842240

research-article2019
ISCXXX10.1177/1053451219842240Intervention in School and ClinicAntill

Technology Trends
Cathy Newman Thomas, Associate Editor
Intervention in School and Clinic 2020, Vol. 55(3) 185­–191
© Hammill Institute on Disabilities 2019
Article reuse guidelines: sagepub.com/journals-permissions
DOI: 10.1177/1053451219842240
https://doi.org/10.1177/1053451219842240
isc.sagepub.com

Family-Centered Applied Behavior Analysis for

Children With Autism Spectrum Disorder

Kendra Antill, MEd1

Abstract
Applied behavior analysis (ABA) services can improve the quality of life for individuals with autism spectrum disorder
(ASD). However, not all children receive services based in ABA. The disconnect between available services and accessing
services may be the result of families experiencing barriers. Online parent training addresses many of these barriers by
connecting families with service providers that they otherwise would not have access to. Furthermore, this approach allows
for a family centered approach that empowers parents. A combination of parent training modules and video conferencing
sessions allow parents to learn techniques and try them out with the support of a service provider. This article provides
service providers with guidelines and suggestions for developing and providing services online.

Keywords
Applied behavior analysis, autism, distance education, early intervention, parent training

Researchers have identified early intervention services as
an important factor in the development of children with
autism spectrum disorder (ASD; Wong et al., 2015).
Services based in applied behavior analysis (ABA) are the
most widely used evidence-based practice for children with
ASD (Peters-Scheffer, Didden, Korzilius, & Sturmey,
2011). Unfortunately, families face barriers in accessing
evidence-based services due to knowledge of services, loca-
tion, availability of service providers, and cost (Cason,
Behl, & Ringwalt, 2012; Cole et al., 2016; DeMoss, Clem,
& Wilson, 2012; Heitzman-Powell, Buzhardt, Rusinko, &
Miller, 2014; H. Meadan & Daczewitz, 2014; J. Meadan
et al., 2016). The utilization of file sharing and video con-
ferencing platforms provide service providers with the
opportunity to disseminate parent training and increase
access to services. File sharing platforms allow service pro-
viders to share training modules and documents with fami-
lies through secure email platforms. Video conferencing
platforms allow service providers and families to communi-
cate via a web camera from remote locations.
discrete trial training, reinforcement, prompting, shaping,
antecedent-based interventions, and modeling (Baer, Wolf,
& Risley, 1968; Cooper, Heron, & Heward, 2007; Wong
et al., 2015). Services are typically provided by profession-
als, and funding resources (e.g., insurance, Medicaid) may
set specific requirements of who must provide those services
in order for reimbursement to be provided (Leaf et al., 2017).
Depending on the individual barriers that a family may face,
such as location, transportation, and availability of service
providers, it may be difficult for families to access services
even when they have insurance or Medicaid coverage.
Teachers, paraprofessionals, parents, and other family mem-
bers can learn to implement techniques and interventions
based in ABA (Sarokoff & Sturmey, 2008). In fact, they are
most likely already implementing strategies without know-
ing the names of the strategies (Cooper, 1982). Therefore,
one potential solution to increase access to services is to
1
Early Childhood, Multilingual, and Special Education, University of
Nevada, Las Vegas, Las Vegas, NV, USA

Current Model
Services based in ABA facilitate positive behavior change
through systematic application of behavioral principles,
Corresponding Author:
Kendra Antill, MEd, Department of Early Childhood, Multilingual, and
Special Education, University of Nevada, Las Vegas, 4505 S. Maryland
Parkway, MS 3014, Las Vegas, NV 89154-3014, USA.
Email: antillk@unlv.nevada.edu
186 Intervention in School and Clinic 55(3)
increase parent training. Research has demonstrated that
parents can learn and implement interventions with their
children (Kasari, Gulsrud, Paparella, Hellemann, & Berry,
2015; Wainer & Ingersoll, 2012). This article provides sug-
gestions and guidelines for providing parent training online.
Parent Involvement
Decades of research have provided support for the impor-
tance of empowering and training parents to implement
interventions (Dunst, 1985; Dunst, Hamby, Trivette, Raab,
& Bruder, 2000). Furthermore, research has demonstrated
that techniques based in ABA can be learned and imple-
mented by parents (Heitzman-Powell et al., 2014;
Subramaniam et al., 2016; Wainer & Ingersoll, 2012). In
addition, when parents are taught to implement interven-
tions, they are more likely to continue interventions after
services end (Hanft & Pilkington, 2000; Woods, Wilcox,
Friedman, & Murch, 2011). Typically, parent interventions
are conducted in person, making it difficult for families
experiencing barriers to participate (Kasari et al., 2015; H.
Meadan & Daczewitz, 2014). Researchers have addressed
this issue by providing parent training through distance edu-
cation models (Heitzman-Powell et al., 2014; H. Meadan &
Daczewitz, 2014; J. Meadan et al., 2016; Pickard, Wainer,
Bailey, & Ingersoll, 2016; Subramaniam et al., 2016;
Vismara, McCormick, Young, Nadhan, & Monlux, 2013).
Distance Education Models
Online training disseminated via file-sharing platforms can
alleviate the constraints of attending in-person trainings.
Training videos, presentation software such as PowerPoint,
interactive activities, specific parent training curriculum,
and learning modules can be shared with parents remotely
(Heitzman-Powell et al., 2014; H. Meadan & Daczewitz,
2014). Parents can access training materials at their conve-
nience using tablets, smartphones, or computers with
Internet or cellular access. One limitation to providing
training through file sharing platforms instead of in person
is the loss of real-time interaction between parents and
trainers (Pickard et al., 2016; Wainer & Ingersoll, 2012).
However, the addition of video conferencing allows for ser-
vice providers to provide feedback and have parents try
interventions in real time (Cole et al., 2016; Vismara et al.,
2013). The following guide was created service providers to
use when considering and developing parent training
programs.
Recommended Components
Effective parent training disseminated remotely should
include opportunities for feedback, specific training related
to needs of the child and family, and follow-up (Ingersoll,
Shannon, Berger, Pickard, & Holtz, 2017; Vismara et al.,
2013). Instead of being a linear progression, parent training
should be a continuous cycle of training, feedback, and
implementation. Furthermore, service providers should
consider the child’s natural environment, incorporate oppor-
tunities for collaboration, and follow guidelines of adult
learning principles (Knowles, Holton, & Swanson, 2014;
Woods & Lindeman, 2008). For a checklist of components
to consider when developing online parent training, refer to
Figure 1. In addition to recommended components, service
providers should consider technical and legal requirements
to providing parent training online.
Special Considerations
Delivering parent training via video conferencing services
requires internet or cellular access and an electronic device
with video recording capabilities. Furthermore, accessing
and utilizing video conferencing and online training
requires technological skills that may need to be addressed
before parent training can start. For example, parents may
need to be trained how to login to video conferencing plat-
forms. Therefore, consideration of family familiarity with
technology is an important step in providing parent train-
ing online.
In addition to training parents to use the technology,
service providers need to be aware of security precau-
tions to take when personal information is shared online.
File sharing and video conferencing platforms should use
security measures that are in compliance with the Health
Insurance Portability and Accountability Act (HIPAA,
1996). Service providers can check HIPAA requirements
and submit compliance questions by accessing the U.S.
Department of Health and Human Services website (U.S.
Department of Health and Human Services, n.d.). In
addition, it is important that professionals are cautious
when recommending parent training and e-coaching. For
example, some children may engage in self-injurious
behaviors (e.g., head banging, skin picking) that require
immediate, in-person intervention. This column provides
suggestions to providing ABA-based training to families
remotely that can be useful to service providers, includ-
ing board-certified behavior analysts (BCBA) and uni-
versity professionals.
Material Development
Providing online parent training may require the develop-
ment of content; however, the development of training
material can be alleviated by utilizing resources already in
existence. For example, service providers can use internet
modules such as Autism Focused Intervention Resources
Antill 187

Online Parent Training Component Checklist

Instructions: Use the following checklist to evaluate online parent training. If a component is missing, then
revisit and address the component until it is addressed.
Component Yes No
The natural environment is considered
Family and child needs are considered in development of train-
ing content
Structured learning formats are utilized (e.g., checklists, task
analyses)
Opportunities for feedback are included
Training to use technology is provided
Training content is based in ABA principles
Training content aligns with identified needs
Assessment protocols have been established to measure effec-
tiveness of modules
Program evaluation is given to parents to measure social validity
of the intervention

Figure 1.  Recommended components for parent training provided online.

and Modules (AFIRM; https://afirm.fpg.unc.edu/afirm-
modules). Furthermore, service providers can access and
share training videos available on video-sharing websites
(e.g., YouTube). In addition to sharing training modules and
videos, service providers should incorporate try-and-apply
activities that allow parents to implement interventions
techniques with their child. A try-and-apply activity can
involve the parent collecting data, incorporating environ-
mental supports into the home, or running discrete trials.
Initial Intake
Before the family begins online parent training, an intake
session should occur to access the needs of the family and
the child. If possible, intake sessions should occur in per-
son. By conducting the intake session in person, the service
provider has the opportunity to interact with the family in
the natural environment. However, if this is not feasible, the
intake session could be conducted through video conferenc-
ing. Whether in person or via video conference, service pro-
viders should establish rapport with the family and ask
questions to understand the routines, customs, and culture
of the family (Knowles et al., 2014; Woods & Lindeman,
2008). This allows the service provider to provide the fam-
ily with supports that are culturally relevant and realistic.
During the initial intake session, service providers should
conduct a functional behavior assessment by collecting
direct and indirect data (Gresham, Watson, & Skinner,
2001). Direct data refer to data collected in real time, in the
child’s natural environment (Cooper, 1981). Indirect data
consist of data collected through interviews and behavior
rating scales (Cooper et al., 2007). To further illustrate the
process, the following scenario is described.
A family living in a rural area contacted a service pro-
vider. The service provider sent a survey with questions
about the family’s routines, concerns about the child’s
behavior, and possible areas that the family would like to
focus (see Figure 2). The service provider reviewed the
responses before the intake session. During the intake
session, the service provider was able to gain more
insight on the family’s needs by clarifying responses
from the questionnaire and asking additional questions.
Furthermore, the service provider provided the parents
with behavior rating scales and checklists such as the
Vineland Adaptive Behavior Scales (Sparrow, Cicchetti,
& Saulnier, 2016).
After completing the interview, rating scales, and
checklists, the family interacted with their child as they
normally would for 15 minutes of play. While observing
the family and child interact, the service provider was able
to take notes of how the parents and child interacted.
During the observation, the child engaged in tantrum
behavior several times. After discussing the interaction,
the service provider and family determined that decreas-
ing tantrum behavior and teaching a more appropriate
replacement skill was the top priority. The service pro-
vider helped the family create an operational definition by
using measurable terms to describe the tantrum behavior.
188 Intervention in School and Clinic 55(3)

Family Questionnaire

Directions: Please fill out the following questionnaire to the best of your ability. Provide specific and detailed responses. This
information is instrumental in providing us with enough background information to move forward and gain insight into your
unique needs.

1. Describe your child’s strengths.

2. Describe the areas that your child struggles the most.

3. In which environments does your child do best?

4. In which environments does your child need the most support?

5. Describe a typical day in your house. Describe your routines.

6. How does your child interact with adults?

7. How does your child interact with others his/her age?

8. Describe your child’s interests.

9. In which areas (e.g. behavior, feeding, communication) do you

feel confident?

10. In which areas (e.g. behavior, feeding, communication) would

you like to receive support and training?

11. What do you hope to gain through parent training?

12. List at least two goals that you wish for your child to meet.

Figure 2.  Sample questionnaire to provide parents during intake process. Questionnaires are an opportunity to ask questions that
provide additional insight to formal assessments.

Table 1.  An Example of the Module Sequence.

Title Objectives Activities

Module 1: Principles Describe the four functions of behavior, PowerPoint presentations, video on behaviors, try-
of Behavior and Data hypothesize the function of given and-apply activity allowing the parent to take ABC
Collection behaviors, and collect antecedent- data on behaviors in a video, and video conference
behavior-consequence (ABC) data sessions
Module 2: Positive Describe positive reinforcement, conduct PowerPoint presentations, videos modeling
Reinforcement a preference assessment, and identify preference assessments and positive reinforcement,
and Preference potential reinforcers for their child try-and-apply activity, and video conference sessions
Assessments
Module 3: Antecedent Identify antecedent strategies (e.g., visual PowerPoint presentations, videos modeling
Interventions supports) that can be implemented within antecedent strategies, printouts of visual supports to
the home utilize in the home, and video conference sessions

Furthermore, the service provider and family determined
what would and would not count as tantrum behavior. For
example, crying without dropping to the floor was not
counted as tantrum behavior. The parents were then pro-
vided with a learning module on how to record antecedent,
behavior, consequence (A-B-C) data (Cooper et al., 2007).
The parents recorded data over a week, then sent the data
to the service provider.
The service provider used the questionnaire, information
gathered from the intake session, behavior scales, and anec-
dotal data to hypothesize the function of the behavior.
Through this process, the service provider and parent devel-
oped a behavior intervention plan to decrease the tantrum
behavior and increase more appropriate replacement behav-
ior. By developing the behavior plan with the parents, the
service provider was able to develop a plan that would be
Antill 189
Dear ________________,
I really liked how you incorporated the use of (technique from module). I specifically liked how you (name 1-3 strengths of the technique implemented).
I have shared (name of video/power point) to further support your use of (strategy). I would suggest that you try (list several suggestions for parent
to work on). Overall, you are doing a fantastic job in (list 1-3 strengths about parent intervention). Please let me know if you have any questions or
concerns.
Best,
____________________.
Figure 3.  Email template for written feedback.
realistically implemented within the home. In addition to
developing a behavior plan, the service provider shared a
series of training modules on functions of behaviors, ante-
cedent interventions, and reinforcement. An example of the
module sequence is provided in Table 1.
E-Coaching and Customized Didactic Sessions
After the intake session and dissemination of online train-
ing modules, service providers could use e-coaching ses-
sions to model strategies. Furthermore, e-coaching sessions
allow the families to implement techniques and strategies
with the immediate feedback, guidance, and support of the
service provider. In order to provide the family with oppor-
tunities to request support, e-coaching sessions should
occur at least once a week (Vismara et al., 2013). This
allows service providers to identify subsequent parent
training to target.
Pretests and posttests can be utilized to determine
learning of module content. Specifics of mastery criteria
to move onto new modules should be established prior to
parents starting modules. For example, 100% mastery
may be more crucial for content involving foundational
skills required for future modules. In addition to setting
mastery criteria for modules, service providers can utilize
data of a target behavior to measure effectiveness of the
parent training intervention. For example, in the provided
scenario, the service provider could use frequency and
duration data of tantrum behavior to determine program
effectiveness.
Feedback
Throughout parent training, it is essential that service provid-
ers give positive, constructive feedback to facilitate learning
(Feil et al., 2008; Pickard et al., 2016; Wainer & Ingersoll,
2012). During video conferences, service providers should
designate time to answer questions or concerns that parents
may have, provide feedback, and problem solve any issues
that arise. After watching submitted videos or engaging in
video conferences with families, service providers could also
submit written feedback. Feedback should be positive,
acknowledge parent strengths, and provide suggestions. For
a sample feedback template, refer to Figure 3. As new con-
cerns and topics are addressed, the cycle would continue.
Social Validity
Social validity is an important component of online parent
training. Service providers should utilize a measure of
social validity to assess if parents find the training to be
worthwhile, feasible to implement, meaningful, and effec-
tive. An example of a survey to measure social validity is
provided in Figure 4.
Conclusion
There are several limitations to providing parent training
online. First, online parent training may not be appropriate
for all children and families. Second, parent training deliv-
ered remotely is not yet accepted by insurance companies
as a billable service (Bearss et al., 2018). However, despite
limited insurance funding, parent training delivered online
can potentially be a cost-effective supplement or alterna-
tive for children who receive limited or no services due to
financial constraints (Dunst et al., 2000; Heitzman-Powell
et al., 2014).
Providing training to parents of children with ASD
through file sharing platforms and e-coaching via platforms
in compliance with HIPPA allows parents to learn strategies
and techniques leading to empowerment. Parent training
can be useful not only for families of children with ASD,
but for families of children without ASD who engage in
behavior that interferes with their daily functioning. By pro-
viding training and coaching remotely, access to families
with transportation issues, irregular work schedules, or to
families in rural areas can be increased. In addition, because
parents are a constant in their child’s life, parents can con-
tinue providing interventions long after services typically
occur (Woods et al., 2011).
190 Intervention in School and Clinic 55(3)

Instructions: Use the following scale to rate your agreement with the statements provided in this survey.
1. Strongly disagree
2. Disagree
3. Agree
4. Strongly agree
Access to Training
1. The online parent training was easy to access. 1 2 3 4
2. I was provided with sufficient training to access the online parent training. 1 2 3 4
3. The e-coaching sessions were easy to access. 1 2 3 4
4. I was provided with sufficient training to conduct e-coaching sessions. 1 2 3 4
Training Content
5. The training content provided was organized and easy to understand. 1 2 3 4
6. I have increased my knowledge of concepts based in ABA as a result of the online training 1 2 3 4
modules.
7. It was easy to implement strategies and techniques learned from the online modules. 1 2 3 4
8. My child’s behavior has improved as a result of implementing strategies and techniques 1 2 3 4
learned from the online modules.
E-coaching Sessions
9. My trainer provided me with constructive and useful feedback during the e-coaching ses- 1 2 3 4
sions.
10. The e-coaching sessions provided me with the opportunity to ask questions and clarify my 1 2 3 4
knowledge of ABA-based strategies.
11. The e-coaching sessions increased my knowledge of ABA-based strategies and my ability 1 2 3 4
to implement them.
12. My child’s behavior has improved as a result of strategies and techniques learned from the 1 2 3 4
e-coaching sessions.

Figure 4.  Sample survey to measure social validity of online parent training.

Declaration of Conflicting Interests Part C) services. International Journal of Telerehabilitation,

The author declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author received no financial support for the research, author-
ship, and/or publication of this article.
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