Table 1.

Chronological Summary of Telehealth Studies Targeting Challenging Behavior

Study	Participants	Remote Site	Procedures	Results
Barretto et al. (2006)	1 boy, 1 girl Age range: 1‐5 years Dx: ASD or severe ID Bx: screaming, noncompliance, destruction, self‐injury	Site: U.S. Local School or U.S. Local DHS office Implementer: Classroom teacher or foster mother and physical therapist Coach: School psychologist at remote site with guidance from behavior consultant at the host site or behavior consultant	FA	FA: Esc (N = 2)
Frieder et al. (2009)	4‐year‐old boy Dx: developmental delay Bx: crying, screaming, aggression	Site: U.S. School Implementers: Teacher, SLP Coach: Behavior consultant in person and via telehealth	FA	FA: Tan
Machalicek et al. (2009)	2 girls Age range: 7‐11 years Dx: moderate ID Bx: aggression, destruction, self‐injury, tantrums	Site: U.S. School Implementer: Graduate student Coach: Supervisor in separate room of the school building	FA	FA: Att + Esc (N = 2)
Gibson et al. (2010)	4‐year‐old boy Dx: ASD Bx: elopement	Site: U.S. School Implementer: Teacher, teacher assistant Coach: Behavior consultant	FCT	FCT: Decreased occurrence of elopement
Wacker et al. (2013a)	17 boys and girls Age range: 2‐6 years Dx: ASD Bx: aggression, self‐injury, destruction, screaming, elopement	Site: U.S. Local Clinics Implementers: Mothers or fathers with assistants at the remote site Coach: Behavior consultant	FCT for Esc (N = 13); Tan (N = 5); Att (N = 1)	FCT: Avg 93% reduction in challenging behavior from baseline levels
Wacker et al. (2013b)	20 boys and girls Age range: 2‐6 years Dx: ASD Bx: aggression, destruction, self‐injury, disruption, dangerous behavior, repetitive behavior	Site: U.S. Local Clinics Implementers: Mothers or fathers with assistants at the remote site Coach: Behavior consultant	FA	FA: Esc (N = 2); Tan (N = 3); Esc + Tan (N = 13); No identified function because of lack of challenging behavior (N = 2)
Suess et al. (2014)	3 boys Age range: 2‐3 years Dx: ASD Bx: self‐injury, aggression, destruction	Site: U.S. Homes Implementers: Parents Coach: Behavior consultant	FA + FCT	FA: Esc + Tan (N = 3) FCT: High levels of parent fidelity across coached and independent trials
Suess et al. (2016)	5 boys and girls Age range: 2‐7 years Dx: ASD Bx: aggression, self‐injury, destruction, crying	Site: U.S. Local Clinics Implementers: Parents with assistant at the remote site Coach: Behavior consultant	FA + FCT	FA: Esc (N = 3); Esc + Tan (N = 1); No identified function because of lack of challenging behavior (N = 1) FCT: Avg 65% reduction in challenging behavior; Avg 34% increase in task completion; Avg 87% increase in manding
Machalicek et al. (2016)	3 boys and girls Age range: 8‐16 years Dx: ASD Bx: aggression, self‐injury, destruction, inappropriate vocalizations, spitting	Site: U.S. Homes Implementers: Mothers or fathers Coach: Behavior consultant	FA + function‐based treatment	FA: Esc (N = 1); Tan (N = 1); Esc + Tan (N = 1) Function‐based treatment: Decreased occurrences in challenging behavior
Simacek et al. (2017)	2 girls Age range: 3‐4 years Dx: ASD Bx: tantrums	Site: U.S. Homes Implementers: Mothers or fathers Coach: Behavior consultant	FA + FCT	FA: Esc (N = 1); Esc + Tan (N = 1) FCT: Decreased occurrences of challenging behavior and increased occurrences of mands
Benson et al. (2018)	2 boys Age range: 5‐8 years Dx: ASD or cerebral palsy Bx: self‐injury	Site: U.S. Home Implementers: Parents Coach: Behavior consultant	FA + FCT	FA: Att (N = 1); Tan (N = 1) FCT: Decreased occurrences of challenging behavior and increased occurrences of mands
Dimian et al. (2018)	7‐year‐old boy Dx: ASD, Lissencephaly, epilepsy Bx: tantrums	Site: U.S. Home Implementer: Parents Coach: Behavior consultant	FA + FCT	FA: Esc FCT: 100% reduction in tantrums and 30% increase in appropriate manding
Schieltz et al. (2018)	1 boy, 1 girl Age range: 2‐6 years Dx: ASD Bx: self‐injury, aggression, destruction	Site: U.S. Home Implementer: Mother Coach: Behavior consultant	FA + FCT	FA: Tan (N = 1); Tan + Esc (N = 1) FCT: Treatment failure Reason: Behavior function switched from a social function to an automatic function (N = 1); Poor parent fidelity (N = 1)
Hoffman et al. (2019)	4 boys Age range: 1‐3 years Dx: speech delay, developmental delay, or ASD Bx: aggression, self‐injury	Site: U.S. Homes or U.S. Local ECSE clinic Implementer: Parents Coach: Behavior specialist at remote site with support from behavior consultant at host site	FA + FCT	FA: Att + Tan (N = 1); Att + Tan + Esc (N = 1); Att (N = 1); Tan (N = 1) FCT: Decreased occurrences of challenging behavior and increased occurrences of mands
Martens et al. (2019)	3 boys* Age range: 4‐8 years Dx: ASD or Rett syndrome Bx: self‐injury, aggression, destruction, tantrums	Site: U.S. Homes Implementer: Parents Coach: Behavior consultant	FA	FA: Tan (N = 1); Tan + Esc (N = 2)
Monlux et al. (2019)	10 boys Age range: 3‐10 years Dx: Fragile X syndrome Bx: self‐injury, aggression	Site: U.S. Homes Implementer: Mothers Coach: Behavior consultant	FCT	FCT: Avg 88% reduction in challenging behavior from baseline levels
Tsami et al. (2019)	12 boys and girls Age range: 3‐13 years Dx: ASD Bx: screaming, aggression, self‐injury, destruction, flopping	Site: International Homes Implementers: Mothers or fathers Coach: Behavior consultant and interpreter	FA + FCT	FA: Esc (N = 4); Tan (N = 2); Att (N = 2); Esc + Tan (N = 2); Att + Esc (N = 1); Att + Tan + Esc (N = 1) FCT: At least 80% reduction in challenging behavior from baseline levels and manding occurred during at least 90% of opportunities
Lindgren et al. (2020)	38 boys and girls Age range: 1‐7 years Dx: ASD and/or ID Bx: aggression, destruction, self‐injury, tantrums	Site: U.S. Homes Implementer: Parents Coach: Behavior consultant	FA + FCT	FA: Esc (N = 22); Tan (N = 35); Att (N = 3)** FCT: Avg 97% reduction in challenging behavior from baseline levels

Note. Coach was always the behavioral consultant at the host site unless otherwise noted. ASD = autism spectrum disorder; Att = attention function; Avg = average; Bx = target challenging behavior; Dx = diagnosis; ECSE = early childhood special education; Esc = escape function; FA = functional analysis; FCT = functional communication training; ID = intellectual disability; N = number of cases; SLP = speech‐language pathologist; Tan = tangible function; U.S. = United States; * = Martens et al. (2019) included a fourth participant whose data were previously reported in Dimian et al. (2018); ** = Lindgren et al. (2020) did not report identified function(s) by participant, but did indicate that most participants had more than one function resulting in a greater sum than total number of participants.