The Feasibility of an Adaptive Telehealth Program for Delivering Parent Mediated Intervention for Autism Spectrum Disorder

Background: There is strong empirical and theoretical support for parent involvement in interventions for autism spectrum disorder (ASD), with rapid growth in the development and evaluation of manualized parent-mediated early interventions (PMI). Despite purported benefits of PMI, such programs are highly under-utilized in community settings, due in large part to a lack of trained professionals, lengthy waitlists, child care, transportation, and reimbursement issues. These barriers compel examination of alternative service delivery methods, such as telehealth, to increase access to care.

Benefits of telehealth include greater provider and patient coverage and opportunities for standardized yet individualized learning. Indeed, telehealth is well-suited to deliver adaptive PMI (e.g., stepped-care models) as varying levels of intensity and support can be automatically provided as needed. Adaptive telehealth can deliver instruction to parents in a self-directed format or with the addition of remote “coaching.” Thus, we have developed a telehealth program to provide PMI in a stepped-care format in an effort to increase dissemination and optimize delivery of early intervention for young children with ASD.

Objectives: We developed a stepped-care telehealth program, Me Too Online, to deliver PMI in an evidence-based imitation intervention called reciprocal imitation training (RIT). The goal of the current pilot randomized control trial (RCT) was to demonstrate feasibility of the stepped-care model, and evaluate the initial impact of the program on parent behavior and experiences, and child social communication.

Methods: This 15-week pilot RCT compared Me Too Online to a waitlist control in 20 young children with ASD and their parents (18 to 49 months). Families in Me Too Online used a self-directed website for five weeks and then responder status was evaluated based on parent fidelity and self-efficacy. Non-responding parents received remote coaching sessions over the next five weeks. Those in the control condition received usual care and were given the chance to participate in Me Too Online after 15 weeks. Parent report and standardized assessments were administered at baseline and at 15 weeks.

Results: Results of ANCOVA indicated children in Me Too Online demonstrated greater increases in parent report of social communication (p<.05, d = 1.27) on the Social Communication Checklist. Specifically, significant increases were observed in ratings of social engagement (p< .05, d = 1.39) and imitation (p< .05, d = 1.49). Results of ANCOVA also indicated significantly greater increases in parenting self-efficacy for Me Too Online relative to control (p < .05, Cohen’s d = 1.4). Parents in Me Too Online showed improvements in fidelity concurrent with participation in the program; roughly seventy percent of parents required additional coaching after use of the website alone. Parents rated Me Too Online content and delivery method as highly acceptable, useful, and effective.

Conclusions: This study provides initial data supporting the feasibility and effectiveness of a stepped-care PMI telehealth program for young children with ASD. An important next step will be to evaluate the extent to which such a program can improve reach and reduce costs associated with early intervention for ASD on a larger scale.