Randomized pilot evaluation of a virtual reality parent training program for severe behavior in children with autism

This federal Project Grant award of $426,234, provided by the National Institute of Child Health and Human Development (NICHD) under the Child Health and Human Development Extramural Research program (CFDA 93.865), aims to refine and test a novel virtual reality (VR) parent training tool for caregivers of children with autism spectrum disorder (ASD) who exhibit severe destructive behavior.

The key products and services to be delivered include: 1) Developing a customizable, in-home VR training tool that allows parents to learn and practice behavioral strategies for managing their child's challenging behavior; and 2) Assessing the acceptability, feasibility, and preliminary efficacy of the VR training tool through a randomized pilot trial with caregivers and clinicians. The project will evaluate factors such as skills acquired, treatment fidelity, training adherence, generalization of skills, usability, acceptability, and cost-effectiveness of the VR-based training compared to a standard in-person training control group. The award was made to Rowan University, a public research university in Glassboro, New Jersey, and the project will run from September 2024 through August 2027.

Abstract

Children with autism spectrum disorder (ASD) frequently engage in severe destructive behavior that presents significant risks to themselves and others, poses substantial barriers to community integration, and results in high familial and societal financial impact. Despite the efficacy of behavior analytic (BA) interventions for decreasing destructive behavior, to produce meaningful outcomes in the natural environment, treatment effects must transfer to natural change agents, such as parents. Parents are often provided with brief in-person training with therapists modeling and practicing procedures and relapse is common. Although parent training on BA interventions for destructive behavior leads to parent skill acquisition, parents experience in-person training barriers, such as time, financial burden, transportation, and childcare, as well as concerns with the quality of training delivered, such as unrealistic training with therapists and a lack of comfort with therapist practice. To address these barriers, we propose to refine and test a novel virtual reality (VR) parent training tool that allows parents to practice intervention implementation in the comfort of their own home at times convenient for their schedule and quality barriers by closely resembling scenarios parents encounter with their own child. Specific aims of this project are to 1) to pilot a fully customizable, in-home VR training tool for caregivers to learn and practice behavioral strategies for managing their child's challenging behavior, and 2) to assess the acceptability, feasibility, and preliminary efficacy of a VR training tool using a randomized pilot trial with caregivers and clinicians. In this proof-of-concept study, we will determine skills acquired, treatment fidelity, training adherence, generalization of skills, usability, acceptability, and cost effectiveness of the VR- based training compared to a standard of care control group who receives in-person training with a therapist. The program will be customized to match the specific child, specific target behaviors, context in which the behavior occurs, and specific treatment components. Parents will be exposed to a treatment challenge to prepare for the durability of children's destructive behavior. The proposed VR tool is individualized, realistic, flexible, safe, and has the potential to transform caregiver training programs for ASD, improve outcomes for children with ASD, and increase caregiver confidence, satisfaction, and well-being.