In the early phase of the COVID-19 pandemic, Stanford Medicine researchers had to pause a study of autism treatment in preschoolers. The participants, young children with speech delays, had been coming to Stanford 12 hours a week for a therapy called pivotal response treatment, which uses autistic children’s interests to motivate them to talk.
The halt was stressful for kids and their families, said pediatric psychologist Grace Gengoux, PhD, the program’s clinical director. So instead of stopping the program altogether, Gengoux and her team tried offering the treatment online. To their surprise, it worked — well. There were even advantages to the telehealth approach that delivering the same treatment in person didn’t offer.
“We were shocked at how effective it was,” Gengoux said. The team recently published a paper about their experiences in the journal Social Sciences.
In traditional PRT, which has a solid scientific evidence base, the therapist uses real-world objects and settings to help children start talking. Kids with autism tend to have restricted interests, focusing in depth on something very specific. So, for instance, if a child who loves dinosaurs tries to ask for the dino toy in his therapist’s office, he is immediately rewarded with a few minutes to play with it.
“We want to teach kids that when they verbally engage with other people, things get better, more fun,” said behavior analyst Devon White, who supervised the study treatments.
After COVID-19 lockdowns began, the researchers’ “aha!” moment came when they realized that virtual settings could multiply kids’ choices during PRT. Instead of giving a dino-loving child access to one or two dinosaur toys, a therapist could create a whole gaggle of onscreen dinosaurs.
The online pilot program included 17 children, five of whom were participating in the study when the pandemic shutdown started, and an additional 12 who later joined the online sessions. The children were 2 to 5 years old, and participated for several hours per week for varied periods, from 10 weeks to a little over a year.
Parents attended the kids’ treatment sessions to provide technical assistance, but therapists took the lead in each session. Like most young kids, many of the participants were interested in iPads and similar gadgets, which Gengoux said gave the team an advantage in engaging children’s attention.
Therapists could enhance the online setting using virtual backgrounds, screen sharing and tricks such as changing the cursor to the shape of the child’s favorite object or animal. Therapists had full control over what happened onscreen; the only way the children could influence what they saw was by talking to the therapist, who made changes to the virtual scene in response to what the child said. The online environment also allowed therapists to better cater to children with very specific or complicated interests.
In some ways, the online environment gave therapists more control than an in-person session, too. Instead of asking a child to return a favorite toy at each step of the therapy, then earn new opportunities to play with it, the therapist could set up potential changes in the virtual world in a way that enticed kids into talking more, prompting new or different events onscreen.
Parents of children receiving the treatment typically get some training of their own, too, to teach them with how to use the approach with their kids outside of the sessions. And because they were around for all virtual sessions, the parents quickly caught on to how the therapy worked, Gengoux said. Families felt encouraged to see that their children could do the treatment at home, not just in a clinical setting, Gengoux said. “It’s immediately relevant to real life.”
Excerpted from “Stanford Team Finds Benefits to Online Autism Treatment” from Stanford Children’s Health. Read the full post online for additional details.
Source: Stanford Children’s Health | Stanford Team Finds Benefits to Online Autism Treatment, https://healthier.stanfordchildrens.org/en/stanford-team-finds-benefits-to-online-autism-treatment | © 2022 Stanford Children’s Health
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