title: Telehealth and Autism: Treating Challenging Behavior at Lower Cost.
abstract: OBJECTIVE
  To determine whether challenging behavior in young children with autism and other developmental disabilities can be treated successfully at lower cost by using telehealth to train parents to implement applied behavior analysis (ABA).
  
  
  METHODS
  We compared data on the outcomes and costs for implementing evidence-based ABA procedures to reduce problem behavior by using 3 service delivery models: in-home therapy, clinic-based telehealth, and home-based telehealth. Participants were 107 young children diagnosed with autism or other neurodevelopmental disorders, and data analysis focused on the 94 children who completed treatment.
  
  
  RESULTS
  All 3 service delivery models demonstrated successful reduction of problem behavior by training parents to conduct functional analysis and functional communication training. The mean percentage reduction in problem behavior was >90% in all 3 groups after treatment, and treatment acceptability based on parent ratings was high for all groups. Total costs for implementing treatment were lowest for home telehealth, but both telehealth models were significantly less costly than in-home therapy.
  
  
  CONCLUSIONS
  This research demonstrated that parents can use ABA procedures to successfully treat behavior problems associated with autism spectrum disorders regardless of whether treatment is directed by behavior consultants in person or via remote video coaching. Because ABA telehealth can achieve similar outcomes at lower cost compared with in-home therapy, geographic barriers to providing access to ABA for treating problem behavior can be minimized. These findings support the potential for using telehealth to provide research-based behavioral treatment to any family that has access to the Internet.
authors.affiliation: Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine; Center for Disabilities and Development, University of Iowa Children's Hospital, Iowa City, Iowa; scott-lindgren@uiowa.edu.
authors.forename: Scott
authors.initials: S
authors.lastname: Lindgren
authors.affiliation: Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine; Center for Disabilities and Development, University of Iowa Children's Hospital, Iowa City, Iowa;
authors.forename: David
authors.initials: D
authors.lastname: Wacker
authors.affiliation: Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine; Center for Disabilities and Development, University of Iowa Children's Hospital, Iowa City, Iowa;
authors.forename: Alyssa
authors.initials: A
authors.lastname: Suess
authors.affiliation: College of Education, University of Missouri, Columbia, Missouri;
authors.forename: Kelly
authors.initials: K
authors.lastname: Schieltz
authors.affiliation: Center for Disabilities and Development, University of Iowa Children's Hospital, Iowa City, Iowa;
authors.forename: Kelly
authors.initials: K
authors.lastname: Pelzel
authors.affiliation: Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa;
authors.forename: Todd
authors.initials: T
authors.lastname: Kopelman
authors.affiliation: Center for Disabilities and Development, University of Iowa Children's Hospital, Iowa City, Iowa;
authors.forename: John
authors.initials: J
authors.lastname: Lee
authors.affiliation: Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Patrick
authors.initials: P
authors.lastname: Romani
authors.affiliation: Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine;
authors.forename: Debra
authors.initials: D
authors.lastname: Waldron
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072357:Applied Behavior Analysis / Q000191:economics* / Q000193:education; D000067877:Autism Spectrum Disorder / Q000191:economics / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010290:Parents / Q000193:education*; D000066553:Problem Behavior; D017216:Telemedicine / Q000191:economics*