Association for Behavior Analysis International

Behavior analytic interventions delivered via telehealth have undergone a number of experimental evaluations with evidence supporting the use of telehealth to reduce problem behavior and increase functional communication. This symposium presents the results of four studies, conducted across three research groups, evaluating innovations in the assessment and treatment of problem behavior via telehealth. First, researchers will present advances in assessment including results from a brief functional analysis delivered via telehealth (Talk 1) and results from a randomized control trial comparing brief observations conducted via telehealth to functional analysis conducted via telehealth (Talk 2). Regarding functional communication treatment, researchers will present results from an intercontinental telehealth-mediated intervention with demonstrated results and acceptability (Talk 3). Researchers will also present on the generalizability of FCT beyond telehealth training contexts (Talk 4). Finally, as a leader in this area of Behavior Analysis, Dr. Jennifer McComas, will discuss the studies, findings, and implications for research and practice.

Practicing BCBAs and Researchers

Many children have do not have access to ABA services due to geographic distance from a provider. Telehealth technology can increase children’s access to effective interventions. The purpose of this study was to evaluate the use of parent-implemented brief functional analysis and function-based intervention with coaching delivered via telehealth technology. Children with autism, age birth to 17 years old, and their parents were eligible to participate in the study. Parents conducted a brief functional analysis, with coaching provided by a researcher via telehealth technology. Following the brief functional analysis, the parent implemented a function-based intervention. The efficacy of the function-based intervention was evaluated using a reversal design. Data collection is ongoing. Implications for practice and directions for future research will be discussed.

Randomized controlled trials (RCTs) are deemed the “gold standard” of scientific research. By contrast, research in applied behavior analysis rarely employs this type of study, which may limit the acceptance of many common and effective behavior analytic procedures. Recently, two large-N RCTs have been conducted using telehealth to provide scientific validation of both FA and FCT procedures (Lindgren & Wacker, 2011-2015; Lindgren & Wacker, 2015-2019). In the initial study, a multi-site RCT of FCT, Lindgren et al. (under review) found FCT superior to a delayed control. In the current study, an RCT of functional analysis (FA) procedures was conducted to determine whether FA procedures are superior to brief observations. A preliminary comparison of treatment outcomes suggests that treatment following an FA may not be more efficient or result in greater reduction in problem behavior than treatment following brief observations. Possible reasons for the findings, implications for practice and recommendations for future research will be discussed.

Interventions combining functional analysis (FA) and functional communication training (FCT) are effective in mitigating socially maintained problem behaviors. Recent studies evaluating the effectiveness of using telehealth to train caregivers across large geographical distances in the United States (Wacker et al., 2016) and internationally (Tsami & Lerman, 2019) indicate that this modality can increase families’ accessibility to evidence-based interventions for problem behavior, such as FCT. Additionally, the telehealth model reduces service costs while maintaining caregiver procedural integrity (Ferguson et al., 2018). Providing these services to international families might decrease barriers to effective treatment and promote parental well- being (e.g., reduce stress and depression; Frantz et al., 2018). In this study, practitioners and interpreters in the United States remotely coached six caregivers of children with autism residing in two developing countries in Asia (i.e., Pakistan and Vietnam) to implement FA and FCT. All children reached the 90% reduction of problem behavior criterion and acquired the communicative response. Additionally, all caregivers indicated that the procedures were acceptable. The impact of training on levels of parenting stress, psychological distress, and self- efficacy also will be discussed. Overall, our findings suggest telehealth is a feasible modality for service delivery in Asia

Functional communication training (FCT) is a well-established treatment for problem behavior in young children with autism (National Autism Center, 2015; Wong et al., 2014). Parent-mediated FCT delivered in the home, but facilitated by therapists through telehealth is an effective approach that extends the treatment model into a natural context (Lindgren et al., 2016). Despite an extensive literature base supporting FCT, little is known about the generalized effects of FCT outside of the training context. In this study, generalization of treatment effects were evaluated as part of a large multi-site study on parent-delivered FCT for children with autism using telehealth. To meet this purpose, data were collected from pre- and post-treatment parent ratings of targeted and non-targeted problem behavior in settings and contexts outside of the training conditions. Results suggest that the effects of FCT may extend beyond the behaviors and contexts targeted for treatment. Possible reasons for successful generalization, implications for practice, and suggestions for future research will be discussed.