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Moore TR, Lee S, Freeman R, Mahmoundi M, Dimian A, Riegelman A, Simacek JJ. A Meta-Analysis of Treatment for Self-Injurious Behavior in Children and Adolescents With Intellectual and Developmental Disabilities. Behav Modif 2024; 48:216-256. [PMID: 38197303 DOI: 10.1177/01454455231218742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Self-injurious behavior (SIB) among children and youth with developmental disabilities has not diminished in prevalence despite the availability of effective interventions, and the impact on quality of life for people and their families is devastating. The current meta-analysis reviews SIB intervention research between 2011 and 2021 using single-case experimental designs with children and youth up to 21 years old and provides a quantitative synthesis of data from high-quality studies including moderator analyses to determine effects of participant and study characteristics on intervention outcomes. Encouraging findings include a high level of effectiveness across studies in the decrease of SIB (Tau-U = -0.90) and increase of positive behavior (Tau-U = 0.73), as well as an increase in studies (relative to prior reviews) reporting intervention fidelity, generalization, maintenance, and social validity. However, our findings shed limited light on potential moderating variables in the development of interventions for children and youth who exhibit SIB. Of the potential moderators of intervention effects, only implementer (researcher/therapist vs. parent/caregiver) and setting (clinic vs. home) were significantly associated with improved outcomes. We discuss the need for more robust involvement of natural communities of implementers in SIB intervention research to better equip them to effectively and sustainably meet the needs of people they care for. We also discuss the importance of creating systems enabling broad access for children with SIB to effective interventions in service of reducing burden for people, families, and society over time.
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Affiliation(s)
- Timothy R Moore
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, USA
| | - Seunghee Lee
- Institute on Community Integration, University of Minnesota, Minneapolis, USA
| | - Rachel Freeman
- Institute on Community Integration, University of Minnesota, Minneapolis, USA
| | - Maryam Mahmoundi
- Institute on Community Integration, University of Minnesota, Minneapolis, USA
| | - Adele Dimian
- Institute on Community Integration, University of Minnesota, Minneapolis, USA
| | - Amy Riegelman
- Social Sciences Libraries, University of Minnesota, Minneapolis, USA
| | - Jessica J Simacek
- Institute on Community Integration, University of Minnesota, Minneapolis, USA
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2
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Abstract
Extensive reviews of functional analysis literature were conducted 10 (Beavers et al., 2013) and 20 (Hanley et al., 2003) years ago; we expanded this review to capture the vast and innovative functional analysis research that has occurred over the past decade. Our review produced 1,333 functional analysis outcomes from 326 studies on the functional analysis of problem behavior between June 2012 and May 2022. Some characteristics of functional analysis studies were similar across the current and previous two reviews (e.g., child participants, developmental disability diagnosis, use of line graphs depicting session means, differentiated response outcomes). Other characteristics deviated from the previous two reviews (e.g., increase in autistic representation, outpatient settings, use of supplementary assessments, the inclusion of tangible conditions, and multiple function outcomes; decrease in session durations). We update previously reported participant and methodological characteristics, summarize outcomes, comment on recent trends, and propose future directions in the functional analysis literature.
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Affiliation(s)
- Isaac J Melanson
- University of Nebraska Medical Center's Munroe-Meyer Institute, Severe Behavior Department, Omaha, United States
| | - Tara A Fahmie
- University of Nebraska Medical Center's Munroe-Meyer Institute, Severe Behavior Department, Omaha, United States
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3
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Abstract
Since the early 2000s, telehealth has been used to provide behavior analytic intervention to individuals with autism spectrum disorder (ASD). Evaluating evidence supporting telehealth remains valuable, especially as there has been increased accessibility since the COVID-19 pandemic. Although there is empirical support for telehealth as an effective service-delivery option, important variables (e.g., costs, implementer training) remain unknown. Despite potential roles in telehealth service-delivery models, a careful review of participant prerequisite skills, implementer characteristics (e.g., experience, education), technology variables (e.g., HIPAA compliance), and skill(s) targeted (i.e., mastered or untrained skills) have not been considered. Therefore, we aimed to extend prior telehealth literature reviews by evaluating current research across variables important for telehealth service-delivery involving individuals with ASD. We found thorough descriptions of participants and implementers, implementer training, and social validity evaluations. Limitations of telehealth literature include exclusion of teen and adult participants, limited description of prerequisite skills and evaluations of direct telehealth interventions. Future research areas were identified.
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4
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Tsami L, Nguyen JT, Alphonso N, Lerman D, Matteucci M, Chen N. Outcomes and Acceptability of Telehealth-Based Coaching for Caregivers in Asian Countries. Behav Modif 2023; 47:297-323. [PMID: 35850586 DOI: 10.1177/01454455221113560] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Recent studies evaluating the effectiveness of using telehealth to train caregivers across large geographical distances in the United States and internationally indicate that this modality can increase families' accessibility to evidence-based interventions for problem behavior. In this study, experimenters and interpreters in the United States remotely coached nine caregivers of children with disabilities residing in three countries in Asia to implement functional analyses (FA) and functional communication training (FCT). Five of the nine families were culturally matched to either the experimenter or the interpreter. Problem behavior was reduced to near-zero levels for all but one participant. Furthermore, all caregivers implemented the procedures with high levels of integrity and rated the assessment and treatment as highly acceptable, regardless of cultural matching or use of interpreters. Overall, findings suggest telehealth-based caregiver coaching and caregiver-implemented FA plus FCT is feasible and acceptable in Asia.
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Affiliation(s)
| | | | | | | | | | - Ning Chen
- University of Houston-Clear Lake, TX, USA
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5
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Hay‐Hansson A, Eldevik S, Strømgren B. Videoconference to supervise early intensive behavioral intervention: A preliminary evaluation of acceptability. Behavioral Interventions 2022. [DOI: 10.1002/bin.1924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- Aina Hay‐Hansson
- The Habilitation Centre for Children and Adolescents Vestre Viken Health Trust Drammen Norway
- Department of Behavioural Science Oslo Metropolitan University Oslo Norway
| | - Sigmund Eldevik
- Department of Behavioural Science Oslo Metropolitan University Oslo Norway
| | - Børge Strømgren
- Department of Behavioural Science Oslo Metropolitan University Oslo Norway
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6
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Meadan H, Lee JD, Chung MY. Parent-Implemented Interventions via Telepractice in Autism Research: A Review of Social Validity Assessments. Curr Dev Disord Rep 2022; 9:213-219. [PMID: 36405977 PMCID: PMC9640782 DOI: 10.1007/s40474-022-00259-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 11/09/2022]
Abstract
Purpose of Review Parent-implemented autism interventions are considered empirically validated interventions and the use of telepractice in these interventions is reported as effective. However, little is known about the social validity assessments and outcomes of these interventions. The purpose of this review is to explore the current practices of conducting social validity assessment and reporting its outcomes within parent-implemented telepractice autism interventions. Recent Findings The 11 reviewed studies included caregivers as participants, telepractice intervention focusing on social communication outcomes of young autistic children, and were published in a peer-reviewed journal within the past five years. Summary The researchers in the reviewed articles reported positive outcomes for parent-implemented telepractice autism interventions. Notably, however, information about social validity assessments of the interventions was limited. Researchers are encouraged to evaluate the social validity of interventions using multiple data sources and methods, and report on their findings as they relate to other types of data.
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Affiliation(s)
- Hedda Meadan
- grid.35403.310000 0004 1936 9991Department of Special Education, University of Illinois Urbana-Champaign, 1310 South Sixth Street, Champaign, IL 61820 USA
| | - James D. Lee
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA
| | - Moon Y. Chung
- grid.419689.b0000 0000 8867 2215Department of Education Studies, Stonehill College, Easton, MA USA
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7
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O’Regan O, Doyle Y, Murray M, McCarthy VJC, Saab MM. Reducing challenging behaviours among children and adolescents with intellectual disabilities in community settings: a systematic review of interventions. Int J Dev Disabil 2022; 70:20-39. [PMID: 38456141 PMCID: PMC10916929 DOI: 10.1080/20473869.2022.2052416] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 03/03/2022] [Indexed: 03/09/2024]
Abstract
Background: Challenging behaviours are common among children and adolescents with intellectual disabilities. Such behaviours often result in poor quality of life outcomes such as physical injury, difficulties with relationships and community integration. Aim: This systematic review aimed to synthesise evidence from studies that assessed the effect of interventions used to reduce/manage challenging behaviour among children with intellectual disabilities in community settings. Methods: Studies published between January 2015 and January 2021 were sought from five electronic databases. The quality of studies was assessed, and a narrative synthesis was conducted. Results: A total of 11 studies were included which utilised various non-pharmacological interventions including multi-model interventions, microswitch technology, cognitive behavioural therapy, art, music and illustrated stories. Microswitch cluster technology was the most used intervention. Studies using pharmacological interventions were not retrieved. Results indicated that a person-centred planning approach was key to offering individualised treatment. Conclusions: The superiority of one intervention or a combination of interventions could not be determined from this review given the heterogeneity of studies. Future research is required to explore the use and effects of pharmacological interventions to compare outcomes and improve quality of care of children with intellectual disabilities.
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Affiliation(s)
- Orla O’Regan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Yvonne Doyle
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Marguerite Murray
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Vera J. C. McCarthy
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Mohamad M. Saab
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
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8
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Aranki J, Wright P, Pompa-Craven P, Lotfizadeh AD. Acceptance of Telehealth Therapy to Replace In-Person Therapy for Autism Treatment During COVID-19 Pandemic: An Assessment of Patient Variables. Telemed J E Health 2022; 28:1342-1349. [PMID: 35119331 DOI: 10.1089/tmj.2021.0397] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Importance: Children with autism achieve improved behavioral outcomes with applied behavior analytic (ABA) interventions. Typically, ABA is delivered in a participant's home or in a clinic setting. At the onset of COVID-19, treatment in these environments was not available due to health exposure concerns. A large social service organization in California rapidly pivoted to the delivery of ABA intervention through telehealth. Access disparity for telehealth has been a historical concern in health care delivery, particularly for disenfranchised populations within the autistic participant population. Objective: This study evaluated the demographic and behavioral variables associated with the acceptance or declination of telehealth by the pediatric participants' caregivers at the onset of the pandemic. Design, Setting, Participants: A non-experimental design was used, and archival data were compared for a random sample of 100 participants with autism who accepted telehealth interventions with 100 participants who declined it. Main Outcomes and Measures: Socioeconomic data, gender, age, ethnicity, language, and household size were compared. Clinical data were compared for treatment dosage, standardized Vineland Adaptive Behavior Scales scores, and Verbal Behavior Milestones Assessment and Placement Program scores. Results: None of the demographic variables were statistically significant in a participant's acceptance or declination of telehealth, but there were moderate differences in treatment dosage across the groups. Conclusions: It is concerning that a large portion of participants initially declined intervention via telehealth, resulting in these participants experiencing a gap in intervention during the pandemic. As intervention is imperative for pediatric autism participants, it is untenable that ∼40% of the population initially declined telehealth at the start of the pandemic.
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Affiliation(s)
- Jenna Aranki
- Autism Services Division, Easterseals Southern California, Irvine, California, USA
| | | | - Paula Pompa-Craven
- Autism Services Division, Easterseals Southern California, Irvine, California, USA
| | - Amin D Lotfizadeh
- Autism Services Division, Easterseals Southern California, Irvine, California, USA
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9
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Edelstein ML, Becraft JL, Gould K, Sullivan A. Evaluation of a delay and denial tolerance program to increase appropriate waiting trained via telehealth. Behavioral Interventions 2021. [DOI: 10.1002/bin.1855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Matthew L. Edelstein
- Kennedy Krieger Institute and Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Jessica L. Becraft
- Kennedy Krieger Institute and Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Kaitlin Gould
- Kennedy Krieger Institute and Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Alicia Sullivan
- Kennedy Krieger Institute and Johns Hopkins University School of Medicine Baltimore Maryland USA
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10
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Standish CM, Lambert JM, Copeland BA, Bailey KM, Banerjee I, Lamers ME. Partially Automated Training for Implementing, Summarizing, and Interpreting Trial-Based Functional Analyses. J Behav Educ 2021; 32:239-260. [PMID: 34602803 PMCID: PMC8477999 DOI: 10.1007/s10864-021-09456-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 05/25/2023]
Abstract
Trial-based functional analysis (TBFA) is an accurate and ecologically valid assessment of challenging behavior. Further, there is evidence to suggest that individuals with minimal exposure to behavior analytic assessment methodology (e.g., parents, teachers) can quickly be trained to conduct TBFAs in naturalistic settings (e.g., schools, homes). Notwithstanding, the response effort associated with training development can be prohibitive and may preclude incorporation of TBFA into practice. To address this, we developed a partially automated training package, intended to increase the methodology's accessibility. Using a multiple-probe across skills design, we assessed the degree to which the package increased caregiver accuracy in (a) implementing TBFAs, (b) interpreting TBFA outcomes, and (c) managing TBFA data. Six caregivers completed this study and all demonstrated proficiency following training, first during structured roleplays and again during assessment of their child's actual challenging behavior.
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Affiliation(s)
- Cassandra M. Standish
- Department of Special Education, Vanderbilt University, PMB 230, Appleton Place, Nashville, TN 37203 USA
| | - Joseph M. Lambert
- Department of Special Education, Vanderbilt University, PMB 230, Appleton Place, Nashville, TN 37203 USA
| | - Bailey A. Copeland
- Department of Special Education, Vanderbilt University, PMB 230, Appleton Place, Nashville, TN 37203 USA
| | - Kathryn M. Bailey
- Department of Special Education, Vanderbilt University, PMB 230, Appleton Place, Nashville, TN 37203 USA
| | - Ipshita Banerjee
- Department of Special Education, Vanderbilt University, PMB 230, Appleton Place, Nashville, TN 37203 USA
| | - Mallory E. Lamers
- Department of Special Education, Vanderbilt University, PMB 230, Appleton Place, Nashville, TN 37203 USA
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11
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Ellison KS, Guidry J, Picou P, Adenuga P, Davis TE. Telehealth and Autism Prior to and in the Age of COVID-19: A Systematic and Critical Review of the Last Decade. Clin Child Fam Psychol Rev 2021; 24:599-630. [PMID: 34114135 PMCID: PMC8191715 DOI: 10.1007/s10567-021-00358-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2021] [Indexed: 01/20/2023]
Abstract
There has been growing interest in the use of telehealth; however, the COVID-19 pandemic and the subsequent isolation and restrictions placed on in-person services have fast-tracked implementation needs for these services. Individuals with autism spectrum disorder (ASD) have been particularly affected due to the often-intensive service needs required by this population. As a result, the aim of this review was to examine the evidence base, methodology, and outcomes of studies that have used telehealth for assessment and/or intervention with children and adolescents with ASD as well as their families over the last decade. Further, the goal is to highlight the advances in telehealth and its use with this special population. A systematic search of the literature was undertaken, with 55 studies meeting inclusion criteria and quality analysis. Specified details were extracted from each article, including participant characteristics, technology, measures, methodology/study design, and clinical and implementation outcomes. Services provided via telehealth included diagnostic assessments, preference assessments, early intervention, applied behavior analysis (ABA), functional assessment and functional communication training, and parent training. Findings, although still emerging, encouragingly suggested that services via telehealth were equivalent or better to services face-to-face. Results support the benefits to using telehealth with individuals with ASD. Future research should continue to explore the feasibility of both assessments and interventions via telehealth with those having ASD to make access to assessment services and interventions more feasible for families, while acknowledging the digital divide it could create.
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Affiliation(s)
- Kimberly S Ellison
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Jerrica Guidry
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Paige Picou
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Paige Adenuga
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Thompson E Davis
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA.
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12
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Abstract
Recent events have emphasized the need for behavior-analytic service delivery models that can remain clinically consistent and produce high-quality outcomes while adapting to environmental change. This paper reports outcomes of an organization that adapted to changes in its service delivery model during a worldwide pandemic. The organization utilized components from the Comprehensive Application of Behavior Analysis to Schooling (CABAS®) model. The components were interconnected within the system and linked by specific interlocking contingencies. Performance data were used to make decisions within the organization on both individual and organizational levels during the transition to telehealth for clients and staff. Results are discussed in terms of how the interconnectedness of components within the organization contributed to the reliable, positive outcomes of the system during the transition to telehealth.
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13
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Leyser M, Schieltz K, Strathearn L, Cooper-Brown L, McBrien D, O'Brien M. Telehealth in the Field of Developmental-Behavioral Pediatrics: Advantages, Challenges, and Future Perspectives. J Dev Behav Pediatr 2021; 42:240-244. [PMID: 33759849 DOI: 10.1097/dbp.0000000000000920] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 12/01/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Marcio Leyser
- Division of Developmental and Behavioral Pediatrics, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA
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14
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Maier CA, Riger D, Morgan‐Sowada H. "It's splendid once you grow into it:" Client experiences of relational teletherapy in the era of COVID-19. J Marital Fam Ther 2021; 47:304-319. [PMID: 33721348 PMCID: PMC8251155 DOI: 10.1111/jmft.12508] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 06/12/2023]
Abstract
The novel Coronavirus pandemic (COVID-19) and subsequent social distancing practices have altered the way we move through the world and access physical and mental healthcare. While researchers and clinicians have begun to explore the impact of telehealth delivery on psychotherapy and treatment outcomes, the purpose of this study was to explore the lived experiences of individuals in teletherapy, specifically those engaging in teletherapy with a romantic partner or family member. Using a thematic analysis of open-ended online survey questions, we explored the experiences of 25 individuals who engaged in couple or family teletherapy after social distancing began. The resulting themes included "making do," safe therapeutic space, convenience, logistical challenges, and therapist accommodation. We discuss the clinical implications of these themes to support effective couple and family teletherapy and offer suggestions and considerations for remote clinical interventions and practices. [Correction added on 22 March 2021, after first online publication: The term '19' has been changed to '(COVID-19)' in the first line of the Abstract section, in this version.].
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Affiliation(s)
| | - Dana Riger
- University of North Carolina‐Chapel HillChapel HillNCUSA
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15
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Hardy NR, Maier CA, Gregson TJ. Couple teletherapy in the era of COVID-19: Experiences and recommendations. J Marital Fam Ther 2021; 47:225-243. [PMID: 33742712 PMCID: PMC8250910 DOI: 10.1111/jmft.12501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 02/15/2021] [Indexed: 06/12/2023]
Abstract
The unprecedented times of the novel Coronavirus quarantine and subsequent stay-at-home orders have changed the way many couple therapists provide clinical services. Understanding couple therapists' experiences with teletherapy is important for optimizing future telehealth delivery with couples. Thus, the purpose of this mixed methods survey study was to explore couple therapists' experiences of transitioning from in-person/traditional therapy to online/telehealth delivery. A total of 58 couple therapists completed an online survey for this study. Reported are both quantitative and qualitative findings. Overall, this study found that couple therapists experienced a positive shift from traditional/in-person therapy to online/telehealth therapy, with a majority of couple therapists (74%) reporting they would continue providing teletherapy after the novel Coronavirus pandemic and social distancing regulations had ended. Thematic analysis was used to identify themes from couple therapists' experiences related to advantages, challenges, and recommendations for practice. Implications for clinical training and future research are discussed.
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16
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Neely L, MacNaul H, Gregori E, Cantrell K. Effects of telehealth‐mediated behavioral assessments and interventions on client outcomes: A quality review. J Appl Behav Anal 2021; 54:484-510. [DOI: 10.1002/jaba.818] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Leslie Neely
- Department of Educational Psychology University of Texas at San Antonio
| | - Hannah MacNaul
- Department of Educational Psychology University of Texas at San Antonio
| | - Emily Gregori
- Department of Special Education University of Illinois at Chicago
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17
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Gerow S, Radhakrishnan S, S Akers J, McGinnis K, Swensson R. Telehealth parent coaching to improve daily living skills for children with ASD. J Appl Behav Anal 2021; 54:566-581. [PMID: 33600614 DOI: 10.1002/jaba.813] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 01/11/2023]
Abstract
Children with autism spectrum disorder often display deficits in daily living skills. Behavior analysts can use telehealth, such as videoconferencing technology, to deliver interventions to families of these children. Given the COVID-19 pandemic and the common barriers to accessing behavioral interventions, it is imperative to evaluate the effectiveness and practicality of delivering behavioral interventions via telehealth. This study evaluated the efficacy of a parent-implemented intervention with coaching via telehealth to improve daily living skills. Children ranging in age from 5 to 9 years participated in the study with 1 or 2 of their parents serving as the primary implementer(s). Parents implemented the intervention with fidelity and the intervention yielded increases in independent daily living skill completion for all 4 participants.
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18
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Pollard JS, LeBlanc LA, Griffin CA, Baker JM. The effects of transition to technician-delivered telehealth ABA treatment during the COVID-19 crisis: A preliminary analysis. J Appl Behav Anal 2021; 54:87-102. [PMID: 33369729 PMCID: PMC7898711 DOI: 10.1002/jaba.803] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 01/05/2023]
Abstract
Telehealth delivery of applied behavior analysis treatment has focused on supervision or staff and parent training, rather than the direct delivery of treatment to clients. The novel coronavirus (COVID-19) crisis had the potential to significantly disrupt access to direct treatment for individuals with autism. We report a sample of 17 cases that transitioned from in-person to telehealth delivery of treatment when shelter-in-place orders were issued. Of these cases, 76% of participants transitioned to technician-delivered telehealth services whereas the rest transitioned to a caregiver-implemented telehealth model. Participants continued to access a similar dosage of treatment hours per week in spite of the treatment model transition (in-person M = 12; telehealth M = 11) and maintained or improved correct independent responding across all targets from in-person treatment (M = 75%) to telehealth treatment (M = 80%). These findings provide initial evidence that some clients with autism benefit from technician-delivered telehealth services.
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Affiliation(s)
- Joy S. Pollard
- Behavior Change Institute
- Stanford University School of Medicine
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19
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Gerow S, Radhakrishnan S, Davis TN, Zambrano J, Avery S, Cosottile DW, Exline E. Parent-implemented brief functional analysis and treatment with coaching via telehealth. J Appl Behav Anal 2020; 54:54-69. [PMID: 33325053 DOI: 10.1002/jaba.801] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 01/11/2023]
Abstract
We evaluated the use of parent-implemented brief functional analyses in the home with coaching delivered via telehealth. Parents of 7 children with autism conducted functional analyses of their child's challenging behavior. For 4 participants, the brief functional analysis provided information regarding the function of the child's challenging behavior. A full functional analysis indicated a social function for 1 participant. The brief functional analysis yielded false positive results and subsequent assessment indicated an automatic function for another participant. The final participant did not engage in sufficient rates of challenging behavior to provide information regarding the function of the child's challenging behavior. Treatment evaluations occurred with 4 participants; these evaluations provided support for the results of the functional analysis. Together with previous research, the results indicate that parent-implemented brief functional analyses, followed by additional assessment as needed, may be an effective method for assessing and treating challenging behavior via telehealth.
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Affiliation(s)
| | | | - Tonya N Davis
- Department of Educational Psychology, Baylor University
| | | | | | | | - Emily Exline
- Department of Educational Psychology, Baylor University
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Davis C, Hendon F, McDonald K, Blanco S. Use of technology in facilitating remote caregiver training for token systems. Int J Dev Disabil 2020; 66:330-338. [PMID: 34150195 PMCID: PMC7942799 DOI: 10.1080/20473869.2020.1827210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 06/02/2023]
Abstract
The prevalence of autism continues to rise, yet the ability to receive treatment or caregiver training through traditional in-person methods continues to be a precluding factor for many families. Studies have shown that parent training provides benefits to caregivers and children through increased success of interventions, implementation, and generalization of skills. This study evaluated the effect of using technology for remote caregiver training of a token economy for use during routine non-preferred activities. A multiple-baseline design was implemented across two participants, through three phases. Additional surveys and interviews were conducted to evaluate social validity. Results revealed that caregivers acquired necessary skills to implement the fixed interval schedule of reinforcement with token system and participants reported experiencing greater positive interactions with the children. Limitations of this study included no data were collected on the children's behavior, nor were they trained on token economy use. Extraneous variables may have affected the results, such as unplanned household events. Results suggest that remote caregiver training can increase desirable interactions between caregiver and child, improve socially significant behaviors, and extend resources not typically available to all families.
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Affiliation(s)
| | | | | | - Sam Blanco
- ABA, Russell Sage Colleges, Troy, NY, USA
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21
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Liao CY, Ganz JB, Vannest KJ, Wattanawongwan S, Pierson LM, Yllades V, Li YF. Caregiver Involvement in Communication Skills for Individuals with ASD and IDD: a Meta-analytic Review of Single-Case Research on the English, Chinese, and Japanese Literature. Rev J Autism Dev Disord 2020. [DOI: 10.1007/s40489-020-00223-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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22
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Simacek J, Elmquist M, Dimian AF, Reichle J. Current Trends in Telehealth Applications to Deliver Social Communication Interventions for Young Children with or at Risk for Autism Spectrum Disorder. Curr Dev Disord Rep 2020; 8:15-23. [PMID: 33072492 PMCID: PMC7548134 DOI: 10.1007/s40474-020-00214-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 01/02/2023]
Abstract
Purpose of Review Early, intensive, and high-quality interventions can often improve social communication outcomes for children with autism spectrum disorder (ASD). Many children experience barriers to intervention, resulting in significant delays to intervention onset or missed opportunities for intervention altogether. With constant advances in technology, the field is experiencing a rapid increase in investigation of telehealth applications to intervention delivery. This article highlights the current trends in social communication intervention via telehealth used in early intervention practices for children with ASD over the past 5 years, including a brief review of studies (from 2014 to January 2020) and our team’s experiences in this area. Recent Findings Based on our experience and the 22 studies we identified in this area, we describe the current trends in telehealth applications used and how interventions were delivered. We also provide recommendations, limitations, and future directions on this topic. Summary Telehealth offers innovative intervention delivery options by increasing intervention access, overcoming barriers such as geography and costs of service delivery for young children with ASD.
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Affiliation(s)
- Jessica Simacek
- Institute on Community Integration, University of Minnesota, Minneapolis, MN USA
| | - Marianne Elmquist
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN USA
| | - Adele F. Dimian
- Institute on Community Integration, University of Minnesota, Minneapolis, MN USA
| | - Joe Reichle
- Department of Speech, Language, and Hearing Sciences, University of Minnesota, Minneapolis, MN USA
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Abstract
The purpose of this systematic review was to systematically locate and analyze the research on caregiver-implemented functional analyses and subsequent function-based interventions. We included 36 studies and examined multiple features of the studies, including participant demographics, functional analysis characteristics, intervention characteristics, procedural fidelity, risks of bias, and social validity. Overall, the studies showed that caregivers were able to implement functional analyses that yielded differential responding, although few studies reported procedural fidelity data. Caregivers were also able to implement function-based interventions that led to socially significant changes in challenging behavior. Implications for practice and future research are discussed.
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Affiliation(s)
- Sara Germansky
- Anita Zucker Center for Excellence in Early Childhood Studies, University of Florida, 1-320 Norman Hall, PO Box 117050, Gainesville, FL 32611-7050 USA
| | - Brian Reichow
- Anita Zucker Center for Excellence in Early Childhood Studies, University of Florida, 1-320 Norman Hall, PO Box 117050, Gainesville, FL 32611-7050 USA
| | - Mackenzie Martin
- Anita Zucker Center for Excellence in Early Childhood Studies, University of Florida, 1-320 Norman Hall, PO Box 117050, Gainesville, FL 32611-7050 USA
| | - Patricia Snyder
- Anita Zucker Center for Excellence in Early Childhood Studies, University of Florida, 1-320 Norman Hall, PO Box 117050, Gainesville, FL 32611-7050 USA
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24
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Schieltz KM, Wacker DP. Functional assessment and function-based treatment delivered via telehealth: A brief summary. J Appl Behav Anal 2020; 53:1242-1258. [PMID: 32643811 PMCID: PMC7361834 DOI: 10.1002/jaba.742] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/06/2020] [Accepted: 06/08/2020] [Indexed: 11/10/2022]
Abstract
As the world navigates the COVID-19 health crisis, behavior analysts are considering how best to support families while maintaining services and ensuring the health and safety of everyone involved. Telehealth is one service delivery option that provides families with access to care in their own communities and homes. In this article, we provide a brief summary of the telehealth literature in applied behavior analysis that provided coaching and training to families for individuals who displayed challenging behavior. These studies targeted functional assessment and function-based treatment for challenging behavior. We briefly summarize what is known relative to the assessment and treatment of challenging behavior via telehealth, place these results within a descriptive context of the decisions made by the research team at the University of Iowa, and discuss what we, as behavior analysts, should consider next to advance our understanding and practice of telehealth.
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Pellegrino AJ, DiGennaro Reed FD. Using telehealth to teach valued skills to adults with intellectual and developmental disabilities. J Appl Behav Anal 2020; 53:1276-1289. [PMID: 32542669 DOI: 10.1002/jaba.734] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 05/15/2020] [Accepted: 05/17/2020] [Indexed: 11/11/2022]
Abstract
Telehealth uses electronic information and telecommunication technologies to deliver long-distance clinical services. It has successfully been used by clinical professionals to teach family and staff members to provide evidence-based assessment and treatment procedures. There is no research to date, however, evaluating the use of telehealth to directly teach individuals with intellectual and developmental disabilities (IDD). Thus, we evaluated the efficacy of a telehealth intervention using total task chaining with least-to-most prompting delivered via videoconference to 2 adults with IDD. Both participants demonstrated low independent responding during baseline with enhanced written instructions present. During intervention, which included vocal and model prompting, both participants met the mastery criterion for each skill in fewer than 15 sessions, which maintained after 2 weeks. Finally, both participants expressed satisfaction with the goals, procedures, and effects of the intervention. We discuss the broader scope of the intervention for individuals with disabilities when face-to-face services may not be feasible.
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26
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Unholz-Bowden E, McComas JJ, McMaster KL, Girtler SN, Kolb RL, Shipchandler A. Caregiver Training Via Telehealth on Behavioral Procedures: A Systematic Review. J Behav Educ 2020; 29:246-281. [PMID: 37670908 PMCID: PMC10479951 DOI: 10.1007/s10864-020-09381-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Telehealth has been utilized to provide behavioral services to families with children with autism spectrum disorder (ASD) and other disabilities. This systematic review provides an update on current research pertaining to the use of telehealth to provide behavior analytic-based services and train caregivers in implementing behavioral procedures. This review also describes information on reported training components and caregivers' procedural fidelity. Empirical studies were collected from five databases. Overall, the studies provide evidence of the utility of telehealth as a service delivery model for providing behavior analytic-based services and for training caregivers to implement behavioral assessments and procedures. The authors discuss potential considerations for developing training packages and training caregivers via telehealth. Future research should use experimental methods to determine effective components for training individuals via telehealth to use behavioral procedures with good fidelity as well as to detect other factors that may influence procedural fidelity.
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Affiliation(s)
- Emily Unholz-Bowden
- Department of Educational Psychology, University of Minnesota, 56 E River Rd, Minneapolis, MN 55455, USA
| | - Jennifer J. McComas
- Department of Educational Psychology, University of Minnesota, 56 E River Rd, Minneapolis, MN 55455, USA
| | - Kristen L. McMaster
- Department of Educational Psychology, University of Minnesota, 56 E River Rd, Minneapolis, MN 55455, USA
| | - Shawn N. Girtler
- Department of Educational Psychology, University of Minnesota, 56 E River Rd, Minneapolis, MN 55455, USA
| | - Rebecca L. Kolb
- Department of Educational Psychology, University of Minnesota, 56 E River Rd, Minneapolis, MN 55455, USA
| | - Alefyah Shipchandler
- Department of Educational Psychology, University of Minnesota, 56 E River Rd, Minneapolis, MN 55455, USA
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Woodcock KA, Blackwell S. Psychological treatment strategies for challenging behaviours in neurodevelopmental disorders: what lies beyond a purely behavioural approach? Curr Opin Psychiatry 2020; 33:92-109. [PMID: 31743125 DOI: 10.1097/YCO.0000000000000571] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Challenging behaviour shown by individuals with neurodevelopmental disorders (NDDs) has a major negative impact. There is robust evidence for the efficacy of treatments based on applied behaviour analysis. However, such approaches are limited in important ways - providing only part of the whole solution. We reviewed the literature to provide an overview of recent progress in psychological treatments for challenging behaviour and how these advance the field beyond a purely behavioural approach. RECENT FINDING We identified 1029 articles via a systematic search and screened for those implementing a psychological intervention with individuals with NDD (or caregivers) and measuring the potential impact on challenging behaviour. Of the 69 included studies published since 2018, more than 50% implemented a purely behavioural intervention. Other studies could generally be categorized as implementing parent training, meditation, skill training or technology-assisted interventions. SUMMARY Greater consideration of the interplay between behavioural and nonbehavioural intervention components; systematic approaches to personalization when going beyond the behavioural model; mental health and broad social communication needs; and models that include cognitive and emotional pathways to challenging behaviour; is needed to advance the field. Furthermore, technology should not be overlooked as an important potential facilitator of intervention efforts.
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28
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Tsami L, Lerman DC. Transfer of treatment effects from combined to isolated conditions during functional communication training for multiply controlled problem behavior. J Appl Behav Anal 2019; 53:649-664. [PMID: 31441043 DOI: 10.1002/jaba.629] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/22/2019] [Indexed: 11/10/2022]
Abstract
Functional communication training (FCT) is highly effective for treating socially maintained problem behavior when based on the results of functional analyses (FA). Research suggests that combining relevant antecedents and consequences of problem behavior during FCT can be an efficient approach to treatment for behavior that is multiply controlled. However, no studies have evaluated whether treatment effects under combined conditions would transfer to single, or isolated, conditions. Participants were 5 children with autism, aged 3 years to 6 years, who engaged in problem behavior maintained by both escape from demands and access to tangibles. An experimenter coached their caregivers via video conferencing to implement FA and FCT in their homes. All participants received FCT under a combined condition, followed by brief exposure to sessions with isolated antecedents and consequences. Treatment effects for just 1 of the 5 participants immediately persisted under isolated conditions. These results suggest that, when caregivers combine variables relevant to multiple functions during FCT, exposure to isolated conditions may at least temporarily produce treatment failures.
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Ferguson J, Craig EA, Dounavi K. Telehealth as a Model for Providing Behaviour Analytic Interventions to Individuals with Autism Spectrum Disorder: A Systematic Review. J Autism Dev Disord 2019; 49:582-616. [PMID: 30155578 DOI: 10.1007/s10803-018-3724-5] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Interventions based on applied behaviour analysis are considered evidence based practice for autism spectrum disorders. Due to the shortage of highly qualified professionals required for their delivery, innovative models should be explored, such as telehealth. Telehealth utilises technology for remote training and supervision. The purpose of our study was to systematically review the literature researching telehealth and ABA. We analysed intervention characteristics, outcomes and research quality in 28 studies and identified gaps. Intervention characteristics were: (1) research design (2) participants (3) technology (4) dependent variables (5) aims. Outcomes were favourable with all studies reporting improvements in at least one variable. Quality ratings were significantly low. Implications for future research and practice are discussed in light of identified methodological downfalls.
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Monlux KD, Pollard JS, Bujanda Rodriguez AY, Hall SS. Telehealth Delivery of Function-Based Behavioral Treatment for Problem Behaviors Exhibited by Boys with Fragile X Syndrome. J Autism Dev Disord 2019; 49:2461-2475. [DOI: 10.1007/s10803-019-03963-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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