Telehealth Delivery of a Caregiver-Mediated Intervention for Minimally Verbal Children with ASD

Background:  It is estimated that 25% to 30% of children with Autism Spectrum Disorder (ASD) remain minimally verbal (i.e., using fewer than five words on a daily basis; Tager-Flusberg & Kasari, 2013; Lord et al., 2004). Intensive behavioral interventions for children with ASD often focus on social initiations such as requests as initial targets for language development (Sundberg & Partington, 1998). Request training teaches individuals to initiate communication with others by incorporating behavioral techniques (e.g., environmental manipulations, prompting, and reinforcement) within naturalistic teaching opportunities (Paul, 2008), and can be implemented through direct services or delivered as a caregiver-mediated intervention (Loughrey et al., 2014). Several barriers to accessing evidence-based treatment for children with autism are common, including lengthy time commitment and geographical restrictions (Thomas et al., 2007). Parents of children with ASD have specifically recognized the need for greater access to applied behavior analysis services (Dymond et al., 2007). Prior studies have provided promising evidence of the utility of telehealth technology to deliver behavioral services to children with ASD (e.g., Wacker et al., 2013; Vismara et al., 2012 and 2013); however, research is limited.

Objectives:  The current study aimed to evaluate the feasibility, caregiver satisfaction, and preliminary efficacy of a caregiver-mediated intervention delivered via telehealth to improve expressive language of 15 young children with ASD and severe language delays.

Methods:  Fifteen minimally verbal children (ages 2 to 4 years) with autism were enrolled in a 12-week caregiver-mediated request training intervention. All participants were diagnosed with ASD using gold standard assessment procedures, and the average Mullen expressive language t-score of the sample was 23.72 (SD = 8.46; Mean AE = 13.63 months). The study utilized a within-group design and compared child vocalization outcomes at pre- and post-intervention, as well as at 1-month follow-up. Intervention procedures were based on Loughrey et al. (2014), and included didactic teaching, video modeling, practice, and feedback.

Results:  Data were collected utilizing both direct and indirect measures that assessed feasibility, caregiver satisfaction, and preliminary efficacy. Out of 15 enrolled participants, the majority (66.67%) completed the entire study. Session attendance was high (M = 82.21%, SD = 13.66%), all participants (100%) reported satisfaction with the services their child received, and most (88.89%) reported that they would participate in telehealth services in the future. During a naturalistic observation from pre- to post-treatment, most children (80%) made gains in unprompted requests, and half (50%) made gains in spontaneous comments.

Conclusions: Our study provides preliminary support for the feasibility and efficacy of a caregiver-mediated intervention to increase language skills in minimally verbal children with ASD delivered entirely through the use of telehealth technology. Given that many young children with ASD do not develop functional communication skills without intervention (Eigsti et al., 2011) and that there are significant barriers to accessing evidence-based treatment, a time-limited and easily accessible intervention such as the one utilized in our study has the potential to make a large positive impact on this population.