Individuals with an Autism Spectrum Disorder and those supporting them are utilizing technological innovations more than ever before through the use of portable electronic devices in the form of tablets, smartphones, and laptops. These devices are used to assist communication needs as well as to serve as reinforcers to access preferred stimuli (videos and music). The growing use of technology has been used by educators and parents to help generalize skills taught in classroom academic settings/day programs to various community settings.
Professionals may use these same devices to help deliver reinforcement in addition to collecting data on acquisition programs, recording observational data to assess function, and monitoring the effectiveness of problem behavior reduction/replacement programs. The beauty of many of these devices is the inclusion of video cameras. One area that this type of technology may help to better their lives is in the use of video consultation for professional services.
For children with an Autism Spectrum Disorder, caregivers often find that their children require additional services and therapies than those provided during a typical school day. Those additional therapies may include speech therapy, social skills groups and sometimes feeding therapy. Navigating to after school therapies and activities may cause stress for any parent, and considering parents whose children have difficulties with transitions, the additional stress of possibly being late or sitting in traffic prior to an appointment. Furthermore, individuals diagnosed with an ASD may have difficulties shifting routines and may engage in problematic behavioral episodes (i.e., tantrums, self-injury) when routines are disrupted. These factors to access services, and their cascading effects, can cause unnecessary hardships for all parties involved.
Video consultation helps to circumvent the issues surrounding transportation and transition difficulties for those in need. Although our home state of New Jersey is relatively small, we have the highest density of individuals per square mile. This density leads to more traffic, which results in lengthy car rides for relatively short distances. By allowing caregivers and professionals an opportunity to consult with those knowledgeable about issues faced by those with an ASD remotely, quality services may not have to be compromised for a lack of psychologists or local board certified behavior analysts (BCBAs). Psychologists, psychiatrists and BCBAs have begun to expand their services by using a video consultation model. Using a secure and HIPAA compliant technology, video consultation has provided families and professionals access to a number of behavior analytic services and trainings. Recently researchers have provided evidence on the benefits of how behavior parent training (Fisher et al., 2014.), treatment of pediatric feeding problems, brief problem behavior assessments, and intervention consultation can occur remotely (Wacker et al., 2013). Results show training sessions that used video consultation have led to significant improvement in the target behavior. By providing video consultation, caregivers and professionals may collaborate at the same time from remote locations. This service may help to ensure that therapeutic services are provided as intended and without disruption. For example, some therapies are provided initially at a clinic setting (e.g., feeding) with the goal to have the individual demonstrate the skill independently in the home, school and community setting. Scheduling these observations for the entire team (child study team members, parents and other professionals) to attend the clinic and problem solve may be possible with the use of video consultation.
With video consultation, parents and caregivers can be supported while providing interventions for the components that have been determined to maintain the problem behavior. They may be taught to provide both intervention and prevention strategies in the comfort of their homes. In some cases, families may struggle to have all caregivers attend trainings at the same place (e.g., traveling to the appointment from a work destination); with video consultation parents can attend from two different remote locations and participate at the same time. An additional benefit is that extended family members (e.g., grandparents, older siblings) can participate in the training, which is helpful to ensuring consistency among all family members. Alternatively, those seeking video consultation services need not be caregivers. Group homes and school districts may find that travel may make accessing BCBA services cost prohibitive. BCBAs may find themselves providing initial on-site consultations with follow-up consultations given remotely. There are clear advantages with video consultation over that of a telephone-consultation model behavior, antecedents and consequences can be observed directly rather than described, making the consultation more effective and efficient. With the portability of electronic devices, behavior can be seen where it happens, in the community or at school as long as the minimum bandwidth is secured.
Other types of video consultation services may be useful. In the area of case management, parents may desire a second opinion from an outside professional. For example, parents may seek advice about their child’s educational program and prefer to have a 1:1 consultation with a professional that they can see rather than a voice over the phone. Additionally, parents may require on-going assistance in securing services from a state’s Division of Developmental Disabilities. A knowledgeable professional may help navigate the state’s system to obtain entitled services. Another aspect where video consultation may prove useful is assisting individuals with more severe disabilities with the transition to adult services/group home settings. Sheltered workshops may not have access to professionals trained in behavior analysis. Travel time and access to the new location may become cost prohibitive and cause difficulties when ensuring services. By using a common professional, continuity of services is ensured and is beneficial to the individual.
Overall, professional services may be able to be provided via video consultation. Psychiatrists, psychologists, and BCBAs may work with families and educators that are encumbered with distance to make the trip to multiple offices impractical. The saying “it takes a village” is truly the norm when we examine the community efforts necessary to provide quality care and services for those with Autism Spectrum Disorder.
Elena Zaklis M.A., BCBA and Glenn Sloman, PhD, BCBA-D, NCSP
