In the past few years, the use of telehealth services in the field of Applied Behavior Analysis (ABA) has grown substantially. Due to health concerns related to COVID-19 and social distancing recommendations, ABA providers now use telehealth more than ever to deliver services remotely. Telehealth allows practitioners to continue providing treatment to individuals and their families while following social distancing guidelines.
There are many benefits to providing behavior analytic-based services using telehealth. Not only can practitioners provide evidence-based interventions to individuals living in rural areas, but these services can be delivered in a more cost-effective way (Ingersoll & Berger, 2015). Other benefits noted by clinicians include quicker generalization of skills and the extension of behavioral education to family members and caregivers.
Research has shown the positive effects of using neurotypical peers to model appropriate behaviors across skills for individuals with Autism Spectrum Disorder (ASD). Jones & Schwartz (2004) suggest that siblings could potentially make ideal peer models due to shared social histories and the ability to model skills within the home. For many children with ASD, the first peer relationship is with a sibling. Neurotypical siblings can help parents manage behaviors of neurodiverse siblings and model social behaviors as well as functional skills (Angell et al., 2012). Using siblings in social skills interventions for children with ASD has proven successful. In one study, researchers taught neurotypical siblings ways to socially engage their siblings with ASD. These lessons included such things as establishing eye contact, initiating conversations, turn-taking, and offering help. The neurotypical siblings were able to effectively use these skills with their sibling with ASD and results showed increases in social interaction as well as joint attention, despite this skill not having been targeted (Tsao & Odem, 2006). Utilizing siblings to model appropriate behaviors is common practice in behavior analytic-based sessions. Sibling involvement during telehealth sessions should also be considered common practice.
In our experience since the world pandemic, we have included siblings during telehealth sessions more now than ever before. Siblings can be utilized in telehealth sessions similarly to how they can be utilized during in person behavior analytic-based sessions. Using siblings during telehealth sessions has been helpful in teaching a variety of social interaction skills. For instance, we have a neurotypical sibling serve as a communication partner for Picture Exchange Communication System (PECS) for their sibling with ASD. This sibling is also used as a model in gross motor imitation and following 1-step directions. As a result, we have witnessed quick and positive responses and interactions between siblings. We have also seen that access to certain siblings can serve as reinforcement during sessions.
Additionally, we have had success with involving neurotypical siblings in a program for teaching their sibling with ASD to accept no. The sibling with ASD was taught to respond to a nonverbal cue (thumbs up for yes and thumbs down for no) when approaching parents and siblings. If given a thumbs up, the sibling knew that the parent or sibling was available to interact at that time. If given a thumbs down, the sibling knew that the parent or sibling was not available to interact at that time. This program helped the sibling with ASD accept no while also providing siblings with ability to advocate for themselves and have a choice in whether they wanted to interact or play.
Telehealth sessions have provided opportunities to work with families who are traveling or on vacations, which can be stressful for individuals with ASD and oftentimes their parents and siblings as well. During a recent session with a family who was on vacation, our colleague could observe the client’s siblings playing nearby and the therapist prompted the client to ask what the sibling was playing. The sibling shared that he was writing scripts in order to record a video and then the therapist modeled how the client could ask to join the sibling. Following the lead of the therapist, the siblings joined activities, which led to the client and sibling writing scripts together, which in turn led to additional family members also joining in the imaginative screen writing session. In the end, the entire extended family participated in the activity and finished with an impromptu dance party!
Although we have observed success with utilizing siblings as peer models during telehealth sessions, more research is needed in this area. Given the growth of telehealth programming across the globe during the pandemic, we look forward to clinicians amassing data on the most effective strategies with telehealth service and sibling involvement.
Kelly Stafford, MS, BCBA, LBA, is a Behavior Analyst and Maria Gilmour, PhD, BCBA-D, LBA, is President of Wynne Solutions, LLC., For more information, email firstname.lastname@example.org and visit www.wynnesolutions.com.
Angell, M. E., Meadan, H., & Stoner, J. B. (2012). Experiences of Siblings of Individuals with Autism Spectrum Disorders. Autism Research and Treatment, 2012, 1-11.
Ingersoll, B., Berger, N. I. (2015). Parent Engagement with a Telehealth-Based Parent-Mediated Intervention Program for Children with Autism Spectrum Disorders: Predictors of Program Use and Parent Outcomes. Journal of Medical Internet Research, 17(10), e227.
Jones, C.D, Schwartz, I.S. (2004). Siblings, Peers, and Adults: Differential Effects of Models for Children with Autism. Topics in Early Childhood Special Education, 24 (4), 187-198.
Tsao, L.L., Odom, S.L. (2006). Sibling-Mediated Social Interaction for Young Children with Autism. Topics in Early Childhood Special Education, 26 (2), 106-123.