Effectiveness of Telehealth Direct Therapy for Individuals with Autism Spectrum Disorder

Abstract

The field of applied behavior analysis (ABA) has utilized telehealth for clinical supervision and caregiver guidance with research supporting the use of both modalities. Research demonstrating effectiveness is crucial, as behavior analysts must ensure the services they provide are effective in order to be ethical. With the increased need for patients to access more services via telehealth, due to the novel coronavirus (COVID-19) pandemic, the current study evaluated the efficacy of telehealth direct therapy to teach new skills to individuals with autism spectrum disorder (ASD). This study examined the utility of natural environment teaching and discrete trial training strategies provided over a videoconferencing platform to teach new skills directly to seven individuals with varying ASD severity levels. The targeted skills were taught solely through telehealth direct therapy with varying levels of caregiver support across participants and included skills in the language, adaptive, and social domains. In a multiple baseline design, all seven participants demonstrated mastery and maintenance for all targets; in addition, generalization to family members was assessed for some targets. The evidence suggests that telehealth is a modality that is effective and can be considered for all patients when assessing the appropriate location of treatment.Keywords telehealth direct therapy . discrete trial training . natural environment teaching . generalization

Preliminary Practice Recommendations for Telehealth Direct Applied Behavior Analysis Services with Children with Autism

“…Guidelines by CASP ( 2020 ), Rodriguez ( 2020 ), and Nohelty, Hirschfeld, and Miyake ( 2021 ) mentioned that reinforcers should be used during telehealth direct sessions, but no detailed considerations were given. Similarly, other studies on telehealth direct ABA services did not specify the type of reinforcers used in their studies (Cihon et al, 2021 ; Pellegrino & DiGennaro Reed, 2020 ; Pollard et al, 2021 ) with an exception of Ferguson et al ( 2020 ) and Nohelty, Bradford, et al ( 2021 ). Ferguson et al noted that they used only verbal praise for correct responses and suggested that future studies explore whether other types of stimuli such as edibles and tangibles would serve as reinforcers via telehealth.…”

“…For example, CASP ( 2020 ) suggested the following models: telehealth direct service (a technician delivers treatment to a client via real-time videoconferencing), partial telehealth model (a technician or caregiver delivers treatment in-person while supervised by a clinician via telehealth), caregiver-implemented service (a caregiver is trained by a clinician via telehealth to deliver ABA treatment protocols on their own in-person; also referred to as parent-coaching model, Wacker et al, 2013 ), and caregiver training and consultation (a clinician meets with a parent to discuss general issues). Furthermore, Pollard et al ( 2021 ) and Nohelty, Bradford et al ( 2021 ) separated telehealth direct ABA service into three different models: (a) the technician-delivered telehealth service model, (b) the caregiver-assisted telehealth model, and (c) the caregiver-implemented telehealth model. In the technician-delivered telehealth service model, a practitioner is the one who provides all the instructions, prompts, reinforcers, and data collection without caregiver support.…”

“…Similarly, with in-person ABA practice, several authors (Carbone et al, 2007 ; Shillingsburg et al, 2014 , 2019 ; Taylor & Fisher, 2010 ) suggested having a demand-free session in the beginning, allowing clients to engage in preferred activities, providing a reinforcer on a dense schedule, and embedding the instructions with positive reinforcement before a practitioner fades in demands slowly over time. For the telehealth direct model, a few authors reported conducting rapport building, though no details were described and it is unclear how rapport took place (e.g., Nohelty, Bradford, et al 2021 ).…”

“…Given the need for telehealth direct ABA service due to the COVID-19 pandemic, a growing number of studies began demonstrating its effectiveness. Pollard et al ( 2021 ) and Nohelty, Bradford et al ( 2021 ) reported the overall effectiveness of telehealth direct ABA services with children with autism. Cihon et al ( 2021 ), Ferguson et al ( 2020 ), and Pellegrino and DiGennaro Reed ( 2020 ) demonstrated the effectiveness of several ABA procedures in telehealth direct service with children and adults with disabilities.…”

Examining clinicians’ concerns delivering telemental health interventions directly to autistic individuals during COVID-19

“…Autism studies that have investigated the remote delivery (via videoconferencing) of direct psychological interventions not targeting mental health, but rather solely targeting functional skills, have likewise shown promise (e.g. Cihon et al, 2021 ; Ferguson et al, 2020 ; Ford, Wang, Koegel, Koegel, & Fedders, 2020 ; Nohelty, Bradford, Hirschfeld, Miyake, & Novack, 2021 ; Pollard, LeBlanc, Griffin, & Baker, 2021 ). These were conducted before and since the pandemic started, and the only challenges reported surrounded technological issues, at-home distractions, instructional control, and the need for parental support for some individuals.…”