathearn L, Cooper-Brown L, McBrien D, O'Brien M. Telehealth in the Field of Developmental-Behavioral Pediatrics: Advantages, Challenges, and Future Perspectives. J Dev Behav Pediatr 2021; 42:240-244. [PMID: 33759849 DOI: 10.1097/dbp.0000000000000920] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 12/01/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Marcio Leyser
- Division of Developmental and Behavioral Pediatrics, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA
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24
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Neely L, MacNaul H, Gregori E, Cantrell K. Effects of telehealth‐mediated behavioral assessments and interventions on client outcomes: A quality review. J Appl Behav Anal 2021; 54:484-510. [DOI: 10.1002/jaba.818] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Leslie Neely
- Department of Educational Psychology University of Texas at San Antonio
| | - Hannah MacNaul
- Department of Educational Psychology University of Texas at San Antonio
| | - Emily Gregori
- Department of Special Education University of Illinois at Chicago
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25
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Gerow S, Radhakrishnan S, S Akers J, McGinnis K, Swensson R. Telehealth parent coaching to improve daily living skills for children with ASD. J Appl Behav Anal 2021; 54:566-581. [PMID: 33600614 DOI: 10.1002/jaba.813] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 01/11/2023]
Abstract
Children with autism spectrum disorder often display deficits in daily living skills. Behavior analysts can use telehealth, such as videoconferencing technology, to deliver interventions to families of these children. Given the COVID-19 pandemic and the common barriers to accessing behavioral interventions, it is imperative to evaluate the effectiveness and practicality of delivering behavioral interventions via telehealth. This study evaluated the efficacy of a parent-implemented intervention with coaching via telehealth to improve daily living skills. Children ranging in age from 5 to 9 years participated in the study with 1 or 2 of their parents serving as the primary implementer(s). Parents implemented the intervention with fidelity and the intervention yielded increases in independent daily living skill completion for all 4 participants.
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26
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Lindgren S, Wacker D, Schieltz K, Suess A, Pelzel K, Kopelman T, Lee J, Romani P, O'Brien M. A Randomized Controlled Trial of Functional Communication Training via Telehealth for Young Children with Autism Spectrum Disorder. J Autism Dev Disord 2021; 50:4449-4462. [PMID: 32300910 DOI: 10.1007/s10803-020-04451-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Many children with autism spectrum disorder (ASD) have problem behaviors that interfere with learning and social interaction. This randomized controlled trial compared treatment with functional communication training (FCT) to "treatment as usual" for young children with ASD (n = 38, ages 21-84 months). FCT was conducted by parents with training and real-time coaching provided by behavioral consultants using telehealth. FCT treatment via telehealth achieved a mean reduction in problem behavior of 98% compared to limited behavioral improvement in children receiving "treatment as usual" during a 12-week period. Social communication and task completion also improved. For children with ASD and moderate to severe behavior problems, parent-implemented FCT using telehealth significantly reduced problem behavior while ongoing interventions typically did not.
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Affiliation(s)
- Scott Lindgren
- Stead Family Department of Pediatrics, University of Iowa College of Medicine, 100 Hawkins Drive, Iowa City, IA, 52242, USA.
| | - David Wacker
- Stead Family Department of Pediatrics, University of Iowa College of Medicine, 100 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Kelly Schieltz
- Stead Family Department of Pediatrics, University of Iowa College of Medicine, 100 Hawkins Drive, Iowa City, IA, 52242, USA
| | | | - Kelly Pelzel
- Department of Psychiatry, University of Iowa College of Medicine, Iowa City, IA, USA
| | - Todd Kopelman
- Department of Psychiatry, University of Iowa College of Medicine, Iowa City, IA, USA
| | - John Lee
- Telehealth Behavioral Consultation Services, Sahuarita, AZ, USA
| | - Patrick Romani
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Matthew O'Brien
- Stead Family Department of Pediatrics, University of Iowa College of Medicine, 100 Hawkins Drive, Iowa City, IA, 52242, USA
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27
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Carnett A, Hansen S, Tullis C, Machalicek W. Using behavioural skills training via telehealth to increase teachers use of communication interventions and increase student use of speech-generating devices in a high school functional skills classroom. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2021; 65:133-148. [PMID: 33185000 DOI: 10.1111/jir.12794] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 08/25/2020] [Accepted: 10/11/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Behavioural skills training (BST) has demonstrated effectiveness in training teachers in evidence-based interventions to increase communication for children with limited repertoires. However, research has yet to extend to youth with developmental disabilities who are learning to communicate using speech-generating devices. The emergent use of telehealth technology in applied behaviour analysis has been associated with greater access to therapeutic services. Although the use of telehealth has been extended as an avenue for parents to access behavioural intervention services for their child, fewer studies have evaluated the use of telehealth for teacher behavioural consultation or with adolescents and young adults with complex communication needs. METHOD In the present study, four teaching staff were trained via telehealth to implement communication facilitation strategies with augmentative and alterative communication users in a high school functional skills classroom. During the coaching sessions, the staff were provided BST on the basic behaviour analytic teaching strategies (e.g. assessing preference, environmental arrangement, and reinforcement strategies). Independent adapted ABAB designs were used to evaluate the effectiveness of modified BST delivered via telehealth on increased teaching staff-implemented communication opportunities within the functional skills classroom and the effectiveness of staff-implemented communication intervention on increased speech-generating device mands for four adolescents/young adults with developmental disabilities. RESULTS The results indicated that the improved staff fidelity of the communication interventions was associated with the increased level of independent student mands for each dyad. Lastly, social validity data suggest that the procedures were acceptable and feasible. These data indicate that the use of telehealth may be a viable model for specialised classroom consultation. CONCLUSION The use of a telehealth delivery model to train classroom staff may be a viable option when specialised support is necessary, but access is limited.
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Affiliation(s)
- A Carnett
- Educational Psychology, School of Education, Victoria University of Wellington, Wellington, New Zealand
| | - S Hansen
- Learning Sciences, Georgia State University, Atlanta, GA, USA
| | - C Tullis
- Learning Sciences, Georgia State University, Atlanta, GA, USA
| | - W Machalicek
- Special Education, University of Oregon, Eugene, OR, USA
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28
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Gerow S, Radhakrishnan S, Davis TN, Zambrano J, Avery S, Cosottile DW, Exline E. Parent-implemented brief functional analysis and treatment with coaching via telehealth. J Appl Behav Anal 2020; 54:54-69. [PMID: 33325053 DOI: 10.1002/jaba.801] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 01/11/2023]
Abstract
We evaluated the use of parent-implemented brief functional analyses in the home with coaching delivered via telehealth. Parents of 7 children with autism conducted functional analyses of their child's challenging behavior. For 4 participants, the brief functional analysis provided information regarding the function of the child's challenging behavior. A full functional analysis indicated a social function for 1 participant. The brief functional analysis yielded false positive results and subsequent assessment indicated an automatic function for another participant. The final participant did not engage in sufficient rates of challenging behavior to provide information regarding the function of the child's challenging behavior. Treatment evaluations occurred with 4 participants; these evaluations provided support for the results of the functional analysis. Together with previous research, the results indicate that parent-implemented brief functional analyses, followed by additional assessment as needed, may be an effective method for assessing and treating challenging behavior via telehealth.
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Affiliation(s)
| | | | - Tonya N Davis
- Department of Educational Psychology, Baylor University
| | | | | | | | - Emily Exline
- Department of Educational Psychology, Baylor University
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29
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Marino F, Chilà P, Failla C, Crimi I, Minutoli R, Puglisi A, Arnao AA, Tartarisco G, Ruta L, Vagni D, Pioggia G. Tele-Assisted Behavioral Intervention for Families with Children with Autism Spectrum Disorders: A Randomized Control Trial. Brain Sci 2020; 10:brainsci10090649. [PMID: 32961875 PMCID: PMC7563357 DOI: 10.3390/brainsci10090649] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Telehealth is useful for both autism spectrum disorder (ASD) diagnosis and treatment, but studies with a direct comparison between teletherapy and traditional in-person therapy are limited. Methods: This randomized control trial—ISRCTN (International Standard Randomised Controlled Trial Number) primary clinical trial registry ID ISRCTN15312724—was aimed at comparing the effect of a tele-assisted and in-person intervention based on a behavioral intervention protocol for families with children affected by ASDs. Forty-two parents with children with autism (30 months to 10 years old) were randomly assigned to 12 sessions of an applied behavioral analysis (ABA) intervention implemented in an individual and group setting, either with or without the inclusion of tele-assistance. Pre- and postintervention assessments were conducted using the Home Situation Questionnaire (HSQ-ASD) and the Parental Stress Index (PSI/SF). Results: Substantial improvements in the perception and management of children’s behavior by parents, as well as in the influence of a reduction in parent stress levels on said children’s behavior through the use of a tele-assisted intervention, were obtained. Conclusions: This randomized controlled trial demonstrates the evidence-based potential for telehealth to improve treatment of ASDs.
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30
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Germansky S, Reichow B, Martin M, Snyder P. A Systematic Review of Caregiver-Implemented Functional Analyses. Behav Anal Pract 2020; 13:698-713. [PMID: 32953398 PMCID: PMC7471228 DOI: 10.1007/s40617-019-00404-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The purpose of this systematic review was to systematically locate and analyze the research on caregiver-implemented functional analyses and subsequent function-based interventions. We included 36 studies and examined multiple features of the studies, including participant demographics, functional analysis characteristics, intervention characteristics, procedural fidelity, risks of bias, and social validity. Overall, the studies showed that caregivers were able to implement functional analyses that yielded differential responding, although few studies reported procedural fidelity data. Caregivers were also able to implement function-based interventions that led to socially significant changes in challenging behavior. Implications for practice and future research are discussed.
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Affiliation(s)
- Sara Germansky
- Anita Zucker Center for Excellence in Early Childhood Studies, University of Florida, 1-320 Norman Hall, PO Box 117050, Gainesville, FL 32611-7050 USA
| | - Brian Reichow
- Anita Zucker Center for Excellence in Early Childhood Studies, University of Florida, 1-320 Norman Hall, PO Box 117050, Gainesville, FL 32611-7050 USA
| | - Mackenzie Martin
- Anita Zucker Center for Excellence in Early Childhood Studies, University of Florida, 1-320 Norman Hall, PO Box 117050, Gainesville, FL 32611-7050 USA
| | - Patricia Snyder
- Anita Zucker Center for Excellence in Early Childhood Studies, University of Florida, 1-320 Norman Hall, PO Box 117050, Gainesville, FL 32611-7050 USA
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Britwum K, Catrone R, Smith GD, Koch DS. A University-Based Social Services Parent-Training Model: A Telehealth Adaptation During the COVID-19 Pandemic. Behav Anal Pract 2020; 13:532-542. [PMID: 32837702 PMCID: PMC7331491 DOI: 10.1007/s40617-020-00450-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
With the COVID-19 pandemic resulting in social-distancing recommendations, many service providers find themselves altering the way they must provide medically necessary therapy. Even with the advent of more advanced telehealth technologies, the implementation of behavioral programming falls mainly on the caregivers of the clients that are served. This crisis brings to light ethical dilemmas and upends the current ways many programs may have been implemented across the world. As a result, a reevaluation of how these services are delivered is in order. This article reviews how a university-based, state-funded service delivery program (USSDP) provided essential and necessary services during the COVID-19 pandemic. Specifically, the purpose of this article is to describe how the USSDP quickly adopted a telehealth care model in a program that previously had not delivered services in this modality. Ethical, contextual, and competency-based factors are reviewed in the context of this organization, followed by a dialogue on broader generalization suggestions utilizing an active support model of care within telehealth restrictions.
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Affiliation(s)
| | - Rocco Catrone
- Southern Illinois University and the Chicago School of Professional Psychology, Chicago, IL USA
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32
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Use of telehealth for facilitating the diagnostic assessment of Autism Spectrum Disorder (ASD): A scoping review. PLoS One 2020; 15:e0236415. [PMID: 32702017 PMCID: PMC7377392 DOI: 10.1371/journal.pone.0236415] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 07/06/2020] [Indexed: 12/13/2022] Open
Abstract
There is a significant delay between seeking help and a confirmed diagnosis of Autism Spectrum Disorder (ASD). This delay can lead to poor outcomes for both the families and individuals. Telehealth potentially offers a way of improving the diagnostic pathway for ASD. We conducted a scoping review examining which telehealth approaches are used in the diagnosis and assessment of ASD in children and adults, whether they are feasible and acceptable, and how they compare with face-to-face diagnosis and assessment methods. A search for all peer-reviewed articles, combining the terms of autism and telehealth was conducted from 2000 to 2019. A total of 10 studies were identified for inclusion in the review. This review of the literature found there to be two methods of using telehealth: (a) Real-Time method e.g. video conferencing that enables teams in different areas to consult with the families and to assess the child/adult in real time and (b) A Store-and-Forward method as Naturalistic Observation Diagnostic Assessment (NODA) system to upload videos of child’s behaviors to a webportal that enables the clinicians to make an assessment remotely. The findings were positive, finding there to be high agreement in terms of the diagnosis between remote methods and face to face methods and with high levels of satisfaction among the families and clinicians. This field is in the very early stages and so only studies with small sample size using surveys and interviews were identified but the findings suggest that there is potential for telehealth methods to improve access to assessment and diagnosis of ASD used in conjunction with existing methods, especially for those with clear autism traits and adults with ASD. Larger randomised controlled trials of this technology are warranted.
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33
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Boutain AR, Sheldon JB, Sherman JA. Evaluation of a telehealth parent training program in teaching self‐care skills to children with autism. J Appl Behav Anal 2020; 53:1259-1275. [DOI: 10.1002/jaba.743] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 11/11/2022]
Affiliation(s)
| | - Jan B. Sheldon
- Department of Applied Behavioral ScienceUniversity of Kansas
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34
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Schieltz KM, Wacker DP. Functional assessment and function-based treatment delivered via telehealth: A brief summary. J Appl Behav Anal 2020; 53:1242-1258. [PMID: 32643811 PMCID: PMC7361834 DOI: 10.1002/jaba.742] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/06/2020] [Accepted: 06/08/2020] [Indexed: 11/10/2022]
Abstract
As the world navigates the COVID-19 health crisis, behavior analysts are considering how best to support families while maintaining services and ensuring the health and safety of everyone involved. Telehealth is one service delivery option that provides families with access to care in their own communities and homes. In this article, we provide a brief summary of the telehealth literature in applied behavior analysis that provided coaching and training to families for individuals who displayed challenging behavior. These studies targeted functional assessment and function-based treatment for challenging behavior. We briefly summarize what is known relative to the assessment and treatment of challenging behavior via telehealth, place these results within a descriptive context of the decisions made by the research team at the University of Iowa, and discuss what we, as behavior analysts, should consider next to advance our understanding and practice of telehealth.
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35
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Unholz-Bowden E, McComas JJ, McMaster KL, Girtler SN, Kolb RL, Shipchandler A. Caregiver Training Via Telehealth on Behavioral Procedures: A Systematic Review. JOURNAL OF BEHAVIORAL EDUCATION 2020; 29:246-281. [PMID: 37670908 PMCID: PMC10479951 DOI: 10.1007/s10864-020-09381-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Telehealth has been utilized to provide behavioral services to families with children with autism spectrum disorder (ASD) and other disabilities. This systematic review provides an update on current research pertaining to the use of telehealth to provide behavior analytic-based services and train caregivers in implementing behavioral procedures. This review also describes information on reported training components and caregivers' procedural fidelity. Empirical studies were collected from five databases. Overall, the studies provide evidence of the utility of telehealth as a service delivery model for providing behavior analytic-based services and for training caregivers to implement behavioral assessments and procedures. The authors discuss potential considerations for developing training packages and training caregivers via telehealth. Future research should use experimental methods to determine effective components for training individuals via telehealth to use behavioral procedures with good fidelity as well as to detect other factors that may influence procedural fidelity.
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Affiliation(s)
- Emily Unholz-Bowden
- Department of Educational Psychology, University of Minnesota, 56 E River Rd, Minneapolis, MN 55455, USA
| | - Jennifer J. McComas
- Department of Educational Psychology, University of Minnesota, 56 E River Rd, Minneapolis, MN 55455, USA
| | - Kristen L. McMaster
- Department of Educational Psychology, University of Minnesota, 56 E River Rd, Minneapolis, MN 55455, USA
| | - Shawn N. Girtler
- Department of Educational Psychology, University of Minnesota, 56 E River Rd, Minneapolis, MN 55455, USA
| | - Rebecca L. Kolb
- Department of Educational Psychology, University of Minnesota, 56 E River Rd, Minneapolis, MN 55455, USA
| | - Alefyah Shipchandler
- Department of Educational Psychology, University of Minnesota, 56 E River Rd, Minneapolis, MN 55455, USA
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Inoue M, Oda M. Consultation on the Functional Assessment of Students with Severe Challenging Behavior in a Japanese Special School for Intellectual Disabilities. Yonago Acta Med 2020; 63:107-114. [PMID: 32494216 DOI: 10.33160/yam.2020.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/28/2020] [Indexed: 11/05/2022]
Abstract
Background It is important to intervene early and treat children and individuals with behavioral disorders. We conducted a functional assessment-based consultation for teachers of several students with severe behavioral disorders and examined the effects of the consultation. Methods Eight students with severe behavioral disorders were selected from two special schools for intellectual disabilities in western Japan. An external consultant team conducted a functional assessment-based consultation in cooperation with a team of teachers. Consultations were held once a month, and comprised three to six sessions per student. Results As a result of the functional assessment, only 8 out of 10 behaviors with some communication function, and 2 with only sensory enhancements were estimated. The Effects of consultations based on functional assessment were presented. It was found that 6 out of 10 target behaviors had obtained high effects. The total score for each behavioral scale showed a statistically significant improvement. Conclusion Although consultations lasted for only six months and occurred from three to six times for each student, scale scores for problem behavior before and after intervention were improved, overall. Each case report suggested that many factors influence the difference in the effects of consultation among individual students. This study is significant in that it provides a model for the consultation system that operates on a short-term basis, and presents a means for small-scale group consultations for students with intellectual disabilities and autism in cooperation with external specialized institutions in special schools in Japan.
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Affiliation(s)
- Masahiko Inoue
- Department of Clinical Psychology, Tottori University Graduate School of Medical Sciences, Yonago 683-8503, Japan
| | - Mayumi Oda
- Department of Clinical Psychology, Tottori University Graduate School of Medical Sciences, Yonago 683-8503, Japan
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Celia T, Freysteinson W, Fredland N, Bowyer P. Battle weary/battle ready: A phenomenological study of parents' lived experiences caring for children with autism and their safety concerns. J Adv Nurs 2019; 76:221-233. [DOI: 10.1111/jan.14213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 08/09/2019] [Accepted: 09/17/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Tania Celia
- Texas Woman's University Denton TX USA
- Sam Houston State University Huntsville TX USA
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Tsami L, Lerman D, Toper-Korkmaz O. Effectiveness and acceptability of parent training via telehealth among families around the world. J Appl Behav Anal 2019; 52:1113-1129. [PMID: 31565804 DOI: 10.1002/jaba.645] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 08/16/2019] [Indexed: 11/08/2022]
Abstract
Teaching parents to conduct functional analyses and to implement functional communication training is an efficacious approach for treating socially maintained problem behavior (Derby et al., 1997). Research has found that delivering this assessment and intervention package via telehealth technologies is efficient and acceptable to caregivers in the United States (Wacker et al., 2013b). We replicated this work with families residing in rural and urban areas of eight countries. Two behavior therapists located in the United States conducted appointments in the participants' native languages, using interpreters as needed. Parent-implemented functional analyses and treatment with functional communication training were highly effective in reducing problem behavior in children diagnosed with autism. Furthermore, parents rated the procedures as acceptable and indicated that the treatment would be effective with their children. These findings indicate that telehealth technologies are a viable option for clinicians to provide behavior analysis services to families around the world.
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Tsami L, Lerman DC. Transfer of treatment effects from combined to isolated conditions during functional communication training for multiply controlled problem behavior. J Appl Behav Anal 2019; 53:649-664. [PMID: 31441043 DOI: 10.1002/jaba.629] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/22/2019] [Indexed: 11/10/2022]
Abstract
Functional communication training (FCT) is highly effective for treating socially maintained problem behavior when based on the results of functional analyses (FA). Research suggests that combining relevant antecedents and consequences of problem behavior during FCT can be an efficient approach to treatment for behavior that is multiply controlled. However, no studies have evaluated whether treatment effects under combined conditions would transfer to single, or isolated, conditions. Participants were 5 children with autism, aged 3 years to 6 years, who engaged in problem behavior maintained by both escape from demands and access to tangibles. An experimenter coached their caregivers via video conferencing to implement FA and FCT in their homes. All participants received FCT under a combined condition, followed by brief exposure to sessions with isolated antecedents and consequences. Treatment effects for just 1 of the 5 participants immediately persisted under isolated conditions. These results suggest that, when caregivers combine variables relevant to multiple functions during FCT, exposure to isolated conditions may at least temporarily produce treatment failures.
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Raulston TJ, Zemantic PK, Machalicek W, Hieneman M, Kurtz-Nelson E, Barton H, Hansen SG, Frantz RJ. Effects of a brief mindfulness-infused behavioral parent training for mothers of children with autism spectrum disorder. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2019. [DOI: 10.1016/j.jcbs.2019.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Telehealth as a Model for Providing Behaviour Analytic Interventions to Individuals with Autism Spectrum Disorder: A Systematic Review. J Autism Dev Disord 2019; 49:582-616. [PMID: 30155578 PMCID: PMC6373531 DOI: 10.1007/s10803-018-3724-5] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Interventions based on applied behaviour analysis are considered evidence based practice for autism spectrum disorders. Due to the shortage of highly qualified professionals required for their delivery, innovative models should be explored, such as telehealth. Telehealth utilises technology for remote training and supervision. The purpose of our study was to systematically review the literature researching telehealth and ABA. We analysed intervention characteristics, outcomes and research quality in 28 studies and identified gaps. Intervention characteristics were: (1) research design (2) participants (3) technology (4) dependent variables (5) aims. Outcomes were favourable with all studies reporting improvements in at least one variable. Quality ratings were significantly low. Implications for future research and practice are discussed in light of identified methodological downfalls.
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Neely L, Garcia E, Bankston B, Green A. Generalization and maintenance of functional communication training for individuals with developmental disabilities: A systematic and quality review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 79:116-129. [PMID: 29471978 DOI: 10.1016/j.ridd.2018.02.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 01/17/2018] [Accepted: 02/03/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Functional communication training (FCT) is considered an evidence-based practice for treating problem behavior in individuals with developmental disabilities (e.g. autism, intellectual disabilities, down syndrome, etc.). However, there is little known on how to sustain behavioral change following FCT interventions. This systematic and quality review synthesizes the current literature base evaluating the maintenance and generalization of behavioral effects following FCT. METHOD A systematic review identified 37 studies that met the pre-set inclusion criteria. Those studies were summarized in terms of: (a) generalization dimension, (b) generalization assessment design, (c) maintenance assessment design, (d) maintenance and generalization teaching strategy, and (e) latency to maintenance probes. All studies employed single-case research designs and were evaluated using the What Works Clearinghouse pilot single-case research standards (Kratochwill et al., 2013) as adapted by Maggin, Briesch, and Chafouleas (2013). Maintenance and generalization data were evaluated using a researcher-developed rubric based on the WWC standards. RESULTS AND DISCUSSION Results indicate that 30 studies met standards or met standards with reservations while only six studies also met all of the maintenance and generalization standards. Of the six studies, five did not implement any additional strategies beyond the contacting natural contingencies that is inherent in the FCT intervention. Implications for future research and practice are discussed.
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Affiliation(s)
- Leslie Neely
- The University of Texas at San Antonio, United States.
| | - Elaina Garcia
- The University of Texas at San Antonio, United States
| | | | - Andrew Green
- The University of Texas at San Antonio, United States
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Keefer A, White SW, Vasa RA, Reaven J. Psychosocial interventions for internalizing disorders in youth and adults with ASD. Int Rev Psychiatry 2018. [PMID: 29537895 DOI: 10.1080/09540261.2018.1432575] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Internalizing disorders are common in individuals with ASD. Psychosocial interventions targeting these disorders in the ASD population have burgeoned in the last decade. Cognitive-behavioural therapy, modified for ASD, is the most frequently investigated model, although other interventions, including behaviour therapy, third-wave interventions, models targeting transdiagnostic constructs, and alternative interventions and treatment delivery methods are now emerging. This review provides a summary of the efficacy of these interventions in treating internalizing disorders in youth and adults with ASD. The barriers to accessing these treatments, which are experienced by many individuals with ASD and their families, as well as future research directions, are also discussed.
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Affiliation(s)
- Amy Keefer
- a Center for Autism and Related Disorders , Kennedy Krieger Institute , Baltimore , MD , USA.,b Department of Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Susan W White
- c Department of Psychology , Virginia Tech , Blacksburg , VA , USA
| | - Roma A Vasa
- a Center for Autism and Related Disorders , Kennedy Krieger Institute , Baltimore , MD , USA.,b Department of Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Judy Reaven
- d Department of Psychiatry , University of Colorado Anschutz Medical Campus , Aurora , CO , USA
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Erturk B, Machalicek W, Drew C. Self-Injurious Behavior in Children With Developmental Disabilities: A Systematic Review of Behavioral Intervention Literature. Behav Modif 2017; 42:498-542. [PMID: 29179569 DOI: 10.1177/0145445517741474] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We reviewed single-case research studies examining the effects of behavioral interventions for self-injurious behavior (SIB) in young children with autism and developmental disabilities. Systematic searches of electronic databases, journals, and reference lists identified 46 studies (66 participants younger than the age of 12) meeting inclusion criteria. Studies were examined based on (a) participant demographics, (b) topography and function of SIB, (c) type of functional behavior assessment (FBA), (d) intervention procedures and outcomes, and (e) experimental design and measurement. Intervention strategies were categorized as antecedent manipulations, teaching behavior, consequence-based procedures, and/or extinction procedures. Positive outcomes were reported for 78% of participants in the reviewed studies and 88% of the participants were diagnosed with autism. Results suggest the effectiveness of behavioral interventions to decrease SIB for young children with disabilities; however, the frequent use of packaged interventions without component analysis limits the conclusiveness of any treatment recommendation. Suggestions for future research are discussed.
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