Adelson Robert P, Ciobanu Madalina, Garikipati Anurag, Castell Natalie J, Barnes Gina, Tawara Ken, Singh Navan P, Rumph Jodi, Mao Qingqing, Vaish Anshu, Das Ritankar
Research and Development, Montera, Inc. DBA Forta, San Francisco, USA.
Engineering, Montera, Inc. DBA Forta, San Francisco, USA.
Cureus. 2024 Jun 14;16(6):e62377. doi: 10.7759/cureus.62377. eCollection 2024 Jun.
BACKGROUND/OBJECTIVES: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social communication difficulties and restricted repetitive behaviors or interests. Applied behavior analysis (ABA) has been shown to significantly improve outcomes for individuals on the autism spectrum. However, challenges regarding access, cost, and provider shortages remain obstacles to treatment delivery. To this end, parents were trained as parent behavior technicians (pBTs), improving access to ABA, and empowering parents to provide ABA treatment in their own homes. We hypothesized that patients diagnosed with severe ASD would achieve the largest gains in overall success rates toward skill acquisition in comparison to patients diagnosed with mild or moderate ASD. Our secondary hypothesis was that patients with comprehensive treatment plans (>25-40 hours/week) would show greater gains in skill acquisition than those with focused treatment plans (less than or equal to 25 hours/week). Methods: This longitudinal, retrospective chart review evaluated data from 243 patients aged two to 18 years who received at least three months of ABA within our pBT treatment delivery model. Patients were stratified by utilization of prescribed ABA treatment, age, ASD severity (per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), and treatment plan type (comprehensive vs. focused). Patient outcomes were assessed by examining success rates in acquiring skills, both overall and in specific focus areas (communication, emotional regulation, executive functioning, and social skills).
Patients receiving treatment within the pBT model demonstrated significant progress in skill acquisition both overall and within specific focus areas, regardless of cohort stratification. Patients with severe ASD showed greater overall skill acquisition gains than those with mild or moderate ASD. In addition, patients with comprehensive treatment plans showed significantly greater gains than those with focused treatment plans.
The pBT model achieved both sustained levels of high treatment utilization and progress toward patient goals. Patients showed significant gains in success rates of skill acquisition both overall and in specific focus areas, regardless of their level of treatment utilization. This study reveals that our pBT model of ABA treatment delivery leads to consistent improvements in communication, emotional regulation, executive functioning, and social skills across patients on the autism spectrum, particularly for those with more severe symptoms and those following comprehensive treatment plans.
背景/目的：自闭症谱系障碍（ASD）是一种神经发育障碍，其特征为社交沟通困难以及受限的重复行为或兴趣。应用行为分析（ABA）已被证明能显著改善自闭症谱系个体的治疗效果。然而，在治疗服务的可及性、成本和提供者短缺方面的挑战仍然是治疗实施的障碍。为此，家长被培训成为家长行为技术员（pBTs），这改善了ABA治疗的可及性，并使家长有能力在自己家中提供ABA治疗。我们假设，与被诊断为轻度或中度ASD的患者相比，被诊断为重度ASD的患者在技能习得的总体成功率方面将取得最大的提升。我们的次要假设是，拥有综合治疗计划（每周超过25 - 40小时）的患者在技能习得方面比拥有集中治疗计划（每周少于或等于25小时）的患者有更大的提升。
这项纵向回顾性病历审查评估了243名年龄在2至18岁之间的患者的数据，这些患者在我们的pBT治疗模式下接受了至少三个月的ABA治疗。患者按规定ABA治疗的使用情况、年龄、ASD严重程度（根据《精神疾病诊断与统计手册》第五版）以及治疗计划类型（综合型与集中型）进行分层。通过检查技能习得的成功率来评估患者的治疗效果，包括总体成功率以及在特定重点领域（沟通、情绪调节、执行功能和社交技能）的成功率。
在pBT模式下接受治疗的患者在总体技能习得以及特定重点领域均取得了显著进展，无论队列分层情况如何。重度ASD患者在总体技能习得方面的提升比轻度或中度ASD患者更大。此外，拥有综合治疗计划的患者比拥有集中治疗计划的患者取得了显著更大的提升。
pBT模式实现了持续的高治疗利用率水平，并朝着患者目标取得了进展。无论治疗利用率水平如何，患者在总体技能习得以及特定重点领域的成功率都有显著提升。这项研究表明，我们的pBT模式的ABA治疗实施能够使自闭症谱系患者在沟通、情绪调节、执行功能和社交技能方面持续改善，特别是对于那些症状更严重以及遵循综合治疗计划的患者。
