Many children with autism spectrum disorder (ASD) have problem behaviors that interfere with learning and social interaction. This randomized controlled trial compared treatment with functional ...communication training (FCT) to “treatment as usual” for young children with ASD (n = 38, ages 21–84 months). FCT was conducted by parents with training and real-time coaching provided by behavioral consultants using telehealth. FCT treatment via telehealth achieved a mean reduction in problem behavior of 98% compared to limited behavioral improvement in children receiving “treatment as usual” during a 12-week period. Social communication and task completion also improved. For children with ASD and moderate to severe behavior problems, parent-implemented FCT using telehealth significantly reduced problem behavior while ongoing interventions typically did not.
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.
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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in press
) 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.
The present study examined the relation between attachment security and several aspects of friendship in early adolescence. One hundred six sixth-grade students completed attachment security measures ...on two caregivers, nominated friends from their grade level, and completed measures of friendship quality on up to six of their nominated friends. Results indicate that attachment security is positively related to having reciprocated friends and reciprocated best friends. Data also supported the hypothesis that securely attached children tend to have reciprocated friendships with other securely attached children at a rate greater than expected by chance and tend to rank their securely attached friends as better friends than their insecurely attached friends. Attachment security was positively related to friendship conflict resolution, both when reported by the participant and their reciprocated friends. Attachment security was also positively associated with the perception of having validating and caring reciprocal friends. Additionally, more securely attached males (but not females) reported more companionship and recreational activities in their friendships. Results did not support the hypothesis that less securely attached individuals would nominate more unreciprocated friendships than more securely attached individuals. Results also did not support the hypothesis that friendship dyads comprised of two securely attached individuals would be less discrepant in their ratings of friendship quality than friendship dyads comprised of one securely attached and one insecurely attached individual. Results and ideas for future study in this area are discussed with an emphasis on refining our understanding of the processes by which attachment security may influence relationships with friends.
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