Association for Behavior Analysis International

Early childhood externalizing behavior problems are both highly prevalent and predictive of significant conduct problems later in life. One frequently used intervention to address these types of problems is Behavioral Parent Training (BPT), wherein caregivers are trained as the primary change agents for their children. While effective, BPT programs face criticism due to high attrition and their reliance on parent report measures as their primary dependent variables. The current study examined the feasibility, acceptability, and outcome of an intensive behavior treatment program (120 minute sessions for 5 days/week over the course of 2 weeks) designed to teach caregivers to increase children’s frustration tolerance via a wait training procedure. Using a changing criterion single case experimental design, 12 children (M child age = 4.9 years) and their primary caregivers completed the two week function-based intervention procedure based on the principles of applied behavior analysis. Using both direct observation and standardized measures, results indicated that the treatment was effective in reducing childhood behavior problems, both within and between appointments (ds = 3.2 and 1.37, respectively). Overall, preliminary evidence suggests that a condensed treatment package designed to train caregivers in function-based intervention strategies is feasible, acceptable, and effective.

Incorporating parent training and telehealth technologies with evidence-based intervention can increase accessibility, generate more learning opportunities, and support positive outcomes. Recently, disruption of services due to the COVID-19 pandemic has highlighted the importance of evaluating intervention delivery via online formats. Two research projects evaluated the delivery of a parent-mediated implementation of the Preschool Life Skills program (PLS; Hanley et al., 2007) via telehealth. The PLS program is a preventive program aimed at teaching important skills to ameliorate risk factors for problem behaviour at preschool stage and set children up for success within this context. Four parents completed the parent PLS program with their neurotypical children (5 males, aged 3-5 years) and four parents completed the program with their children with diagnoses of autism spectrum disorder (ASD, 4 males, aged 3-5 years). Parents were taught to deliver the PLS program at home via behavioural skills training within weekly video conferencing sessions. Results indicated increases in children’s preschool life skills and parental use of teaching strategies, decreases in children’s behavioural difficulties, and positive social validity outcomes. The findings of this research are important in informing future research and development of parent training via telehealth and adaptation of interventions across contexts and populations.

The American Academy of Pediatrics (2014) recommends individuals with a diagnosis of autism spectrum disorder (ASD) receive applied behavior analysis (ABA) services as soon as they are diagnosed. Ruppel et al. (2021) demonstrated that a parent-implemented problem behavior prevention program, Balance, was effective in reducing problem behavior and increasing social, communication, and cooperation skills in all four participants under the age of six. Access to effective intervention, like Balance, is critical, but waitlists for early intervention services can be long or the individual may reside in an area where ABA services are not readily available (Antezana et al., 2017). In these instances, the use of telehealth may be useful for supporting caregivers as they implement behavior-change programs. This study evaluated the effects of Balance implemented via telehealth using a multiple baseline design nested within a randomized control trial with children aged three and six years. Preliminary results indicate that emerging problem behavior remained high and skills were not acquired for the children randomly assigned to the control group (i.e., delayed intervention). By contrast, children in the test group who received immediate intervention engaged in zero to low levels of problem behavior and social and communication skills were high. Strategies for supporting caregivers attempting to prevent the development of problem behavior via telehealth will be discussed.

Teaching individuals to tolerate times when preferred toys, materials, and social interactions are delayed or unavailable is essential in preparing them to manage everyday challenging situations. Ruppel et al. (2021) demonstrated the efficacy of an approach to teach children who exhibited deficits in communication and tolerance of delays and denials to reinforcement. Their approach could protect individuals from emerging problem behavior toward the same goals as other prevention programs (e.g., Preschool Life Skills, Hanley et al., 2007). However, a potential limitation of Ruppel et al.’s approach is the omission of diverse situations (risk factors) shown to influence problem behavior based on the assessment and treatment literature (Hanley et al., 2014; Slaton & Hanley, 2018). The primary aim of this study was to systematically extend Ruppel et al. by including primary challenging situations and risk factor (generalization) tests that expand the application of protective skills. Four children were taught protective skills using a multiple probe design across primary challenging situations. Risk factor tests were evaluated following the acquisition of all protective skills. Results indicated that acquiring the target skills protected children from a variety of challenging situations and risk factors. Moreover, children were protected from situations mediated by caregivers.