“…Individuals with autism spectrum disorders (ASD) and intellectual and developmental disabilities (IDD) have benefited from the use of telehealth to train caregivers and staff in the assessment and delivery of ABA services (Barretto et al, 2006; Boisvert et al, 2010; Ferguson et al, 2019; Fisher et al, 2014; Lindgren et al, 2016; Tomlinson et al, 2018; Unholz‐Bowden et al, 2020; Vismara et al, 2009). A growing scientific evidence base indicates that some treatment services can be delivered directly to clients via telehealth using synchronous (i.e., real‐time) videoconferencing technology (Ferguson et al, 2020; Myers et al, 2017; Pellegrino & DiGennaro‐Reed, 2020) and that parents and staff can be trained via telehealth to deliver services to clients in‐person (Bearss et al, 2018; Benson et al, 2018; Higgins et al, 2017; Monlux et al, 2019; Suess et al, 2014; Unholz‐Bowden et al, 2020).…”
Telehealth delivery of applied behavior analysis treatment has focused on supervision or staff and parent training, rather than the direct delivery of treatment to clients. The novel coronavirus (COVID‐19) crisis had the potential to significantly disrupt access to direct treatment for individuals with autism. We report a sample of 17 cases that transitioned from in‐person to telehealth delivery of treatment when shelter‐in‐place orders were issued. Of these cases, 76% of participants transitioned to technician‐delivered telehealth services whereas the rest transitioned to a caregiver‐implemented telehealth model. Participants continued to access a similar dosage of treatment hours per week in spite of the treatment model transition (in‐person M = 12; telehealth M = 11) and maintained or improved correct independent responding across all targets from in‐person treatment (M = 75%) to telehealth treatment (M = 80%). These findings provide initial evidence that some clients with autism benefit from technician‐delivered telehealth services.
“…Individuals with autism spectrum disorders (ASD) and intellectual and developmental disabilities (IDD) have benefited from the use of telehealth to train caregivers and staff in the assessment and delivery of ABA services (Barretto et al, 2006; Boisvert et al, 2010; Ferguson et al, 2019; Fisher et al, 2014; Lindgren et al, 2016; Tomlinson et al, 2018; Unholz‐Bowden et al, 2020; Vismara et al, 2009). A growing scientific evidence base indicates that some treatment services can be delivered directly to clients via telehealth using synchronous (i.e., real‐time) videoconferencing technology (Ferguson et al, 2020; Myers et al, 2017; Pellegrino & DiGennaro‐Reed, 2020) and that parents and staff can be trained via telehealth to deliver services to clients in‐person (Bearss et al, 2018; Benson et al, 2018; Higgins et al, 2017; Monlux et al, 2019; Suess et al, 2014; Unholz‐Bowden et al, 2020).…”
Telehealth delivery of applied behavior analysis treatment has focused on supervision or staff and parent training, rather than the direct delivery of treatment to clients. The novel coronavirus (COVID‐19) crisis had the potential to significantly disrupt access to direct treatment for individuals with autism. We report a sample of 17 cases that transitioned from in‐person to telehealth delivery of treatment when shelter‐in‐place orders were issued. Of these cases, 76% of participants transitioned to technician‐delivered telehealth services whereas the rest transitioned to a caregiver‐implemented telehealth model. Participants continued to access a similar dosage of treatment hours per week in spite of the treatment model transition (in‐person M = 12; telehealth M = 11) and maintained or improved correct independent responding across all targets from in‐person treatment (M = 75%) to telehealth treatment (M = 80%). These findings provide initial evidence that some clients with autism benefit from technician‐delivered telehealth services.
“…Thus, the analysis was conducted on 30 children who received telehealth-enabled FCT and 27 children who continued with treatment as usual. Note that data from the first 10 participants randomized to the treatment group are described in Monlux et al [ 60 ]. Fig.…”
Section: Methodsmentioning
confidence: 99%
“…Prior to initiation of treatment, a member of the study team, who was a Board Certified Behavior Analyst (BCBA), traveled to the child’s home to conduct a functional analysis (FA) of the child’s problem behavior [ 60 ]. Briefly, six FA test conditions (i.e., ignore , attention , tangible , social escape , academic escape , and transition escape ) and one control condition ( play ) were conducted at least 4 to 6 times over 2 days in the child’s home [ 33 , 60 ]. In the ignore condition, the child was observed with no leisure items (e.g., toys) in the room, and caregivers were coached to ignore the child’s problem behavior.…”
Section: Methodsmentioning
confidence: 99%
“…The treatment protocol was tailored to the results of each child’s FA [ 60 ]. For example, if the results of the FA indicated that the function of the child’s problem behavior was to gain access to attention and/or tangibles, the caregiver was coached to ignore the problem behavior when it occurred and to provide attention and/or preferred items for an appropriate alternative communicative response.…”
Section: Methodsmentioning
confidence: 99%
“…Based on best practice guidelines, the caregiver was initially taught to provide immediate and continuous reinforcement each time their child engaged in the appropriate communicative response to strengthen the new replacement communication. To prevent a loss in treatment effects when natural caregiver delays to providing reinforcement would inevitably occur, children were subsequently taught to tolerate delays by systematically increasing the response requirement or the amount of time required to wait for the reinforcer [ 60 ]. To increase generalization effects, we simulated environmental conditions that the child regularly encountered at home through collaboration with the caregivers.…”
Background
Children with fragile X syndrome (FXS) are at increased risk for exhibiting problem behaviors such as aggression and self-injury. However, many children with FXS have limited access to behavioral treatments that have known efficacy due to the low availability of treatment providers and the wide geographical dispersion of families with FXS across the country. Telehealth may offer a cost-effective and practical solution to overcome these significant barriers. We examined the effect of administering an established behavior analytic intervention called functional communication training (FCT) via telehealth on levels of problem behaviors exhibited by boys with FXS. We also examined treatment acceptability, as well as the effect of the treatment on levels of parenting stress.
Methods
Boys with FXS, aged 3 to 10 years, who displayed problem behaviors daily, were randomized to receive FCT via telehealth (n = 30) or treatment as usual (n = 27) over 12 weeks. Outcome measures included in-session observations of problem behavior, the Aberrant Behavior Checklist—Community (ABC-C), the Treatment Acceptability Rating Form—Revised (TARF-R), and the Parenting Stress Index, 4th edition (PSI-4).
Results
Intention-to-treat analyses indicated that scores on the irritability subscale of the ABC-C, our primary outcome measure, decreased significantly for boys who received FCT via telehealth compared to boys who received treatment as usual (p < .001, Cohen’s d = 0.65). In-session observations conducted for those who received treatment showed that levels of problem behavior decreased by 91% from baseline. Levels of parenting stress related to child behavioral problems were also lower following FCT treatment, and caregivers reported that the intervention was acceptable.
Conclusions
These findings support telehealth-enabled FCT as a framework for expanding access to behavioral treatments for problem behaviors in children with FXS. Expanded delivery of behavior analytic treatment via telehealth also has the potential to lower healthcare costs, improve child and family quality of life, and lead to advances in the treatment of problem behavior in the broader population of individuals with neurodevelopmental disorders.
Trial registration
ClinicalTrials.gov, NCT03510156. Registered 27 April 2018
Applied behavior analysis (ABA) service delivery is a complicated process and some issues stemming from this process can be controversial. Ethical dilemmas can challenge ABA practitioners and require thorough examination. The goal of this paper is to identify the existence of value‐based ethical dilemmas stemming from potential tensions among underlying values and to provide behavior practitioners with a systematic approach to addressing these dilemmas. Specifically, we use a step‐by‐step protocol for ethical deliberation and dilemma resolution in situations involving value‐based ethical dilemmas. We describe the application of this approach to clinical cases and its implications for services provided via telehealth.
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