Perspectives on Early Childhood Psychology and Education

Submission Type



The current study describes outcomes for seven families who participated in telehealth services from an early intervention clinic in a rural state during the COVID-19 pandemic. Families received different levels of care from a Board-Certified Behavior Analyst (BCBA®) over three months, ranging from one hour to 20 hours per week. The telemedicine sessions primarily focused on teaching caregivers to implement protocols that focused on rapport-building (i.e., Time-In [TI]), increasing child compliance with instructions (i.e., Effective Instruction Delivery [EID]), and language acquisition programs selected from the Promoting Emergence of Advanced Knowledge (PEAK) Comprehensive Assessment and Curriculum. At the conclusion of the telemedicine sessions, parents implemented the protocols with high degrees of treatment integrity, and improvements in skill acquisition on a standardized language assessment were observed for children with autism spectrum disorder (ASD). Implications for providing telemedicine services to rural and underserved communities without access to early intervention services and future directions for research are discussed.

Impact Statement

Families of children with ASD often experience limited availability of ABA providers in rural states, leaving many children without access to early intervention services. With nearly one-fifth of the United States living in rural areas (U.S. Census Bureau, 2010), telemedicine has become a viable, cost-effective option for addressing many of the barriers these families face when attempting to access ABA therapy (Pollard et al., 2017). And, it is possible that a primary focus on high treatment integrity for protocols that focus on rapport building, instruction following, and effective teaching practices may lead to improved language development in early childhood. While the results of this study may only provide preliminary evidence that caregiver-led telemedicine sessions in rural states could result in improvements in language development, practitioners may consider programs that provide a hybrid model whereby families initially attend clinic-based services with their child for an initial assessment and parent training, followed by telemedicine sessions once a treatment plan is developed and parents reach mastery of protocols similar to those included in this study. Thus, it is possible that families in areas with limited access to clinic-based or home-based ABA providers may observe progress in their child’s language development with parent participation in a telemedicine program. These positive outcomes may be accomplished while simultaneously providing significant cost savings for the family, similar to other models for delivering telemedicine therapy

Special Issue

second special issue on behavioral outcomes in Perspectives in Early Childhood Psychology and Education