Parent implemented treatment for repetitive behaviors in children with ASD: Using a novel telehealth approach to increase service access

PROJECT SUMMARY
Families are facing significant challenges during the COVID-19 pandemic, especially those caring for a child with
autism spectrum disorder (ASD). A recent SPARK survey1 (N = 8,000) found that approximately 95% of parents
reported increases in their child’s challenging behaviors as a result of COVID-19, and the restricted, repetitive
behaviors and interests (RRBI) of children likely fall within this category. Since only 35% of parents who took the
SPARK survey indicated their child is receiving therapy services remotely, the COVID-19 pandemic will likely
exacerbate this core symptom of ASD. RRBIs are often the target for clinical treatment, as they can significantly
interfere with learning, and are associated with long-term functional impairment, and psychiatric comorbidities
(e.g., anxiety). Given children with ASD are currently out of routine and experiencing a severe reduction in
therapeutic and educational services, the RRBIs and comorbidities of children are likely magnified at this time.
Yet, there are no effective therapies to treat the full range of repetitive, inflexible behaviors found in ASD, and
there have been no large-scale studies of behavioral interventions specifically developed to target this core
symptom domain. This has resulted in a significant treatment gap between the number of effective behavioral
therapies used to target atypical social-communication behaviors in autism when compared to those designed
to treat repetitive behaviors. Thus, our team developed and pilot-tested the Family-Implemented Treatment for
Behavioral Inflexibility (FITBI), derived from neurobehavioral models of reward and learning. The overall goal of
FITBI is to teach parents how to identify high probability cues in the environment that can elicit RRBI symptoms
and teach their child to inhibit repetitive behaviors and instead replace them with flexible and more functional
behaviors. Since our initial pilot studies, the need for technology-based interventions has certainly increased.
While the effectiveness of telehealth interventions for children with ASD is emerging, early research suggests
interventions delivered via telehealth for children with ASD may be just as effective as in-person interventions.
Yet, we currently have no understanding of the effectiveness of RRBI interventions delivered remotely.
Therefore, the overall goal of this project is to conduct a parallel group randomized controlled trial (RCT)
comparing remote delivery of FITBI (12-week intervention + 3 booster sessions over 6 months) to remote delivery
of a parent education only (PE) control condition in a final sample size of 100 (3-9 years) children with ASD and
high rates of ritualistic repetitive behaviors. We will use TORSH, a comprehensive secure online platform that
enhances therapist-parent coaching via telehealth. Further, an important objective of this proposal is to examine
child and parent factors associated with treatment response and uptake in order to advance translational
research and knowledge on personalized intervention approaches.

Grant Number: 5R01HD105036-05
NIH Institute/Center: NIH
Principal Investigator: Brian Boyd