Parent-implemented communication intervention for children with

severe neurodevelopmental disabilities: An application of telehealth

as a service delivery mechanism
Jessica Simacek, Adele Dimian, Jennifer J. McComas, & Joe Reichle
Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA

Communication
Intervention Model via Telehealth

Introduction
Telehealth, the use of remote video conferencing, has a growing evidence base as a service
delivery mechanism to increase access to some behavioral services, including the remote
coaching of parents to conduct functional analysis and to intervene on challenging behavior
for children with autism spectrum disorders.1,2,3 Implementing successful interventions with
children with problem behavior requires a functional behavioral assessment to identify
consequences that maintain the behavior and positive behavioral support strategies.

Experimental design. Assessment: A multi-element single case design examined the

contexts associated with problem behavior via a functional behavior assessment (Ella &
Sidney) that for Ella included a consequent-based functional analysis.

communicative behavior or challenging behavior

through functional assessment/analysis

Hitting tray

Live coaching via

telehealth

Determine
contexts/routi
nes to embed
intervention

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Intervention: Caregiver-implemented
communication intervention to increase
requesting through AAC, prompting, and
reinforcement

Rate of Tantrums per min

Responses per min

Yell
Lead

5
4

Tantrum

3
2
1
0

10
5

8
7
6

Free Play

Attention

Demand

9 10 11 12 13 14 15 16 17

5-Min Sessions
5-Min Session

Baseline

Snack/Drink

Figure 2. Functional analysis (FA) of tantrums with

Ella

Ella: Intervention contexts: (1) Snack /drink, (2) video, and (3) break from demand.
Idiosyncratic behavior (leading parents & tantrums), and AAC requests (Picture cards for
more and all done).

FCT

Baseline

FCT

Rate of responses per min

Baseline

Video

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FCT

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0

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FCT

Switch
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Parental
Attention

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Baseline

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FCT

Approach
parent
Switch
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5 Min Session

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This study investigated the efficacy of parent-implemented assessment and FCT to

teach early, AAC requests across multiple contexts.
There were several findings that are tied to potential benefits and needs for future
research:
(1) Unconventional/potentially communicative behaviors and contexts/routines
when these behaviors occurred were identified for both participants during the
SDA (and the FA for Ella).

(4) Therefore, telehealth should continue to be investigated as a potential service

delivery mechanism for children: (a) outside of geographic locations for services,
(b) on waitlists, or (c) to connect with experts if the child has complex and/or
low incidence disabilities.

'More' Card
1

Baseline

Break from Demand

10

11

12

13

1Wacker,

'All Done'
Card
1

Selected References

FCT

Yell

1
0

Lead

(3) Neither participant received communication intervention within the home; Ella
had been on a waitlist for early intensive intervention services for 1 year, and
Sidney did not receive services in home (there is a lack of available
communication service options for girls with Rett syndrome).

(2) Both participants acquired the AAC requests across all contexts. Embedding
early communication intervention into contexts in which communication
attempts are already occurring may be a feasible and efficacious way for parentimplemented intervention.

'More'
Card

Lead

Results & Discussion

Tangible

Figure 4. Multiple-probe design of occurrences of Sidneys

unconventional/potentially communicative behavior and AAC request across
three contexts

Figure 1. Structured descriptive assessment (SDA) to

determine potentially communicative acts across
contexts reported by parents in the functional
interview

Reach/grab

15

10

10

0
7

Baseline
Snack:
Living
Room

15

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Telehealth equipment. Remote coaching was provided from trained interventionists, who
were located at the University of Minnesota Telehealth lab via a secure server and Google
Hangout video-conferencing sessions; Ellas parent used a desktop MAC computer with a
Logitech web-camera on a moveable tripod and Sidneys parent used a laptop kit from the
University with a Logitech web-camera.

Switch

Dependent measures and contexts. Direct observation data were recorded from videos on
both unconventional behaviors and AAC requests across three contexts.

Telehealth Equipment

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Occurrence of response

Assessment: Identify contexts of potential

Intervention: An adapted, multiple probe design across requests was used to investigate the
efficacy of FCT on allocation of responding between unconventional behavior and the new
communicative alternative.

Sidney: Intervention contexts: (1) Dinner in high chair, (2) snack in living room, and (3)
parental attention. Idiosyncratic behavior (hitting high chair tray, approaching parents, &
reaching), and AAC request (Microswitch with graphic symbol more).

FCT

Baseline

20

(1) Functional assessment through an interview, direct observation, and a parentimplemented (with coaching via telehealth) structured descriptive assessment4 to identify
behaviors serving a potentially communicative purpose and multiple contexts in which to
embed communication intervention.

Participants & setting. Two young girls (Ella, 4, diagnosed with ASD and Sidney, 3.5,
diagnosed with Rett syndrome) participated in this study. For both participants, sessions
occurred in the family home, with their parents serving as interventionists while receiving
live coaching via telehealth from the research team.

25

FCT

The purposes of the current study were to determine the efficacy of:

Methods

Baseline
Food: High
Chair

10

Functional assessment identifies socially maintaining reinforcement for problem behavior

(including unconventional communicative forms). Once identified, functional communication
training (FCT) is an effective intervention at teaching more recognizable communication in
place of problem behaviors (e.g., teaching child to use a graphic symbol to request a break
rather than throw materials). To date, the functional assessment + FCT procedure has not yet
been replicated in parent-implemented interventions involving unconventional behaviors
across multiple contexts/routines.

(2) Parent-implemented FCT using AAC embedded into three contexts for two young
participants with neurodevelopmental disabilities.

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5 Min Sessions

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Figure 3. Multiple-probe design of occurrences of Ellas unconventional/potentially

communicative behavior and AAC requests across three contexts

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D. P., Lee, J. F., Dalmau, Y. C. P., Kopelman, T. G., Lindgren, S. D., Kuhle, J., ... & Waldron, D. B. (2013). Conducting
functional communication training via telehealth to reduce the problem behavior of young children with autism. Journal of
developmental and physical disabilities, 25, 35-48.
2Wacker, D. P., Lee, J. F., Dalmau, Y. C. P., Kopelman, T. G., Lindgren, S. D., Kuhle, J., ... & Waldron, D. B. (2013). Conducting
functional analyses of problem behavior via telehealth. Journal of Applied Behavior Analysis, 46, 31-46.
3Barretto, A., Wacker, D. P., Harding, J., Lee, J., & Berg, W. K. (2006). Using telemedicine to conduct behavioral assessments.
Journal of applied behavior analysis, 39, 333-340.
4Anderson, C. M., & Long, E. S. (2002). Use of a structured descriptive assessment methodology to identify variables affecting
problem behavior. Journal of Applied Behavior Analysis, 35, 137-154.

This work was supported in part by grant #2-T73MC12835-03-00 from the Maternal & Child Health Bureau
(MCHB) of the U.S. Department of Health and Human Services awarded to the University of Minnesota.