Measuring the Effects of Training Parents to Provide Intervention Via Telemedicine

Background:  With the dramatic increase in children diagnosed with autism spectrum disorders (ASD) has come a shortage of qualified interventionists to provide services. The lack of interventionists is even more of a challenge for those who reside in rural or remote regions.  One way to address this growing need is to systematically train parents to implement intervention during natural language interactions with their child. Two previous studies demonstrated that an intensive one-week parent training program is effective for teaching parents to implement Pivotal Response Treatment (PRT) and increasing social communication in children (Koegel, Symon, & Koegel, 2002; Symon, 2005). Following training, parents were required to mail videotapes monthly for 3 consecutive months, and then received feedback via phone calls.  While the data suggest that these follow up procedures were efficacious, they lack efficiency considering the technology that is currently available. Further, using technology to provide follow up support may more effectively address the changing needs of children over time.

Objectives:  To evaluate the efficacy of using telemedicine (via Behavior Imaging technology) as a tool for providing immediate feedback and continued support for parents within a randomized clinical trial.

Methods: Forty-three parent-child dyads were randomly assigned to treatment and control groups.  Both groups received one-week of intensive, in-vivo parent training in PRT at our research center.  Consistent with previously published research, the control group (non-telemedicine) mailed a video tape monthly for 3 consecutive months and received feedback via phone calls.  The treatment (telemedicine) group uploaded 3 videos per week over 3 consecutive months to Behavior Imaging’s secure website, received “tagged” feedback on each video from a PRT therapist, and received feedback via a phone call at the end of each week.  Primary dependant measures—parent fidelity of implementation of PRT and functional verbalizations produced by the child—were collected for each parent-child dyad at baseline, post initial in-vivo parent training, and again at follow up.  Data on compliance with the follow up procedures (telemedicine vs. non-telemedicine) were also collected.  To ensure integrity with treatment protocols, the main analysis was limited to families who demonstrated 75% or better compliance. 

Results:  While both groups improved significantly on each of the primary dependent measures, no significant differences between treatment and control groups were observed.  However, the treatment group (telemedicine) demonstrated significantly better compliance with follow-up procedures. 

Conclusions:  While differences between telemedicine and non-telemedicine groups were not observed, compliance may be a critical mediating variable.  That is, significant improvements in parent fidelity of implementation of PRT and functional verbal utterances produced by the child were observed when parents maintained 75% or better compliance with follow up procedures, regardless of whether telemedicine was used.  The data indicating that parents were significantly more compliant in the treatment group suggests that telemedicine technology may improve compliance with treatment protocols, and, therefore, may lead to more reliable treatment gains.  The results of this study may also have important implications for delivery of cost-effective and efficacious intervention for families living in rural or remote areas.