Authors Explore Using Telehealth to Deliver Behavioral Treatment to Young Children with Developmental Disabilities

September 18, 2013

"The results of the current investigation support . . . [earlier results] showing that behavioral treatments such as FCT [functional communication training] can be delivered effectively via telehealth," write the authors of an article published in the Journal of Behavioral Education online on September 14, 2013. FCT is one of the most common differential reinforcement procedures used to treat severe problem behavior. The purpose of FCT is to teach an individual an appropriate communicative response to access the same reinforcement that maintained problem behavior and to place problem behavior on extinction. To identify the maintaining reinforcer, a functional analysis (FA) typically precedes the implementation of FCT. The combination of FA plus FCT and other differential reinforcement procedures has been demonstrated to be effective for reducing problem behavior displayed by individuals diagnosed with developmental disabilities. Recently, investigators developed FA plus FCT treatment interventions for parents to implement with their children while parents received all consultation via telehealth. In the present investigation, parents received coaching via telehealth on how to implement FCT procedures within their homes. In the descriptive study described in this article, the authors evaluated the fidelity with which parents implemented treatment procedures and the types of fidelity errors they made during coached and independent trials. The authors evaluated the levels of fidelity during coached and independent trials within a multielement design and recorded parents' omission and commission errors during different components of the treatment over time.

Study participants were three children enrolled in a federally funded research project: a 2-year, 11-month-old male; a 2-year, 7-month-old male; and a 3-year, 3-month-old male. All were diagnosed with pervasive developmental disorder, not otherwise specified; one was also diagnosed with intellectual disability. All training was provided to the parents via telehealth by a behavior consultant in a tertiary-level hospital setting. FCT trials coached by the behavior consultant were conducted during weekly 1-hour visits. Parents made video recordings of treatment trials in which they conducted the procedures independent of coaching. Problem child behaviors included self-injurious behavior, property destruction, elopement (i.e., the child's moving or attempting to move away from the parent when the parent was delivering a demand or when the child attempted to leave the designated work area), crying/screaming, and noncompliance.

The authors found that

  • All three children showed reductions in problem behaviors, with no to very little problem behavior occurring during the telehealth FCT coached trials by the end of treatment.
  • For the three families, there were no consistent differences between coached and independent trials relative to the fidelity with which parents delivered treatment.
  • No consistent relationship between the occurrence of child problem behavior and the fidelity of treatment delivered by the parents occurred across parents for the coached and independent trials.

The authors conclude that "continued analysis of telehealth-delivered behavioral treatment is warranted given the positive treatment effects achieved to date." They continue, "as more telehealth treatment is conducted in the future, many more children can be served who live in areas that do not provide routine access to behavioral services."

Suess AN, Romani PW, Wacker DP, et al. 2013. Evaluating the treatment fidelity of parents who conduct in-home functional communication training with coaching via telehealth. Journal of Behavioral Education [published online on September 14, 2013]. Abstract available at