Tele-treatments
Autism spectrum disorder
Evidence reviewed as of before 20-05-2021
Author(s): Ogourtsova, T. (PhD OT), Osman, G. (MSc OT student), & Dunn, T. (MSc student)
Introduction
For autism spectrum disorder (ASD), we found 16 studies on tele-treatments. Four of them are high quality randomized clinical trials (RCTs), 1 is a fair quality RCT, 1 is a low quality RCT, and 10 are non-RCTs.
These tele-treatments were provided by psychologists, behavioral therapists and psychotherapists, occupational therapists, and a multidisciplinary team of professionals. Most tele-treatments (81.3% of studies) targeted to improve both, parent- and child-related outcomes. For instance, interventions focused on parent’s skills, participation, wellbeing and self-efficacy, as well as child’s language, behavior, anxiety, sensory processing, social skills and participation. Interventions were mainly provided through videoconferencing (in 87.5% of studies) and clinicians were mainly actively involved in all sessions (68.7% of studies).
Sixty-five (n=65) different outcomes were studied, and 38.4% of them emerged from RCTs. Telerehabilitation was found to be more effective (vs. no treatment) in improving 66.7% of outcomes; more effective (vs. another intervention) in improving 63.1% of outcomes; and more effective (vs. a face-to-face intervention) in improving 85.7% of outcomes.
Proceed to the Clinician information section to find out more.
Clinician information
In this section, you will find a list of outcomes that were examined in the selected studies; whether telerehabilitation was more or as effective (for RCTs) or effective/not effective (for non-RCTs); the comparison intervention (e.g., usual care, if present); and the level of evidence. Find out more about the levels of evidence here.Behavioral therapy/Psychotherapy
Results TableFor autism spectrum disorder (ASD), there were 5 studies on tele-treatments provided by behavioral therapists or psychotherapists. Out of those studies, one was a high quality RCT, and four were non-RCTs.
The focus of the tele-interventions provided by behavioral therapists and psychotherapists was to improve disruptive/noncompliant behavior, parental distress, parent-child functional interaction, parenting techniques, use of applied behavior analysis strategies with children, and child behavior problems.
Seven (n=9) different outcomes were studied, and 77.7% of them emerge from the RCT.
Expand on the outcomes below to find out more.
Demand avoidanceMore effective vs. In-person ABA therapy1b
One high quality RCT (Marino et al., 2020) investigated the effect of telerehabilitation on demand avoidance among children with autism spectrum disorder (ASD). This high quality RCT randomized participants (parent alone) to receive telerehabilitation (Tele-assisted group [TG] with Applied Behaviour Analysis Therapy [ABA], targeting disruptive and noncompliant behaviour, parental distress, and parent-child functional interaction in 3 phases comprised of 2-hour sessions a week for 12 weeks each, with the final phase including tele-assistance) vs. in-person ABA therapy. Demand avoidance was measured by the Home Situation Questionnaire (HSQ-ASD) at post-treatment (12 weeks). A significant between-group difference was found, favouring telerehabilitation vs. in-person ABA therapy.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (TG with ABA therapy, targeting disruptive and noncompliant behaviour, parental distress, and parent-child functional interaction) is more effective than the comparison intervention (in-person ABA therapy) in improving demand avoidance among children with ASD.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (TG with ABA therapy, targeting disruptive and noncompliant behaviour, parental distress, and parent-child functional interaction) is more effective than the comparison intervention (in-person ABA therapy) in improving demand avoidance among children with ASD.
Disruptive or noncompliant behaviourMore effective vs. In-person ABA therapy1b
One high quality RCT (Marino et al., 2020) investigated the effect of telerehabilitation on disruptive or noncompliant behaviour among children with autism spectrum disorder (ASD). This high quality RCT randomized participants (parent alone) to receive telerehabilitation (Tele-assisted group [TG] with Applied Behaviour Analysis Therapy [ABA], targeting disruptive and noncompliant behaviour, parental distress, and parent-child functional interaction in 3 phases of 2-hour sessions a week for 12 weeks each, with the final phase including tele-assistance) vs. in-person ABA therapy. Disruptive/noncompliant behaviour was measured by the Home Situation Questionnaire (HSQ-ASD) at post-treatment (12 weeks). A significant between-group difference was found, favouring TG with ABA vs. in-person ABA therapy.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (TG with ABA therapy, targeting disruptive and noncompliant behaviour, parental distress, and parent-child functional interaction) is more effective than the comparison intervention (in-person ABA therapy) in improving disruptive or noncompliant behaviour among children with ASD.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (TG with ABA therapy, targeting disruptive and noncompliant behaviour, parental distress, and parent-child functional interaction) is more effective than the comparison intervention (in-person ABA therapy) in improving disruptive or noncompliant behaviour among children with ASD.
Parent-child dysfunctional interactionMore effective vs. In-person ABA therapy1b
One high quality RCT (Marino et al., 2020) investigated the effect of telerehabilitation on parent-child dysfunctional interaction among families with children with autism spectrum disorder (ASD). This high quality RCT randomized participants (parent alone) to receive telerehabilitation (Tele-assisted group [TG] with Applied Behaviour Analysis Therapy [ABA], targeting disruptive and noncompliant behaviour, parental distress, and parent-child functional interaction in 3 phases comprised of 2-hour sessions a week for 12 weeks each, with the final phase including tele-assistance) vs. comparison intervention (in-person ABA therapy). Parent-child dysfunctional interaction was measured by the Parental Stress Index Short Form (PSI/SF) at post-treatment (12 weeks). Significant between-group differences were found, favouring TG with ABA vs. in-person ABA therapy.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (TG with ABA therapy, targeting disruptive and noncompliant behaviour, parental distress, and parent-child functional interaction) is more effective than the comparison intervention (in-person ABA therapy) in improving parent-child dysfunctional interaction among families with children with ASD.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (TG with ABA therapy, targeting disruptive and noncompliant behaviour, parental distress, and parent-child functional interaction) is more effective than the comparison intervention (in-person ABA therapy) in improving parent-child dysfunctional interaction among families with children with ASD.
Parental distressMore effective vs. In-person ABA therapy1b
One high quality RCT (Marino et al., 2020) investigated the effect of telerehabilitation on parental distress among parents of children with autism spectrum disorder (ASD). This high quality RCT randomized participants (parent alone) to receive telerehabilitation (Tele-assisted group [TG] with Applied Behaviour Analysis Therapy [ABA], targeting disruptive and noncompliant behaviour, parental distress, and parent-child functional interaction in 3 phases comprised of 2-hour sessions a week for 12 weeks each, with the final phase including tele-assistance) vs. in-person ABA therapy. Parental distress was measured by the Parental Stress Index - Short Form at post-treatment (12 weeks). Significant between-group differences were found, favouring TG with ABA vs. in-person ABA therapy.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (TG with ABA therapy targeting disruptive and noncompliant behaviour, parental distress, and parent-child functional interaction) is more effective than the comparison intervention (in-person ABA therapy) in improving parental distress among parents of children with ASD.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (TG with ABA therapy targeting disruptive and noncompliant behaviour, parental distress, and parent-child functional interaction) is more effective than the comparison intervention (in-person ABA therapy) in improving parental distress among parents of children with ASD.
Parent stressMore effective vs. In-person ABA therapy1b
One high quality RCT (Marino et al., 2020) investigated the effect of telerehabilitation on parental stress among parents of children with autism spectrum disorder (ASD). This high quality RCT randomized participants (parent alone) to receive telerehabilitation (Tele-assisted group [TG] with Applied Behaviour Analysis Therapy [ABA], targeting disruptive and noncompliant behaviour, parental distress, and parent-child functional interaction in 3 phases comprised of 2-hour sessions a week for 12 weeks each, with the final phase including tele-assistance) vs. comparison intervention (in-person ABA therapy). Parental stress was measured by the Parental Stress Index/Short Form (PSI/SF) at post-treatment (12 weeks). Significant between-group differences were found, favouring TG with ABA vs. in-person ABA therapy.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (TG with ABA therapy targeting disruptive and noncompliant behaviour, parental distress, and parent-child functional interaction) is more effective than the comparison intervention (in-person ABA therapy) in improving parental stress among parents of children with ASD.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (TG with ABA therapy targeting disruptive and noncompliant behaviour, parental distress, and parent-child functional interaction) is more effective than the comparison intervention (in-person ABA therapy) in improving parental stress among parents of children with ASD.
Social inflexibilityMore effective vs. In-person ABA therapy1b
One high quality RCT (Marino et al., 2020) investigated the effect of telerehabilitation on social inflexibility among children with autism spectrum disorder (ASD). This high quality RCT randomized participants (parent alone) to receive telerehabilitation (Tele-assisted group [TG] with Applied Behaviour Analysis Therapy [ABA], targeting disruptive and noncompliant behaviour, parental distress, and parent-child functional interaction in 3 phases comprised of 2-hour sessions a week for 12 weeks each, with the final phase including tele-assistance) vs. in-person ABA therapy. Social inflexibility was measured by the Home Situation Questionnaire (HSQ-ASD) at post-treatment (12 weeks). A significant between-group difference was found, favouring telerehabilitation vs. in-person ABA therapy.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (TG with ABA, targeting disruptive and noncompliant behaviour, parental distress, and parent-child functional interaction) is more effective than the comparison intervention (in-person ABA therapy) in improving social inflexibility among children with ASD.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (TG with ABA, targeting disruptive and noncompliant behaviour, parental distress, and parent-child functional interaction) is more effective than the comparison intervention (in-person ABA therapy) in improving social inflexibility among children with ASD.
Parental perception of difficult childrenAs effective vs. In-person ABA therapy1b
One high quality RCT (Marino et al., 2020) investigated the effect of telerehabilitation on the parental perception of difficult children among parents of children with autism spectrum disorder (ASD). This high quality RCT randomized participants (parent alone) to receive telerehabilitation (Tele-assisted group [TG] with Applied Behaviour Analysis Therapy [ABA], targeting disruptive and noncompliant behaviour, parental distress, and parent-child functional interaction in 3 phases comprised of 2-hour sessions a week for 12 weeks each, with the final phase including tele-assistance) vs. in-person ABA therapy. Parental perception of difficult children was measured by the Parental Stress Index/Short Form (PSI/SF) at post-treatment (12 weeks). No significant between-group difference was found.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (TG with ABA therapy targeting disruptive and noncompliant behaviour, parental distress, and parent-child functional interaction) is as effective as the comparison intervention (in-person ABA therapy) in improving the parental perception of difficult children among parents of children with ASD.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (TG with ABA therapy targeting disruptive and noncompliant behaviour, parental distress, and parent-child functional interaction) is as effective as the comparison intervention (in-person ABA therapy) in improving the parental perception of difficult children among parents of children with ASD.
Problematic behaviourEffective5
One non-RCT study (Wacker et al., 2013) investigated the effect of telerehabilitation on problem behaviour among children with autism spectrum disorder (ASD). This non-RCT study assigned participants (child/youth and parent) to telerehabilitation (functional communication training [FCT] targeting children problem behaviour with 60-minute sessions, 1 session a week for an average of 13 weeks. Problem behaviour was measured by parent report at baseline and post-treatment (average of 13 weeks). A significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (FCT targeting children problem behaviour) in problem behaviour among children with ASD. However, one non-RCT study found improvements following telerehabilitation.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (FCT targeting children problem behaviour) in problem behaviour among children with ASD. However, one non-RCT study found improvements following telerehabilitation.
Satisfaction with e-learning modulesEffective5
One non-RCT study (Heitzman-Powell et al., 2014) investigated the effect of telerehabilitation on satisfaction with e-learning modules among parents of children with autism spectrum disorder (ASD) living in remote communities. This non-RCT study assigned participants (child/youth and parent) to receive telerehabilitation (Online and Applied System for Intervention Skills [OASIS] targeting parenting techniques and use of Applied Behaviour Analysis (ABA) strategies with children in 60-minutes of computer time per week, and 90-120-minute coaching with an occupational therapist for a total of 13-19 sessions) vs. no treatment. Satisfaction with e-learning modules was measured by a 5-point Likert scale at baseline and post-treatment (after completion of 8 modules). Parents rated OASIS training and coaching with a high degree of satisfaction.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (OASIS targeting parenting techniques and use of ABA strategies) on the satisfaction with e-learning modules among parents of children with ASD living in remote communities. However, one non-RCT study found improvements following telerehabilitation.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (OASIS targeting parenting techniques and use of ABA strategies) on the satisfaction with e-learning modules among parents of children with ASD living in remote communities. However, one non-RCT study found improvements following telerehabilitation.
Health education
Results TableFor autism spectrum disorder (ASD), there was one study on a tele-treatment that did not actively involve a clinician delivering an intervention. Instead, online educational videos were provided to the participants. This study was a low-quality RCT.
The focus of the tele-intervention was to improve caregivers’ use of positive thinking skills.
Expand on the outcome below to find out more.
Use of positive thinking skillsEffective2b
One low quality mixed-methods RCT (Bekhet et al., 2017) investigated the effect of telerehabilitation on use of positive thinking skills among caregivers of children with autism spectrum disorder (ASD). This RCT study randomized participants (parent alone) to receive telerehabilitation (Positive Thinking Training [PTT] targeting caregiver’s wellbeing with 1 session a week for 6 weeks) vs. no treatment. The use of positive thinking skills was measured by the Positive Thinking Skills Scale (PTSS) at follow-up (6 weeks). A significant between-group difference was found, favouring telerehabilitation vs. no treatment.
Conclusion: There is limited evidence (Level 2b) from one low quality mixed methods study that telerehabilitation (PTT targeting caregiver’s wellbeing) is more effective than the comparison intervention (internet resources) in improving the use of the positive thinking skills among caregivers of children with ASD.
Conclusion: There is limited evidence (Level 2b) from one low quality mixed methods study that telerehabilitation (PTT targeting caregiver’s wellbeing) is more effective than the comparison intervention (internet resources) in improving the use of the positive thinking skills among caregivers of children with ASD.
Multidisciplinary team
Results TableFor autism spectrum disorder (ASD), there was one study on tele-treatments provided by a multidisciplinary team consisting of teachers, a government coordinator, an OT, an SLP, and a support worker. This study was non-RCT (case series).
The focus of the tele-interventions provided was to improve transition planning from school.
Expand on the outcome below to find out more.
Satisfaction with e-learning modulesEffective5
One non-RCT study (Hatfield et al., 2017) investigated the effect of telerehabilitation on satisfaction with e-learning modules related to school transition planning among youth with autism spectrum disorder (ASD). This study assigned participants (youth + parents) to receive telerehabilitation (BOOST-A, targeting transition from school). Satisfaction with the learning modules was measured using a 4-point Likert rating scale (modules’ helpfulness, relevance, meaningfulness, and understandability) at post-treatment (3 modules). Most to all participants reported moderate to strong satisfaction with the e-learning modules.
Conclusion: There is insufficient evidence (Level 5) regarding the effectiveness of telerehabilitation (BOOST-A, targeting transition from school) on satisfaction with the e-learning modules. However, one non-RCT study found improvements following telerehabilitation.
Conclusion: There is insufficient evidence (Level 5) regarding the effectiveness of telerehabilitation (BOOST-A, targeting transition from school) on satisfaction with the e-learning modules. However, one non-RCT study found improvements following telerehabilitation.
Occupational therapy
Results Table For autism spectrum disorder (ASD), there were 2 studies on tele-treatments provided by occupational therapists. Both studies were non-RCT.The focus of the tele-interventions provided by OT was sensory processing, parent participation, child-caregiver interactions, child-learning opportunities, and child participation.
Thirteen (n=13) different outcomes were studied.
Expand on the outcomes below to find out more.
Child participation performanceEffective5
One non-RCT study (Little et al., 2018) investigated the effectiveness of telerehabilitation on child participation performance among children with autism spectrum disorder (ASD). This non-RCT study assigned participants (parents alone) to receive telerehabilitation (Occupation-based coaching targeting opportunities and child participation for 12 weeks). Child participation performance was measured by the Canadian Occupational Performance Measure (COPM-2) on performance at baseline and post-treatment (12 weeks). A significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (occupation-based coaching targeting opportunities and child participation) on performance of child participation in children with ASD. However, one non-RCT study found improvements following telerehabilitation.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (occupation-based coaching targeting opportunities and child participation) on performance of child participation in children with ASD. However, one non-RCT study found improvements following telerehabilitation.
Child participation satisfactionEffective5
One non-RCT study (Little et al., 2018) investigated the effectiveness of telerehabilitation on satisfaction with the child’s participation among parents of children with autism spectrum disorder (ASD). This non-RCT study assigned participants (parents alone) to receive telerehabilitation (Occupation-based coaching targeting opportunities and child participation for 12 weeks). Satisfaction with child’s participation was measured by the Canadian Occupational Performance Measure (COPM-2: Satisfaction) at post-treatment (12 weeks). A significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (occupation-based coaching targeting opportunities and child participation) on satisfaction with the child’s participation among parents of children with ASD. However, one non-RCT study found improvements following telerehabilitation.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (occupation-based coaching targeting opportunities and child participation) on satisfaction with the child’s participation among parents of children with ASD. However, one non-RCT study found improvements following telerehabilitation.
Goal attainmentEffective5
One non-RCT study (Little et al., 2018) investigated the effectiveness of telerehabilitation on goal attainment among children with autism spectrum disorder (ASD). This non-RCT study assigned participants (parents alone) to receive telerehabilitation (Occupation-based coaching targeting opportunities and child participation for 12 weeks). Goal attainment was measured by the Goal Attainment Scale at baseline and post-treatment (12 weeks). A significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (occupation-based coaching targeting opportunities and child participation) on goal attainment in children with ASD. However, one non-RCT study found improvements following telerehabilitation.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (occupation-based coaching targeting opportunities and child participation) on goal attainment in children with ASD. However, one non-RCT study found improvements following telerehabilitation.
Parenting efficacyEffective5
One non-RCT study (Little et al., 2018) investigated the effectiveness of telerehabilitation on parenting efficacy among parents of children with autism spectrum disorder (ASD). This non-RCT study assigned participants (parents alone) to receive telerehabilitation (Occupation-based coaching targeting opportunities and child participation for 12 weeks). Parenting efficacy was measured by the Parent Sense of Competence Scale at post-treatment (12 weeks). A significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (occupation-based coaching targeting opportunities and child participation) on parenting efficacy among parents of children with ASD. However, one non-RCT study found improvements following telerehabilitation.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (occupation-based coaching targeting opportunities and child participation) on parenting efficacy among parents of children with ASD. However, one non-RCT study found improvements following telerehabilitation.
Play frequencyEffective5
One non-RCT study (Little et al., 2018) investigated the effectiveness of telerehabilitation on play frequency among children with autism spectrum disorder (ASD). This non-RCT study assigned participants (parents alone) to receive telerehabilitation (Occupation-based coaching targeting opportunities and child participation for 12 weeks). Play frequency was measured by the Assessment of Preschool Children’s Participation at post-treatment (12 weeks). A significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (occupation-based coaching targeting opportunities and child participation) on play frequency among children with ASD. However, one non-RCT study found improvements following telerehabilitation.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (occupation-based coaching targeting opportunities and child participation) on play frequency among children with ASD. However, one non-RCT study found improvements following telerehabilitation.
Satisfaction with telerehabilitation services Effective5
One non-RCT study (Gibbs & Toth-Cohen, 2011) investigated the effect of telerehabilitation on satisfaction with telerehabilitation services among families of children with autism spectrum disorder (ASD). This non-RCT study assigned participants (child/youth and parent) to receive telerehabilitation (WebEx targeting sensory processing and parent participation with 4 in-person 30-minute sessions over 4 weeks, followed by 6 telerehabilitation sessions of the same duration over 6 weeks). Satisfaction with telerehabilitation services were measured by parental interview at post-treatment (10 weeks). A significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (WebEx targeting sensory processing and parent participation) on the satisfaction with telerehabilitation services among families of children with ASD. However, one non-RCT study found improvements following telerehabilitation.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (WebEx targeting sensory processing and parent participation) on the satisfaction with telerehabilitation services among families of children with ASD. However, one non-RCT study found improvements following telerehabilitation.
Skill development diversityEffective5
One non-RCT study (Little et al., 2018) investigated the effectiveness of telerehabilitation skill development diversity among children with autism spectrum disorder (ASD). This non-RCT study assigned participants (parents alone) to receive telerehabilitation (Occupation-based coaching targeting opportunities and child participation for 12 weeks). Skill development diversity was measured by the Assessment of Preschool Children’s Participation (APCP) at post-treatment (12 weeks). A significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (occupation-based coaching targeting opportunities and child participation) on skill development diversity in children with ASD. However, one non-RCT study found improvements following telerehabilitation.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (occupation-based coaching targeting opportunities and child participation) on skill development diversity in children with ASD. However, one non-RCT study found improvements following telerehabilitation.
Total activity frequency and diversityEffective5
One non-RCT study (Little et al., 2018) investigated the effectiveness of telerehabilitation on total activity frequency and diversity among children with autism spectrum disorder (ASD). This non-RCT study assigned participants (parents alone) to receive telerehabilitation (Occupation-based coaching targeting opportunities and child participation for 12 weeks). Total activity frequency and diversity were measured by the Assessment of Preschool Children’s Participation (APCP) at baseline and post-treatment (12 weeks). A significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (occupation-based coaching targeting opportunities and child participation) on total activity frequency and diversity in children with ASD. However, one non-RCT study found improvements following telerehabilitation.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (occupation-based coaching targeting opportunities and child participation) on total activity frequency and diversity in children with ASD. However, one non-RCT study found improvements following telerehabilitation.
Parent satisfactionNot effective5
One non-RCT study (Little et al., 2018) investigated the effectiveness of telerehabilitation on parent satisfaction among parents of children with autism spectrum disorder (ASD). This non-RCT study assigned participants (parents alone) to receive telerehabilitation (Occupation-based coaching targeting opportunities and child participation for 12 weeks). Parent satisfaction was measured by the Parent Sense of Competence Scale (PSOC) at post-treatment (12 weeks). No significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (occupation-based coaching targeting opportunities and child participation) on parent satisfaction among parents of children with ASD.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (occupation-based coaching targeting opportunities and child participation) on parent satisfaction among parents of children with ASD.
Physical recreation diversity and frequencyNot effective5
One non-RCT study (Little et al., 2018) investigated the effectiveness of telerehabilitation on physical recreation diversity and frequency in children with autism spectrum disorder (ASD). This non-RCT study assigned participants (parents alone) to receive telerehabilitation (Occupation-based coaching targeting opportunities and child participation for 12 weeks). Physical recreation diversity and frequency were measured by the Assessment of Preschool Children’s Participation (at post-treatment (12 weeks). No significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (occupation-based coaching targeting opportunities and child participation) on physical recreation diversity and frequency among children with ASD.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (occupation-based coaching targeting opportunities and child participation) on physical recreation diversity and frequency among children with ASD.
Play diversityNot effective5
One non-RCT study (Little et al., 2018) investigated the effectiveness of telerehabilitation on play diversity among children with autism spectrum disorder (ASD). This non-RCT study assigned participants (parents alone) to receive telerehabilitation (Occupation-based coaching targeting opportunities and child participation for 12 weeks). Play diversity was measured by the Assessment of Preschool Children’s Participation (APCP) at baseline and post-treatment (12 weeks). No significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (occupation-based coaching targeting opportunities and child participation) on play diversity in children with ASD.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (occupation-based coaching targeting opportunities and child participation) on play diversity in children with ASD.
Skill development frequencyNot effective5
One non-RCT study (Little et al., 2018) investigated the effectiveness of telerehabilitation on skill development frequency in children with autism spectrum disorder (ASD). This non-RCT study assigned participants (parents alone) to receive telerehabilitation (Occupation-based coaching targeting opportunities and child participation for 12 weeks). Skill development frequency was measured by the Assessment of Preschool Children’s Participation (APCP) at post-treatment (12 weeks). No significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (occupation-based coaching targeting opportunities and child participation) on skill development frequency in children with ASD.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (occupation-based coaching targeting opportunities and child participation) on skill development frequency in children with ASD.
Social activities frequency and diversityNot effective5
One non-RCT study (Little et al., 2018) investigated the effectiveness of telerehabilitation on social activities frequency and diversity in children with autism spectrum disorder (ASD). This non-RCT study assigned participants (parents alone) to receive telerehabilitation (Occupation-based coaching targeting opportunities and child participation for 12 weeks). Social activities frequency and diversity were measured by the Assessment of Preschool Children’s Participation (APCP) at post-treatment (12 weeks). No significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (occupation-based coaching targeting opportunities and child participation) on social activities frequency and diversity in children with ASD.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (occupation-based coaching targeting opportunities and child participation) on social activities frequency and diversity in children with ASD.
Psychology
Results TableFor autism spectrum disorder (ASD), we found 6 studies on tele-treatments provided by psychologists. Out of those studies, 2 are high quality randomized clinical trials (RCTs), 1 is a fair quality RCT, and 3 are non-RCTs.
The focus of the tele-interventions provided by psychologists was to improve child’s behavior, language, anxiety, parent’s self-efficacy and interaction skills.
Twenty (n=20) different outcomes were studied, and 33.3% of them emerge from RCTs.
Expand on the outcomes below to find out more.
AnxietyMore effective vs. Waitlist1b
One high quality RCT (Conaughton et al., 2017) and one quasi-experimental study (Hepburn et al., 2016) investigated the effect of telerehabilitation on anxiety symptoms among children with high functioning autism spectrum disorder (HFASD) and anxiety disorder.
The high quality RCT (Conaughton et al., 2017) randomized participants (child/youth and parent) to receive telerehabilitation (BRAVE-ONLINE targeting child behaviour and anxiety in 60-minute sessions once a week for 6 weeks with the parent, or 60- minute sessions once a week for 10-12 weeks with the child) vs. waitlist. Anxiety symptoms were measured by the parent-reported Screen for Anxiety and Related Emotional Disorders in Children at follow-up (after 10-12 sessions). A significant between-group difference was found, favoring BRAVE-ONLINE vs. waitlist.
The non-RCT study (Hepburn et al., 2016) assigned participants (child/youth and parent) to receive telerehabilitation (Telehealth Facing Your Fears [FYF] targeting youth anxiety and parent sense of competence with 1-hour sessions, 1 session per week for 10 weeks). Anxiety symptoms were measured by the child and parent-reported Spence Children’s Anxiety Scale at post-treatment (3 months). A significant improvement was found.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that telerehabilitation (BRAVE-ONLINE targeting child behaviour and anxiety) is more effective than the comparison intervention (waitlist) in improving anxiety symptoms among children with HFASD and anxiety.
The high quality RCT (Conaughton et al., 2017) randomized participants (child/youth and parent) to receive telerehabilitation (BRAVE-ONLINE targeting child behaviour and anxiety in 60-minute sessions once a week for 6 weeks with the parent, or 60- minute sessions once a week for 10-12 weeks with the child) vs. waitlist. Anxiety symptoms were measured by the parent-reported Screen for Anxiety and Related Emotional Disorders in Children at follow-up (after 10-12 sessions). A significant between-group difference was found, favoring BRAVE-ONLINE vs. waitlist.
The non-RCT study (Hepburn et al., 2016) assigned participants (child/youth and parent) to receive telerehabilitation (Telehealth Facing Your Fears [FYF] targeting youth anxiety and parent sense of competence with 1-hour sessions, 1 session per week for 10 weeks). Anxiety symptoms were measured by the child and parent-reported Spence Children’s Anxiety Scale at post-treatment (3 months). A significant improvement was found.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that telerehabilitation (BRAVE-ONLINE targeting child behaviour and anxiety) is more effective than the comparison intervention (waitlist) in improving anxiety symptoms among children with HFASD and anxiety.
Behavioural challenges More effective vs. Waitlist1b
One high quality RCT (Kuravackel et al., 2018) investigated the effect of telerehabilitation on behavioural challenges among children with autism spectrum disorder (ASD). This high quality RCT randomized participants (child/youth and parent) to receive telerehabilitation (C-Hope telehealth [TH] targeting parent-parent interaction and parent knowledge and skills, with 4 group sessions for 2 hours, and 4 individual 1-hour sessions over 8 weeks) vs. waitlist. Behavioural challenges were measured by the Eyberg Child Behaviour Inventory (ECBI) at follow-up (8 weeks). A significant between-group difference was found, favouring C-Hope TH vs. waitlist.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (C-Hope TH targeting parent-parent interaction and parent knowledge and skills) is more effective than the comparison intervention (waitlist) in improving behavioural challenges among children with ASD.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (C-Hope TH targeting parent-parent interaction and parent knowledge and skills) is more effective than the comparison intervention (waitlist) in improving behavioural challenges among children with ASD.
Internalizing behaviours More effective vs. Waitlist1b
One high quality RCT (Conaughton et al., 2017) investigated the effect of telerehabilitation on internalizing behaviours among children with high-functioning autism spectrum disorder (HFASD) and anxiety disorder. This high quality RCT randomized participants (child/youth and parent) to receive telerehabilitation (BRAVE-ONLINE targeting child behaviour and anxiety in 60-minute sessions once a week for 6 weeks with the parent, or 60-minute sessions once a week for 10-12 weeks with the child) vs. waitlist. Internalizing behaviours were measured by the Child Behaviour Checklist at follow-up (after 10-12 sessions). A significant between-group difference was found, favouring BRAVE-ONLINE vs. waitlist.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (BRAVE-ONLINE targeting child behaviour and anxiety) is more effective than the comparison intervention (waitlist) in improving internalizing behaviours among children HFASD with and anxiety disorder.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (BRAVE-ONLINE targeting child behaviour and anxiety) is more effective than the comparison intervention (waitlist) in improving internalizing behaviours among children HFASD with and anxiety disorder.
Overall level of functioningMore effective vs. Waitlist1b
One high quality RCT (Conaughton et al., 2017) investigated the effect of telerehabilitation on overall level of functioning among children with high functioning autism spectrum disorder (HFASD) and anxiety disorder. This high quality RCT randomized participants (child/youth and parent) to receive telerehabilitation (BRAVE-ONLINE targeting child behaviour and anxiety in 60-minute sessions once a week for 6 weeks with the parent, or 60-minute sessions once a week for 10-12 weeks with the child) vs. waitlist. Overall level of functioning was measured by the Children’s Global Assessment Scale at follow-up (after 10-12 sessions). A significant between-group difference was found, favoring BRAVE-ONLINE vs. waitlist.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (BRAVE-ONLINE targeting child behaviour and anxiety) is more effective than the comparison intervention (waitlist) in improving overall level of functioning among children with HFASD and anxiety disorder.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (BRAVE-ONLINE targeting child behaviour and anxiety) is more effective than the comparison intervention (waitlist) in improving overall level of functioning among children with HFASD and anxiety disorder.
Parenting competency As effective vs. Waitlist1b
One high quality RCT (Kuravackel et al., 2018) investigated the effect of telerehabilitation on parenting competency among parents of children with autism spectrum disorder (ASD). This high quality RCT randomized participants (child/youth and parent) to receive telerehabilitation (C-Hope telehealth [TH] targeting parent-parent interaction and parent knowledge and skills, with 4 group sessions for 2 hours, and 4 individual 1-hour sessions over 8 weeks) vs. waitlist. Parenting competency was measured by the Being a Parent Scale (BPS) at follow-up (8 weeks). No significant between-group difference was found.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (C-Hope TH targeting parent-parent interaction and parent knowledge and skills) is as effective as the comparison intervention (waitlist) in improving parenting competency among parents of children with ASD.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (C-Hope TH targeting parent-parent interaction and parent knowledge and skills) is as effective as the comparison intervention (waitlist) in improving parenting competency among parents of children with ASD.
Parent stress As effective vs. Waitlist1b
One high quality RCT (Kuravackel et al., 2018) investigated the effect of telerehabilitation on parent stress among parents of children with autism spectrum disorder (ASD). This high quality RCT randomized participants (child/youth and parent) to receive telerehabilitation (C-Hope telehealth [TH] targeting parent-parent interaction and parent knowledge and skills, with 4 group sessions for 2 hours, and 4 individual 1-hour sessions over 8 weeks) vs. waitlist. Parent stress was measured by the Parent Stress Index (PSI) at follow-up (8 weeks). No significant between-group difference was found.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (C-Hope telehealth TH targeting parent-parent interaction and parent knowledge and skills) is as effective as the comparison intervention (waitlist) in improving parent stress among parents of children with ASD.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (C-Hope telehealth TH targeting parent-parent interaction and parent knowledge and skills) is as effective as the comparison intervention (waitlist) in improving parent stress among parents of children with ASD.
Program engagement More effective vs. Information only2a
One fair quality RCT (Ingersoll et al., 2017) investigated the effect of telerehabilitation on program engagement among parents of children with autism spectrum disorder (ASD). This fair quality RCT randomized participants (parent alone) to receive telerehabilitation (ImPACT online targeting child language level, adaptive behaviour, and parent self-efficacy and stress with 75-minute sessions, 1 session a week for 12 weeks) vs. information only. Program engagement was measured by the electronic tracking of user behaviour at follow-up (6 months). A significant between-group difference was found, favouring telerehabilitation vs. information only.
Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that telerehabilitation (ImPACT online targeting child language level, adaptive behaviour, and parent self-efficacy and stress) is more effective than the comparison intervention (information only) in improving program engagement among parents of children with ASD.
Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that telerehabilitation (ImPACT online targeting child language level, adaptive behaviour, and parent self-efficacy and stress) is more effective than the comparison intervention (information only) in improving program engagement among parents of children with ASD.
Parent knowledge More effective vs. Information only2a
One fair quality RCT (Ingersoll et al., 2017) investigated the effect of telerehabilitation on parent intervention knowledge among parents of children with autism spectrum disorder (ASD). This fair quality RCT randomized participants (parent alone) to receive telerehabilitation (ImPACT online targeting child language level, adaptive behaviour, and parent self-efficacy and stress with 75-minute sessions, 1 session a week for 12 weeks) vs. the comparison intervention (information only). Parent intervention knowledge was measured by the 20-item multiple-choice quiz at follow-up (6 months). A significant between-group difference was found, favouring telerehabilitation vs. information only.
Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that telerehabilitation (ImPACT online targeting child language level, adaptive behaviour, and parent self-efficacy and stress) is more effective than the comparison intervention (information only) in improving parent intervention knowledge among parents of children with ASD.
Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that telerehabilitation (ImPACT online targeting child language level, adaptive behaviour, and parent self-efficacy and stress) is more effective than the comparison intervention (information only) in improving parent intervention knowledge among parents of children with ASD.
Parent adherence More effective vs. No treatment2b
One non-RCT study (St. Peter et al., 2014) investigated the effect of telerehabilitation on parent adherence to intervention among parents of children with autism spectrum disorder (ASD). This non-RCT study assigned participants (parent alone) to receive telerehabilitation (video material targeting parental adherence with a minimum of 1 session a week between parent and child) vs. comparison intervention (written material). Parent adherence to intervention was measured at post-treatment (10 months). A significant improvement was found favoring telerehabilitation vs. written material.
Conclusion: There is limited evidence (Level 2b) from one non-RCT study that telerehabilitation (video material targeting parental adherence) is more effective than the comparison intervention (written material) in improving parent adherence to the intervention among parents of children with ASD.
Conclusion: There is limited evidence (Level 2b) from one non-RCT study that telerehabilitation (video material targeting parental adherence) is more effective than the comparison intervention (written material) in improving parent adherence to the intervention among parents of children with ASD.
Child NoncomplianceEffective 5
One non-RCT study (Bearss et al., 2018) investigated the effect of telerehabilitation on child noncompliance among children with autism spectrum disorder (ASD). This non-RCT study assigned participants (parent and child) to receive telerehabilitation (Research Unit on Behavioural Interventions Parent Training [RUBI-PT] targeting child behaviour, skill deficits, and disruptive behaviour in 60–90-minute sessions for 11-13 sessions over 16 weeks). Child noncompliance was measured by the Home Situations Questionnaire-Autism Spectrum Disorder (HSQ-ASD) at post-treatment (24 weeks). A significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (RUBI-PT targeting child behaviour, skill deficits, and disruptive behaviour) on child noncompliance among children with ASD. However, one non-RCT study found improvements following telerehabilitation.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (RUBI-PT targeting child behaviour, skill deficits, and disruptive behaviour) on child noncompliance among children with ASD. However, one non-RCT study found improvements following telerehabilitation.
HyperactivityEffective5
One non-RCT study (Bearss et al., 2018) investigated the effect of telerehabilitation on hyperactivity among children with autism spectrum disorder (ASD). This non-RCT study assigned participants (parent and child) to receive telerehabilitation (Research Unit on Behavioural Interventions Parent Training [RUBI-PT] targeting child behaviour, skill deficits, and disruptive behaviour in 60–90-minute sessions for 11-13 sessions over 16 weeks). Hyperactivity was measured by the Aberrant Behaviour Checklist (ABC) hyperactivity subscale at post-treatment (24 weeks). A significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (RUBI-PT targeting child behavior, skill deficits, disruptive behaviour) on hyperactivity in children with ASD.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (RUBI-PT targeting child behavior, skill deficits, disruptive behaviour) on hyperactivity in children with ASD.
Inappropriate speechEffective5
One non-RCT study (Bearss et al., 2018) investigated the effect of telerehabilitation on inappropriate speech among children with autism spectrum disorder (ASD). This non-RCT study assigned participants (parent and child) to receive telerehabilitation (Research Unit on Behavioural Interventions Parent Training [RUBI-PT] targeting child behaviour, skill deficits, and disruptive behaviour in 60–90-minute sessions for 11-13 sessions over 16 weeks). Inappropriate speech was measured by the Aberrant Behaviour Checklist (ABC: Inappropriate speech subscale) at post-treatment (24 weeks). A significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (RUBI-PT targeting child behaviour, skill deficits, and disruptive behaviour) on inappropriate speech among children with ASD. However, one non-RCT study found improvements following telerehabilitation.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (RUBI-PT targeting child behaviour, skill deficits, and disruptive behaviour) on inappropriate speech among children with ASD. However, one non-RCT study found improvements following telerehabilitation.
IrritabilityEffective5
One non-RCT study (Bearss et al., 2018) investigated the effect of telerehabilitation on irritability among children with autism spectrum disorder (ASD). This non-RCT study assigned participants (parent and child) to receive telerehabilitation (Research Unit on Behavioural Interventions Parent Training [RUBI-PT] targeting child behaviour, skill deficits, and disruptive behaviour in 60–90-minute sessions for 11-13 sessions over 16 weeks). Irritability was measured by the Aberrant Behavior Checklist (ABC) at post-treatment (24 weeks). A significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (RUBI-PT targeting child behaviour, skill deficits, and disruptive behaviour) on irritability among children with ASD. However, one non-RCT study found improvements following telerehabilitation.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (RUBI-PT targeting child behaviour, skill deficits, and disruptive behaviour) on irritability among children with ASD. However, one non-RCT study found improvements following telerehabilitation.
Social withdrawal Effective5
One non-RCT study (Bearss et al., 2018) investigated the effect of telerehabilitation on social withdrawal among children with autism spectrum disorder (ASD). This non-RCT study assigned participants (parent and child) to receive telerehabilitation (Research Unit on Behavioural Interventions Parent Training [RUBI-PT] targeting child behaviour, skill deficits, and disruptive behaviour in 60–90-minute sessions for 11-13 sessions over 16 weeks). Social withdrawal was measured by the Aberrant Behaviour Checklist (ABC) social withdrawal subscale at post-treatment (24 weeks). A significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (RUBI-PT targeting child behaviour, skill deficits, and disruptive behaviour) on social withdrawal among children with ASD. However, one non-RCT study found improvements following telerehabilitation.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (RUBI-PT targeting child behaviour, skill deficits, and disruptive behaviour) on social withdrawal among children with ASD. However, one non-RCT study found improvements following telerehabilitation.
Stereotypes Effective5
One non-RCT study (Bearss et al., 2018) investigated the effect of telerehabilitation on stereotypes among children with autism spectrum disorder (ASD). This non-RCT study assigned participants (parent and child) to receive telerehabilitation (Research Unit on Behavioural Interventions Parent Training [RUBI-PT] targeting child behaviour, skill deficits, and disruptive behaviour in 60–90-minute sessions for 11-13 sessions over 16 weeks). Stereotypes were measured by the Aberrant Behaviour Checklist (ABC: Stereotypes subscale) at post-treatment (24 weeks). A significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (RUBI-PT targeting child behaviour, skill deficits, disruptive behaviour) on stereotypes among children with ASD. However, one non-RCT study found improvements following telerehabilitation.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (RUBI-PT targeting child behaviour, skill deficits, disruptive behaviour) on stereotypes among children with ASD. However, one non-RCT study found improvements following telerehabilitation.
Communication skillsNot effective5
One non-RCT study (Bearss et al., 2018) investigated the effect of telerehabilitation on communication skills among children with autism spectrum disorder (ASD). This non-RCT study assigned participants (parent and child) to receive telerehabilitation (Research Unit on Behavioural Interventions Parent Training [RUBI-PT] targeting child behaviour, skill deficits, and disruptive behaviour in 60–90-minute sessions for 11-13 sessions over 16 weeks). Communication skills were measured by Vineland Adaptive Behaviour Scales, Second Edition (VABS-II) at post-treatment (24 weeks). No significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (RUBI-PT targeting child behaviour, skill deficits, and disruptive behaviour) on communication skills among children with ASD.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (RUBI-PT targeting child behaviour, skill deficits, and disruptive behaviour) on communication skills among children with ASD.
Composite skillsNot effective5
One non-RCT study (Bearss et al., 2018) investigated the effect of telerehabilitation on composite skills among children with autism spectrum disorder (ASD). This non-RCT study assigned participants (parent and child) to receive telerehabilitation (Research Unit on Behavioural Interventions Parent Training [RUBI-PT] targeting child behaviour, skill deficits, and disruptive behaviour in 60–90-minute sessions for 11-13 sessions over 16 weeks). Composite skills were measured by Vineland Adaptive Behaviour Scales, Second Edition (VABS-II) at post-treatment (24 weeks). No significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (RUBI-PT targeting child behaviour, skill deficits, and disruptive behavior) on composite skills among children with ASD.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (RUBI-PT targeting child behaviour, skill deficits, and disruptive behavior) on composite skills among children with ASD.
Daily living skillsNot effective5
One non-RCT study (Bearss et al., 2018) investigated the effect of telerehabilitation on daily living skills among children with autism spectrum disorder (ASD). This non-RCT study assigned participants (parent and child) to receive telerehabilitation (Research Unit on Behavioural Interventions Parent Training [RUBI-PT] targeting child behaviour, skill deficits, and disruptive behavior in 60–90-minute sessions 11-13 sessions over 16 weeks). Daily living skills were measured by Vineland Adaptive Behaviour Scales, Second Edition (VABS-II) at post-treatment (24 weeks). No significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (RUBI-PT targeting child behaviour, skill deficits, and disruptive behaviour) on daily living skills among children with ASD.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (RUBI-PT targeting child behaviour, skill deficits, and disruptive behaviour) on daily living skills among children with ASD.
Motor skillsNot effective5
One non-RCT study (Bearss et al., 2018) investigated the effect of telerehabilitation on motor skills among children with autism spectrum disorder (ASD). This non-RCT study assigned participants (parent and child) to receive telerehabilitation (Research Unit on Behavioural Interventions Parent Training [RUBI-PT] targeting child behaviour, skill deficits, and disruptive behaviour in 60–90-minute sessions for 11-13 sessions over 16 weeks). Motor skills were measured by Vineland Adaptive Behaviour Scales, Second Edition (VABS-II) at post-treatment (24 weeks). No significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (RUBI-PT targeting child behaviour, skill deficits, and disruptive behaviour) on motor skills among children with ASD.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (RUBI-PT targeting child behaviour, skill deficits, and disruptive behaviour) on motor skills among children with ASD.
Socialization Not effective5
One non-RCT study (Bearss et al., 2018) investigated the effect of telerehabilitation on socialization among children with autism spectrum disorder (ASD). This non-RCT study assigned participants (parent and child) to receive telerehabilitation (Research Unit on Behavioural Interventions Parent Training [RUBI-PT] targeting child behaviour, skill deficits, and disruptive behaviour in 60–90-minute sessions for 11-13 sessions over 16 weeks). Socialization was measured by Vineland Adaptive Behaviour Scales, Second Edition (VABS-II) at post-treatment (24 weeks). No significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (RUBI-PT targeting child behaviour, skill deficits, and disruptive behaviour) on socialization among children with ASD.
Conclusion: There is insufficient evidence (Level 5) regarding the effect of telerehabilitation (RUBI-PT targeting child behaviour, skill deficits, and disruptive behaviour) on socialization among children with ASD.
Speech language pathology
Results TableFor autism spectrum disorder (ASD), there were 3 studies that focused on tele-treatments provided by SLPs. Out of these studies, one was a high quality RCT, and two were non-RCTs.
The focus of tele-interventions provided by SLPs was to improve child language level, adaptive behavior, social and cognitive skills, and parent-self-efficacy, stress, and participation.
Twenty-one (n=21) different outcomes were studied, and 47.6 of them emerge from RCTs.
Expand on the outcomes below to find out more.
Daily living skillsMore effective vs. Self-directed telerehab1b
One high quality RCT (Ingersoll et al., 2016) investigated the effect of telerehabilitation on daily living skills among children with autism spectrum disorder (ASD). This high quality RCT randomized participants (parent alone) to receive telerehabilitation (ImPACT Online targeting child language level, adaptive behaviour, parent self-efficacy, and stress with therapist-assisted coaching in 30-minute sessions, 2 sessions a week for 12 weeks) vs. the comparison intervention (ImPACT Online, 6 months access, self-directed). Daily living skills were measured by the Vineland Adaptive Behaviour Scales, Second Edition (VABS-II) at follow-up (3 months). A significant between-group difference was found, favouring therapist-assisted ImPACT Online vs. self-directed ImPACT Online.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (ImPACT Online with therapist-assisted coaching targeting child language level, adaptive behaviour, parent self-efficacy, and stress) is more effective than the comparison intervention (ImPACT Online, self-directed) in improving daily living skills among children with ASD.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (ImPACT Online with therapist-assisted coaching targeting child language level, adaptive behaviour, parent self-efficacy, and stress) is more effective than the comparison intervention (ImPACT Online, self-directed) in improving daily living skills among children with ASD.
Motor skillsMore effective vs. Self-directed telerehab1b
One high quality RCT (Ingersoll et al., 2016) investigated the effect of telerehabilitation on motor skills among children with autism spectrum disorder (ASD). This high quality RCT randomized participants (parent alone) to receive telerehabilitation (ImPACT Online targeting child language level, adaptive behaviour, parent self-efficacy, and stress with therapist-assisted coaching in 30-minute sessions, 2 sessions a week for 12 weeks) vs. the comparison intervention (ImPACT Online, 6 months access, self-directed). Motor skills were measured by the Vineland Adaptive Behaviour Scales, Second Edition (VABS-II) at follow-up (3 months). A significant between-group difference was found, favouring therapist-assisted ImPACT Online vs. self-directed ImPACT Online.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (ImPACT Online with therapist-assisted coaching targeting child language level, adaptive behaviour, parent self-efficacy, and stress) is more effective than the comparison intervention (ImPACT Online, self-directed) in improving motor skills among children with ASD.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (ImPACT Online with therapist-assisted coaching targeting child language level, adaptive behaviour, parent self-efficacy, and stress) is more effective than the comparison intervention (ImPACT Online, self-directed) in improving motor skills among children with ASD.
Parent fidelityMore effective vs. Self-directed telerehab1b
One high quality RCT (Ingersoll et al., 2016) and two non-RCT studies from 1 project (Vismara 2012; 2013) investigated the effect of telerehabilitation on parent fidelity among families of children with autism spectrum disorder (ASD).
The high quality RCT (Ingersoll et al., 2016) randomized participants (parent alone) to receive telerehabilitation (ImPACT Online targeting child language level, adaptive behaviour, parent self-efficacy, and stress with therapist-assisted coaching for 30 minutes a session, 2 sessions a week for 12 weeks) vs. the comparison intervention (ImPACT Online, 6 months access, self-directed). Parent fidelity was measured by the parent-child interactions score at follow-up (3 months). A significant between-group difference was found at 3 months post- treatment only.
Two non-RCT studies from 1 project (Vismara 2012; 2013) assigned participants (parents alone) to receive telerehabilitation (Early Start Denver Model [ESDM] targeting Language, social skills, cognitive skills, and parent participation in 1 hour sessions once a week for 12 weeks, with 3 additional 1 hour follow up sessions scheduled 2 weeks apart). Parent fidelity was measured by the Early Start Denver Model (ESDM) Fidelity scale at post-treatment (12 weeks). A significant improvement was found.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT and two non-RCT studies from 1 project that telerehabilitation (therapist-assisted coaching of ImPACT Online targeting child language level, adaptive behaviour, parent self-efficacy, and stress; ESDM targeting language, social skills, cognitive skills, and parent participation) is more effective than the comparison intervention (self-directed ImPACT Online; no treatment) in improving parent fidelity among families with children with ASD.
The high quality RCT (Ingersoll et al., 2016) randomized participants (parent alone) to receive telerehabilitation (ImPACT Online targeting child language level, adaptive behaviour, parent self-efficacy, and stress with therapist-assisted coaching for 30 minutes a session, 2 sessions a week for 12 weeks) vs. the comparison intervention (ImPACT Online, 6 months access, self-directed). Parent fidelity was measured by the parent-child interactions score at follow-up (3 months). A significant between-group difference was found at 3 months post- treatment only.
Two non-RCT studies from 1 project (Vismara 2012; 2013) assigned participants (parents alone) to receive telerehabilitation (Early Start Denver Model [ESDM] targeting Language, social skills, cognitive skills, and parent participation in 1 hour sessions once a week for 12 weeks, with 3 additional 1 hour follow up sessions scheduled 2 weeks apart). Parent fidelity was measured by the Early Start Denver Model (ESDM) Fidelity scale at post-treatment (12 weeks). A significant improvement was found.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT and two non-RCT studies from 1 project that telerehabilitation (therapist-assisted coaching of ImPACT Online targeting child language level, adaptive behaviour, parent self-efficacy, and stress; ESDM targeting language, social skills, cognitive skills, and parent participation) is more effective than the comparison intervention (self-directed ImPACT Online; no treatment) in improving parent fidelity among families with children with ASD.
Positive perceptions of the child More effective vs. Self-directed telerehab1b
One high quality RCT (Ingersoll et al., 2016) investigated the effect of telerehabilitation on positive perceptions of the child among parents of children with autism spectrum disorder (ASD). This high quality RCT randomized participants (parent alone) to receive telerehabilitation (ImPACT Online targeting child language level, adaptive behavior, parent self-efficacy, and stress with therapist-assisted coaching in 30-minute sessions, 2 sessions a week for 12 weeks) vs. the comparison intervention (ImPACT Online, 6 months access, self-directed). Positive perceptions of the child were measured by the Family Impact Questionnaire at follow-up (3 months). A significant between-group difference was found, favoring therapist-assisted ImPACT Online vs. self-directed ImPACT Online.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (ImPACT Online with Therapist-assisted coaching targeting child language level, adaptive behavior, parent self-efficacy, and stress) is more effective than the comparison intervention (ImPACT Online, self-directed) in improving positive perceptions of the child among parents of children with ASD.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (ImPACT Online with Therapist-assisted coaching targeting child language level, adaptive behavior, parent self-efficacy, and stress) is more effective than the comparison intervention (ImPACT Online, self-directed) in improving positive perceptions of the child among parents of children with ASD.
SocializationMore effective vs. Self-directed telerehab1b
One high quality RCT (Ingersoll et al., 2016) investigated the effect of telerehabilitation on socialization among children with autism spectrum disorder (ASD). This high quality RCT randomized participants (parent alone) to receive telerehabilitation (ImPACT Online targeting child language level, adaptive behavior, parent self-efficacy, and stress with therapist-assisted coaching in 30-minute sessions, 2 sessions a week for 12 weeks) vs. the comparison intervention (ImPACT Online, 6 months access, self-directed). Socialization was measured by the Vineland Adaptive Behavior Scales, Second Edition (VABS-II) at follow-up (3 months). A significant between-group difference was found, favoring therapist-assisted ImPACT Online vs. self-directed ImPACT Online.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (ImPACT Online with therapist-assisted coaching targeting child language level, adaptive behavior, parent self-efficacy, and stress) is more effective than the comparison intervention (ImPACT Online, self-directed) in improving socialization among children with ASD.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (ImPACT Online with therapist-assisted coaching targeting child language level, adaptive behavior, parent self-efficacy, and stress) is more effective than the comparison intervention (ImPACT Online, self-directed) in improving socialization among children with ASD.
Parental self-efficacyAs effective vs. Self-directed telerehab1b
One high quality RCT (Ingersoll et al., 2016) investigated the effect of telerehabilitation on parental self-efficacy among parents of children with autism spectrum disorder (ASD). This high quality RCT randomized participants (parent alone) to receive telerehabilitation (ImPACT Online targeting child language level, adaptive behaviour, parental self-efficacy, and stress with therapist-assisted coaching in 30-minute sessions, 2 sessions a week for 12 weeks) vs. the comparison intervention (ImPACT Online, 6 months access, self-directed). Parental self-efficacy was measured by the Parent Sense of Competence Scale at follow-up (3 months). No significant between-group difference was found.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (ImPACT Online with Therapist-assisted coaching targeting child language level, adaptive behaviour, parent self-efficacy, and stress) is as effective as the comparison intervention (ImPACT Online, self-directed) in improving parental self-efficacy among parents of children with ASD.
Communication As effective vs. Self-directed telerehab1b
One high quality RCT (Ingersoll et al., 2016) investigated the effect of telerehabilitation on communication among children with autism spectrum disorder (ASD). This high quality RCT randomized participants (parent alone) to receive telerehabilitation (ImPACT Online targeting child language level, adaptive behaviour, parent self-efficacy, and stress with therapist-assisted coaching for 30-minute sessions, 2 sessions a week for 12 weeks) vs. the comparison intervention (ImPACT Online, 6 months access, self-directed). Communication was measured by the Vineland Adaptive Behaviour Scales, Second Edition (VABS-II) at follow-up (3 months). No significant between-group difference was found.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (ImPACT Online with therapist-assisted coaching targeting child language level, adaptive behaviour, parent self-efficacy, and stress) is as effective as the comparison intervention (ImPACT Online, self-directed) in improving communication among children with ASD.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (ImPACT Online with therapist-assisted coaching targeting child language level, adaptive behaviour, parent self-efficacy, and stress) is as effective as the comparison intervention (ImPACT Online, self-directed) in improving communication among children with ASD.
Expressive vocabularyAs effective vs. Self-directed telerehab1b
One high quality RCT (Ingersoll et al., 2016) and two non-RCT studies from 1 project (Vismara 2012; 2013) investigated the effect of telerehabilitation on expressive vocabulary among families of children with autism spectrum disorder (ASD).
The high quality RCT (Ingersoll et al., 2016) randomized participants (parent alone) to receive telerehabilitation (ImPACT Online targeting child language level, adaptive behaviour, parent self-efficacy, and stress with therapist-assisted coaching for 30 minutes a session, 2 sessions a week for 12 weeks) vs. the comparison intervention (ImPACT Online, 6 months access, self-directed). Expressive vocabulary was measured by the parent-reported MacArthur-Bates Communicative Development Inventory (MCDI) at follow-up (3 months). No significant between-group difference was found.
Two non-RCT studies from 1 project (Vismara 2012; 2013) assigned participants (parents alone) to receive telerehabilitation (Early Start Denver Model [ESDM] targeting Language, social skills, cognitive skills, and parent participation in1 hour sessions once a week for 12 weeks, with 3 additional 1 hour follow up sessions scheduled 2 weeks apart). Expressive vocabulary was measured by the MacArthur-Bates Communicative Development Inventory (MCDI) at post-treatment (12 weeks). Significant improvements were found.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT and two non-RCT studies from 1 project that telerehabilitation (therapist-assisted coaching of ImPACT Online targeting child language level, adaptive behaviour, parent self-efficacy, and stress; ESDM targeting language, social skills, cognitive skills, and parent participation) was as effective as the comparison intervention (self-directed ImPACT Online; no treatment) in improving expressive vocabulary among families with children with ASD.
The high quality RCT (Ingersoll et al., 2016) randomized participants (parent alone) to receive telerehabilitation (ImPACT Online targeting child language level, adaptive behaviour, parent self-efficacy, and stress with therapist-assisted coaching for 30 minutes a session, 2 sessions a week for 12 weeks) vs. the comparison intervention (ImPACT Online, 6 months access, self-directed). Expressive vocabulary was measured by the parent-reported MacArthur-Bates Communicative Development Inventory (MCDI) at follow-up (3 months). No significant between-group difference was found.
Two non-RCT studies from 1 project (Vismara 2012; 2013) assigned participants (parents alone) to receive telerehabilitation (Early Start Denver Model [ESDM] targeting Language, social skills, cognitive skills, and parent participation in1 hour sessions once a week for 12 weeks, with 3 additional 1 hour follow up sessions scheduled 2 weeks apart). Expressive vocabulary was measured by the MacArthur-Bates Communicative Development Inventory (MCDI) at post-treatment (12 weeks). Significant improvements were found.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT and two non-RCT studies from 1 project that telerehabilitation (therapist-assisted coaching of ImPACT Online targeting child language level, adaptive behaviour, parent self-efficacy, and stress; ESDM targeting language, social skills, cognitive skills, and parent participation) was as effective as the comparison intervention (self-directed ImPACT Online; no treatment) in improving expressive vocabulary among families with children with ASD.
Language targets As effective vs. Self-directed telerehab1b
One high quality RCT (Ingersoll et al., 2016) investigated the effect of telerehabilitation on language targets among children with autism spectrum disorder (ASD). This high quality RCT randomized participants (parent alone) to receive telerehabilitation (ImPACT Online targeting child language level, adaptive behavior, parent self-efficacy, and stress with therapist-assisted coaching in 30-minute sessions, 2 sessions a week for 12 weeks) vs. the comparison intervention (ImPACT Online, 6 months access, self-directed). Language targets were measured by the parent-child Interactions score at follow-up (3 months). No significant between-group difference was found.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (ImPACT Online with therapist-assisted coaching targeting child language level, adaptive behaviour, parent self-efficacy, and stress) is as effective as the comparison intervention (ImPACT Online, self-directed) in improving language targets among children with ASD.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (ImPACT Online with therapist-assisted coaching targeting child language level, adaptive behaviour, parent self-efficacy, and stress) is as effective as the comparison intervention (ImPACT Online, self-directed) in improving language targets among children with ASD.
Parent stressAs effective vs. Self-directed telerehab1b
One high quality RCT (Ingersoll et al., 2016) investigated the effect of telerehabilitation on parent stress among parents of children with autism spectrum disorder (ASD). This high quality RCT randomized participants (parent alone) to receive telerehabilitation (ImPACT Online targeting child language level, adaptive behavior, parent self-efficacy, and stress with therapist-assisted coaching in 30-minute sessions, 2 sessions a week for 12 weeks) vs. the comparison intervention (ImPACT Online, 6 months access, self-directed). Parent stress was measured by the Family Impact Questionnaire at follow-up (3 months). No significant between-group difference was found.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (ImPACT Online with therapist-assisted coaching targeting child language level, adaptive behavior, parent self-efficacy, and stress) is as effective as the comparison intervention (ImPACT Online, self-directed) in improving parent stress among parents of children with ASD.
Conclusion: There is a moderate level of evidence (Level 1b) from one high quality RCT that telerehabilitation (ImPACT Online with therapist-assisted coaching targeting child language level, adaptive behavior, parent self-efficacy, and stress) is as effective as the comparison intervention (ImPACT Online, self-directed) in improving parent stress among parents of children with ASD.
Achievement oriented behaviourEffective5
Two non-RCT studies from one project (Vismara et al., 2012; 2013) investigated the effect of telerehabilitation on achievement-oriented behaviour among children with autism spectrum disorder (ASD). These non-RCT studies assigned participants (parent alone) to receive telerehabilitation (Early Start Denver Model [ESDM] targeting language, social skills, cognitive skills, and parent participation in 1-hour sessions, 1 session a week for 12 weeks with 3 additional 1-hour sessions scheduled 2 weeks apart at follow up). Achievement oriented behaviour was measured by the Maternal Behaviour Rating Scale (MBRS) at baseline and post-treatment (12 weeks). A significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effectiveness of telerehabilitation (ESDM targeting language, social skills, cognitive skills, and parent participation) in achievement-oriented behaviour among children with ASD. However, two non-RCT studies found improvements following telerehabilitation.
Conclusion: There is insufficient evidence (Level 5) regarding the effectiveness of telerehabilitation (ESDM targeting language, social skills, cognitive skills, and parent participation) in achievement-oriented behaviour among children with ASD. However, two non-RCT studies found improvements following telerehabilitation.
Adaptive behaviourEffective5
Two non-RCT studies from one project (Vismara et al., 2012; 2013) investigated the effect of telerehabilitation on adaptive behaviour among children with autism spectrum disorder (ASD). These non-RCT studies assigned participants (parent alone) to receive telerehabilitation (Early Start Denver Model [ESDM] targeting language, social skills, cognitive skills, and parent participation with 1-hour sessions, 1 session a week for 12 weeks with 3 additional 1-hour sessions scheduled 2 weeks apart at follow up). Adaptive behaviour was measured by the Vineland Adaptive Behaviour Scales 2nd Edition (VABS-II) at baseline and post-treatment (12 weeks). A significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effectiveness of telerehabilitation (ESDM targeting language, social skills, cognitive skills, and parent participation) in adaptive behaviour among children with ASD. However, two non-RCT studies found improvements following telerehabilitation.
Conclusion: There is insufficient evidence (Level 5) regarding the effectiveness of telerehabilitation (ESDM targeting language, social skills, cognitive skills, and parent participation) in adaptive behaviour among children with ASD. However, two non-RCT studies found improvements following telerehabilitation.
Child attentionEffective5
Two non-RCT studies from one project (Vismara et al., 2012; 2013) investigated the effect of telerehabilitation on child attention among children with autism spectrum disorder (ASD). These non-RCT studies assigned participants (parent alone) to receive telerehabilitation (Early Start Denver Model [ESDM] targeting language, social skills, cognitive skills, and parent participation with 1-hour sessions, 1 session a week for 12 weeks with 3 additional 1-hour sessions scheduled 2 weeks apart at follow up). Child attention was measured by the Child Behaviour Rating Scale (CBRS) at baseline and post-treatment (12 weeks). A significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effectiveness of telerehabilitation (ESDM targeting language, social skills, cognitive skills, and parent participation) in child attention among children with ASD. However, two non-RCT studies found improvements following telerehabilitation.
Child InitiationEffective5
Two non-RCT studies from one project (Vismara et al., 2012; 2013) investigated the effect of telerehabilitation on child initiation among children with autism spectrum disorder (ASD). These non-RCT studies assigned participants (parent alone) to receive telerehabilitation (Early Start Denver Model [ESDM] targeting language, social skills, cognitive skills, and parent participation in 1-hour sessions, 1 session a week for 12 weeks with 3 additional 1-hour sessions scheduled 2 weeks apart at follow up). Child initiation was measured by the Child Behaviour Rating Scale (CBRS) at baseline and post-treatment (12 weeks). A significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effectiveness of telerehabilitation (ESDM targeting language, social skills, cognitive skills, and parent participation) in child initiation among children with ASD. However, two non-RCT studies found improvements following telerehabilitation.
Conclusion: There is insufficient evidence (Level 5) regarding the effectiveness of telerehabilitation (ESDM targeting language, social skills, cognitive skills, and parent participation) in child initiation among children with ASD. However, two non-RCT studies found improvements following telerehabilitation.
ComprehensionEffective5
Two non-RCT studies from one project (Vismara et al., 2012; 2013) investigated the effect of telerehabilitation on comprehension among children with autism spectrum disorder (ASD). These non-RCT studies assigned participants (parent alone) to receive telerehabilitation (Early Start Denver Model [ESDM] targeting language, social skills, cognitive skills, and parent participation in 1-hour sessions, 1 session a week for 12 weeks with 3 additional 1-hour sessions scheduled 2 weeks apart at follow up). Comprehension was measured by the MacArthur-Bates Communicative Development Inventory (MCDI) at baseline and post-treatment (12 weeks). A significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effectiveness of telerehabilitation (ESDM targeting language, social skills, cognitive skills, and parent participation) in comprehension among children with ASD. However, two non-RCT studies found improvements following telerehabilitation.
Conclusion: There is insufficient evidence (Level 5) regarding the effectiveness of telerehabilitation (ESDM targeting language, social skills, cognitive skills, and parent participation) in comprehension among children with ASD. However, two non-RCT studies found improvements following telerehabilitation.
Parent affectEffective5
Two non-RCT studies from one project (Vismara et al., 2012; 2013) investigated the effect of telerehabilitation on parent affect among parents of children with autism spectrum disorder (ASD). These non-RCT studies assigned participants (parent alone) to receive telerehabilitation (Early Start Denver Model [ESDM] targeting language, social skills, cognitive skills, and parent participation in 1-hour sessions, 1 session a week for 12 weeks with 3 additional 1-hour sessions scheduled 2 weeks apart at follow up). Parental affect was measured by the Maternal Behaviour Rating Scale (MBRS) at baseline and post-treatment (12 weeks). A significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effectiveness of telerehabilitation (ESDM targeting language, social skills, cognitive skills, and parent participation) in parent affect among parents of children with ASD. However, two non-RCT studies found improvements following telerehabilitation.
Conclusion: There is insufficient evidence (Level 5) regarding the effectiveness of telerehabilitation (ESDM targeting language, social skills, cognitive skills, and parent participation) in parent affect among parents of children with ASD. However, two non-RCT studies found improvements following telerehabilitation.
Parent responsivenessEffective5
Two non-RCT studies from one project (Vismara et al., 2012; 2013) investigated the effect of telerehabilitation on parent responsiveness among parents of children with autism spectrum disorder (ASD). These non-RCT studies assigned participants (parent alone) to receive telerehabilitation (Early Start Denver Model [ESDM] targeting language, social skills, cognitive skills, and parent participation in 1-hour sessions, 1 session a week for 12 weeks with 3 additional 1-hour sessions scheduled 2 weeks apart at follow up). Parent responsiveness was measured by the Maternal Behaviour Rating Scale (MBRS) at baseline and post-treatment (12 weeks). A significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effectiveness of telerehabilitation (ESDM targeting language, social skills, cognitive skills, and parent participation) in parent responsiveness among parents of children with ASD. However, two non-RCT studies found improvements following telerehabilitation.
Conclusion: There is insufficient evidence (Level 5) regarding the effectiveness of telerehabilitation (ESDM targeting language, social skills, cognitive skills, and parent participation) in parent responsiveness among parents of children with ASD. However, two non-RCT studies found improvements following telerehabilitation.
Prompted verbalizationsEffective5
Two non-RCT studies from one project (Vismara et al., 2012; 2013) investigated the effect of telerehabilitation on prompted verbalizations among children with autism spectrum disorder (ASD). These non-RCT studies assigned participants (parent alone) to receive telerehabilitation (Early Start Denver Model [ESDM] targeting language, social skills, cognitive skills. and parent participation with 1-hour sessions, 1 session a week for 12 weeks with 3 additional 1-hour sessions scheduled 2 weeks apart at follow up). Prompted verbalizations were measured by examiner point-rating at baseline and post-treatment (12 weeks). A significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effectiveness of telerehabilitation (ESDM targeting language, social skills, cognitive skills, and parent participation) in prompted verbalizations among children with ASD. However, two non-RCT studies found improvements following telerehabilitation.
Conclusion: There is insufficient evidence (Level 5) regarding the effectiveness of telerehabilitation (ESDM targeting language, social skills, cognitive skills, and parent participation) in prompted verbalizations among children with ASD. However, two non-RCT studies found improvements following telerehabilitation.
Spontaneous imitationEffective5
Two non-RCT studies from one project (Vismara et al., 2012; 2013) investigated the effect of telerehabilitation on spontaneous imitation among children with autism spectrum disorder (ASD). These non-RCT studies assigned participants (parent alone) to receive telerehabilitation (Early Start Denver Model [ESDM] targeting language, social skills, cognitive skills, and parent participation with 1-hour sessions, 1 session a week for 12 weeks with 3 additional 1-hour sessions scheduled 2 weeks apart at follow up). Spontaneous imitation was measured by examiner point-rating at baseline and post-treatment (12 weeks). A significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effectiveness of telerehabilitation (ESDM targeting language, social skills, cognitive skills, and parent participation) in spontaneous imitation among children with ASD. However, two non-RCT studies found improvements following telerehabilitation.
Conclusion: There is insufficient evidence (Level 5) regarding the effectiveness of telerehabilitation (ESDM targeting language, social skills, cognitive skills, and parent participation) in spontaneous imitation among children with ASD. However, two non-RCT studies found improvements following telerehabilitation.
Spontaneous verbalizationsEffective5
Two non-RCT studies from one project (Vismara et al., 2012; 2013) investigated the effect of telerehabilitation on spontaneous verbalizations among children with autism spectrum disorder (ASD). These non-RCT studies assigned participants (parent alone) to receive telerehabilitation (Early Start Denver Model [ESDM] targeting language, social skills, cognitive skills, and parent participation with 1-hour sessions, 1 session a week for 12 weeks with 3 additional 1-hour sessions scheduled 2 weeks apart at follow up). Spontaneous verbalizations were measured by examiner point-rating at baseline and post-treatment (12 weeks). A significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effectiveness of telerehabilitation (ESDM targeting language, social skills, cognitive skills, and parent participation) in spontaneous verbalizations among children with ASD. However, two non-RCT studies found improvements following telerehabilitation.
Conclusion: There is insufficient evidence (Level 5) regarding the effectiveness of telerehabilitation (ESDM targeting language, social skills, cognitive skills, and parent participation) in spontaneous verbalizations among children with ASD. However, two non-RCT studies found improvements following telerehabilitation.
Directive behaviourNot effective5
Two non-RCT studies from one project (Vismara et al., 2012; 2013) investigated the effect of telerehabilitation on directive behaviour among children with autism spectrum disorder (ASD). These non-RCT studies assigned participants (parent alone) to receive telerehabilitation (Early Start Denver Model [ESDM] targeting language, social skills, cognitive skills, and parent participation with 1-hour sessions, 1 session a week for 12 weeks with 3 additional 1-hour sessions scheduled 2 weeks apart at follow up). Directive behaviour was measured by the Maternal Behaviour Rating Scale (MBRS) at baseline and post-treatment (12 weeks). No significant improvement was found.
Conclusion: There is insufficient evidence (Level 5) regarding the effectiveness of telerehabilitation (ESDM targeting language, social skills, cognitive skills, and parent participation) in directive behaviour in children with ASD.
Conclusion: There is insufficient evidence (Level 5) regarding the effectiveness of telerehabilitation (ESDM targeting language, social skills, cognitive skills, and parent participation) in directive behaviour in children with ASD.
References
Bearss, K., et al., Feasibility of Parent Training via Telehealth for Children with Autism Spectrum Disorder and Disruptive Behavior: A Demonstration Pilot. J Autism Dev Disord, 2018. 48(4): p. 1020-1030.Conaughton, R.J., C.L. Donovan, and S. March, Efficacy of an internet-based CBT program for children with comorbid High Functioning Autism Spectrum Disorder and anxiety: A randomised controlled trial. Journal of Affective Disorders, 2017. 218: p. 260-268.
Hatfield, M., et al., Pilot of the BOOST-A-: An online transition planning program for adolescents with autism. Australian Occupational Therapy Journal, 2017. 64(6): p. 448-456.
Hepburn, S.L., et al., Telehealth delivery of cognitive-behavioral intervention to youth with autism spectrum disorder and anxiety: A pilot study. Autism, 2016. 20(2): p. 207-18.
Ingersoll, B., et al., Comparison of a Self-Directed and Therapist-Assisted Telehealth Parent-Mediated Intervention for Children with ASD: A Pilot RCT. J Autism Dev Disord, 2016. 46(7): p. 2275-84.
Ingersoll, B., et al., Self-Directed Telehealth Parent-Mediated Intervention for Children With Autism Spectrum Disorder: Examination of the Potential Reach and Utilization in Community Settings. Journal of medical Internet research, 2017. 19(7): p. e248.
Kuravackel, G.M., et al., COMPASS for Hope: Evaluating the Effectiveness of a Parent Training and Support Program for Children with ASD. Journal of Autism and Developmental Disorders, 2018. 48(2): p. 404-416.
Little, L., et al., Occupation-based coaching by means of telehealth for families of young children with autism spectrum disorder. American Journal of Occupational Therapy, 2018. 72(2): p. 7202205020 1-7.
Marino, F., et al., Tele-Assisted Behavioral Intervention for Families with Children with Autism Spectrum Disorders: A Randomized Control Trial. Brain Sci, 2020. 10(9).
St. Peter, C.C., Brunson, L. Y., Cook, J. E., Subramaniam, S., Larson, N. A., Clingan, M., & Poe, S. G., Adherence to discrete‐trial instruction procedures by rural parents of children with autism. Behavioral Interventions, 2014. 29(3): p. 200-212.
Vismara, L.A., G.S. Young, and S.J. Rogers, Telehealth for expanding the reach of early autism training to parents. Autism Res Treat, 2012. 2012: p. 121878.
Vismara, L.A., et al., Preliminary findings of a telehealth approach to parent training in autism. J Autism Dev Disord, 2013. 43(12): p. 2953-69.
What research is available?
There are 16 studies on different available telerehab-treatments.
How strong is the research behind these treatments?
While there are 5 studies of high and moderate research quality, 11 studies are of low research quality.
Telerehabilitation is an emerging and a rapidly growing field. More high-quality research is on its way.
We are dedicated to update the available information with the most recent findings.
We are dedicated to update the available information with the most recent findings.
Who provides these treatments?
These telerehab-treatments are provided by different specialists including:
• Psychologists
• Behavioral therapists
• Psychotherapists
• Speech language pathologists (SLP)
• Occupational therapists (OT)
• Multidisciplinary teams of different professionals (e.g., OT, SLP).
What is the involvement of the clinician in these treatments?
Clinicians are mainly actively involved in these telerehab-treatments. In other words, they are present and engaged with you and/or the child in every therapy session.
How are these treatments provided?
In most cases, telerehab-treatments are provided through videoconferencing by using different platforms (e.g., Skype, Zoom, or other video calls options).
Who receives these treatments?
Most telerehab-treatments are provided directly to parents of children with ASD. Fewer treatments involve parents together with their child. No treatments engaged the child alone in their approach.
What are the goals of these treatments?
Most of these telerehab-treatments focus on improving both, child and parent-related outcomes including:
Parent’s… • Abilities and interaction skills with their child • Wellbeing and stress levels • Sense of self-efficacy/competence and knowledge;
Child’s… • Language and communication abilities • Behavioral challenges • Anxiety levels • Ability to process sensory information (e.g., sounds, movement, textile) • Social skills • Participation in activities (e.g., self-care tasks such as dressing, play).
Parent’s… • Abilities and interaction skills with their child • Wellbeing and stress levels • Sense of self-efficacy/competence and knowledge;
Child’s… • Language and communication abilities • Behavioral challenges • Anxiety levels • Ability to process sensory information (e.g., sounds, movement, textile) • Social skills • Participation in activities (e.g., self-care tasks such as dressing, play).
Does it work?
Yes! Telerehab-treatments are shown to work for children and youth with ASD and their families.
For instance, telerehab delivered by psychologists, speech language pathologists and behavioral therapists were shown to be more effective in improving numerous skills and abilities among parents and children than when family receives:
• No treatment • Self-directed online learning • Face-to-face comparable treatment
In addition, telerehab delivered by occupational therapists was shown to improve different outcomes related to child’s participation in daily and leisure activities.
It is important to note that no studies showed that the telerehab-treatments were less effective (than other interventions) or detrimental.
For instance, telerehab delivered by psychologists, speech language pathologists and behavioral therapists were shown to be more effective in improving numerous skills and abilities among parents and children than when family receives:
• No treatment • Self-directed online learning • Face-to-face comparable treatment
In addition, telerehab delivered by occupational therapists was shown to improve different outcomes related to child’s participation in daily and leisure activities.
It is important to note that no studies showed that the telerehab-treatments were less effective (than other interventions) or detrimental.
Are there any side effects/risks?
If your medical and rehabilitation team have cleared you and/or your child to engage in telerehabilitation, there are no specific associated risks or side effects. Your rehabilitation professional will help you and your child to perform the therapy safely and effectively.
However, it is important to relay any concerns and/or questions to your rehabilitation professional because telerehabilitation is a relatively new approach and it is different from the traditional face-to-face method. For instance, sometimes, technical issues (e.g., access to suitable technology such as a computer or a smart phone, internet connection, the platform that is used) might come up. We encourage you to discuss these and other issues with your rehabilitation specialist to promote best results and optimize your therapy sessions.
However, it is important to relay any concerns and/or questions to your rehabilitation professional because telerehabilitation is a relatively new approach and it is different from the traditional face-to-face method. For instance, sometimes, technical issues (e.g., access to suitable technology such as a computer or a smart phone, internet connection, the platform that is used) might come up. We encourage you to discuss these and other issues with your rehabilitation specialist to promote best results and optimize your therapy sessions.
How many treatments are necessary to make progress?
On average, improvements were noted following telerehab-treatments that were provided for 30-60 minutes, 1-2 times per week, for about 9 weeks.
However, every child’s needs and progress journeys, as well as parents’ resources, preferences, and availabilities are different.
In collaboration with your rehabilitation professional, you can determine the duration and frequency of tele-treatments that are most optimal and suitable for you and your child.
However, every child’s needs and progress journeys, as well as parents’ resources, preferences, and availabilities are different.
In collaboration with your rehabilitation professional, you can determine the duration and frequency of tele-treatments that are most optimal and suitable for you and your child.
Is this appropriate for me and my child?
Telerehab could be a great option for certain interventions that are feasible to be delivered and received virtually.
Children with ASD aged anywhere from about 2 to 8 years old, and their families, can benefit from telerehab. However, every child’s needs, family’s resources, and progress journeys are different. We encourage that you discuss the appropriateness of telerehabilitation with your health professional.
Children with ASD aged anywhere from about 2 to 8 years old, and their families, can benefit from telerehab. However, every child’s needs, family’s resources, and progress journeys are different. We encourage that you discuss the appropriateness of telerehabilitation with your health professional.
Where can I access more detailed information (e.g., that I can share with my child’s health provider)?