Smart Technology to Empower Collaborative Partnerships Among Behavior Practitioners and Caregivers to Deliver Quality ABA

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This project addresses a key NIH mission to ameliorate intellectual and developmental disabilities (IDD) by developing and applying smart technologies for the treatment of children with Autism Spectrum Disorder (ASD). Care for ASD will cost U.S. citizens $461 billion annually by 2025, exceeding yearly care costs for diabetes, ADHD, and stroke. Increasing availability to high-quality Applied Behavior Analysis (ABA), the most effective and scientifically-validated approach to remediate impairments associated with ASD, could reduce these costs. Best practices call for at least 25 hours per week of high-quality ABA, however, most children receive less than 10 hours per week due to provider shortage and costs. This project leverages smart technology (GAINS) to empower caregivers of children with ASD to become active, collaborative partners with behavior practitioners in their children’s ABA therapy, bridging gaps left by insufficient access to therapy and limited availability of behavior practitioners, which especially affects marginalized communities. GAINS is a smart technology platform that uniquely incorporates knowledge of ABA theory and practice personalized for the individual with developmental challenges. In a similar way to navigation systems for drivers, GAINS is a unique navigation system for instructors and caregivers implementing ABA therapy programs that help learners acquire skills and improve prosocial behaviors. Innovations to GAINS will further enhance collaborative partnerships by empowering caregivers to be more effective eyes and ears of behavior practitioners and providing caregiver-appropriate reporting so caregivers can more easily understand the progress and needs of their children to achieve a mutual understanding with behavior practitioners. Clinical evaluation of the efficacy of smart technology to empower caregivers to teach their children with ASD and related disorders life skills will be evaluated: 1) Does GAINS improve child independent life skill performance when used by a caregiver? 2) Is GAINS guidance sufficient for caregivers to teach life skills to children? 3) Is GAINS useful and usable for teaching life skills? Research design. Single Case Research Designs (SCRDs) using changing criterion (CC). This allows rigorous experimental evaluation of intervention effects and provides a strong basis for establishing causal inferences. Power analysis using pilot data requires a minimum of 8 dyads, but 12 will be recruited. Participants: Dyads (child with ASD and a caregiver) recruited from clinical sites in three U.S. states (2 of 3 rural, underserved populations). Setting: family homes. Independent Variable: GAINS expert guiding technology to support teaching life skills using task analysis, chaining, and prompting. Primary Outcome: child independent life skill performance percentage (at least 8 of 12 children reach at least 90% independent performance with GAINS). Secondary Outcomes: Procedural fidelity; perceived usability and usefulness of the technology; social validity survey related to the goals, procedures, and caregiver effort/child results; and caregiver frequency and duration of GAINS use.