Parent Ratings of Generalized and Indirect Effects of Functional Communication Training for Children with Autism Spectrum Disorder

O’Brien and team asked parents to rate what happened after telehealth FCT. The families already finished the standard coaching sessions. No extra steps were added to make skills spread to new places.

Parents filled out short surveys about child behavior and their own stress. The study looked at both the problem behavior that was treated and other behaviors that were never directly worked on.

Parents said problem behavior dropped for the reasons that were treated. They also saw drops in behaviors that were never part of the plan.

Mom and dad stress went down too. These bonus changes are called generalized and indirect effects. They showed up even though the team did not add extra generalization drills.

Lindgren et al. (2020) ran an earlier RCT and saw a 98% drop in problem behavior after 12 weeks of telehealth FCT. O’Brien’s 2022 study lines up with that big effect and adds parent stress data.

Hall et al. (2020) tested the same telehealth model on boys with fragile X. They also found large behavior drops plus lower parent stress. The new study shows the same pattern happens in autism families.

Schieltz et al. (2022) repeated the protocol with 199 families around the world. Both papers found strong parent-rated gains, proving the result is not just a U.S. fluke.

Spackman et al. (2025) later used a quicker, progressive FA and still hit 80% behavior cuts. Their success supports O’Brien’s claim that telehealth FCT keeps working even when the front-end assessment is streamlined.

You can tell families that telehealth FCT often gives two-for-one benefits. The child’s main problem behavior shrinks, and other behaviors improve without extra sessions. Parent stress falls as well, so the whole house feels calmer. When you write goals, include parent well-being and watch for untargeted behavior drops during your normal data checks.