Randomized Controlled Trial of Telehealth-Enabled Versus In-Person Parent-Mediated Behavioral Treatment for Challenging Behaviors in Autism Spectrum Disorder
Abstract
Rationale and Objectives: Children diagnosed with autism spectrum disorder (ASD) often display challenging behaviors such as aggression or self-injury that can cause significant distress for parents, caregivers, teachers, and others involved in the child’s care. Behavioral treatments based on the principles of applied behavior analysis are highly effective for reducing or eliminating challenging behaviors commonly exhibited by children diagnosed with ASD. An important component of successful behavioral treatments for challenging behavior in ASD is the involvement of parents or primary caregivers in the child’s behavioral care because parental involvement readily promotes generalization and maintenance of behavioral skills. Unfortunately, due to limited availability of qualified providers and the high costs associated with delivering traditional in-person behavioral care for ASD, particularly in rural areas, many parents or primary caregivers are unable to learn how to manage their child’s challenging behavior. This lack of exposure to effective care can vastly lower quality of life for both the child and their family. Telehealth may be an effective solution to help families access parent-mediated behavioral therapy in their home communities without the need to travel to a clinic or have a provider come to their home. However, with the exception of one recently published small-scale study, remote delivery of parental-mediated behavioral therapy for children with ASD has not been directly compared to traditional in-person behavioral therapy in a randomized controlled trial. Furthermore, while benefits coverage for affected families has improved, not all insurance providers will cover parent-mediated behavioral therapy delivered via telehealth, further limiting access to care for families in rural or underserved areas. Our proposed study will address this gap in the scientific literature and significantly inform clinical decision-making by establishing whether parent-mediated behavioral therapy delivered via telehealth is equivalent or better than traditional in-person delivery. This project therefore addresses two primary areas of interest outlined in the FY21 ARP: (1) Dissemination/implementation of clinically validated interventions and (2) Behavioral, cognitive, and other nonpharmacological therapies for ASD core symptoms or to alleviate co-occurring conditions. Type of Patient Helped and How: This study aims to answer the critical question of whether families of children with ASD can access parent-mediated behavioral therapy for their child’s challenging behavior via telehealth that is more effective and satisfactory than what they would receive with traditional in-person behavioral therapy for children diagnosed with ASD. The study results will be extremely important for determining whether telehealth offers advantages to families above and beyond traditional in-person behavioral therapy for challenging behavior in ASD. Specialty providers will be able to utilize the results of this study to decide which treatment options are best to offer a particular family, and families will be able to use the study results as they are considering which method of care will best meet their individual family and child’s needs. The study holds great promise for advancing crucial knowledge about the care of children diagnosed with ASD who exhibit challenging behavior that can be highly stressful for the patient’s family, teachers, and other stakeholders in the child’s life. Clinical Applications, Benefits, and Risks: Following our engagement with stakeholders, we expect that parents will be receptive to telehealth-enabled behavioral interventions, that stakeholders will describe more benefits than barriers to treatment with telehealth, and that opportunities to enhance parent-mediated behavioral therapies using different telehealth modalities (e.g., synchronous videoconference, telephonic care, text messages) will be
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 28, 2022
- Source ID
- W81XWH2210321
Entities
People
- Scott Hall
Organizations
- Stanford University
- United States Army