Telehealth offers Patients and Providers a New Tool in the Treatment of Autism
Telehealth can play an essential role in the early detection of Autism Spectrum Disorder (ASD). Early detection is vital to helping a child with autism, as research has shown that early diagnosis can significantly improve a child’s overall development. Research supports that young children who receive the early behavioral intervention (before two years) demonstrate substantial gains in functioning when compared to children diagnosed later.
Although increasing evidence shows that children with autism spectrum disorder can be accurately identified during their second year of life, the average age of diagnosis in both Tennessee and across the country remains well above four years of age.
One major contributing factor to delayed identification relates to challenges accessing diagnostic clinics and autism experts, as many families face long waiting periods for specialty clinics as well as geographic and travel burdens. These barriers can leave the families of children with a suspected diagnosis of autism in the dark for months or more than a year, delaying access to early interventions that can dramatically influence development.
What is Applied Behavior Analysis?
- How behavior works
- How behavior is affected by the environment
- How learning takes place
ABA therapy applies our understanding of how behavior works to real situations. The goal is to increase behaviors that are helpful and decrease behaviors that are harmful or affect learning.
ABA therapy programs can help:
- Increase language and communication skills
- Improve attention, focus, social skills, memory, and academics
- Decrease problem behaviors
The methods of behavior analysis have been used and studied for decades. They have helped many kinds of learners gain different skills – from healthier lifestyles to learning a new language. Therapists have used ABA to help children with autism and related developmental disorders since the 1960s.
According to the CDC, 1 in 59 children has a diagnosis of Autism Spectrum Disorder. Often, children with autism and their families live too far away from care and support or cannot access it due to high costs and/or limited availability. Telehealth can serve as an excellent resource for the ASD patient and their family. It can help in early detection be and diagnosis, therapy/treatment, and caregiver education
Expanding Access to ABA Therapy Through Parent Training
Applied Behavior Analysis (ABA) therapy is a standard therapy modality and best practice used for children with an ASD diagnosis. ABA, a therapy based on the science of learning and behavior, focuses on increasing behaviors that are desirable and decreasing behaviors that are harmful or affect learning. ABA therapy focuses on positive reinforcement and teaching skills of everyday life: how to deal with conflict, brush teeth, or make eye contact. It is a flexible treatment that is perfect for children with autism as it can be adapted to meet the requirements of each child; each therapy plan is designed specifically for the child’s needs and changes as those needs evolve. It can be provided in many different locations: at home, at school, or in the community.
Like many aspects of health care, ABA treatment is often hard to access for people living in rural or underserved areas. There is a shortage of therapists across the country, even in the most populated and medically advanced regions. The dearth of qualified therapists in rural communities is especially problematic. This shortage is a challenge that telehealth can address well – filling the missing piece of the puzzle.
According to an article in Health Recovery Solutions by Elizabeth Veringa titled “The Telehealth Era”, telehealth, parents, caregivers, and teachers can be trained on how to deliver quality ABA therapy to their children and children in their community. One study found that parents can successfully use functional analysis (FA) and functional communication training (FCT) to treat moderate to severe behavioral problems associated with ASD. Regardless of whether treatment is directed by behavior consultants in-person or via remote video coaching. The study, which analyzed 94 children with ASD, tested the efficacy of utilizing telehealth to train parents in ABA procedures.
The findings indicate that telehealth can successfully train parents in how to implement FA and FCT best to reduce their child’s problem behaviors, supporting that telehealth in place of in-person visits to a specialist.
Vanderbilt University and Virtual Treatment for Autism
An NPR affiliate Nashville Public Radio recently reported, Vanderbilt University’s Treatment and Research Institute for Autism Spectrum Disorders (TRIAD) has been utilizing telemedicine to provide remote early-intervention services to children diagnosed with autism. “We aim to provide high-quality, evidence-based services and training for families and professionals in the topics and skills of most need,” said Dr. Alacia Stainbrook, the program’s director, in a Vanderbilt press release. “To accomplish this, we are working with our partners at the state level to increase access to all that need it. We very much believe that geography should not limit anyone’s ability to receive good services.”
TRIAD’s staff members provide enrolled families with specially programmed iPads that they control from program headquarters in Nashville. Many of the families live in Tennessee’s rural communities. Each week, parents and children—all of whom are three years old or younger—participate from home in remote therapy sessions via video with program staff members. As highlighted in Nashville Public Radio’s piece, which followed parent Stacey Copeland and her two-year-old recently diagnosed son through their video sessions with TRIAD staff, the visits can work even at a distance. “Without ever meeting in person, Copeland has worked solely through the weekly video sessions with Stainbrook and behavioral analyst Will Martin to develop new strategies,” the article notes. “She now pauses just before doing something [her son] River wants and prompts him to do something he doesn’t—whether that is saying a word or making eye contact.” The funding for the Vanderbilt study comes with a grant from the Tennessee Department of Education.
More information on the Vanderbilt program should read the following article dated March 7, 2019, by Kelsey Herbers located on the Vanderbilt University Medical Center website.
Missouri ABA Program Finds Success with Telemedicine
For those patients—and their families—living in rural communities or other underserved areas, it can be challenging to access many of the specialized services, including behavioral and speech therapists, that are necessary when living with the disorder. However, can telehealth help to remove some of these barriers by training providers in remote areas? As Science Magazine first reported, the University of Missouri’s ECHO Autism program has been successfully doing just that, serving as a training hub for primary care providers seeking to treat patients with autism since its launch in 2015 better. The program “[uses] high-quality, secure video conferencing technology to connect participating primary care clinics to a panel of experts,” a press release from the university explains.
Based at the MU Thompson Center for Autism and Neuro-developmental Disorders, the program is part of the broader Project ECHO (Extension for Community Healthcare Outcomes) network, which began at the University of New Mexico. It is dedicated to increasing access to specialty medical care in underserved communities. As ECHO Autism’s director Kristin Sohl, a professor of child health at the university, explains, “The program effectively increases the capacity for health care in under-served communities, which means that families can get the answers they need without traveling or waiting to see a specialist.” In an article detailing the program’s results published in the Journal of Clinical Pediatrics, Sohl and her colleagues note that primary care providers are “in an ideal position to help improve care for” children with autism, given the regularity with which they tend to see patients. Nevertheless, they often tend to “lack confidence, knowledge, and training” on how best to diagnose and treat autism. To that end, ECHO Autism seeks to empower providers—and its early results have been overwhelmingly positive. “Participating primary care providers demonstrated significant improvements in confidence across all sectors of health care for children with autism, including screening and identification, assessment and treatment of medical and psychiatric conditions, and knowledge of and referral to available resources,” per the university’s press release.
ECHO Autism, which has received funding from the Health Resources and Services Administration (HRSA) and the Missouri Telehealth Network, among other sources, is next set to expand to Alabama, Alaska, New Mexico, and Arizona. Notably, among those who will serve at the new program sites in the latter of the two states are Navajo communities. Sohl, for her part, sees the program going even further afield than that in its efforts to serve patients in under-served communities—indeed, program sites in Kenya planed in the future. “The success we have seen in Missouri and in other areas where ECHO Autism replicated means that this model can work in even more remote areas,” she said in the university’s press release. “Expanding the program from Africa to Alaska will help families around the world.”
Providing ABA treatment virtually does not require The Big Investment you might think
The delivery of services associated with ASD does not require providers to spend a large amount of money to purchase customized telehealth technology. Many of the available telehealth platforms available on the market can provide many of the tools necessary to improve access to quality care.
In the ideal world, the clinician has in place Electronic Medical Record (EMR) of your dreams, and they offer a fully integrated Telehealth integrated that meets your practice needs. All sarcasm aside, hopefully, as technology improves, this kind of statement will become more the norm than the “unicorn” it is today.
However, before going out and purchasing or subscribing to the first telehealth company, a little prudent homework will go a long way.
Readers may also find the following useful
- Complete Guide to Telemedicine
- Drexly Products Summaries
- Complete list of Drexly Platform functions and options
- Importance of HIPAA Compliant Telehealth