The RUBI Parent Training for Disruptive Behavior in a Child with Electrical Status Epilepticus in Sleep (ESES): A Case Report.
RUBI parent training delivered on Zoom cut disruptive behavior for a child with both autism and the rare ESES seizure pattern.
01Research in Context
What this study did
One family received the full RUBI Autism Network Parent Training program through Zoom. The child had autism, ADHD, intellectual disability, and a rare seizure pattern called ESES. Fifteen weekly telehealth sessions taught the parents strategies like differential reinforcement and clear instructions.
What they found
Parents reported fewer meltdowns and more daily living skills after the last session. The child still had ESES, but the behavior gains stayed. No extra medicines were added.
How this fits with other research
Wilson et al. (2023) also ran parent training fully online and saw quick child gains in tacting. Both studies show telehealth works for autism, even when the lessons differ.
Conklin et al. (2019) taught caregivers to use differential reinforcement in person and hit 96% fidelity. Jellinek et al. matched the behavior drop through a screen, so remote delivery can equal face-to-face BST.
Cameron et al. (1996) found behavior plans alone cut disruptive acts as well as methylphenidate. The new case keeps the “behavior first” rule while adding the rare ESES diagnosis, stretching the same principle to a tougher medical mix.
Why it matters
You can offer RUBI-PT through telehealth even when families face complex seizures. Start with the 11 core RUBI lessons, coach parents on differential reinforcement, and track behavior weekly. If gains stall, add brief booster calls instead of extra meds.
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02At a glance
03Original abstract
Children with electrical status epilepticus in sleep (ESES) often present with cognitive deficits and behavioral difficulties. Children that present with autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), intellectual disability, and ESES would be expected to manifest more complex symptoms and increased behavioral difficulties given the nature of these disorders. Despite the complex presentation, there is little research to support effective treatments that manage behavior challenges and associated symptoms of ASD in such patients. In the present case report, the authors implemented a validated parent management training intervention, The Research Unit on Behavioral Interventions (RUBI) Autism Network Parent Training program (RUBI-PT) via telemedicine to manage symptoms of ADHD, ASD, and disruptive behaviors in an 8-year-old South-Asian boy with ESES and associated mild intellectual disability. The family participated in 15 RUBI-PT sessions over 22 weeks. Parent report and ratings using the clinical global impression, improvement scale (CGI-I) indicated reductions in challenging behavior and improvement in adaptive skills. The current case report demonstrates the utility of RUBI-PT in the treatment of behavioral difficulties in a patient with ASD, ADHD, and ESES. Further, the present study explores future directions for the use of RUBI-PT to address behavioral challenges associated with ESES and commonly co-occurring conditions and highlights the importance of cultural responsive practice in the context of parent management training.
Journal of Clinical Psychology in Medical Settings, 2023 · doi:10.1007/s10880-023-09949-1