Telehealth and Autism: A Randomized Controlled Trial of Functional

Analysis Procedures for Children with Autism

Matthew OBrien, PhD, BCBA-D, David Wacker, PhD, Scott Lindgren, PhD, Wendy Berg, MA, Dorothea Lerman1, PhD, BCBA-D,
Nathan Call2, PhD, BCBA-D
1The University of Houston Clear Lake, 2Marcus Autism Center and Emory University

Design
Introduction Randomized controlled trial - noninferiority design
52 Standard FA group
52 Pragmatic group.
Overcoming Barriers to Access for Research and Services Stratification across site, gender, age, and intellectual ability.
Researchers, clinicians, and families of children with autism living in rural Single case design to structure assessments and interventions.
areas are challenged by the distance to travel to contribute to studies and
access services. Recent research suggests that services provided via
telehealth may help overcome the distance barrier and increase access to
affordable treatment with similar outcomes as face-to-face services
(Lindgren et al., 2016). Additionally, telehealth provides a tool to access
participants for studies involving autism.

Bridging the Gap Between Research and Practice

In the field of applied behavior analysis, incongruence exists between the
practices of researchers and non-research clinicians (Roscoe et al., 2015;
Oliver, Pratt, & Normand, 2015). Researchers advocate for using
functional analysis (FA) procedures, but clinicians are more likely to use
less-precise assessment tools (e.g., descriptive assessments). For
behavior analysts working with children with autism, there is a need for
consensus on how best to evaluate the problem behaviors these children
demonstrate.

Telehealth and Autism Research

A multi-site research grant (Lindgren & Wacker, 2015) is underway using
telehealth to conduct a randomized controlled trial of functional analysis
procedures for young children with autism. The general focus of this
research is on the following questions:
1. Are treatment outcomes (i.e., reduction in problem behavior; time to
reduction criterion) similar for children who receive a more rigorous
assessment (FA) than those who do not?
2. What family factors (e.g., stress, mood, social support) contribute to
successful outcomes?
3. Is there a cost savings associated with conducting FA procedures?
Methods
Participants
135 families to be enrolled
102 caregiver-child dyads to complete the study
Participant child must meet the following criteria:
Diagnosed with autism (DSM-V criteria)
18 mo. to 83 mo. (6 yr., 11 mo.)
Exhibit destructive or disruptive behavior (score of 12+ on ABC
Irritability subscale)
Live or receive services in Iowa, Georgia, or Texas
Setting
Clinic-to-home
Sessions in participant home (e.g., bedroom, living room)
Remote coaching from telehealth center at each site
This investigation is supported by Grant R01-MH104363 from the National Institute of Mental Health of the National Institutes of Health. The content is solely the
responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or National Institutes of Health.
Discussion
Hypothesized Reasons for Differences
Treatment What if there is no difference in assessment + treatment length (or more
FCT is customized to match the results of the Standard FA or the Pragmatic
rapid reductions for the Pragmatic/BAM group)?
Assessment/BAM Pragmatic/BAM = more rapid initiation of treatment
Avoidance of strengthening effect with continuous reinforcement
Criteria for Completion schedule
Three consecutive sessions with:
Reduction of problem behavior by 90% over baseline What if Standard FA group shows greater reduction or more rapid results?
Compliance with 90% of task requests Standard FA allows for causal statements (more accurate)/better
Independent and appropriate manding assurance
Moderator variables:
Follow-up Therapists perceptions (e.g., more confident)
Maintenance probes at 6 mo. post treatment completion Parent understanding is improved
Implications for Practice
Analysis of assessment+treatment length has three possible outcomes:
Subset Results (UIowa Only) 1. No difference between two groupsCurrent practice may be adequate
2. Pragmatic/BAM group has more rapid reductionStart with BAM
Taken from first 12 participants to complete project at University of Iowa Avoids concerns with evoking dangerous behaviors
7 completed Pragmatic/BAM Avoids strengthening behavior in continuous schedule and possible
5 completed Standard FA relapse
No consideration for differences in demographics or baseline behavior 3. Standard FA group has more rapid reductionChoose Standard FA
Avoid erroneous results and inadvertent reinforcement of behavior
More confidence in results and better understanding of true behavior
strengthening variables