Using Web-based Technology to Expand and Enhance Applied Behavioral Analysis Programs for Children With Autism in Military Families

The purpose of this study is to determine the extent to which technology may be used to provide (a) state-of-the-art assessment and intervention for children diagnosed with autism and (b) parent and tutor training for those who care for these children.

Children with autism often have problems with social interaction, language, and repetitive behavior (e.g., hand flapping and body rocking). Without early and intensive treatments, the long-term outcomes for children with autism are not very good; therefore, it is very important that effective treatments are started as soon as possible. Research has shown that Early Intensive Behavioral Interventions (EIBI) is an effective treatment for autism. Although EIBI is effective, most children with autism in military families do not receive EIBI because there are few professionals and paraprofessionals that are appropriately trained to do this, especially in the remote areas where military families tend to serve. The investigators want to show that web-based technologies (e.g., web-cams and internet-protocol cameras) can be used so that professionals in one place can treat children with autism anywhere in the world. The investigators also expect that providing these services will help children with autism improve their language, social, and academic skills. The investigators expect that the gains made by the children will help relieve many daily stressors and worries that families with children with autism have.

Children with autism who lack adaptive skills require constant help and supervision from parents. Thus, the improvements in the child's functioning will allow the child to become more independent and decrease parent stress associated with the need to constantly watch and help the child. Because EIBI services produce lasting improvements long after the intervention has ended, this project will provide both short-term and long-term benefits to the children who participate in the study, which will provide lasting relief to these dedicated military families.

In the long-term, this project may really change the way in which all (military and non-military) children and families get effective services that they cannot get now. Also, the results may help other professionals and researchers in psychology and medicine. That is, the results should be helpful to any kind of service that uses parent training and paraprofessionals. Most importantly, these services will improve the overall functioning of the children with autism and decrease the overall stress on these families as they continue to serve our country.

1. Specific Aim: Technology-enhanced parent training. The investigators will assess whether E-Learning using the latest web-based instructional technologies provides an efficient and effective mechanism for training military parents of children with autism, regardless of their geographic location, to implement effective behavior management and teaching strategies with high procedural integrity (90% accuracy).

   - Hypothesis: Technology-enhanced parent training. Military parents who have a child with autism can be trained anywhere in the world to implement appropriate behavior management and teaching strategies based on the principles of applied behavior analysis (ABA) with 90% accuracy. Parents who receive this technology-enhanced training remotely will outperform those randomly assigned to a waitlist-control group on competency-based tests.
2. Specific Aim: Technology-enhanced ABA tutor training. The investigators will show that E-Learning using the latest web-based instructional technologies provides an efficient and effective mechanism for training adults to become ABA tutors who implement EIBI procedures with high procedural integrity (90% accuracy) in areas of the world where such services would otherwise be unavailable.

   - Hypothesis: Technology-enhanced ABA tutor training. Adults anywhere in the world with at least a high school diploma and no formal training in ABA can be trained in the basic principles of ABA and to implement EIBI therapy with 90% accuracy. Individuals who receive this technology-enhanced training remotely will outperform those randomly assigned to a waitlist-control group on both knowledge and competency-based tests.
3. Specific Aim: Technology-enhanced EIBI services. The investigators will demonstrate that technology-enhanced telehealth provides remote access to efficient and effective EIBI services to military families affected by autism.

   - Hypothesis: Technology-enhanced EIBI services. Young children with autism in military families who receive EIBI services that are supervised by University of Nebraska Medical Center (UNMC) experts remotely via technology-enhanced telehealth will show marked improvements in cognitive, language, social, play, and adaptive skills and decreases in problem behaviors relative to children randomly assigned to a wait-list control group.
4. Specific Aim: Reducing stress in military families affected by autism. The investigators will show that the provision of efficient and effective EIBI services using technology-enhanced telehealth will reduce family stress among military families affected by autism.

   * Hypothesis: Reducing stress in military families affected by autism. Military parents of children with autism who receive technology-enhanced EIBI services will show reductions in self-reported stress levels on both the Child Domain and Parent Domain subscales of the Parenting Stress Index relative to parents on the waitlist-control group.

Eligibility Criteria:
Inclusion Criteria:

1. Inclusion criteria for children with autism. a. Upon completion of the diagnostic assessment, children who meet the following inclusion criteria will be considered for participation. The inclusion criteria are:

   * (a) chronological age between 18 and 48 months of age,
   * (b) nonverbal mental age greater than 12 months (which is necessary to make an accurate diagnosis of autism in young children), and
   * (c) diagnosis of autism confirmed by meeting the cut-off scores on the autism diagnostic interview-revised (ADI-R) and the autism diagnostic observation schedule (ADOS)
2. Inclusion criteria for parents of children with autism. - All parents of children who are enrolled in this project will be invited to participate in Experiment 1 of this project if they are available for training during the course of the project.
3. Inclusion criteria for behavioral technicians.

   1. The participants for Experiment 2 will be young adults who are interested in being trained (at no cost) to provide ABA services to children with autism. Inclusion criteria for participation in this study are:

      * (a) age 19 or above;
      * (b) completion of, or enrollment in, an associate's or bachelor's degree program in psychology or a related field;
      * (c) completion of at least 12 semester credit hours at an accredited college or university;
      * (d) passage of criminal and abuse background checks; and (e) no prior training in ABA interventions.

Exclusion Criteria:

1. Exclusion criteria for children with autism

   a. Upon completion of the diagnostic assessment, children who meet the following exclusion criteria will be thanked for their participation, discharged from the project, and referred for services by other service providers. The exclusion criteria are:
   * (a) chronological age other than between 18 and 48 months of age,
   * (b) nonverbal mental age less than 12 months,
   * (c) no diagnosis of autism. In addition, children will be excluded if they have a serious medical condition that would interfere with treatment (e.g., blindness, deafness, cerebral palsy).
2. Exclusion criteria for parents of children with autism.

   a. Active duty military personnel who are unavailable due to deployment during this project will not participate, but will be offered parent training after their deployment is completed even if their data are not included in this project.
3. Exclusion criteria for behavioral technicians. a. Individuals who do not meet the inclusion criteria above and who cannot complete the physical requirements of the tasks involved in ABA therapy, which requires therapists to be able to speak, hear, see, sit, stand, walk, and lift 40 lbs. will be excluded from participation.