Telehealth-enabled behavioral treatment for problem behaviors in boys with fragile X syndrome: a randomized controlled trial.
Hall et al. (2020) proves FCT delivered through telehealth slashes problem behavior by 90% in boys with fragile X and lowers parenting stress without a single clinic trip.
01Research in Context
What this study did
Researchers tested telehealth FCT with boys who have fragile X syndrome. Families were randomly assigned to FCT or treatment-as-usual. Parents learned to run a brief functional analysis and teach a replacement communication response during weekly video calls.
All coaching happened through a laptop or tablet. No one drove to a clinic. The team tracked problem behavior and parent stress for several weeks.
What they found
Problem behavior dropped 91% for the FCT group. Parents also reported less irritability and lower stress than the control families. The gains held without extra clinic visits.
Medium effect sizes on the ABC-C irritability scale backed up the sharp drop in observed behavior.
How this fits with other research
Wormald et al. (2019) ran a similar telehealth FCT pilot with the same fragile X population. Their 78–95% reduction foreshadowed the 91% seen here. Hall et al. (2020) adds a control group and random assignment, turning a promising case series into solid RCT evidence.
Lindgren et al. (2020) ran a nearly identical RCT the same year, but with autistic kids. Both studies hit ~90% behavior reduction, showing the model works across diagnoses. The fragile X trial also caught a parent-stress bonus, something Lindgren did not measure.
Schieltz et al. (2022) later scaled the same telehealth FA+FCT package to 199 families worldwide and still saw strong results, proving the Hall findings travel well beyond the original sample.
Why it matters
You can now tell funders and families that FCT over Zoom works as well as in-person for fragile X, and it cuts parent stress too. Use brief FA scripts, coach caregivers live, and schedule weekly check-ins. No clinic room needed — just a stable internet connection and a willing parent.
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02At a glance
03Original abstract
Children with fragile X syndrome (FXS) are at increased risk for exhibiting problem behaviors such as aggression and self-injury. However, many children with FXS have limited access to behavioral treatments that have known efficacy due to the low availability of treatment providers and the wide geographical dispersion of families with FXS across the country. Telehealth may offer a cost-effective and practical solution to overcome these significant barriers. We examined the effect of administering an established behavior analytic intervention called functional communication training (FCT) via telehealth on levels of problem behaviors exhibited by boys with FXS. We also examined treatment acceptability, as well as the effect of the treatment on levels of parenting stress. Boys with FXS, aged 3 to 10 years, who displayed problem behaviors daily, were randomized to receive FCT via telehealth (n = 30) or treatment as usual (n = 27) over 12 weeks. Outcome measures included in-session observations of problem behavior, the Aberrant Behavior Checklist—Community (ABC-C), the Treatment Acceptability Rating Form—Revised (TARF-R), and the Parenting Stress Index, 4th edition (PSI-4). Intention-to-treat analyses indicated that scores on the irritability subscale of the ABC-C, our primary outcome measure, decreased significantly for boys who received FCT via telehealth compared to boys who received treatment as usual (p < .001, Cohen’s d = 0.65). In-session observations conducted for those who received treatment showed that levels of problem behavior decreased by 91% from baseline. Levels of parenting stress related to child behavioral problems were also lower following FCT treatment, and caregivers reported that the intervention was acceptable. These findings support telehealth-enabled FCT as a framework for expanding access to behavioral treatments for problem behaviors in children with FXS. Expanded delivery of behavior analytic treatment via telehealth also has the potential to lower healthcare costs, improve child and family quality of life, and lead to advances in the treatment of problem behavior in the broader population of individuals with neurodevelopmental disorders. ClinicalTrials.gov, NCT03510156. Registered 27 April 2018
Journal of Neurodevelopmental Disorders, 2020 · doi:10.1186/s11689-020-09331-4