Lindgren Scott, Wacker David, Suess Alyssa, Schieltz Kelly, Pelzel Kelly, Kopelman Todd, Lee John, Romani Patrick, Waldron Debra
Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine; Center for Disabilities and Development, University of Iowa Children's Hospital, Iowa City, Iowa;
College of Education, University of Missouri, Columbia, Missouri;
Pediatrics. 2016 Feb;137 Suppl 2(Suppl 2):S167-75. doi: 10.1542/peds.2015-2851O.
To determine whether challenging behavior in young children with autism and other developmental disabilities can be treated successfully at lower cost by using telehealth to train parents to implement applied behavior analysis (ABA).
We compared data on the outcomes and costs for implementing evidence-based ABA procedures to reduce problem behavior by using 3 service delivery models: in-home therapy, clinic-based telehealth, and home-based telehealth. Participants were 107 young children diagnosed with autism or other neurodevelopmental disorders, and data analysis focused on the 94 children who completed treatment.
All 3 service delivery models demonstrated successful reduction of problem behavior by training parents to conduct functional analysis and functional communication training. The mean percentage reduction in problem behavior was >90% in all 3 groups after treatment, and treatment acceptability based on parent ratings was high for all groups. Total costs for implementing treatment were lowest for home telehealth, but both telehealth models were significantly less costly than in-home therapy.
This research demonstrated that parents can use ABA procedures to successfully treat behavior problems associated with autism spectrum disorders regardless of whether treatment is directed by behavior consultants in person or via remote video coaching. Because ABA telehealth can achieve similar outcomes at lower cost compared with in-home therapy, geographic barriers to providing access to ABA for treating problem behavior can be minimized. These findings support the potential for using telehealth to provide research-based behavioral treatment to any family that has access to the Internet.
通过使用远程医疗培训家长实施应用行为分析（ABA），确定能否以更低成本成功治疗患有自闭症和其他发育障碍的幼儿的挑战性行为。
我们比较了使用三种服务提供模式实施基于证据的ABA程序以减少问题行为的结果和成本数据：家庭治疗、基于诊所的远程医疗和基于家庭的远程医疗。参与者为107名被诊断患有自闭症或其他神经发育障碍的幼儿，数据分析聚焦于完成治疗的94名儿童。
所有三种服务提供模式均通过培训家长进行功能分析和功能性沟通训练，成功减少了问题行为。治疗后，所有三组问题行为的平均减少百分比均>90%，基于家长评分的治疗可接受性在所有组中都很高。家庭远程医疗实施治疗的总成本最低，但两种远程医疗模式的成本均显著低于家庭治疗。
本研究表明，无论治疗是由行为顾问亲自指导还是通过远程视频指导，家长都可以使用ABA程序成功治疗与自闭症谱系障碍相关的行为问题。由于与家庭治疗相比，ABA远程医疗可以以更低成本实现类似结果，因此可以将提供ABA治疗问题行为的地理障碍降至最低。这些发现支持了使用远程医疗为任何能够上网的家庭提供基于研究的行为治疗的潜力。
