Parent Training Via Telehealth for Children with Autism Spectrum Disorder and Disruptive Behavior: A Demonstration Pilot

Background: As the number of cases of ASD has increased, so have the challenges of serving these children and their families. Telehealth is a potential solution to the problem of limited access to specialized services for children with ASD and families in rural areas. The Research Units in Behavioral Interventions (RUBI) PT program showed that a 24-week, structured parent training (PT) program was effective for reducing disruptive behavior in children with ASD when delivered 1:1 in a clinical setting. A promising expansion involves telehealth delivery of RUBI-PT, as this modality could increase access to care in rural and underserved communities.

Objectives: This open-label pilot study evaluated the feasibility and initial efficacy of the RUBI-PT program when delivered via telehealth to families of children with ASD and disruptive behaviors in rural areas. We define feasibility as evidence that the treatment is acceptable to families and therapists, that the outcome measures can be collected as scheduled, and that the treatment can be delivered reliably by trained therapists via telehealth. Efficacy was evaluated through change on the parent-rated Aberrant Behavior Checklist-Irritability subscale (ABC-I) and independent evaluator ratings of overall improvement on the Clinical Global Impression-Improvement (CGI-I) scale.

Methods: Parents of children ages 3-8 with a community diagnosis of ASD and disruptive behavior living in rural Georgia were enrolled in the 24-week study. The RUBI PT curriculum is based on principles of applied behavior analysis and provides parents with specific techniques to manage child behavioral problems and promote adaptive skills. Eleven core sessions and up to two supplemental sessions (e.g. toileting, feeding, sleep issues) were delivered over 16 weeks. Follow up telephone boosters were conducted at Weeks 18, 20, and 22 to promote skill generalization and maintenance. Assessments occurred at Baseline, Weeks 8 and 16 and 24.

Results: Fourteen children with a community diagnosis of ASD were screened and all met eligibility criteria. Families were recruited from 4 telehealth sites (2 schools, 1 primary care center, 1 regional medical center). Mean age was 5.8 ± 1.7 years; 64% were males; mean IQ = 69.4 ± 17.6. Thirteen of 14 families (92.9%) completed the 24-week treatment. Feasibility outcomes showed 98% therapist fidelity to treatment, high parental engagement in treatment (91.6% of core sessions attended) and 94.6% attainment of in-session goals. Despite the distance from the center, we were able to collect 95% of outcome data from parents and caregivers across the 24-week trial. Parents reported greater confidence in managing problem behaviors and both therapists and parents reported high levels of comfort with the telehealth technology. Regarding efficacy of the telehealth treatment, parents reported a 46.4% decrease in disruptive behaviors on the ABC-I at Week 24. Eleven of 14 (78.5%) participants were rated as much/very much improved on the CGI-I by an independent evaluator.

Conclusions: The delivery of PT via telehealth appears to be acceptable to parents and therapists. Preliminary efficacy findings are promising and suggest that delivery of the RUBI PT program via telehealth may produce notable reductions in parent-reported child disruptive and noncompliant behaviors.