2016 Gatlinburg Conference Symposium
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Symposium Title: Experimental Analysis and Intervention for Severe Behavior Problems of Individuals with Rett Syndrome and
ASD via Remote Videoconferencing
Chair: Jennifer McComas
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Overview: Access to experts who can provide effective individualized intervention for self-injurious behavior (SIB), aggression,
and communication is limited for individuals with neurodevelopmental disorders such as Rett syndrome and autism spectrum
disorders (ASD). Preliminary research has demonstrated that videoconferencing can be an effective technology for providing
remote consultation to families of young children with ASD. This symposium will feature work at the University of Minnesota to
expand the application of videoconferencing for conducting experimental analysis and effective intervention for severe SIB,
aggression, and limited formal communication in individuals with Rett syndrome and ASD. This symposium will begin with an
overview of behavioral teleconsultation including its early development and current applications. The overview will also include a
brief demonstration of how the technology is used and adapted to a variety of situations. Next, Brittany Pennington will present
a study conducted with young girls with Rett syndrome and who have limited formal communication repertoires. Consultation
was conducted remotely with parents who taught their daughters to use formal communication systems across three contexts.
Stephanie Benson will present the next study in which the experimenters successfully coached a parent remotely via
teleconsultation to conduct the conditions of a functional analysis and then intervention for a child with ASD who engaged in SIB.
Adele Dimian will deliver the final presentation demonstrating the effects of remote coaching with group home staff to conduct
an analysis and intervention for aggressive behavior of a young adult diagnosed with ASD who resided in a group home. After the
data-based presentations, the chair will facilitate a discussion with the audience focused on issues relevant to expanding
telehealth implementation including generalization of intervention effects and issues of implementation including fidelity and
maintenance in settings such as group homes.
Paper 1 of 4
Paper Title: Applications and Extensions of Remote Videoconferencing to Conduct Experimental Analyses and Intervention for
Severe Behavior Problems and Limited Communication Repertoires of Individuals with Neurodevelopmental Disorders
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Authors: Jennifer McComas
This presentation will consist of an overview and introduction to the three data-based interventions that will follow. A brief
background of the use of remote videoconferencing for the analysis and intervention of behavior problems will be followed by
an overview of the current applications of remote videoconferencing. A demonstration of the technology will also be provided to
provide a foundation for the three presentations that will follow.
Paper 2 of 4
Paper Title: Telehealth as A Mechanism for Coaching Parent-Implemented Communication Intervention for Children with Severe
Neurodevelopmental Disabilities
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Authors: Brittany Pennington , Jessica Simacek , Jennifer McComas
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University of Minnesota
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Introduction: Early and intensive intervention is strongly recommended as critical for children with autism spectrum disorder
(ASD) and related severe neurodevelopmental disabilities such as Rett syndrome to reach optimal outcomes1,2,3. However,
there are numerous barriers to accessing needed intervention for this population. The purpose of the current study was to
determine the effectiveness of parent-implemented communication assessment and intervention with coaching via telehealth
(i.e., video conferencing) on the acquisition of early communication skills for three young children (3.5-4 years old) with severe
neurodevelopmental disabilities.
Methods: Assessment included a structured descriptive assessment and functional analysis to identify idiosyncratic/potentially
communicative responses and communicative contexts for each child. Functional communication training (FCT) was
implemented as intervention to increase augmentative and alternative communication skills. Parents conducted all assessment
and intervention sessions with remote coaching by experts in functional analysis and FCT via telehealth technology. The effects
of FCT were evaluated using an adapted, multiple-probe design across three contexts for each child.
Results: Prior to intervention, none of the children engaged in reliable or easily recognizable communication forms; however,
during FCT intervention all three children acquired the targeted communication skills.
Discussion: The results demonstrate the effects of functional reinforcement on communicative responses of young children with
severe neurodevelopmental disorders. Implications from this study support the efficacy of parent-implemented intervention
delivered with coaching via telehealth and the potential for future research to examine telehealth within a service delivery model
to increase access to services for children with severe neurodevelopmental disorders and their families.
References/Citations:
• American Academy of Pediatrics, 2007; 2Individuals with Disabilities Education ACT [IDEA], 2004; 3Satcher, 2000.
• American Academy of Pediatrics [AAP], (2007). Management of children with autism spectrum disorder. Pediatrics, 120,
1162 -1182. doi: 10.1542/peds.2007-2362.
• Individuals with Disabilities Education Act of 2004. 20 U. S. C. §1400 et seq. (2004). Satcher, D. S. (2000). Executive
summary: a report of the Surgeon General on mental health. Public Health Reports, 115, 89-101.
Paper 3 of 4
Paper Title: Using Telehealth to Conduct Functional Analysis and Functional Communication Training for Challenging Behavior
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Authors: Stephanie Benson , Kelsey Quest , Adele Dimian , Jennifer McComas
Introduction: Children with developmental disabilities sometimes engage in challenging behavior which if left untreated can
persist over time and interfere with and individual's ability to learn (Didden et al., 2012). Functional analysis (FA) is a tool that
has been demonstrated to be effective across a variety of settings and interventionists (Hanley et al, 2003). The functional
reinforcer(s) identified in the FA can be differentially applied to an appropriate alternative response during functional
communication training (FCT) to effectively compete with the challenging behavior. FCT has been repeatedly and reliably shown
to be an effective tool in reducing challenging behavior (Carr & Durand, 1985, Iwata et al., 1994) when based on the results of an
FA. There is a growing need for trained behavior analysts who can conduct these assessments in rural areas of the country. One
potential way to address this need is through the use of telehealth technology. The purpose of the current study was to examine
the use of telehealth for conducting FBA and FCT for a boy with Autism spectrum disorders (ASD) who engages in challenging
behavior.
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Indiana University
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Methods: A seven year old boy diagnosed with ASD was referred for this study through a local service agency in Minnesota due
to his engagement in self injurious behavior. A functional analysis interview was conducted with the child's mother over the
telephone. A structured descriptive assessment (SDA) was conducted followed by a functional analysis of the challenging
behavior. After the function of the behavior was identified, functional communication training (FCT) was conducted to teach the
child an appropriate communicative alternative to replace the challenging behavior. All analyses and FCT were conducted in the
child's home with the parent with live coaching via telehealth.
Results: The results of the functional analysis revealed that his challenging behavior was most sensitive to restricted access to a
tangible item. Results of FCT indicated that the child was successful in learning a communicative replacement for his challenging
behavior.
Discussion: This study extends previous research using telehealth to conduct FA and FCT for a child with challenging behavior.
These results suggest that telehealth was successful in identifying a function for the challenging behavior and the use of FCT via
telehealth was successful in decreasing the challenging behavior and increasing the communicative alternative. Future research
should seek to replicate these findings and include a cost analysis for delivering services in home or at a site versus using
telehealth technology.
References/Citations:
• Didden, R., Sturmey, P., Sigafoos, J., Lang, R., O'Reilly, M.F., & Lancioni, G.E. (2012). Nature, prevalence, and
characteristics of challenging behavior. In J.L. Matson (Ed.), Functional assessment for challenging behaviors (pp. 2544). doi: 10.1007/978-1-4614-3037-7_3.
• Hanley, G. P., Iwata, B.A., McCord, B.E. (2003) Functional analysis of problem behavior: A review. Journal of Applied
Behavior Analysis, 36, 147-185.
• Carr, E. G. & Durand V.M. (1985). Reducing behavior problems using functional communication training. Journal of
Applied Behavior Analysis, (18), 111-126.
• Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K. E., & Richman, G. S. (1982/1994). Toward a functional analysis of
self-injury. Journal of Applied Behavior Analysis, (27) 197-209. doi:10.1016/0270-4684(82)90003-9.
Paper 4 of 4
Paper Title: Assessment and Intervention for Challenging Behavior Via Telehealth in A Group-Home Setting
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Authors: Adele Dimian , Jessica Simacek , Jennifer McComas
Introduction: Preliminary studies have demonstrated that telehealth technology can be used to remotely coach parents to
implement behavioral procedures related to the treatment of challenging behavior (i.e., tantrums, self-injury, aggression) for
individuals with autism (Seuss et
al., 2014; Wacker et al., 2013a; 2013b). Due to the high level of need associated with services for people with autism, and
limitations due to geographic location, there is a need for access to service providers with expertise in addressing challenging
behavior and intervention beyond the geographic proximity to university clinics or other centers with expertise in addressing
severe challenging behavior. Group home settings in particular can have high staff turn- over and need support with addressing
challenging behavior. To date, there have been no published studies conducting assessments for challenging behavior via
telehealth in a group home setting. The purpose of the current study was to coach staff in a group home via telehealth to
implement behavioral assessments and a reinforcement-based intervention to address aggression exhibited by an adolescent
with autism spectrum disorder (ASD).
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Methods: The participant was a 17- year old male with a diagnosis of ASD. He engaged in a sequence of challenging behavior
that typically started with noncompliance and verbal refusals to complete a demand or task. The noncompliance then would
escalate to verbal threats (e.g., "I want to hit you"), followed by physical aggression in the form of hitting, kicking, and or
scratching. A structured descriptive assessment (SDA) was implemented via telehealth (i.e., video conferencing over Google
Hangout with the group home staff) with coaching from the research team. All sessions were approximately 5 min long and were
conducted by the staff. A Bluetooth device was used to coach the staff through each condition over the telephone. Antecedents
in the form of demands and diverted attention were observed and aggression or attempts was recorded. No programmed
consequences were provided for challenging behavior and the staff were instructed to attend to the challenging behavior as they
typically would. The results of the SDA were then used to create a treatment package that included shortening demands, using a
token board to signal how much work the participant had to do, and differential reinforcement of alternative (DRA) behavior.
The treatment package was implemented using an ABAB reversal design. Three different staff members implemented the
sessions and procedural fidelity was measured with a checklist for each treatment session conducted.
Results: The SDA results showed higher rates of aggression (average 1 per min) during demand conditions compared to diverted
attention and control conditions. The assessment was implemented across 3 days with three different staff members. Following
the SDA, the treatment package was implemented and results indicated decreases in aggression and increases in latency to
comply with demands. Data were variable across the different staff members implementing the intervention. Procedural fidelity
ranged from 70% to 100% and covaried with instances of aggression.
Discussion: Overall, the treatment package reduced instances of aggression to zero levels and increased latency to comply with
demands to within 2 s. Aggression was observed during the treatment conditions when procedural fidelity was below 85% and
varied across staff members. These results show that telehealth may help support assessment and intervention of challenging
behavior occurring in group home settings with individuals with disabilities. Ongoing training and coaching may be needed to
ensure implementation fidelity over time; telehealth could help facilitate service delivery among residents within group homes,
but more research is warranted.
References/Citations:
• Seuss, A.N., Romani, P.W., Wacker, D.P., Dyson, S.M., Kuhle, J.L., Lee, J.F., Lindgren, S.D., Kopelman, T.G., Pelzel, K.E., &
Waldron, D.B. (2014). Evaluating the treatment fidelity of parents who conduct in-home functional communication
training with coaching via telehealth. Journal of Behavioral Education, 23, 34-59. doi: 10.1007/s10864-013-9183-3.
• Wacker, D.P., Lee, J.F., Padilla Dalmau, Y.C., Kopelman, T.G., Lindgren, S.D., Kuhle, J. ... Waldron, D.B. (2013a).
Conducting functional communication training via telehealth to reduce the problem behavior of young children with
autism. Journal of Developmental and Physical Disabilities, 25(1), 35-48. doi:10.1007/s10882-012-9314-0.
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