Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder. Previous surveys have reported a steady increase in ASD prevalence in US children over the past decades. Several behavioral ...therapies and medications have been developed to treat the symptoms of ASD; however, little is known about the current status of treatment usage for children diagnosed as having ASD.
To estimate the prevalence and treatment patterns of ASD among US children using nationally representative data.
This study used data from the 2016 National Survey of Children's Health, a nationwide, population-based, cross-sectional survey. We included 43 032 children aged 3 to 17 years. Data were collected through questionnaires completed by a parent or guardian. Data were analyzed from February 2018 to March 2018.
Outcome variables included ASD diagnosed by a physician or health professional and the use of behavioral treatment or medication treatment among children with ASD.
Of the 43 032 included participants, 22 072 (51.3%) were male, and the mean (SD) age was 10.7 (4.4) years. The weighted prevalence of ever-diagnosed ASD and current ASD were 2.79% (95% CI, 2.46-3.12) and 2.50% (95% CI, 2.21-2.79), respectively. The state-level prevalence of ever-diagnosed ASD varied from 1.54% (95% CI, 0.60-2.48) in Texas to 4.88% (95% CI, 2.72-7.05) in Florida. Nationally, about 70% of children with current ASD (70.5%; 95% CI, 65.1-75.8) were treated; 43.3% (95% CI, 37.4-49.2) received behavioral treatment only, 6.9% (95% CI, 3.7-10.1) received medication treatment only, and 20.3% (95% CI, 16.5-24.1) received both behavioral and medication treatments. The remaining 29.5% (95% CI, 24.2-34.9) of children with current ASD did not receive either behavioral or medication treatment.
This study showed that the prevalence of ASD in the United States was relatively high, and it varied substantially across US states. Almost 30% of US children with ASD did not receive behavioral or medication treatment, which calls for a critical need to understand and address the barriers for those children to receive appropriate treatments.
To determine whether challenging behavior in young children with autism and other developmental disabilities can be treated successfully at lower cost by using telehealth to train parents to ...implement applied behavior analysis (ABA).
We compared data on the outcomes and costs for implementing evidence-based ABA procedures to reduce problem behavior by using 3 service delivery models: in-home therapy, clinic-based telehealth, and home-based telehealth. Participants were 107 young children diagnosed with autism or other neurodevelopmental disorders, and data analysis focused on the 94 children who completed treatment.
All 3 service delivery models demonstrated successful reduction of problem behavior by training parents to conduct functional analysis and functional communication training. The mean percentage reduction in problem behavior was >90% in all 3 groups after treatment, and treatment acceptability based on parent ratings was high for all groups. Total costs for implementing treatment were lowest for home telehealth, but both telehealth models were significantly less costly than in-home therapy.
This research demonstrated that parents can use ABA procedures to successfully treat behavior problems associated with autism spectrum disorders regardless of whether treatment is directed by behavior consultants in person or via remote video coaching. Because ABA telehealth can achieve similar outcomes at lower cost compared with in-home therapy, geographic barriers to providing access to ABA for treating problem behavior can be minimized. These findings support the potential for using telehealth to provide research-based behavioral treatment to any family that has access to the Internet.
Functional communication training (FCT) is an evidence-based intervention that has been widely used and implemented to reduce problem behavior and teach replacement behavior in a variety of settings. ...Specific procedures have been researched and documented to ensure correct implementation. Functional communication training can be broken into three steps: (a) identifying the function of the problem behavior through a functional behavior assessment (FBA); (b) selecting an appropriate replacement communicative response; and (c) building new skills acquisition through teaching and rehearsal while using reinforcements and extinction.
We conducted a retrospective, descriptive evaluation of the fidelity with which parents of three children with autism spectrum disorders conducted functional communication training (FCT) in their ...homes. All training was provided to the parents via telehealth by a behavior consultant in a tertiary-level hospital setting. FCT trials coached by the behavior consultant were conducted during weekly 1-h visits. Parents made video recordings of treatment trials in which they conducted the procedures independent of coaching. We evaluated the levels of fidelity during coached and independent trials within a multielement design and recorded parents' omission and commission errors during different components of the treatment over time. The results showed no consistent differentiation between the coached and the independent trials. Some errors (e.g., omission errors associated with reinforcing manding) occurred more frequently overall, but none of the errors appeared to have a strong relationship with treatment outcomes. All children showed substantial reductions in problem behavior during the final treatment trials and especially during the coached trials. These results suggest that behavior analysts can use telehealth to implement FCT with acceptable fidelity and to achieve substantial reductions in children's problem behavior.
Functional communication training (FCT) was conducted by parents of 17 young children with autism spectrum disorders who displayed problem behavior. All procedures were conducted at regional clinics ...located an average of 15 miles from the families’ homes. Parents received coaching via telehealth from behavior consultants who were located an average of 222 miles from the regional clinics. Parents first conducted functional analyses with telehealth consultation (Wacker, Lee et al.
Journal of Applied Behavior Analysis
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) and then conducted FCT that was matched to the identified function of problem behavior. Parent assistants located at the regional clinics received brief training in the procedures and supported the families during the clinic visits. FCT, conducted within a nonconcurrent multiple baseline design, reduced problem behavior by an average of 93.5 %. Results suggested that FCT can be conducted by parents via telehealth when experienced applied behavior analysts provide consultation.
Behavior consultants conducted functional analyses (FAs) via telehealth with 20 young children with autism spectrum disorders between the ages of 29 and 80 months who displayed problem behavior and ...lived an average of 222 miles from the tertiary hospital that housed the behavior consultants. Participants' parents conducted all procedures during weekly telehealth consultations in regional clinics located an average of 15 miles from the participants' homes. Behavior consultants briefly trained parent assistants to provide on‐site support for families during consultations. FAs completed within a multielement design identified environmental variables that maintained problem behavior for 18 of the 20 cases, and interrater agreement averaged over 90%. Results suggested that behavior analysts can conduct FAs effectively and efficiently via telehealth.
Functional communication training (FCT) is a behavioral treatment that has been shown to reduce problem behavior and increase appropriate communication in young children with autism spectrum disorder ...(ASD). In this study, we assessed the effects of FCT on targeted and nontargeted problem behaviors outside of the training context, as well as parent stress, for 30 young children with ASD and their parents. Indirect measures of generalization treatment effects were administered prior to and following FCT treatment delivered via telehealth. Children demonstrated significant improvement on both targeted (measured via observation) and nontargeted (measured via checklist) problem behaviors, both within and outside of the training context, and parent stress was significantly reduced following treatment. These results suggest that the impact of FCT may extend beyond the training context for both the children being treated and the parents delivering treatment, even when generalization is not specifically programmed for during treatment.
Functional communication training (FCT) is a widely used and effective function-based treatment for problem behavior. The purpose of this article is to present two cases in which FCT was unsuccessful ...in reducing the occurrence of problem behavior displayed by two young children with an autism spectrum disorder. Both children received the same functional analysis plus FCT treatment package via telehealth that had proven to be highly successful for the other participants. The FCT package was conducted within tightly controlled single-case designs for each participant, which permitted subsequent analyses to determine why FCT was unsuccessful. These analyses suggested distinct reasons for the treatment failure for each child. Although the negative results of treatment appeared to be similar for both children, the specific reasons for treatment failure were highly individualistic and identifiable via the single-case analyses conducted. We present findings from both our initial and subsequent analyses and discuss the implications.
The researchers in the project used telehealth to conduct functional analyses and functional communication training in homes of children diagnosed with autism who displayed problem behavior. Parents ...conducted all assessment and treatment procedures within their homes while receiving coaching from applied behavior analysts located approximately 200 miles away from them. In this article, the researchers summarize the technical systems they used to develop a telehealth service and the concerns and problems they have encountered using telehealth and provide some guidelines for how to troubleshoot those problems.
We conducted a retrospective analysis of consumption of classes of reinforcement during functional communication training (FCT). The four participants were diagnosed with an autism spectrum disorder ...and displayed problem behavior maintained by positive (tangibles) and negative (escape from demands) reinforcement via a functional analysis (FA). In Experiment 1 of the current analysis, data were collected on consumption of tangibles, attention, and escape during reinforcement intervals of FCT. As hypothesized, reinforcers shown to maintain problem behavior were often consumed. However, three participants also consumed moderate to high levels of attention, an arbitrary reinforcer not identified by the FA. In Experiment 2, we studied the relationship between quality of attention and consumption of attention. Significant correlations were shown between quality of attention and consumption of attention for three participants. These data showed that while classes of reinforcement identified as maintaining problem behavior are consistently consumed during FCT, arbitrary classes of reinforcement might be important to consider also for treatment.
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