Telehealth Brings Behavior Analysis Training to Iowa Families (IA UCEDD)

October 28, 2013

Psychologists at the University of Iowa Center for Disabilities and Development (CDD), Iowa's UCEDD, are combining clinical expertise and distance technology to deliver applied behavior analysis (ABA) training for Iowa families of children with autism spectrum disorders (ASD) and other developmental disabilities.

The concept of applying behavioral telehealth to children with autism grew out of the pioneering work of Dr. David Wacker, Professor of Pediatrics at the University of Iowa Carver College of Medicine and a behavioral psychologist at the UI Children's Hospital and CDD. Wacker achieved significant behavioral improvements in young children with ASD and other developmental disorders by providing in-home training for parents on the use of ABA techniques. Wacker and his colleagues hypothesized that these results could be replicated by offering the training remotely to families across Iowa who would otherwise be unable to access services due to the cost and inconvenience of driving to Iowa City for care.  Teaming up with co-principal investigator Scott Lindgren, also a Professor of Pediatrics at the University of Iowa, Wacker obtained initial funding from the National Institute of Mental Health in 2009-2012 to test the outcomes achieved by providing telehealth coaching to families attending weekly sessions at regional Title V clinics close to their homes.  A randomized clinical trial to bring telehealth services directly into family homes is now being funded by the Maternal and Child Health Bureau of the Health Resources and Services Administration.

Children are enrolled in the current study if they are between 18 months and 6 years of age, have a diagnosis of ASD, and exhibit significant behavior problems.  Before starting the project, they must travel to CDD for a comprehensive assessment that includes interviews, observations, and standardized testing. Once enrolled in the study, families are provided with a laptop computer and high-speed internet access if they do not already have this access.  They are then connected via Skype to a behavior consultant at CDD.

Families receive weekly telehealth consultations for a period of approximately 4 to 6 months, and parents conduct all sessions themselves.  Consultants coach families on the use of an ABA technique known as functional analysis (FA) to determine a behavior's "function" for each child.  Under the guidance of the consultants, parents place the child in a variety of situations to determine how the behavior is being reinforced.  These observations may lead, for example, to a determination that a child's aggression is accomplishing the goal of escaping a task such as picking up toys from the floor after a play session.  Once the consultant has identified a problem behavior's function, parents learn to guide their child in reducing the target behavior through a treatment technique known as functional communication training (FCT).  Using FCT for a child who becomes aggressive when directed to pick up toys, the parent would no longer reward the child's outbursts by excusing him/her from picking up the toys.  Instead, the child would be prompted to communicate by using a more positive response, such as asking for help or requesting to take a break from the task.  Parents are instructed to practice these techniques between sessions and to record several sessions each week to get more feedback for the consultants on how they are doing.

Drs. Lindgren and Wacker are very pleased with the outcomes achieved to date.  The results obtained through telehealth training mirror the results achieved by sending therapists out to homes in person.  Not only are staff time and transportation costs decreased dramatically, but problem behavior is reduced by more than 90%.  After training, parents now have strategies to shape behavior that can be generalized to school and other community settings.  Providing training through telehealth resulted in an average weekly cost of $60 compared to a cost of $291 per week to send therapists out to homes.  Most importantly, parents report that quality of life for their children has improved significantly.  One mother placed the benefits of the training in perspective by reporting that for the first time, her daughter has friends to invite to her birthday party.

Initial publications describing Iowa's ABA telehealth research include (1) "Conducting functional analyses of problem behavior via telehealth" in the Journal of Applied Behavior Analysis (2013),  (2) "Conducting functional communication training via telehealth to reduce the problem behavior of young children with autism" in the Journal of Developmental and Physical Disabilities (2013), and (3) "Evaluating the treatment fidelity of parents who conduct in-home functional communication training with coaching via telehealth" in the Journal of Behavioral Education (2013).



1.  Wacker, D.P., Lee, J.F., Padilla Dalmau, Y.C., Kopelman, T.G., Lindgren, S.D., Kuhle, J., Pelzel, K.E., & Waldron, D.B.  (2013). Conducting functional analyses of problem behavior via telehealth.  Journal of Applied Behavior Analysis, 46, 31-46. DOI: 10.1002/jaba.29.

2.  Wacker, D. P., Lee, J. F., Padilla Dalmau, Y. C., Kopelman, T. G., Lindgren, S. D., Kuhle, J., Pelzel, K. E., Dyson, S., Schieltz, K. M., & Waldron, D. B. (2013). Conducting functional communication training via telehealth to reduce the problem behavior of young children with autism. Journal of Developmental and Physical Disabilities. PMCID:PMC3608527. DOI:10.1007/s10882-02-9314-0

3.  Suess, A.N., Romani, P.W., Wacker, D.P., Dyson, S.M., Kuhle, J.L., Lee, J.F., Lindgren, S.D., Kopelman, T.G., Pelzel, K.E., Waldron, D.B. (2013). Evaluating the treatment fidelity of parents who conduct in-home functional communication training with coaching via telehealth.  Journal of Behavioral Education. DOI: 10.1007/s10864-013-9183-3