Comparing Behavioral Assessments Using Telehealth for Children With Autism

Managing challenging behavior in autism spectrum disorders (ASD) can profoundly improve
quality of life for children and families. However, many families lack access to
research-based treatment, such as applied behavior analysis (ABA). This study is a randomized
trial comparing outcomes of treatment for ASD using either a standard Functional Analysis
Plus Functional Communication Training (FA+FCT) package or a pragmatic version that offers a
briefer, less time-intensive model of FA+FCT. Both types of FA+FCT are provided via
telehealth in family homes to maximize generalizability to real-life settings. Providing ABA
through telehealth makes an effective treatment accessible across geographic barriers so that
no child is excluded based on where they live. The study also examines key family factors
that influence successful outcomes.

The study has 3 primary aims: (1) To assess outcomes for ABA telehealth by assigning children
to either a Pragmatic FA+FCT group or to a group receiving Standard FA+FCT. Outcomes will be
compared based on the percent reduction in problem behavior, communication increases, time to
achieve outcomes, treatment fidelity, family acceptance of treatment, and generalization and
maintenance of treatment gains. (2) The study will assess the relation of family factors to
treatment efficacy and acceptability by assessing parent stress, mood, and social support in
relation to outcomes. (3) Cost effectiveness will be assessed in relation to the treatment
methods used and the efficiency of ABA telehealth.

The study will include 102 children who meet eligibility criteria from among a larger sample
of 150 children. Thirty-six children will receive intervention in each of three states: Iowa,
Georgia, and Texas. Study design is a randomized trial using an intent-to-treat analysis.
Half of the sample will be randomized to Pragmatic FA+FCT and half to Standard FA+FCT.
Treatment will be provided via telehealth using FCT, which is a function-based ABA technique
in which parents are trained to be therapists under the direction of behavior consultants.
Study procedures typically are completed within 6 months, and follow-up assessments occur 6
months after treatment completion. Data analyses include comparisons between assessment
groups, single-case designs examining responses in individual children, cost analyses, and
regression analyses of the effects of family factors on outcomes.

The investigators prior research shows that problem behavior can be reduced by over 90% in
most children with ASD after 4-6 months of telehealth treatment. If Pragmatic FA+FCT can
reduce problem behavior at rates comparable to Standard FA+FCT, then treatment can be started
sooner and families can achieve successful outcomes at lower cost. Although pragmatic FA+FCT
provides less behavioral information, it may be more resistant to treatment relapse because
it does not involve reinforcing high rates of problem behavior.

Inclusion Criteria:

- Confirmed diagnosis of autism spectrum disorder

- Significant behavior problems requiring treatment

- At least one parent willing to be trained in behavior analysis via telehealth

Exclusion Criteria:

- Unstable or degenerative neurological disorder