Parent-Led Applied Behavior Analysis to Impact Clinical Outcomes for Individuals on the Autism Spectrum: Retrospective Chart Review

Abstract

Background: Autism spectrum disorder (ASD) can have traits that impact multiple domains of functioning and quality of life, which can persevere throughout life. To mitigate the impact of ASD on the long-term trajectory of an individual's life, it is imperative to seek early and adequate treatment via scientifically validated approaches, of which applied behavior analysis (ABA) is the gold standard. ABA treatment must be delivered via a behavior technician with oversight from a board-certified behavior analyst. However, shortages in certified ABA therapists create treatment access barriers for individuals on the autism spectrum. Increased ASD prevalence demands innovations for treatment delivery. Parent-led treatment models for neurodevelopmental conditions are effective yet underutilized and may be used to fill this care gap.

Objective: This study reports findings from a retrospective chart review of clinical outcomes for children that received parent-led ABA treatment and intends to examine the sustained impact that modifications to ABA delivery have had on a subset of patients of Montera, Inc. dba Forta ("Forta"), as measured by progress toward skill acquisition within multiple focus areas (FAs).

Methods: Parents received ≥40 hours of training in ABA prior to initiating treatment, and patients were prescribed focused (<25 hours/week) or comprehensive (>25-40 hours/week) treatment plans. Retrospective data were evaluated over ≥90 days for 30 patients. The clinical outcomes of patients were additionally assessed by age (2-5 years, 6-12 years, 13-22 years) and utilization of prescribed treatment. Treatment encompassed skill acquisition goals; to facilitate data collection consistency, successful attempts were logged within a software application built in-house.

Results: Improved goal achievement success between weeks 1-20 was observed for older age, all utilization, and both treatment plan type cohorts. Success rates increased over time for most FAs, with the exception of executive functioning in the youngest cohort and comprehensive plan cohort. Goal achievement experienced peaks and declines from week to week, as expected for ABA treatment; however, overall trends indicated increased skill acquisition success rates. Of 40 unique combinations of analysis cohorts and FAs, 20 showed statistically significant positive linear relationships (P<.05). Statistically significant positive linear relationships were observed in the high utilization cohort (communication with P=.04, social skills with P=.02); in the fair and full utilization cohorts (overall success with P=.03 for the fair utilization cohort and P=.001 for the full utilization cohort, and success in emotional regulation with P<.001 for the fair utilization cohort and P<.001 for the full utilization cohort); and in the comprehensive treatment cohort (communication with P=.001, emotional regulation with P=.045).

Conclusions: Parent-led ABA can lead to goal achievement and improved clinical outcomes and may be a viable solution to overcome treatment access barriers that delay initiation or continuation of care.

Keywords: applied behavior analysis; autism spectrum disorder; parent training; patient outcomes; pediatrics; skill acquisition.

Figure 1.. Attrition chart. Figure created using Lucidchart [38].

Figure 2.. High utilization cohorts by (A) age and (B) weekly utilization. Goal achievement/success rate by utilization (C) overall and (D) for each focus area. Black lines aggregate all patients; each gray line represents a single patient; a vertical dashed line at 13 weeks denotes the cutoff for the minimum amount of data that each patient was required to have for inclusion in the study. This figure was created using Plotly in Python.

Figure 3.. Goal achievement/success rate by treatment intensity: overall (top panels) and for each focus area (bottom panels). Black lines aggregate all patients; each gray line represents a single patient; a vertical dashed line at 13 weeks denotes the cutoff for the minimum amount of data that each patient was required to have for inclusion in the study. This figure was created using Plotly in Python.

Figure 4.. Goal achievement/success rate by age cohort: overall (top panels) and for each focus area by age (bottom panels). Black lines aggregate all patients; each gray line represents a single patient; a vertical dashed line at 13 weeks denotes the cutoff for the minimum amount of data that each patient was required to have for inclusion in the study. This figure was created using Plotly in Python.