Accelerating the Pace of Treatment Research In Autism Spectrum Disorder

Background: There are various challenges to delivering health care to families with Autism Spectrum Disorder (ASD) with long waiting lists and few specialist services. Barriers to service delivery and utilization are even more exacerbated for families living in rural or remote areas, often resulting in limited access to preventative mental health services in general and parenting ASD interventions in particular. Telemedicine, or using technology to deliver treatment, can support long-distance clinical health care; however there is little information as to how this resource may translate into practice for families with ASD.

Objectives: The current pilot study examined a manualized, telemedicine-delivered parent-implemented intervention to families of toddler-aged children with ASD. The aim was that telemedicine as a teaching modality would optimize parenting intervention strategies for supporting children’s social, affective, communicative, and play development.

 Methods: Ten families received 12 weekly one-hour sessions of direct coaching and instruction of the Early Start Denver Model (ESDM) Parent Delivery Model through an Internet-based video conferencing program. Each week parents were coached on a specific aspect of the intervention through video conferencing program and webcam, allowing parent and therapist to see, hear, and communicate with one another. Parents were taught how to integrate the ESDM into natural, developmentally and age-appropriate play activities and caretaking routines in their homes. Video data were recorded within a single subject design from 10 minutes of parent-child interaction at the start of each session and coded by two independent raters blind to the order of sessions and hypotheses of the study.

Results: Findings suggested that integrating telemedicine as a teaching modality facilitated: (a) parents to implement the ESDM more skillfully after coaching; (b) an increase in the number of children’s spontaneous words, gestures, and imitative behaviors; and (c) perceived satisfaction and a sense of connection with remote coaching and transfer of skills.

Conclusions: The findings provide initial support of telemedicine as an effective teaching modality for transferring an evidence-based, comprehensive early intervention model into parents’ homes to be delivered within typical parent-child activities. Additional research is needed to confirm the promise and utility of telemedicine for transporting services to families with limited access.