Conducting Assessment and Treatment of Problem Behavior for Children with Autism Via Telehealth

Background:  Problem behavior (e.g., aggression toward others, self-injurious behavior, property destruction) is recognized as a significant stressor for caregivers of children with autism.  It can also be a barrier to early intervention efforts.  Delivering evidence-based treatment for problem behavior via telehealth is a promising method for increasing access to these services, particularly for families who live in rural areas.

Objectives:  The purpose of this investigation was to evaluate the efficacy of remotely training and coaching caregivers via telehealth to conduct functional analyses and implement functional communication training to address problem behaviors displayed by young children with an autism spectrum disorder in their homes.  In addition to a summary of this project and its impact on problem behavior displayed by children with autism, a discussion of how telehealth was utilized and set up within the home environment will be presented.

Methods:  Fifty-one children ages 1-6 were diagnosed with an autism spectrum disorder using the ADOS and the ADI-R; most of these participants continued with the behavior assessment and treatment phases of the study.  Functional analyses and functional communication training were conducted by children’s caregivers, who received remote training as well as “real time” remote coaching from a behavior therapist who was on average 123 miles from the families’ homes.  We evaluated these effects on three-levels: individual, group, and caregiver. At the individual level, we evaluated the effects of functional analyses and functional communication training on problem behavior displayed in session by each child using single-case designs. At the group level, we will evaluate the effects of functional communication training for children participating in a randomized control trial. At the caregiver level, we evaluated changes in caregiver stress and self-efficacy ratings at pre- and post-treatment, as well as six months after treatment ended.

Results: Individual analyses to date show that 83% of children reached at least a 90% reduction in their identified problem behavior. Group results analyzed to date demonstrate that problem behavior decreases by an average of 91% following the implementation of functional communication training. Caregiver results suggest improved functioning following treatment, with caregivers reporting reduced stress and increased self-efficacy over time. The overall costs of providing six months of weekly behavioral services to the children averaged $1,440 per family whereas when the same procedures were conducted in vivo in a previous project, the average cost was $6,984.

Conclusions:  Functional analysis and functional communication training can be successfully delivered to children with autism via telehealth.  Caregivers are able to conduct the assessment and treatment sessions in their own homes with remote training and coaching from a behavior therapist.