JMIR Publications

ABSTRACT

Background:

Approximately 40-60% of children diagnosed with autism spectrum disorder (ASD) exhibit challenging behaviors such as aggression, elopement, self-injury, and property destruction that can endanger the health and safety of the child or others, often cause significant distress for families, and hinder the child’s developmental progress. Although behavioral treatments grounded in the principles of applied behavior analysis have been shown to effectively reduce or eliminate these behaviors, significant gaps remain in how to deliver these interventions equitably.

Objective:

The primary objective of this trial is to compare the efficacy of delivering in-person versus telehealth caregiver-mediated behavioral treatment for challenging behaviors in children with ASD.

Methods:

The Caregiver Outreach for Autism Coaching at Home (COACH) trial is a single-site, multi-arm, parallel-group randomized controlled trial to evaluate the efficacy of delivering caregiver-mediated behavioral treatment for autistic children who exhibit challenging behaviors. We aim to recruit 90 caregiver-child dyads with autistic children aged 2 years, 0 months to 7 years, 11 months from metropolitan, suburban, and rural areas across New Mexico and the neighboring El Paso, Texas region. Following a practical functional assessment (PFA) to identify the function(s) of the child’s challenging behavior, caregiver-child dyads will be randomized into one of three parallel treatment arms: (1) caregiver-mediated behavioral treatment delivered via telehealth, (2) caregiver-mediated behavioral treatment delivered in-person, or (3) caregiver online education. Interventions will be delivered by clinicians in weekly 1-hour sessions in the home setting over 12 weeks.

Results:

Primary outcomes will include in-session levels of child challenging behavior and caregiver stress measured at baseline and weeks 4, 8, 12, and at 4-week follow-up. Secondary outcome variables will include quality of life, treatment satisfaction, treatment adherence, and attrition.

Conclusions:

This study will address a critical gap in the scientific literature on scalable, family-centered approaches to safely and effectively reduce challenging behavior in children with ASD and decrease caregiver stress. Findings may inform best practices and payer policy for telehealth-delivered behavioral interventions targeting child safety and caregiver well-being. Clinical Trial: This study was registered as a clinical trial at ClinicalTrials.gov (ID# NCT0526879) on 02/24/2022.