Abstract

Years can elapse between parental suspicion of a developmental delay and a diagnostic assessment, ultimately delaying access to medically necessary, autism-specific intervention. Using a single-case, concurrent multiple baseline design, autism spectrum disorder symptomology (i.e., higher-order restrictive and repetitive behaviors and interests; higher-order RRBIs) was targeted in toddlers (21–35 months) waiting for a diagnostic appointment. Caregivers were coached via telehealth to mediate early intervention to decrease interfering, inflexible higher-order RRBIs during play using four evidence-based applied behavior analytic strategies: modeling, prompting, differential reinforcement of appropriate behaviors, and response interruption and redirection. Six mother–child dyads were recruited from pediatrician offices and early intervention service districts in the United States. All families were considered under-served, under-resourced, or living in rural locations. A visual analysis of the data combined with Tau-U revealed a strong basic effect between the intervention package and parent strategy use and child flexible and inflexible behavior. Findings were consistent across participants with one exception demonstrating a moderate effect for flexible behaviors yet a strong effect for inflexible behaviors. Standardized mean difference was beyond zero for all participants. Implications for science and practice include support for early intervention of higher-order RRBIs for young children with and at risk for ASD.

Highlights

  • Autism spectrum disorder (ASD), an early emerging neurodevelopmental disorder defined by social communication delays and restricted and repetitive behavior and interests (RRBIs) [1], has steadily risen to the current rate of 1 in 54 children in the United States (US) [2] and 1 in 160 children worldwide [3]

  • This study demonstrated the utility and effectiveness of coaching via telehealth on increased parent use of intervention strategies addressing inflexible child behaviors for toddlers on the waitlist for an ASD diagnosis

  • Outcomes demonstrated the positive effects of this parent-implemented intervention package during play on their young child’s flexible and inflexible behaviors

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Summary

Introduction

The increase in children at risk for autism has caused a surge in wait times for a medical diagnosis. Statistics vary by country, long waitlists specific to an ASD diagnosis are not unique to the US (e.g., in Ireland [4]; in the UK [5]; in Australia [6]; in Canada [7]). Years can elapse between parental suspicion of a developmental delay and a diagnostic assessment, delaying access to medically necessary, autism-specific intervention [8]. Diagnosis of ASD is imperative as individualized early intervention (e.g., applied behavior analysis; ABA) can reduce the severity of ASD symptomology and, for some, result in no longer meeting diagnostic criteria for ASD [9]. Referrals often occur before age two, and statistics demonstrate that children can receive a reliable diagnosis by 18 months

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