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Cited by 12Autism Spectrum Disorder ResearchTelemedicine and Telehealth ImplementationBehavioral and Psychological Studies

Telehealth Versus Face-to-Face Fine Motor and Social Communication Interventions for Children With Autism Spectrum Disorder: Efficacy, Fidelity, Acceptability, and Feasibility

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Su, Wan-Chun, Cleffi, Corina, Srinivasan, Sudha, Bhat, Anjana·2023·American Journal of Occupational Therapy
DOI 10.5014/ajot.2023.050282PMC PMC10846418
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Abstract

Importance: The efficacy of telehealth (TH) interventions needs to be studied. Objective: To compare the efficacy, fidelity, acceptability, and feasibility of face-to-face (F2F) versus TH seated play (SP) interventions among children with autism spectrum disorder (ASD). Design: As part of a larger randomized controlled trial, children were assigned to the SP group and received TH and F2F interventions over 8 wk using a pretest–posttest study design. Setting: A research lab or through videoconferencing. Participants: Fifteen children with ASD (ages 5–14 yr) were randomly assigned to the SP group and received the intervention F2F or through TH. Intervention: Children received 16 SP intervention sessions (2 sessions per week for 8 wk). Outcomes and Measures: Pretests and posttests included standardized fine motor assessments. Video coding compared socially directed verbalization during training sessions. Parents and trainers provided feedback on their experiences. Results: Seven children received the intervention F2F, whereas 8 received TH intervention. Children in both subgroups showed similar training improvements in fine motor skills and socially directed verbalizations ( p s > .01). Parents rated both interventions as acceptable and feasible; however, they reported longer preparation time and effort during TH interventions ( p s < .01). Trainers reported greater parental involvement but more communication and technological issues during TH interventions. Fidelity checks indicated fewer reinforcements during TH versus F2F sessions. Conclusions and Relevance: TH intervention is feasible and effective in improving fine motor and social communication performance. Clinicians should reduce parental burden and overcome technological issues. What This Article Adds: This study confirmed the efficacy, fidelity, acceptability, and feasibility of delivering seated play, standard of care interventions for children with autism spectrum disorder via telehealth. However, clinicians should work on reducing parental burden and overcoming communication and technological issues related to telehealth.

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  • Telehealth-based SST requires greater preparation time and effort from parents compared to face-to-face sessions.

    “For example, telehealth-based SST requires greater preparation time and effort from parents compared to F2F sessions [93].”

    From The Impact of Social Media &amp; Technology on Child and Adolescent Mental Health (2025) · cites this paper as [93]

    The ‘Increased Parental Burden’ section reports that parents in the telehealth group spent longer preparing and exerted more effort supervising their children than parents in the face-to-face group. However, the ‘Training Protocol for Seated Play Intervention’ describes a seated-play intervention targeting both social communication and fine motor skills; the paper does not establish this finding specifically for SST. (LLM, conf=0.83)

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Research works printed but not linked: 39

  1. American Occupational Therapy Association. (2018). Telehealth in occupational therapy. American Journal of Occupational Therapy, 72(Suppl. 2), 7212410059. https://doi.org/10.5014/ajot.2018. · DOI
  2. 72S219 · DOI
  3. Aranki, J., Wright, P., Pompa-Craven, P., & Lotfizadeh, A. D. (2022). Acceptance of telehealth therapy to replace in-person therapy for autism treatment during COVID-19 pandemic: An assessment of patient variables. Telemedicine Journal and e-Health, 28, 1342-1349. https://doi.org/10.1089/tmj.2021.0397 · DOI
  4. Benson, J. D., Blaskowitz, M. G., Collins, A., Smitsky, D., Chippich, E., & Connell, C. (2022). The effect of a Sensory Activity Schedule (SAS) on the on-task behaviors of children with autism spectrum disorders. Journal of Occupational Therapy, Schools, and Early Intervention, 15, 439-454. https://doi.org/10.1080/19411243.2021.2003734 · DOI
  5. Bernier, A., Ratcliff, K., Hilton, C., Fingerhut, P., & Li, C. Y. (2022). Art interventions for children with autism spectrum disorder: A scoping review. American Journal of Occupational Therapy, 76, 7605205030. https://doi.org/10.5014/ajot.2022.049320 · DOI
  6. Bhat, A., Landa, R., & Galloway, J. C. (2011). Current perspectives on motor functioning in infants, children, and adults with autism spectrum disorders. Physical Therapy, 91, 1116-1129. https://doi.org/ 10.2522/ptj.20100294 · DOI
  7. Bhat, A., Su, W. C., Cleffi, C., & Srinivasan, S. (2021). A hybrid clinical trial delivery model in the COVID-19 era. Physical Therapy, 101, pzab116. https://doi.org/10.1093/ptj/pzab116 · DOI
  8. Bondy, A., & Frost, A. (2003). Communication strategies for visual learners. In O. I. Lovaas (Ed.), Teaching individuals with developmental delays: Basic intervention techniques (pp. 291-304).
  9. Bruininks, R., & Bruininks, B. (2005). Bruininks-Oseretsky Test of Motor Proficiency: Examiner's manual (2nd ed.). Pearson.
  10. Case-Smith, J., & Miller, H. (1999). Occupational therapy with children with pervasive developmental disorders. American Journal of Occupational Therapy, 53, 506-513. https://doi.org/10.5014/ ajot.53.5.506 · DOI
  11. Case-Smith, J., Weaver, L. L., & Fristad, M. A. (2015). A systematic review of sensory processing interventions for children with autism spectrum disorders. Autism, 19, 133-148. https://doi.org/10.1177/ 1362361313517762 · DOI
  12. Cihon, J. H., Ferguson, J. L., Lee, M., Leaf, J. B., Leaf, R., & McEachin, J. (2021). Evaluating the cool versus not cool procedure via telehealth. Behavior Analysis in Practice, 15, 260-268. https://doi.org/10.1007/ s40617-021-00553-z · DOI
  13. Constantino, J. N., Przybeck, T., Friesen, D., & Todd, R. D. (2000). Reciprocal social behavior in children with and without pervasive developmental disorders. Journal of Developmental and Behavioral Pediatrics, 21, 2-11. https://doi.org/10.1097/00004703-200002000-00002 · DOI · Paper page
  14. Criss, M. J. (2013). School-based telerehabilitation in occupational therapy: Using telerehabilitation technologies to promote improvements in student performance. International Journal of Telerehabilitation, 5, 39-46. https://doi.org/10.5195/ijt.2013.6115 · DOI
  15. Feldhacker, D., Vanessa, D., LeSage, S., Collins, H., Lohman, H., & Russell, M. (2022). Telehealth interventions within the scope of occupational therapy practice: A systematic review. American Journal of Occupational Therapy, 76, 7606205090. https://doi.org/10.5014/ ajot.2022.049417 · DOI
  16. Ferguson, J., Dounavi, K., & Craig, E. A. (2022). The impact of a telehealth platform on ABA-based parent training targeting social communication in children with autism spectrum disorder. Journal of Developmental and Physical Disabilities, 34, 1089-1120. https://doi. org/10.1007/s10882-022-09839-8 · DOI
  17. Gabellone, A., Marzulli, L., Matera, E., Petruzzelli, M. G., Margari, A., Giannico, O. V., & Margari, L. (2022). Expectations and concerns about the use of telemedicine for autism spectrum disorder: A cross- sectional survey of parents and healthcare professionals. Journal of Clinical Medicine, 11, 3294. https://doi.org/10.3390/jcm11123294 · DOI
  18. Gentile, M., Messineo, L., La Guardia, D., Arrigo, M., Citt a, G., Ayala, A., . . . Allegra, M. (2022). A parent-mediated telehealth program for children with autism spectrum disorder: Promoting parents' ability to stimulate the children's learning, reduce parenting stress, and boost their sense of parenting empowerment. Journal of Autism and Developmental Disorders, 52, 5285-5300. https://doi.org/10.1007/ s10803-022-05482-6 · DOI
  19. Gibbs, V., Cai, R. Y., Aldridge, F., & Wong, M. (2021). Autism assessment via telehealth during the Covid 19 pandemic: Experiences and perspectives of autistic adults, parents/carers and clinicians. Research in Autism Spectrum Disorders, 88, 101859. https://doi.org/ 10.1016/j.rasd.2021.101859 · DOI
  20. Hepburn, S. L., Blakeley-Smith, A., Wolff, B., & Reaven, J. A. (2016). Telehealth delivery of cognitive-behavioral intervention to youth with autism spectrum disorder and anxiety: A pilot study. Autism, 20, 207-218. https://doi.org/10.1177/1362361315575164 · DOI
  21. Iwanaga, R., Honda, S., Nakane, H., Tanaka, K., Toeda, H., & Tanaka, G. (2014). Pilot study: Efficacy of sensory integration therapy for Japanese children with high-functioning autism spectrum disorder. Occupational Therapy International, 21, 4-11. https://doi.org/10.1002/oti.1357 · DOI
  22. Jeste, S., Hyde, C., Distefano, C., Halladay, A., Ray, S., Porath, M., . . . Thurm, A. (2020). Changes in access to educational and healthcare services for individuals with intellectual and developmental disabilities during COVID-19 restrictions. Journal of Intellectual Disability Research, 64, 825-833. https://doi.org/ 10.1111/jir.12776 · DOI
  23. Lord, C., Rutter, M., Goode, S., Heemsbergen, J., Jordan, H., Mawhood, L., & Schopler, E. (1989). Autism Diagnostic Observation Schedule: A standardized observation of communicative and social behavior. Journal of Autism and Developmental Disorders, 19, 185-212. https:// doi.org/10.1007/BF02211841 · DOI · Paper page
  24. Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism Diagnostic Interview-Revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24, 659-685. https://doi.org/10.1007/BF02172145 · DOI · Paper page
  25. Lovaas, O. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3-9. https://doi.org/10.1037/ 0022-006X.55.1.3 · DOI · Paper page
  26. Marvin, A. R., Marvin, D. J., Lipkin, P. H., & Law, J. K. (2017). Analysis of Social Communication Questionnaire (SCQ) screening for children less than age 4. Current Developmental Disorders Reports, 4, 137-144. https://doi.org/10.1007/s40474-017-0122-1 · DOI
  27. McCrae, C. S., Chan, W. S., Curtis, A. F., Nair, N., Deroche, C. B., Munoz, M., . . . Mazurek, M. O. (2021). Telehealth cognitive behavioral therapy for insomnia in children with autism spectrum disorder: A pilot examining feasibility, satisfaction, and preliminary findings. Autism, 25, 667-680. https://doi.org/ 10.1177/1362361320949078 · DOI · Paper page
  28. Mesibov, G., Shea, V., & Schopler, E. (2004). The TEACCH approach to autism spectrum disorders. Springer. https://doi.org/10.1007/ 978-0-306-48647-0 · DOI
  29. Pfeiffer, B. A., Koenig, K., Kinnealey, M., Sheppard, M., & Henderson, L. (2011). Effectiveness of sensory integration interventions in children with autism spectrum disorders: A pilot study. American Journal of Occupational Therapy, 65, 76-85. https://doi.org/10.5014/ ajot.2011.09205 · DOI
  30. Schoen, S. A., Lane, S. J., Mailloux, Z., May-Benson, T., Parham, L. D., Smith-Roley, S., & Schaaf, R. C. (2019). A systematic review of Ayres sensory integration intervention for children with autism. Autism Research, 12, 6-19. https://doi.org/10.1002/aur.2046 · DOI
  31. Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland Adaptive Behavior Scales (2nd ed.). Pearson.
  32. Srinivasan, S. M., & Bhat, A. N. (2013). A review of "music and movement" therapies for children with autism: Embodied interventions for multisystem development. Frontiers in Integrative Neuroscience, 7, 1-15. https://doi.org/10.3389/ fnint.2013.00022 · DOI
  33. Srinivasan, S. M., Eigsti, I.-M., Neelly, L., & Bhat, A. N. (2016). The effects of embodied rhythm and robotic interventions on the spontaneous and responsive social attention patterns of children with autism spectrum disorder (ASD): A pilot randomized controlled trial. Research in Autism Spectrum Disorders, 27, 54-72. https://doi.org/ 10.1016/j.rasd.2016.01.004 · DOI
  34. Srinivasan, S. M., Kaur, M., Park, I. K., Gifford, T. D., Marsh, K. L., & Bhat, A. N. (2015). The effects of rhythm and robotic interventions on the imitation/praxis, interpersonal synchrony, and motor performance of children with autism spectrum disorder (ASD): A pilot randomized controlled trial. Autism Research and Treatment, 2015, 736516. https://doi.org/10.1155/2015/736516 · DOI
  35. Srinivasan, S. M., Su, W. C., Cleffi, C., & Bhat, A. N. (2021). From social distancing to social connections: Insights from the delivery of a clinician-caregiver co-mediated telehealth-based intervention in young children with autism spectrum disorder. Frontiers in Psychiatry, 12, 700247. https://doi.org/10.3389/fpsyt.2021.700247 · DOI
  36. Tenforde, A. S., Borgstrom, H., Polich, G., Steere, H., Davis, I. S., Cotton, K., . . . Silver, J. K. (2020). Outpatient physical, occupational, and speech therapy synchronous telemedicine: A survey study of patient satisfaction with virtual visits during the COVID-19 pandemic. American Journal of Physical Medicine and Rehabilitation, 99, 977-981. https://doi.org/10.1097/PHM.0000000000001571 · DOI
  37. Terrell, E. A., Aftab, S., Babitz, A., Butler, L., Hernandez, N. G., Hornik, B., . . . Thomas, J. (2021). The evolution of telehealth from pre-COVID-19 pandemic through a hybrid virtual care delivery model: A pediatric hospital's journey. International Journal of Telerehabilitation, 13, e6432. https://doi.org/10.5195/ ijt.2021.6432 · DOI
  38. van de Groep, S., Zanolie, K., & Crone, E. A. (2020). Giving to friends, classmates, and strangers in adolescence. Journal of Research on Adolescence, 30, 290-297. https://doi.org/10.1111/jora.12491 · DOI
  39. Wilson B. N., Crawford S. G., Green D., Roberts G., Aylott A., & Kaplan B.J. (2009). Psychometric properties of the revised Developmental Coordination Disorder. Physical & Occupational Therapy in Pediatrics, 29, 182-202. https://doi.org/10.1080/ 01942630902784761 · DOI

Cited by

Sorted by citations

Authors
Su, W.-C., Cleffi, C., Srinivasan, S., & Bhat, A.
Affiliations
  • National Institutes of Health (US)
  • University of Delaware (US)
  • University of Connecticut (US)
Corresponding author
Bhat, Anjana
ORCID
Venue
American Journal of Occupational Therapy
Publisher
SAGE Publications
Published
2023-11
Volume
77
Issue
6
Pages
1125-1137
ISSN
  • 0272-9490 (ISSN-L)
  • 1943-7676
DOI
10.5014/ajot.2023.050282
PMC
PMC10846418
OpenAlex
W4389313136
Cited by
12
References
2
Citations by year
2026: 3 · 2025: 6 · 2024: 3
FWCI
1.80
Type
journal article
Language
en
Open access
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • American Journal of Occupational Therapy (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Library, Museums and Press - UDSpace (University of Delaware) (submittedVersion)
Funders
  • University of Connecticut
  • National Institute of General Medical Sciences (GM104941, P20GM103446, U54GM104941)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
Keywords
telemedicine, autism spectrum disorder, fine motor skills, social communication, videoconferencing, intervention fidelity, acceptability, feasibility, parental involvement, parental burden, technological barriers, children
MeSH terms
Autism Spectrum Disorder, Adolescent, Child, Child, Preschool, Communication, Feasibility Studies, Humans, Parents, Telemedicine

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