Guide to Telemedicine & ABA Therapy
Applied behavior analysis (ABA) therapy discourages negative behaviors (such as self-harm) while encouraging positive behaviors (such as asking permission). Therapists have used this approach to help people with autism spectrum disorder (ASD) since the 1960s. Today, telemedicine is changing the therapy in new and unprecedented ways.
Therapists who use telemedicine may be hundreds or even thousands of miles away from their clients. But the ABA approaches they use might be very familiar to families that have been through in-person sessions. The technology is the only real differentiator. The therapeutic underpinnings remain the same.
While research on ABA’s effectiveness and telemedicine’s contributions is burgeoning, a few small studies suggest that this approach can help young people with ASD while cutting costs. Telemedicine can also help families in far-flung communities get the help they need, even if a therapist isn’t available in their local area.
What Is ABA Therapy?
The Centers for Disease Control and Prevention refers to ABA as a “notable treatment approach” for people with autism. It’s accepted by health care professionals, schools, treatment centers, and clinics.
Multiple types of ABA exist, such as:
- Early Start Denver Model
- Early Intensive Behavioral Intervention
- Discrete Trial Training
- Pivotal Response Training
- Verbal Behavior Intervention
Therapists choose from these approaches based on a client’s age, current challenges, and life goals. Therapists may also swap one method for another if they don’t see the shifts they’d like as the treatment continues.
The Association for Science in Autism Treatment explains that ABA methods can help people with ASD to:
- Increase or maintain behaviors. A child might need to learn to stay on task, maintain self-control, or monitor emotions.
- Learn new skills. A child might need help to communicate clearly or interact with peers.
- Transfer behaviors. Some people with autism deal with site-specific behaviors. They might complete a task successfully at home but not at school, for example.
- Reduce or restrict interfering behaviors. Self-harm, whether that happens in one place or anywhere the child goes, can be a focus of therapy.
Therapists typically create practice situations or simulations, and they use those as a launching pad for conversations. When the child reacts or does something deemed a positive part of the treatment plan, the child is praised. When the child does something negative, the therapist offers negative feedback or none at all.
For example, a child working with a therapist on improving verbal skills could have a session that looks like this:
- Props appear. The therapist shows the child cards that have a solid color on one side and an interesting photo on the other.
- Prompts begin. The therapist asks the child to call out a color.
- Rewards are delivered. The child calls out “yellow,” and the therapist flips over the card to show the image on the back.
- Feedback starts. The child calls out no color, so the therapist flips over cards and looks privately at the photos while describing the fun the child is missing.
This is a simplistic example, of course. But it demonstrates how therapists might use cues and rewards to talk with their clients, as well as how they might dispense rewards.
Telemedicine Brings Therapy to You
In a typical therapy situation, the therapist and client are separated by just a few feet. In a telemedicine session, they might be miles apart from one another, but they are connected via high-quality audio and video. A simple webcam does the trick in most cases.
Experts call telemedicine “ABA’s new frontier“, as it has the potential to:
- Make treatment accessible. In the past, families could only use ABA if a trained therapist worked within driving distance. Telemedicine makes treatment available to anyone with an internet connection.
- Advance training. Telemedicine could help experts teach others how to use ABA techniques.
- Improve treatment times. When only one provider works in an area, families suffer. They must wait weeks or even months to get help. Telemedicine makes more doctors available.
- Allow teams to treat more clients. When therapists don’t have to travel between clients, they can hold more appointments.
Families play an important role in successful ABA programs. They help to reinforce lessons taught in therapy. They can also apply lessons in novel locations, such as grocery stores and movie theaters, that are usually inaccessible to therapists. This real-world application of lessons can make a big difference in a child’s progress.
Researchers say ABA techniques can be taught via telemedicine. In one study of this approach, parents increased their knowledge of concepts by an average of 39%.
It is widely believed that therapy works best when therapists and their clients share the same room. Body language cues can sometimes be lost in translation, and some children don’t interact with technology in the same way they might with a human.
In-person care is preferable, but it’s not always a feasible option. Sometimes, telemedicine offers the next best thing.
How to Measure Success
Consumers are accustomed to reading reports of efficacy and improvement before they sign up for a treatment. We all want to make sure something works. But assessing the benefits of ABA is difficult, and even though the treatment has been in use for decades, experts aren’t quite sure how to measure or define success.
When the therapy was first designed, the Child Mind Institute explains, therapists were interested in helping children to seem “normal.” Treatment teams walked into their appointments with a clear picture of what a child should look like and do, and they used ABA to help the child conform to that idea.
Early studies of ABA pitted the therapist’s goals against the child’s presentation. If the child seemed to conform, the therapy was deemed successful. Much has changed since then.
Modern therapists use individualized approaches. They build on a child’s strengths and interests, with the goal of helping the child to participate in the world as a whole.
Success can be subjective. Teams can’t take blood tests to see if their clients meet therapeutic goals. So professionals must rely on imprecise measurements, such as:
- School reports. How often has the child been removed from class for disruption? How often has the child turned in assignments on time? How are they progressing in classes?
- Self-harm. How often have these episodes happened? Do they happen in one place or everywhere? Does the urge to self-harm remain?
- Parental reports. How have the child’s relationships with their parents changed? Have their relationships with siblings changed?
- Peer responses. Does the child seem accepted by their peer group?
For some researchers, these sorts of metrics seem soft and hard to quantify. When they attempt to conduct an assessment of all available research on ABA, they often can’t find studies that use data they can trust.
For example, in a systematic review of ABA on adults, researchers looked over 1,217 studies, but they found only 13 met their strict inclusion criteria.
It’s critical to understand that this doesn’t mean ABA doesn’t work. But it does mean it’s tough to point to one definitive study that showcases how the approach works and why.
What the Research Says
Even though measuring ABA’s success is difficult, researchers are trying, and progress is being made. Their studies suggest that the approach can work well for some children with ASD and that adding telemedicine approaches can be helpful.
In one study of 48 toddlers with ASD, researchers broke the kids into two groups. One group received ABA therapy from trained professionals, while the other group was referred to community providers. The group that got ABA therapy had improvements in the following areas:
- IQ scores
- Adaptive behavior
- ASD symptoms that lead to diagnosis
In a study that compared telemedicine and in-person ABA therapy, researchers found that both approaches could reduce problem behavior. Because telemedicine makes ABA therapy more available to more clients, its application is important to the autism community.
Other researchers caution that studies on telemedicine to treat autism are often small, and they tend to describe pilot programs. These experts press for larger, randomized trials. Studies like this could help experts understand whether it’s best to sit in a room with a therapist, whether telemedicine works better, or whether a combination is the best approach.
Best Practices for Telemedicine ABA
Whether your child is sitting in a room with a therapist or interacting with them via a computer, ABA principles should not change. The best practices that have made this an accepted therapy should translate into any setting in which a child receives care.
That means your child should work with a trained professional who supervises the program. ABA is a complicated form of therapy, and it can take years to learn how to apply it correctly. Parents should work with someone who has been through that training and has experience with a range of clients.
The treatment must also be intensive to be effective, says Autism Speaks. Studies suggest that helpful programs provide 25 to 40 hours of programming per week, and they last for one to three years. Whether that teaching happens online or at home, that timeframe should remain the same.
Finding a provider like this can take time. But the success of the program can depend on finding the right help.
Treatment and Intervention Services for Autism Spectrum Disorder. (September 2019). Centers for Disease Control and Prevention.
Treatment Patterns in Children With Autism in the United States. (March 2019). Autism Research.
Applied Behavior Analysis. Association for Science in Autism Treatment.
Telehealth: ABA’s New Frontier. (February 2018). Behavioral Science in the 21st Century.
Formative Evaluation of an ABA Outreach Training Program for Parents of Children with Autism in Remote Areas. (October 2013). Focus on Autism and Other Developmental Disabilities.
The Controversy Around ABA. Child Mind Institute.
A Systematic Review of Psychosocial Interventions for Adults with Autism Spectrum Disorders. (March 2013). Journal of Autism and Developmental Disorders.
Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver Model. (January 2010). Pediatrics.
Telehealth and Autism: Treating Challenging Behavior at Lower Cost. (February 2016). Pediatrics.
A Systematic Review of Telemedicine in Autism Spectrum Disorders. (August 2016). Review Journal of Autism and Developmental Disorders.
TRICARE Extends Temporary Telehealth Support for Applied Behavior Analysis Services. (March 2020). TRICARE.
Can Telehealth Fill Gap in Autism Services? Michigan State University.
Applied Behavior Analysis (ABA). Autism Speaks.
Using Telemedicine to Conduct Behavioral Assessments. (Fall 2006). Journal of Applied Behavior Analysis.
The Effects of Transition to Technician-Delivered Telehealth ABA Treatment During the COVID-19 Crisis: A Preliminary Analysis. (Winter 2021). Journal of Applied Behavior Analysis.