Anurag Garikipati, Madalina Ciobanu, Navan Preet Singh, Gina Barnes, Frank A Dinenno, Jennifer Geisel, Qingqing Mao, Ritankar Das
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引用次数: 0
Abstract
Background: Autism spectrum disorder (ASD) can have traits that impact multiple domains of functioning and quality of life, which can persevere throughout life. To mitigate the impact of ASD on the long-term trajectory of an individual's life, it is imperative to seek early and adequate treatment via scientifically validated approaches, of which applied behavior analysis (ABA) is the gold standard. ABA treatment must be delivered via a behavior technician with oversight from a board-certified behavior analyst. However, shortages in certified ABA therapists create treatment access barriers for individuals on the autism spectrum. Increased ASD prevalence demands innovations for treatment delivery. Parent-led treatment models for neurodevelopmental conditions are effective yet underutilized and may be used to fill this care gap.
Objective: This study reports findings from a retrospective chart review of clinical outcomes for children that received parent-led ABA treatment and intends to examine the sustained impact that modifications to ABA delivery have had on a subset of patients of Montera, Inc. dba Forta ("Forta"), as measured by progress toward skill acquisition within multiple focus areas (FAs).
Methods: Parents received ≥40 hours of training in ABA prior to initiating treatment, and patients were prescribed focused (<25 hours/week) or comprehensive (>25-40 hours/week) treatment plans. Retrospective data were evaluated over ≥90 days for 30 patients. The clinical outcomes of patients were additionally assessed by age (2-5 years, 6-12 years, 13-22 years) and utilization of prescribed treatment. Treatment encompassed skill acquisition goals; to facilitate data collection consistency, successful attempts were logged within a software application built in-house.
Results: Improved goal achievement success between weeks 1-20 was observed for older age, all utilization, and both treatment plan type cohorts. Success rates increased over time for most FAs, with the exception of executive functioning in the youngest cohort and comprehensive plan cohort. Goal achievement experienced peaks and declines from week to week, as expected for ABA treatment; however, overall trends indicated increased skill acquisition success rates. Of 40 unique combinations of analysis cohorts and FAs, 20 showed statistically significant positive linear relationships (P<.05). Statistically significant positive linear relationships were observed in the high utilization cohort (communication with P=.04, social skills with P=.02); in the fair and full utilization cohorts (overall success with P=.03 for the fair utilization cohort and P=.001 for the full utilization cohort, and success in emotional regulation with P<.001 for the fair utilization cohort and P<.001 for the full utilization cohort); and in the comprehensive treatment cohort (communication with P=.001, emotional regulation with P=.045).
Conclusions: Parent-led ABA can lead to goal achievement and improved clinical outcomes and may be a viable solution to overcome treatment access barriers that delay initiation or continuation of care.
背景:自闭症谱系障碍(ASD)的特征会影响多个领域的功能和生活质量,并可能持续终生。为了减轻自闭症对个人长期生活轨迹的影响,必须通过经过科学验证的方法寻求早期和适当的治疗,其中应用行为分析(ABA)是黄金标准。应用行为分析治疗必须通过行为技术员进行,并由经委员会认证的行为分析师进行监督。然而,经过认证的 ABA 治疗师的短缺给自闭症谱系中的患者造成了治疗障碍。ASD 患病率的增加要求对治疗方法进行创新。以家长为主导的神经发育疾病治疗模式非常有效,但却未得到充分利用,可用于填补这一治疗空白:本研究报告了对接受家长主导型 ABA 治疗的儿童临床结果进行回顾性病历审查的结果,并打算根据多个重点领域(FAs)的技能掌握进展情况,研究 ABA 治疗方法的改变对 Montera, Inc:方法:在开始治疗前,家长接受了≥40小时的ABA培训,并为患者制定了重点治疗计划(25-40小时/周)。对30名患者≥90天的回顾性数据进行评估。此外,还按年龄(2-5 岁、6-12 岁、13-22 岁)和处方治疗的使用情况对患者的临床效果进行了评估。治疗包括技能习得目标;为便于数据收集的一致性,成功的尝试都记录在内部开发的软件应用程序中:结果:在第 1-20 周期间,观察到年龄较大、使用所有治疗方法和两种治疗计划类型的人群的目标实现成功率都有所提高。随着时间的推移,大多数 FA 的成功率都有所提高,但最年轻组群和综合计划组群的执行功能除外。正如 ABA 治疗所预期的那样,目标实现情况每周都会出现高峰和低谷;然而,总体趋势表明技能掌握成功率在上升。在 40 个分析队列和 FA 的独特组合中,有 20 个显示出统计学意义上的正线性关系(结论:家长主导的 ABA 可以提高技能学习的成功率:以家长为主导的 ABA 可以实现目标并改善临床疗效,可能是克服治疗障碍的可行方案,因为这些障碍会延误治疗的开始或持续。