Table 2.
Summary of studies of telehealth interventions for children with ASD using group designs
| Study | Intervention | Study design | N | Child age group | Implementer | Telehealth setting | Telehealth equipment provided | Coaching component | Length of intervention | Child outcome measures | Implementer outcome measures | Summary of findings |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Blackman et al. (2020) | ABA principles | RCT: In vivo vs. online self-paced vs. waitlist control. Groups were matched based on pretraining assessment scores |
N = 18 In vivo (n = 7) Online (n = 6) Control (n = 5) |
< 8 yrs | Parents | N/A | N/A | None — parent training only | 6 weeks (1×/week, 60–75 min) | Positive parent interactions in play | Positive parent–child play interactions, knowledge assessment, parental stress (PSI-SF), parental competence (PSOC) | Positive parent–child interactions and parent knowledge of ABA increased significantly in both training groups, and the two did not significantly differ from each other. No differences in parental stress or parental competence |
| Dai et al. (2018) | Parent training program — 6 DVD modules with clips of ABA-based intervention | RCT: treatment group vs. waitlist control group. Groups matched based on clinic locations, child age, gender, and maternal education |
N = 29 Treatment (n = 13) Control (n = 16) |
18–70 mos | Parents | Home | Research coordinators ensured that participants could access a DVD player | Therapist contacted families for a weekly 15-min phone call | 14–16 weeks | None | Self-efficacy (EIPSES), intervention knowledge assessment | Parents rated the program highly and reported that children responded well. Quiz scores for parents in the treatment group increased by 8 points. According to analyses of item-level data, parents in the treatment group became more confident in their parenting abilities post-intervention, while parents in the control group became less confident over time |
| Fisher et al. (2020) | Parent training program — 9 multimedia modules describing ABA skills; 6 including scripted roleplay | RCT: treatment group vs. waitlist control group. Parents randomly assigned to groups in dyads |
N = 25 Treatment (n = 13) Waitlist control (n = 12) |
N/A | Parents | Home | Webcam, roleplay materials, Bluetooth headset, and laptop provided when necessary | Researcher provided live coaching while parents roleplayed skills with family member | 9 modules (35–60 min) completed at parents’ own pace (between 1.6 and 10.7 mos) | None | Behavioral implementation of skills (BISWA and BISPA), social validity | Treatment group showed marked improvement in correct ABA skills, whereas control group showed small changes. Parents generally rated the virtual training program as socially acceptable |
| Hao et al. (2021) | SKILLS (based on ImPACT) | Quasi-experimental: parents chose in-person or online training. Groups were matched from a larger population based on child’s age and gender, and maternal education |
N = 30 On-site (n = 15) Videoconference training (n = 15) |
1–10 yrs | Parents | N/A | N/A | Clinicians guided implementation of strategies while parents interacted with children | 8 1-h sessions, including introduction and closing session | Frequency of initiations and responses, number of words, mean length of utterances | Fidelity of intervention implementation | In both groups, parents demonstrated significant increase in fidelity of intervention implementation and children showed significant gains in lexical diversity and morphosyntactic complexity. No significant differences between on-site and videoconference groups |
| Hay-Hansson and Eldevik (2013) | DTT | RCT: on-site DTT training vs. videoconference training |
N = 16 On-site (n = 8) Videoconference training (n = 8) |
5–14 yrs | Teachers | Remote sites at schools | Computers and software were provided to remote sites | Experimenter observed teaching sessions and provided feedback or prompting as needed | 3 15-min sessions | None | ETE scoring sheet to measure teacher skills | Both groups on avg improved significantly in implementation of DTT at post-test; scores at follow-up decreased somewhat for both groups |
| Hepburn et al. (2016) | Facing Your Fears (FYF) | Pilot RCT: telehealth intervention vs. waitlist group |
N = 33 Telehealth intervention (n = 17) Waitlist control group (n = 16) |
7–19 yrs | Parents | Home | N/A | Parents spoke with therapists regularly | 12 1.5-h sessions across 3–4 mos | Youth anxiety symptoms (SCARED) | PSOC | Telehealth group showed a significant reduction in youth anxiety symptoms and a significant increase in parenting sense of competence |
| Ingersoll and Berger (2015) | ImPACT Online | Pilot RCT: Self-directed vs. therapist-assisted telehealth parent training |
N = 27 Self-directed (n = 13) Therapist-assisted (n = 14) |
27–73 mos | Parents | Home | Families without a personal computer, webcam, or high-speed Internet in the home were provided the necessary technology | Parents in the therapist-assisted group received 2 30-min remote coaching sessions per week (24 total) | Both groups given access to website for 6 mos | None | Intervention fidelity, ImPACT Knowledge Quiz, parent satisfaction survey, parent engagement | Parent engagement and satisfaction was high for both groups, but therapist assistance increased engagement |
| Ingersoll et al. (2016) | ImPACT Online | Pilot RCT: self-directed vs. therapist-assisted telehealth parent training |
N = 27 Self-directed (n = 13) Therapist-assisted (n = 14) |
19–73 mos | Parents | N/A (likely home) | N/A, but parents could contact staff with technology-related issues | Parents received 2 30-min live-coaching coaching sessions per week (24 total) | Both groups given access to website for 6 mos | Use of language targets from parent–child interaction, MCDI, VABS-II | Intervention fidelity, PSOC, FIQ | Parents in both groups improved on parent outcomes; parents in the therapist-assisted group had greater gains in fidelity and positive perceptions of child. Children in both groups improved on language measures, but only children in the therapist-group improved in social skills |
| Kuravackel et al. (2018) | COMPASS for Hope | RCT: in-person vs. telehealth vs. waitlist control |
N = 33 In-person training (n = 13) Telehealth training (n = 10) Waitlist control (n = 10) |
3–12 yrs | Parents | Regional clinic | Equipment available at telemedicine sites | Parents received direct training and support from therapists, either in person or via telehealth | 8 weeks — 4 group sessions (2 h), 4 individual sessions (1 h) | Problem behaviors (ECBI) | PSI-4-SF, BPS, CSQ, GSRS | Controlling for pre-treatment behaviors, children in the telehealth condition had fewer parent-rated problem behaviors post-treatment compared to waitlist control; no differences in child outcome between telehealth and in-person condition. No differences in treatment modality on parent outcomes |
| Lindgren et al. (2016) | FA + FCT | Group comparison: in-home therapy vs. clinic-based telehealth vs. home-based telehealth (not randomized). Child outcomes examined through single-subject analyses |
N = 94 In-home therapy (n = 44) Clinic telehealth (n = 20) Home telehealth (n = 30) |
21–84 mos | Parents | Home, telehealth center/regional clinic | Provided computer equipment to all families | Parents received remote coaching; parent assistants managed equipment at clinic sites |
FA: 3–5 sessions (5 min/session) FCT: 25 + weeks or until specific outcome criteria met (5 min/session), ~ 60 min per weekly visit |
Video coding of problem behavior, manding, task completion | TARF-R | All 3 models successfully reduced problem behavior. Parent ratings of treatment acceptability were consistently high |
| Marino et al. (2020) | ABA-based intervention | RCT: Tele-assisted group vs. control group. Randomized block design used to balance groups on gender, age, and developmental quotient |
N = 42 parents Tele-assisted (n = 22) Control (n = 20) |
3–10 yrs | Parents | Home | N/A | Parents received 1:1 behavioral training and coaching, either in person or via telehealth | 12 weeks — 2 h/week of 1:1 training and coaching | Severity of disruptive and noncompliant child behavior, as assessed by parents | PSI-SF | Tele-assisted intervention had a significant positive effect on parents’ stress levels, perception of disruptive and noncompliant behavior of their children, coping with children’s behaviors, and influence on children’s behavior |
| Pickard et al. (2016) | ImPACT Online | RCT: Self-directed vs. therapist-assisted telehealth parent training |
N = 28 Self-directed (n = 13) Therapist-assisted telehealth (n = 15) |
19–73 mos | Parents | N/A | N/A | Parents received 2 30-min live-coaching coaching sessions per week (24 total) | 12 lessons (length of time N/A) | Perceived child social communication gains (parent survey) | Surveyed intervention acceptability, burden on the family, frequency of program use | Parents in therapist-assisted group showed higher treatment acceptability ratings and perceived greater improvements in child social communication |
| Ruble et al. (2013) | COMPASS | RCT: COMPASS with face-to-face coaching, COMPASS with web coaching, control |
N = 44 Placebo control (n = 15) Face-to-face coaching (n = 14) Web coaching (n = 15) |
3–9 yrs | Teachers | School | Laptop, webcam, headphones, video camera | 4 1.5-h coaching sessions (web or face-to-face) — once every 5 weeks; 30-min technology training for web group prior to coaching | School year | Child progress on IEP goals (PET-GAS) | Teacher adherence to implementation of teaching plants | Students with teachers in the web-based coaching group made greater improvements in goal attainment than students with teachers in the placebo control group; no differences between web and face-to-face groups in student or teacher outcomes |
| Shire et al., (2020) | JASPER | RCT: face-to-face training vs. remote training |
N = 27 Face-to-face (n = 16) Remote training (n = 11) (N = 50 children) |
2–8 yrs | Interventionists | Home or clinic | N/A | Weekly real-time support | 3 mos | JA & BR (ESCS), play acts (SPA) | Implementation fidelity from TCX | No differences in interventionist fidelity (or fidelity improvement) between face-to-face and remote training groups. All children made improvements in IJA and IBR but no group differences. Children with therapists in face-to-face group had greater improvement in total play types |
| Vismara et al. (2018) | P-ESDM | RCT: telehealth P-ESDM vs. community telehealth TAU |
N = 24 P-ESDM (n = 14) Community telehealth TAU (n = 10) |
18–28 mos | Parents | Home | N/A | 12 weekly 1.5-h video-conferencing sessions — discussion + practice with coaching | 12 weeks | Social comm. behaviors (verbal utt., nonverbal JA, imit. functional play) | Treatment fidelity, program website use, satisfaction | P-ESDM group had greater fidelity gains and higher program satisfaction than the community telehealth group. Children in both groups improved in social communication (no group differences) |
| Vismara et al. (2009) | ESDM | Quasi experimental, effectiveness trial of ESDM and parent coaching for ESDM |
N = 10 In-person (n = 5) Remote (n = 5) |
12–60 mos | Interventionists (and parents) | Telehealth equipped facilities | N/A |
No live coaching of intervention Training: (1) self-instruc., (2) didactic trainings (case discussion, practice), (3) team supervision (discussion, feedback) |
10 mos (5 mos direct intervention, 5 mos parent coaching) | Freq of child communic. behaviors (verbal utt., imit. play, imit. verbal utt.), attn. and social init. (CBRS) | Treatment fidelity (therapist and parent), therapist satisfaction | No differences between in-person vs. remote training conditions on ESDM fidelity, parent fidelity, satisfaction with training, child outcomes. Child outcomes were related to therapist and parent fidelity. Limitation: Time and training step were confounded |
Note: Interventions. ABA, applied behavior analysis; COMPASS, Collaborative Model for Promoting Competence and Success; DTT, Discrete Trial Training; ESDM, Early Start Denver Model; FA, functional analysis; FCT, functional communication training; ImPACT, Improving Parents As Communication Teachers; JASPER, Joint Attention, Symbolic Play, Engagement, Regulation; P-ESDM, Parent training in ESDM
Child outcomes. BR, behavior regulation; CBRS, Child Behavior Rating Scale; ECBI, Eyberg Child Behavior Inventory; ESCS, Early Social Communication Scales; JA, joint attention; MCDI, MacArthur-Bates Communicative Development Inventories; PET-GAS, Psychometrically Equivalence Tested Goal Attainment Scaling; SCARED, Screening for Childhood Anxiety and Related Emotional Disorders; SPA, Structured Play Assessment; VABS-II, Vineland Adaptive Behavior Scales-2nd edition
Implementer outcomes. BISWA, Behavioral Implementation of Skills for Work Activities; BISPA, Behavioral Implementation of Skills for Play Activities; BPS, Being a Parent Scale; CSQ, Consultation Satisfaction Questionnaire; EIPSES, Early Intervention Parenting Self-Efficacy Scale; ETE, Evaluation of Therapeutic Effectiveness; FIQ, Family Impact Questionnaire; GSRS, Group Session Rating Scale; PSI-SF, Parenting Stress Index-Short Form; PSOC, Parenting Sense of Competence; TARF-R, Treatment Acceptability Rating Form-Revised; TCX, Therapist-Child Interaction