The main purpose of this study is to determine the most efficient way for families to reduce
problem behavior in their children with an autism spectrum disorder. Parents will be trained
using telehealth to use applied behavior analysis (ABA) procedures to improve child behavior
and communication. The study compares an established type of ABA assessment and treatment to
a briefer, more streamlined version of this same type of assessment/treatment.
Managing challenging behavior in autism spectrum disorders (ASD) can profoundly improve
quality of life for children and families. However, many families lack access to
research-based treatment, such as applied behavior analysis (ABA). This study is a
randomized trial comparing outcomes of treatment for ASD using either a standard Functional
Analysis Plus Functional Communication Training (FA+FCT) package or a pragmatic version that
offers a briefer, less time-intensive model of FA+FCT. Both types of FA+FCT are provided via
telehealth in family homes to maximize generalizability to real-life settings. Providing ABA
through telehealth makes an effective treatment accessible across geographic barriers so
that no child is excluded based on where they live. The study also examines key family
factors that influence successful outcomes.
The study has 3 primary aims: (1) To assess outcomes for ABA telehealth by assigning
children to either a Pragmatic FA+FCT group or to a group receiving Standard FA+FCT.
Outcomes will be compared based on the percent reduction in problem behavior, communication
increases, time to achieve outcomes, treatment fidelity, family acceptance of treatment, and
generalization and maintenance of treatment gains. (2) The study will assess the relation of
family factors to treatment efficacy and acceptability by assessing parent stress, mood, and
social support in relation to outcomes. (3) Cost effectiveness will be assessed in relation
to the treatment methods used and the efficiency of ABA telehealth.
The study will include 102 children who meet eligibility criteria from among a larger sample
of 150 children. Thirty-six children will receive intervention in each of three states:
Iowa, Georgia, and Texas. Study design is a randomized trial using an intent-to-treat
analysis. Half of the sample will be randomized to Pragmatic FA+FCT and half to Standard
FA+FCT. Treatment will be provided via telehealth using FCT, which is a function-based ABA
technique in which parents are trained to be therapists under the direction of behavior
consultants. Study procedures typically are completed within 6 months, and follow-up
assessments occur 6 months after treatment completion. Data analyses include comparisons
between assessment groups, single-case designs examining responses in individual children,
cost analyses, and regression analyses of the effects of family factors on outcomes.
The investigators prior research shows that problem behavior can be reduced by over 90% in
most children with ASD after 4-6 months of telehealth treatment. If Pragmatic FA+FCT can
reduce problem behavior at rates comparable to Standard FA+FCT, then treatment can be
started sooner and families can achieve successful outcomes at lower cost. Although
pragmatic FA+FCT provides less behavioral information, it may be more resistant to treatment
relapse because it does not involve reinforcing high rates of problem behavior.
- Confirmed diagnosis of autism spectrum disorder
- Significant behavior problems requiring treatment
- At least one parent willing to be trained in behavior analysis via telehealth
- Unstable or degenerative neurological disorder