Applied Behavior Analysis Using Telehealth Increases Access and

Decreases Costs for Treating Challenging Behavior in Children with Autism

Scott Lindgren, PhD1, David Wacker, PhD1, Alyssa Suess, PhD1, Kelly Schieltz, PhD2, Kelly Pelzel, PhD1, Todd Kopelman, PhD1, John Lee1, Patrick Romani, PhD3, & Debra Waldon, MD1
1University of Iowa Childrens Hospital, Iowa City, IA

2University of Missouri-Columbia, Columbia, MO

3University of Nebraska Medical Center, Omaha, NE

scott-lindgren@uiowa.edu

Objective

Results

This study was designed 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).

All three service

models produced a
significant reduction
in problem behavior
by training parents to
use FA and FCT with
their children. Mean
percent reduction in
problem
behavior
was over 90% in all
groups.
Treatment acceptability based on parent ratings was
also high for all groups. Total costs for implementing
treatment were lowest for home telehealth. In-Home
Therapy was most expensive, due mainly to the high cost
of therapist travel and a greater number of home visits
needed to complete FCT.

Methods
The study compared data on the outcomes and costs for
implementing research-based ABA procedures to reduce
problem behavior using 3 service delivery models: (1) inhome therapy, (2) clinic-based telehealth, or (3) homebased telehealth. Participants were 94 young children (75
male, ages 21-84 months old) with either an autism
spectrum disorder (n=63) or another developmental
disability (n=31). Intellectual disability was present in 71%
of the children. The families in the In-Home Therapy group
participated in 1996-2009, the Clinic Telehealth group
participated in 2009-2012, and the Home Telehealth group
participated in 2012-2015 (the latter 2 groups included only
children with ASD).
Functional analysis (FA) and functional communication
training (FCT) were conducted by parents who received realtime coaching from a behavior therapist who was either in
the home or on a video link to the home or to a nearby
clinic. Families lived from 3 to 317 miles from the UI
Children's Hospital. Independent data coders scored
problem behavior, mands (i.e., appropriate requests), and
task completion in 6-sec intervals from video recordings.

Acknowledgments

David Wacker and Alyssa Suess coach a mother who is implementing FCT with her son.

Outcomes and Costs of FA+FCT Treatment

For ANOVAs, groups with the same superscript did not differ significantly.

Impact
This research demonstrates that parents can use ABA
procedures to successfully treat behavior problems
associated with autism and other developmental
disabilities 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 to in-home therapy,
geographic barriers to providing access to ABA can be
minimized. These findings support the potential for using
telehealth to provide research-based behavioral
treatment for any family that has access to the internet.

This research was supported by grants R40 MC22644 from the Maternal and Child Health Bureau of the Health Resources and Services Administration, R01 MH89607 from the National Institute of Mental Health, and R01
HD029402 from the National Institute of Child Health and Human Development. We thank the research assistants and the staff of the University of Iowa Child Health Specialty Clinics for their invaluable
contributions to these studies. We are especially grateful to all of the families who have shared their lives with us.