Comparison of the Effects of Movement-based Interventions Delivered Face-to-Face versus via Telehealth on Restricted and Repetitive Behaviors of Children with Autism Spectrum Disorder (ASD)
ABSTRACT
Background:
Autism Spectrum Disorder (ASD) is the most common pediatric neurodevelopmental disorder with a prevalence of 1 in every 44 children. Children with ASD exhibit social communication and behavioral impairments including poor verbal and nonverbal communication and heightened frequencies of repetitive and maladaptive behaviors (RB).
Objective:
Our randomized controlled trial compares face-to-face versus telehealth-based intervention delivery for three types of interventions: two whole-body gross motor interventions and a conventional seated play intervention on repetitive and maladaptive behaviors in children with ASD.
Methods:
45 children with a confirmed diagnosis of ASD (5 to 14 years) were recruited, matched on age bands & level of functioning, and randomly assigned to one of the 3 intervention groups, Creative Movement (CM), General Movement (GM) or Seated Play (SP). Sessions were 1-1.5 hours long and were conducted with the child twice a week over 8 weeks by an expert clinician, adult confederate, and the caregiver. We coded videos of early and late training sessions for 3 types of repetitive behaviors (RBs): sensory, stereotyped, and negative. Frequencies per standard time were calculated for RBs across early and late sessions.
Results:
Data from a subset of 39 children suggest that there was a significant reduction in total RBs from an early to a late session in the CM group (Means(SE): Early:34.8(5.0), Late: 24.7(3.9), p = 0.01), but not in the GM (Means(SE): Early:34.8(5.0), Late: 24.7(3.9), p = 0.01) and SP groups (Means(SE): Early:14.6(3.1), Late: 15.2(4.0), p = 0.79). The reduction in total RBs in the CM group did not differ significantly between children seen F2F (14.2(4.4)) versus via TH (5.3(3.8), p =0.2). The CM group specifically reduced frequencies of sensory (Early: 10.7(1.8), Late: 6.2(1.9), p = 0.03) and negative (Early: 10.7(2.6), Late: 7.4(2.3), p = 0.01) behaviors. Similar to the trends reported above, the reductions were not significantly different for children seen F2F and via TH (Sensory: F2F (5.1 (1.8), TH (4.7(3.7), p =0.92; Negative: F2F (2.6 (1.3), TH (3.7(2.1), p =0.66).
Conclusions:
Creative movement activities involving music and movement are novel contexts and lead to higher frequencies of RBs at baseline compared to conventional seated play activities in children with ASD. However, training children reduced the frequencies of RBs, especially negative and sensory behaviors. No improvements were found in the GM or SP groups. Although our sample size was limited, preliminary data suggests similar trends for improvement in children seen F2F versus via TH. Telehealth-based training seems to be a viable mode of intervention delivery for families with difficulties accessing in-person care. Clinical Trial: N/A
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