Looking at Europe’s recent behavioral telehealth practices for children and families impacted by neurodevelopmental disabilities

Figures & data

Table 1 Search terms.

Diagnosis	Autism, neurodevelopmental disability, neuro-developmental, ASD, autism spectrum disorder, developmental disability.
Participants	Children, family, parent, caregiver, adolescent, child.
Mode of delivery	Telehealh, telepractice, remote service, synchronous, telemedicine, telecare, e health, video consult, electronic consult, e consult, virtual consult, remote consult, videoconference.
Location	Europe, EU, European Union, OECD, Albania, Andorra, Armenia, Austria, Azerbaijan, Belarus, Belgium, Bosnia, Herzegovina, Bulgaria, Croatia, Cyprus, Czech, Denmark, Estonia, Finland France, Georgia, Germany, Greece, Hungary, Iceland, Ireland, Italy, Kazakhstan, Kosovo, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Moldova, Monaco, Montenegro, Netherlands, Macedonia, Norway, Poland, Portugal, Romania, Russia, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey, Ukraine, United Kingdom, England, Scotland.

Table 2 Technical components of the studies.

Article	Location	Design	Child Participants	Caregiver Participants	Child Behavior Targets	Caregiver Behavior Targets
Dai et al. 2018	Albania	Treatment and control group comparison.	29 children with autism aged 18–70 months.	29 mothers.	None.	Scores on knowledge quizzes and the Early Intervention Parenting Self-Efficacy Scale.
Griffiths 2020	Albania	Non-concurrent multiple baseline design (MBD) across participants.	Three children with autism aged 4-8 years.	Three mothers.	Mands (requests).	Implementation of a mand training procedure as assessed via a fidelity checklist.
Guðmundsdóttir et al. 2017	Iceland	MBD across people for one participant and across settings for the other.	Two children with autism aged 4-5 years.	Two families, mothers were the main participants.	Request or social attending.	Teaching episodes which included correct implementation of the taught DANCE procedures.
Guðmundsdóttir et al. 2019	Iceland	MBD across child behaviors replicated across parents.	Three children with autism aged 3-4 years.	Three families, mothers were the main participants.	Communication response.	Teaching episodes which included correct implementation of the taught DANCE procedures.
Marino et al. 2020	Italy	Randomized control trial. Random assignment 2 group comparison (training with or without telehealth component).	23 children with autism aged 30 months to 10 years.	42 parents completed the study, 23 mothers and 19 fathers.	None.	Pre- and post-training assessments using the Home Situation Questionnaire (HSQ-ASD) and the Parental Stress Index (PSI/SF).
Tsami et al. 2019	Greece, Turkey, Russia, Ukraine, Mexico, Saudi Arabia, Costa Rica, USA.	MBD across participants (parent and child dyads).	12 children with autism aged 3-13 years.	14 parents completed the study, 12 mothers, 1 brother, and 1 father.	Challenging behaviors (e.g. aggression, self-injury, property destruction, etc..) and mands.	Implementation of functional assessment and functional communication training procedures.

Table 3 Training and telehealth components of the studies.

Article	Strategies used via Telehealth	Asynchronous Components	Synchronous Components	Telehealth Technology	In-situ Component
Dai et al. 2018	Independent learning activities using videos, vignettes, manuals, and tests.	Video recordings of the teaching material.	Telephone interviews to answer questions about the teaching material presented in the recordings.	DVD player, recordings, telephone.	Yes
Griffiths 2020	All 4 components of the Behavioral Skills Training (BST) procedure (instructions, modelling, rehearsal, feedback).	File sharing of the teaching materials and videos for clinician assessment.	Video conferencing for BST training.	Computer or smartphone, Skype, Zoom, and Dropbox	No
Guðmundsdóttir et al. 2017	Training package using explanation, modelling, positive and corrective feedback, written summary of teaching procedures, and reviewing data with the caregivers.	Sessions were recorded and later watched and scored by a clinician.	Video conferencing for trainings and assessments.	Laptops, desktop, webcams, Skype, closed file system, encrypted website, video camera.	Yes
Guðmundsdóttir et al. 2019	Training package using explanation, modelling, positive and corrective feedback, written summary of teaching procedures, and reviewing data and self-monitoring videos with the caregivers.	Sessions were recorded and later watched and scored by a clinician.	Video conferencing for trainings and assessments.	Laptops, webcams, Skype, closed file system, encrypted website.	Yes
Marino et al. 2020	Coaching as individualized ABA therapy, engaging parents in behavioral interactive play activities with their young children.	None.	Video conferencing for one-to-one behavioral parent training and coaching.	Web platform within G-Suite, video conference tools.	Yes
Tsami et al. 2019	Coaching, prompting, prompt fading, explanation.	Sessions were recorded and later watched and scored by a clinician.	Video conferencing for trainings and assessments.	Laptop, desktop, phone, iPad, Vidyo (video conference software).	No

Table 4 Outcome components of the studies.

Article	Cultural Competence	Child Outcomes	Caregiver Outcomes	Social Validity Outcomes
Dai et al. 2018	Materials created with parent input and in native language. Local clinicians with US collaboration. Most videos locally created.	None.	Small improvement in the telehealth treatment group over control group for the test scores and Early Intervention Parenting Self-Efficacy Scale.	Caregivers rated the social validity of the information in each training module. Ratings were on average over 4 (5-point scale).
Griffiths 2020	Materials and training provided in native language but from the US. Intervention goals were created in collaboration with the parents.	All children's mands increased.	Fidelity of their implementation of the mand training procedure increased.	The social validity questionnaire data collected were an average of 4.7 or higher (5-point scale).
Guðmundsdóttir et al. 2017	One parent was taught in her native language and one parent was not. Intervention goals were created in collaboration with the parents.	All children's skills increased.	Parent delivery of teaching episodes increased.	None.
Guðmundsdóttir et al. 2019	All parents were taught in their native language. Intervention goals were created in collaboration with the parents.	All children's skills increased.	Parent delivery of teaching episodes increased.	Full information on social validity assessment procedures not provided in this article. Only positive anecdotal social validity reports discussed.
Marino et al. 2020	No information provided.	None	Parents in the telehealth group had statistically significant positive effects over the control group on their reported stress levels and the perceptions of their children's behavior as reported in the HSQ-ASD and PSI/SF.	None.
Tsami et al. 2019	Trainings were provided in either the native language or with a trained interpreter. Intervention goals were created in collaboration with the parents.	All children's problem behaviors decreased and mands increased.	Fidelity of the FCT and FA procedures for all but one parent had at least 90% accuracy across sessions.	Social validity means via Treatment Acceptability Rating Form were high.

Figure 1. Screening and retrieval process.

Dai, Y. G., Brennan, L., Como, A., Hughes-Lika, J., Dumont-Mathieu, T., Rathwell, I. C., Minxhozi, O., Aliaj, B. and Fein, D. A. 2018. A video parent-training program for families of children with autism spectrum disorder in Albania. Research in Autism Spectrum Disorders, 56, 36–49.

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Griffiths, F. 2020. The effects of telehealth training on parents of children with autism in Albania. Unpublished Thesis. Brigham Young University, Utah.

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Guðmundsdóttir, K., Sigurðardóttir, Z. G. and Ala'i-Rosales, S. 2017. Evaluation of caregiver training via telecommunication for rural Icelandic children with autism. Behavioral Development Bulletin, 22, 215–229.

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Guðmundsdóttir, K., Ala’i-Rosales, S. and Sigurðardóttir, Z. G. 2019. Extending caregiver training via telecommunication for rural Icelandic children with autism. Rural Special Education Quarterly, 38, 26–42.

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Marino, F., Chilà, P., Failla, C., Crimi, I., Minutoli, R., Puglisi, A., Arnao, A. A., Tartarisco, G., Ruta, L., Vagni, D. and Pioggia, G. 2020. Tele-assisted behavioral intervention for families with children with autism spectrum disorders: A randomized control trial. Brain Sciences, 10, 649. doi: 10.3390/brainsci10090649

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Tsami, L., Lerman, D., and Toper‐Korkmaz O. 2019. Effectiveness and acceptability of parent training via telehealth among families around the world. Journal of Applied Behavior Analysis, 52, 1113–1129.

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