Social Innovation Ventures, Lewes, DE, USA.
Kyo, San Francisco, CA, USA.
World J Pediatr. 2023 Aug;19(8):753-760. doi: 10.1007/s12519-022-00643-0. Epub 2022 Nov 17.
BACKGROUND: With increasing numbers of individuals diagnosed with autism spectrum disorder (ASD) and with affirmation of applied behavior analysis (ABA) as an evidence-based standard of care for ASD, there has been a proliferation of agencies offering ABA services over the last several decades. Disagreement exists among ABA providers and health plans that reimburse those providers on the optimal number of hours of ABA services that should be reimbursed. This study aims to understand whether children who receive more hours of ABA therapy achieve better outcomes and to evaluate the impact of the COVID-19-induced shift to telehealth clinical supervision on outcomes. METHODS: A retrospective cohort analysis was performed using data from the Vineland 3 Comprehensive Interview Form to assess function throughout ABA treatment. Paired sample t tests, independent sample t tests, Cohen's D, and Pearson correlations were used to determine relationships between Vineland scores and input variables including hours of service and modality of supervision (in-person vs. telehealth). RESULTS: While statistically and clinically significant improvements in function were observed, children appear to have improved outcomes independent of the number of hours of service received. There were also no significant associations between modality of supervision and Vineland standard scores. CONCLUSIONS: These findings challenge prior research that demonstrated a linear dose-response relationship. By tailoring treatment dosage to the individual client's needs, providers may be able to better maximize functional progress of the client, to preserve family time, and to utilize health plan dollars more efficiently.
背景:随着被诊断患有自闭症谱系障碍(ASD)的个体数量不断增加,以及应用行为分析(ABA)被确认为 ASD 的循证护理标准,过去几十年来,提供 ABA 服务的机构大量涌现。ABA 服务提供商和支付这些提供商费用的健康计划之间存在分歧,即应报销多少小时的 ABA 服务。本研究旨在了解接受更多小时 ABA 治疗的儿童是否能取得更好的结果,并评估 COVID-19 导致的临床监督转向远程医疗对结果的影响。
方法:使用来自 Vineland 3 综合访谈表的数据进行回顾性队列分析,以评估整个 ABA 治疗过程中的功能。采用配对样本 t 检验、独立样本 t 检验、Cohen's D 和 Pearson 相关分析来确定 Vineland 评分与包括服务小时数和监督模式(面对面与远程医疗)在内的输入变量之间的关系。
结果:尽管在功能上观察到统计学和临床意义上的显著改善,但儿童的结果似乎与其接受的服务小时数无关。监督模式与 Vineland 标准分数之间也没有显著关联。
结论:这些发现挑战了先前表明线性剂量反应关系的研究。通过根据个体客户的需求调整治疗剂量,提供者可以更好地最大限度地提高客户的功能进展,节省家庭时间,并更有效地利用健康计划资金。
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