Telehealth Versus In-Person Caregiver-Mediated Behavioral Treatment for Challenging Behaviors in Children With Autism Spectrum Disorder: Protocol for COACH (Caregiver Outreach for Autism Coaching at Home) Randomized Controlled Trial

Approximately 40%-60% of children diagnosed with autism spectrum disorder (ASD) exhibit challenging behaviors such as aggression, elopement, self-injury, and property destruction that can endanger the health and safety of the child or others, often cause significant distress for families, and hinder the child's developmental progress. Although behavioral treatments grounded in the principles of applied behavior analysis have been shown to effectively reduce or eliminate these behaviors, significant gaps remain in how to deliver these interventions equitably.

This study aims to compare the efficacy of delivering in-person versus telehealth caregiver-mediated behavioral treatment for challenging behaviors in children with ASD.

The Caregiver Outreach for Autism Coaching at Home trial is a single-site, multiarm, parallel-group randomized controlled trial to evaluate the efficacy of delivering caregiver-mediated behavioral treatment for children with ASD who exhibit challenging behaviors. We aim to recruit 90 caregiver-child dyads with children with ASD aged 2 years, 0 months to 7 years, 11 months from metropolitan, suburban, and rural areas across New Mexico and the neighboring El Paso, Texas region. Following a practical functional assessment to identify the potential social-environmental variables maintaining the child's challenging behavior, caregiver-child dyads will be randomized into one of three parallel treatment arms: (1) caregiver-mediated behavioral treatment delivered via telehealth, (2) caregiver-mediated behavioral treatment delivered in person, or (3) caregiver online psychoeducation. Interventions will be delivered by clinicians in weekly 1-hour sessions in the home setting over 12 weeks.

The study was funded in May 2022, and recruitment began in January 2024. As of March 2026, 81 caregiver-child dyads have been enrolled, with equal allocation across the 3 study groups (27 per group). Recruitment is expected to conclude in October 2026, with data analysis planned for Winter 2026 through Spring 2027.

This study will address a critical gap in the scientific literature on scalable, family-centered approaches to safely and effectively reduce challenging behavior in children with ASD and decrease caregiver stress. Findings may inform best practices and payer policy for telehealth-delivered behavioral interventions targeting child safety and caregiver well-being.