Journal of Autism and Developmental Disorders

, Volume 45, Issue 12, pp 3877–3890 | Cite as

Increasing Access to an ASD Imitation Intervention Via a Telehealth Parent Training Program

  • Allison L. WainerEmail author
  • Brooke R. Ingersoll
Original Paper


Systematic research focused on developing and improving strategies for the dissemination and implementation of effective ASD services is essential. An innovative and promising area of research is the use of telehealth programs to train parents of children with ASD in intervention techniques. A hybrid telehealth program, combining self-directed internet-based instruction with remote coaching, was created to introduce parents of children with ASD to an imitation intervention. A single-subject multiple-baseline design study evaluated the effect of the program on changes in parent and child behavior. Parents improved in their use of the intervention techniques and their children demonstrated concurrent increases in spontaneous imitation skills. Parents also indicated that the intervention and telehealth service delivery model were acceptable, useable, and effective. Results suggest that this hybrid telehealth program has the potential to increase access to ASD services.


Telehealth Parent training Autism spectrum disorder 



This project was supported by an Autism Speaks Grant (#7416) to the first author.

Supplementary material

10803_2014_2186_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 16 kb)


  1. Allen, K. D., & Warzak, W. J. (2000). The problem of parental nonadherence in clinical behavior analysis: Effective treatment is not enough. Journal of Applied Behavior Analysis, 33, 373–391. doi: 10.1901/jaba.2000.33-373.PubMedCentralCrossRefPubMedGoogle Scholar
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington: American Psychiatric Association.Google Scholar
  3. American Telemedicine Association. (2013, September 1). What is telemedicine? Retrieved from
  4. Anaraki, F. (2004). Developing an effective and efficient elearning platform. International Journal of the Computer, the Internet, and Management, 12, 57–63.Google Scholar
  5. Baggett, K. M., Davis, B., Feil, E. G., Sheeber, L. L., Landry, S. H., Carta, J. J., et al. (2010). Technologies for expanding the reach of evidence-based interventions: Preliminary results for promoting social-emotional development in early childhood. Topics in Early Childhood Special Education, 29, 226–238. doi: 10.1177/0271121409354782.PubMedCentralCrossRefPubMedGoogle Scholar
  6. Baharav, E., & Reiser, C. (2010). Using telepractice in parent training in early autism. Telemedicine and E-Health, 16, 727–731. doi: 10.1089/tmj.2010.0029.CrossRefPubMedGoogle Scholar
  7. Bonk, C., & Cunningham, D. (1998). Searching for learner-centered, constructivist, and sociocultural components of collaborative educational learning tools. In C. Bonk & K. King (Eds.), Electronic collaborators. Learner-centered technologies for literacy, apprenticeship, and discourse. New Jersey: Lawrence Erlbaum Associates.Google Scholar
  8. Casebeer, L., Kristofco, R. E., Strasser, S., Reilly, M., Krishnamoorthy, P., Rabin, A., et al. (2004). Standardizing evaluation of on-line continuing medical education: Physician knowledge, attitudes, and reflection on practice. Journal of Continuing Education in the Health Professions, 24, 68–75.CrossRefPubMedGoogle Scholar
  9. Center for Disease Control and Prevention. (2014). Prevalence of autism spectrum disorders—Autism and developmental disabilities monitoring network, 11 sites, United States, 2010. Surveillance Summaries. March 28, 2014/63(SS02);1–21.Google Scholar
  10. Charlop, M. G. H., & Trasowech, J. E. (1991). Increasing autistic children’s daily spontaneous speech. Journal of Applied Behavior Analysis, 24, 747–761.PubMedCentralCrossRefPubMedGoogle Scholar
  11. Dingfelder, H. E., & Mandell, D. S. (2011). Bridging the research-to-practice gap in autism intervention: An application of diffusion of innovation theory. Journal of Autism and Developmental Disorders, 41, 597–609. doi: 10.1007/s10803-010-1081-0.PubMedCentralCrossRefPubMedGoogle Scholar
  12. Edgington, E. S. (1996). Randomized single-subject research designs. Behaviour Research and Therapy, 34, 567–574.CrossRefPubMedGoogle Scholar
  13. Elliott, S. N., & Treuting, M. V. (1991). The behavior intervention rating scale: Development and validation of a pretreatment acceptability and effectiveness measure. Journal of School Psychology, 29, 43–51.CrossRefGoogle Scholar
  14. Feil, E. G., Baggett, K. M., Davis, B., Sheeber, L., Landry, S., Carta, J. J., et al. (2008). Expanding the reach of preventive interventions: Development of an internet-based training for parents of infants. Child Maltreatment, 13, 334–346. doi: 10.1177/1077559508322446.PubMedCentralCrossRefPubMedGoogle Scholar
  15. File, T. (2013). Computer and internet use in the United States. Current Population Survey Reports, P20-568. U.S. Census Bureau, Washington, DC.Google Scholar
  16. Gliner, J. A., Morgan, G. A., & Harmon, R. J. (2000). Single-subject designs. Journal of the American Academy of Child and Adolescent Psychiatry, 39(10), 1327–1329.CrossRefPubMedGoogle Scholar
  17. Gros, D. F., Morland, L. A., Greene, C. J., Acierno, R., Strachan, M., Egede, L. E., et al. (2013). Delivery of evidence-based psychotherapy via video telehealth. Journal of Psychopathology and Behavioral Assessment, 35, 506–521. doi: 10.1007/s10862-013-9363-4.CrossRefGoogle Scholar
  18. Hamad, C. D., Serna, R. W., Morrison, L., & Fleming, R. (2010). Extending the reach of early intervention training for practitioners. Infants & Young Children, 23, 195–208. doi: 10.1097/IYC.0b013e3181e32d5e.CrossRefGoogle Scholar
  19. Hersen, M., & Barlow, D. H. (1976). Single case experimental designs: Strategies for studying behavior change. New York: Pergamon.Google Scholar
  20. Howroyd, C., & Peeters, T. (2007). Parent participation in early intervention with software-assisted guidance from AutismPro. Good Autism Practice (GAP), 8, 31–36.Google Scholar
  21. Ingersoll, B. (2010). Brief report: Pilot randomized controlled trial of reciprocal imitation training for teaching elicited and spontaneous imitation to children with autism. Journal of Autism and Developmental Disorders, 40, 1154–1160. doi: 10.1007/s10803-010-0966-2.PubMedCentralCrossRefPubMedGoogle Scholar
  22. Ingersoll, B., & Gergans, S. (2007). The effect of a parent-implemented imitation intervention on spontaneous imitation skills in young children with autism. Research in Developmental Disabilities, 28, 163–175. doi: 10.1016/j.ridd.2006.02.004.CrossRefPubMedGoogle Scholar
  23. Ingersoll, B., & LaLonde, K. (2010). The impact of object and gesture imitation training on language use in children with autism. Journal of Speech, Language, and Hearing Research, 53, 1040–1051. doi: 10.1044/1092-4388(2009/09-0043.PubMedCentralCrossRefPubMedGoogle Scholar
  24. Ingersoll, B., & Schreibman, L. (2006). Teaching reciprocal imitation skills to young children with autism using a naturalistic behavioral approach: Effects on language, pretend play, and joint attention. Journal of Autism and Developmental Disorders, 36, 487–505. doi: 10.1007/s10803-006-0089-y.CrossRefPubMedGoogle Scholar
  25. Ingersoll, B., & Wainer, A. (2013a). Initial efficacy of Project ImPACT: A parent-mediated social communication intervention for young children with ASD. Journal of Autism and Developmental Disorders, 43, 2943–2952.CrossRefPubMedGoogle Scholar
  26. Ingersoll, B., & Wainer, A. (2013b). Using distance learning technology to increase dissemination of evidence-based practice in ASD. In K. Boser, M. Goodman, & S. Wayland (Eds.), Technology tools for students with autism: Innovations that enhance independence and learning. Baltimore, MD: Brookes Publishing.Google Scholar
  27. Jang, J., Dixon, D., Tarbox, J., Granpeesheh, D., Kornack, J., & de Nocker, Y. (2012). Randomized controlled trial of an eLearning program for training family members of children with autism in the principles and procedures of applied behavior analysis. Research in Autism Spectrum Disorders, 6, 852–856. doi: 10.1016/j.rasd.2011.11.004.CrossRefGoogle Scholar
  28. Kacir, C. D., & Gordon, D. A. (1999). Parenting adolescents wisely: The effectiveness of an interactive videodisk parent training program in Appalachia. Child and Family Behavior Therapy, 21, 1–22. doi: 10.1300/J019v21n04_01.CrossRefGoogle Scholar
  29. Kaminski, J. W., Valle, L. A., Filene, J. H., & Boyle, C. L. (2008). A meta-analytic review of components associated with parent training effectiveness. Journal of Abnormal Child Psychology, 36, 567–589. doi: 10.1007/s10802-007-9201-9.CrossRefPubMedGoogle Scholar
  30. Kazdin, A. (2008). Evidence-based treatments and delivery of psychological services: Shifting our emphases to increase impact. Psychological Services, 5, 201–215. doi: 10.1037/a0012573.CrossRefGoogle Scholar
  31. Koegel, R. L., Bimbela, A., & Schreibman, L. (1996). Collateral effects of parent training on family interactions. Journal of Autism and Developmental Disabilities, 26, 347–359.CrossRefGoogle Scholar
  32. Kogan, M. D., Strickland, B. B., Blumberg, S. J., Singh, G. K., Perrin, J. M., & van Dyck, P. C. (2008). A national profile of the health care expenses and family impact of autism spectrum disorders among children in the United states, 2005–2006. Pediatrics, 122, e1149–e1158. doi: 10.1542/peds.2008-1057.CrossRefPubMedGoogle Scholar
  33. Lord, C., Wagner, A., Rogers, S., Szatmari, P., Aman, M., Charman, T., et al. (2005). Challenges in evaluating psychosocial interventions for autistic spectrum disorders. Journal of Autism and Developmental Disorders, 35, 695–708. doi: 10.1007/s10803-005-0017-6.CrossRefPubMedGoogle Scholar
  34. MacKenzie, E. P., & Hilgedick, J. M. (1999). The computer-assisted parenting program (CAPP): The use of a computerized behavioral parent training program as an educational tool. Child & Family Behavior Therapy, 21, 23–42. doi: 10.1300/J019v21n04_02.CrossRefGoogle Scholar
  35. Nefdt, N., Koegel, R., Singer, G., & Gerber, M. (2010). The use of a self-directed learning program to provide introductory training in pivotal response treatment to parents of children with autism. Journal of Positive Behavior Interventions, 12, 23–33. doi: 10.1177/1098300709334796.CrossRefGoogle Scholar
  36. O’Donohue, W. T., & Draper, C. (2011). The case for evidence-based stepped care as part of a reformed delivery system. In W. T. O’Donohue & C. Drapper (Eds.), Stepped care and e-health: Practical applications to behavioral disorders. New York: Springer.Google Scholar
  37. Phaneuf, L., & McIntyre, L. L. (2011). The application of a three-tier model of intervention to parent training. Journal of Positive Behavior Interventions, 13, 198–207. doi: 10.1177/1098300711405337.PubMedCentralCrossRefPubMedGoogle Scholar
  38. Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York: Free Press.Google Scholar
  39. Rogers, S. J., & Dawson, G. (2010). The early start Denver model for young children with autism: Promoting language, learning, and engagement. New York, NY: Guilford Press.Google Scholar
  40. Rogers, S. J., Estes, A., Lord, C., Vismara, L., Winter, J., Fitzpatrick, A., et al. (2012). Effects of a brief early start Denver model (ESDM)-based parent intervention on toddlers at risk for autism spectrum disorders: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 51, 1052–1065. doi: 10.1016/j.jaac.2012.08.003.PubMedCentralCrossRefPubMedGoogle Scholar
  41. Romanov, K., & Nevgi, A. (2007). Do medical students watch video clips in elearning and do these facilitate learning? Medical Teacher, 29, 490–494. doi: 10.1080/01421590701542119.CrossRefGoogle Scholar
  42. Rutter, M., Bailey, A., & Lord, C. (2003). SCQ: The social communication questionnaire. Los Angeles, CA: Western Psychological Services.Google Scholar
  43. Smith, T., Scahill, L., Dawson, G., Guthrie, D., Lord, C., Odom, S., et al. (2007). Designing research studies on psychosocial interventions in autism. Journal of Autism and Developmental Disorders, 37, 354–366. doi: 10.1007/s10803-006-0173-3.CrossRefPubMedGoogle Scholar
  44. Sparrow, S. S., Cicchetti, D. C., & Balla, D. A. (2005). Vineland adaptive behavior scales, second edition (Vineland-II). Minneapolis, MN: Pearson Assessments.Google Scholar
  45. Sperry, L. A., Whaley, K. T., Shaw, E., & Brame, K. (1999). Services for young children with autism spectrum disorder: Voices of parents and providers. Infants & Young Children, 11, 17–33.CrossRefGoogle Scholar
  46. Stahmer, A. C. (1995). Teaching symbolic play skills to children with autism using pivotal response training. Journal of Autism and Developmental Disorders, 25, 123–141.CrossRefPubMedGoogle Scholar
  47. Stahmer, A. C. (2007). The basic structure of community early intervention programs for children with autism: Provider descriptions. Journal of Autism and Developmental Disorders, 37, 1344–1354. doi: 10.1007/s10803-006-0284-x.PubMedCentralCrossRefPubMedGoogle Scholar
  48. Stahmer, A. C., & Gist, K. (2001). The effects of an accelerated parent education program on technique mastery and child outcome. Journal of Positive Behavior Interventions, 3, 75–82. doi: 10.1177/109830070100300203.CrossRefGoogle Scholar
  49. Stahmer, A. C., Schreibman, L., & Cunningham, A. B. (2011). Toward a technology of treatment individualization for young children with autism spectrum disorders. Brain Research, 1380, 229–239.PubMedCentralCrossRefPubMedGoogle Scholar
  50. Steever, M. (2011). Autism. In W. T. O’Donohue & C. Drapper (Eds.), Stepped care and e-health: Practical applications to behavioral disorders. New York: Springer.Google Scholar
  51. Suess, A. N., Romani, P. W., Wacker, D. P., Dyson, S. M., Kuhle, J. L., Lee, J. F., et al. (2014). Evaluating the treatment fidelity of parents who conduct in-home functional communication training with coaching via telehealth. Journal of Behavioral Education, 23, 34–59.CrossRefGoogle Scholar
  52. Symon, J. B. (2001). Parent education for autism: Issues in providing services at a distance. Journal of Positive Behavior Interventions, 3, 160–174. doi: 10.1177/109830070100300304.CrossRefGoogle Scholar
  53. Symon, J. B. (2005). Expanding interventions for children with autism: Parents as trainers. Journal of Positive Behavior Interventions, 7, 159–173. doi: 10.1177/10983007050070030501.CrossRefGoogle Scholar
  54. Taylor, T. K., Webster-Stratton, C., Feil, E. G., Broadbent, B., Widdop, C. S., & Severson, H. H. (2008). Computer-based intervention with coaching: An example using the incredible years program. Cognitive Behaviour Therapy, 37, 233–246. doi: 10.1080/16506070802364511.PubMedCentralCrossRefPubMedGoogle Scholar
  55. United States Department of Education, Office of Planning, Evaluation, and Policy Development. (2010). Evaluation of evidence-based practices in online learning: A meta-analysis and review of online learning studies. Washington, DC: United States Department of Education, Office of Planning, Evaluation, and Policy Development.Google Scholar
  56. Van den Noortgate, W., & Onghena, P. (2003). Hierarchical linear models for the quantitative integration of effect sizes in single-case research. Behavior Research Methods, Instruments, & Computers, 35(1), 1–10. doi: 10.3758/BF03195492.CrossRefGoogle Scholar
  57. Vismara, L. A., McCormick, C., Young, G. S., Nadhan, A., & Monlux, K. (2013). Preliminary findings of a telehealth approach to parent training in autism. Journal of Autism and Developmental Disorders, 43(12), 2953–2969. doi: 10.1007/s10803-013-1841-8.CrossRefPubMedGoogle Scholar
  58. Vismara, L., Young, G. S., & Rogers, S. J. (2012). Telehealth for expanding the reach of early autism training to parents. Autism Research and Treatment. doi: 10.1155/2012/121878.PubMedCentralPubMedGoogle Scholar
  59. Wainer, A. L., & Ingersoll, B. R. (2013a). Disseminating ASD interventions: A pilot study of a distance learning program for parents and professionals. Journal of Autism and Developmental Disorders, 43, 11–24. doi: 10.1007/s10803-012-1538-4.CrossRefPubMedGoogle Scholar
  60. Wainer, A., & Ingersoll, B. (2013b). Intervention fidelity: An essential component for understanding ASD parent training research and practice. Clinical Psychology: Science and Practice, 20, 335–357. doi: 10.1111/cpsp.12045.Google Scholar
  61. Weingardt, K. R. (2004). The role of instructional design and technology in the dissemination of empirically supported, manual-based therapies. Clinical Psychology: Science and Practice, 11, 313–331. doi: 10.1093/clipsy/bph087.Google Scholar
  62. Wetzel, C. D., Radtke, R. H., & Stern, H. W. (1994). Instructional effectiveness of video media. Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of PsychologyMichigan State UniversityEast LansingUSA

Personalised recommendations