Comparing the Effectiveness of Discrete Trial Training Delivered via Telehealth and In-Person on Skill Acquisition

Introduction

The use of telehealth in behavior analysis has grown rapidly, especially since the COVID-19 pandemic. For children with Autism Spectrum Disorder (ASD), Early Intensive Behavioral Intervention (EIBI) is a crucial tool in skill development. A recent study by Lindgren, Higbee, Osos, Nichols, and Campbell (2024) directly compares the effectiveness of Discrete Trial Training (DTT) delivered via telehealth versus in-person instruction.

This blog post will break down the study’s findings, explain what DTT is, and explore the implications of using telehealth in applied behavior analysis (ABA) services.

What is Discrete Trial Training (DTT) and Early Intensive Behavioral Intervention (EIBI)?

Early Intensive Behavioral Intervention (EIBI)

EIBI is an evidence-based intervention for young children with ASD that focuses on structured teaching methods to enhance learning and skill acquisition. Key components of EIBI include:

• Individualized programming tailored to a child's strengths and needs.
• Data-driven decision-making to track progress.
• Structured teaching methods, including DTT, to help acquire skills like language, play, and social interactions.

Understanding Discrete Trial Training (DTT)

DTT is a structured teaching approach that breaks learning into small, manageable steps. Each trial within DTT consists of five key components:

1. Instruction (Discriminative Stimulus) – The instructor presents a clear direction or question.
2. Prompting – Assistance is provided if needed to ensure success.
3. Learner Response – The child attempts to complete the task.
4. Differential Consequence – Correct responses receive reinforcement, while incorrect ones lead to error correction.
5. Intertrial Interval – A brief pause before the next trial.

DTT has long been recognized as an effective method for teaching children with ASD essential skills.

The Role of Telehealth in Behavior Analysis

Telehealth has gained traction in ABA services due to its potential for increased accessibility and efficiency.

What is Telehealth?

Telehealth uses electronic communication (e.g., video conferencing and digital data collection) to provide services remotely. Telehealth can be synchronous (live sessions) or asynchronous (prerecorded material and feedback).

Benefits of Telehealth for ABA Services

1. Increases access to services, especially in underserved areas.
2. Provides opportunities for caregiver involvement through guided sessions.
3. Reduces costs associated with travel and in-person staffing.

Though initially used for caregiver training, direct telehealth-based intervention—where therapists conduct sessions remotely—is now receiving more attention.

Previous Research on Telehealth-Based DTT

Over the years, studies have examined the feasibility of telehealth in ABA practice. Several key findings include:

• Caregiver training via telehealth can be effective (Barretto et al., 2006; Lindgren et al., 2016).
• Direct implementation of DTT via telehealth has shown promise in small-scale studies (Ferguson et al., 2020; Nohelty et al., 2021).
• Knopp et al. (2023) conducted one of the first direct comparisons between telehealth and in-person DTT delivery, noting potential differences in learner performance.

The Study: Comparing Telehealth vs. In-Person DTT

Lindgren et al. (2024) aimed to directly compare how well children learned new skills via telehealth-based DTT versus traditional in-person instruction.

Study Design

• Participants: The study observed children with ASD receiving EIBI.
• Setting: Sessions were conducted either in-person or via live telehealth.
• Skills Targeted: Various new skills were taught using DTT procedures.
• Measures: Researchers tracked the number of trials required to acquire skills and the overall learning rate.

Key Findings

1. Skill acquisition was comparable between telehealth and in-person sessions.
2. Telehealth delivery did not significantly slow down learning.
3. Individual learner differences impacted performance, meaning some children adapted better to telehealth than others.

These results suggest that telehealth can be a viable option for providing DTT interventions.

Implications for Behavior Analysts

For behavior analysts considering telehealth as a service-delivery method, this research highlights important takeaways:

Advantages of Telehealth-Based DTT

• Broader access to ABA services for families in remote locations.
• Consistent intervention delivery, even when in-person options are unavailable.
• Potential for increased caregiver involvement during sessions.

Challenges to Consider

• Not all children respond equally well to remote instruction.
• Technological disruptions can impact the consistency of instruction.
• Caregiver involvement may be necessary for prompting and reinforcement.

Best Practices for Telehealth-Based DTT

• Ensure a stable internet connection and a distraction-free environment.
• Use clear, concise instructions to keep learners engaged.
• Maintain strong collaboration with caregivers for effective prompting and reinforcement.

Final Thoughts and Future Directions

Lindgren et al. (2024) provide valuable evidence supporting telehealth-based DTT as an effective alternative to in-person services. While telehealth may not be ideal for all learners, it can expand access to high-quality interventions when used effectively.

For clinicians, balancing telehealth and in-person services based on the individual needs of learners will be key. Future research can explore long-term outcomes and refine best practices for telehealth-based ABA interventions.

Want to Read the Full Study?

Check out the original research by Lindgren et al. (2024) in Behavior Analysis in Practice. Read it here.