O2069: A Short-Term Caregiver Education Program for Parents of Children with Autism Spectrum Disorder

Background: Applied behavior analysis (ABA) is the standard of care for autism spectrum disorder (ASD), but its intense time commitment presents logistical challenges. ABA therapy is typically delivered one-on-one in the family home >20 hours weekly. A shortage of trained providers and low Medicaid reimbursement rates means that despite its evidence base, < 30% of children with ASD receive ABA therapy. Innovative therapy models to support children with ASD are needed to increase access and reduce disparities. We developed a short-term educational model of parent training to teach ABA principals and enabled intermittent scheduling of sequential lessons. This study evaluates the acceptability and clinical outcomes of this alternative short-term, low-intensity ABA intervention model.

Methods: Patients completed IRB consent and surveys on enrollment. Neighborhood socioeconomic disadvantage was measured by the National Area Deprivation Index (NADI). The intervention included an online self-paced parent training program divided into five lessons covering topics such as behavior intervention and redirection strategies, promoting skill development, bedtime routines, food selectivity, and toilet training. After completing each lesson, parents received one hour of ABA parent training while their children received one hour of ABA therapy. The content of each parent training and child therapy visit corresponded to completed lessons, totaling five hours of one-on-one child therapy and five hours of parent training. Participants were instructed to complete the program at their own pace and received reminder phone calls throughout the program. After completing all therapy and educational visits, parents completed exit assessments and were referred to additional services.

Results: Thirty-seven children with ASD enrolled in the study with their parents. Children were 73% male; 68% Non-Hispanic Black, 21.2% Hispanic, and 10.8% Non-Hispanic White, and of mean(range) age 4.8(3.5-10.4) years. Seventy-three percent had a single parent and 87% used public health insurance. NADI was median(range) 73(16-100). On average, parents scheduled appointments every two weeks. Over two-thirds of participants completed all modules and study visits. All families who were offered ongoing ABA therapy accepted. Parents demonstrated significant improvement in knowledge in ABA and behavior management techniques over the program. Parents described they enjoyed the scheduling flexibility and self-pacing. They also described learning strategies on handling difficult behaviors, transitions, and overall having a better understanding of their child’s capacity to learn and engage.

Conclusion: A pilot sample of children with ASD who had never received ABA therapy, most from minoritized and low-income communities, completed a short-term ABA and parent training program with positive outcomes. Most families completed the program and there were significant increases in parental knowledge about ABA and behavior management techniques. Notably, when given flexibility, parents opted for biweekly appointments, demonstrating that typical clinic models may not match family capacity. Our model shows promise at increasing ABA access for children from disadvantaged communities.