Feasibility of Conducting FBA’s in the Schools with Web-Based Video Recording Technology

Purpose of Current Study:

  • To determine the efficacy of using web-based video recording technology to conduct functional behavioral assessments (FBA’s) in the schools for children with ASD or related disorders.
  • Explore the cost-benefit (i.e., time and money) of using Behavior Imaging for FBA’s in the schools when compared to archival records of FBA’s conducted in person (i.e., traditional approach).

View the entire ABAI poster: ABAI Poster – 5-6 ro highlgihts

Current Innovations

4888532947_535c5482aaThe ability to start autism screening and diagnosis the same day – which saves an average of 6 to 9 months in earlier diagnosis and earlier intervention – sets the child miles ahead in development. Telehealth holds this same promise for a huge array of health and behavior issues where time is of the essence.

It’s innovations like that which has won grants and the support of our sponsors.

Here are more features of our current technology that our sponsors and supporters value:

Visual Evidence – “Visual Behavior Specimens” – are a Game-changer

  • Video makes for rich, quality, informative data
  • Multiple reviews/assessments of one set of evidence – Multiple examiners
  • These factors lead to evidence-based practice and less subjective research, diagnosis, and care
  • Unlike observation, video can be stored, archived, and can be revisited later
  • This builds a research subject pool for scientists
  • We’re creating a registry of data, the world’s largest video pool of “Visual Behavior Specimens”

NODA- Naturalistic Observation Diagnostic Assessment

  • Quality of data capture based in natural environments using NODA for direct observation
  • Application to wide array of health and behavior applications from nursing transfer training to PTSD and Alzheimer’s intervention, to medication management

Technology Lowers Connection Barriers

  • Accessible and Portable to overcome 5 barriers – Time, Geography, Professional expertise, Cost, Communication
  • Flexibility among Dx systems; Ease of transfer for Dx results
  • Quickly switch between DSM4 and DSM5 – debates may rage on but the video data never change
  • Access to specialists improves quality and speed of diagnosis and care


Problems We’re Tackling

The Critical Need For Telehealth Research

5-31-2013-7-49-56-PM-150x150There is a pressing need for diagnostic and intervention services to support the rapidly growing population of children with Autism Spectrum Disorders (Autism and Developmental Disabilities Monitoring (ADDM) Network, 2009). Direct observation of the child remains the gold standard practice in diagnosis, assessment, and treatment planning for children with autism and related developmental disabilities (Filipek, Accardo, Barnek, Cook, Dawson, Gordon, et al.,1999; National Research Council, 2001; Ozonoff, Goodlin-Jones & Solomon, 2005). Moreover, the literature supports early screening to ensure that children are referred for diagnostic assessments sooner, and that timely evaluations of eligibility for services result in immediate implementation of appropriate early intervention (American Academy of Pediatrics Council on Children With Disabilities, 2007; Johnson, Myers).

Despite this literature, many rural communities that are also characterized by low socio-economic status (SES) are marked by lack of access to autism-specific expertise among professionals in mental health, primary care, and education (Belfer & Saxena, 2006; Marcin, Ellis, Mawis, et al., 2004; Nesbitt, Rogers, Rich, et al., 2006). Even in urban communities where services are more widely available, timely access to diagnostic and intervention services is often hampered by long waiting lists at centers focused on diagnosis and treatment (Hayden, 2011).

Telehealth Practices Promising and in Need of More Research

Despite gvlcsnap-2013-02-18-18h44m59s235-e1379549601825-150x150rowing recognition of the potential for telehealth to improve access to care for individuals with ASDs (Karp, Grigsby, McSwiggan-Hardin, Pursley-Crotteau, Adams, Bell, W., et al., 2000; Saint-André, Zalentein, Robin, & Lazartigues, 2011; Terry, 2009; Baharav & Reiser, 2010), few peer-reviewed evaluations of telehealth technologies applied to autism have been published (Boisvert, Lang, Andrianopoulus & Boscardin, 2010). Boisvert and colleagues (2010) found that 7 of the 8 studies reviewed reported successful implementation and positive outcomes of services delivered via telepractice. However, the total number of participants across these studies was extremely small (n=46), most lacked a true experimental design, and only a single study directly compared the effectiveness of services delivered via telepractice to the same services delivered in person.

The authors concluded that telepractice is a promising service delivery approach for individuals with ASD that warrants additional research, particularly with respect to technological requirements to support diagnostic protocols and intervention procedures, analysis of clinical efficacy and effectiveness, and cost-benefit analyses. Based on these identified areas of need, our system for approaching both diagnostic assessment and treatment planning will address these shortcomings and the effectiveness and efficacy of the system will be tested in two separate clinical settings using rigorous scientific methods.

Shortening Wait Lists, Providing Care to Remote Areas

vlcsnap-2013-04-23-12h17m29s122-150x150Asynchronous (store-and-forward) telehealth technology, such as our own Behavior Imaging technology, demonstrates how contextual video capture and a complementary online consultation platform effectively address the need for observation of the child by a professional who can make more timely clinical decisions regarding diagnosis and treatment. Beyond the potential for such technology to improve access to care for remotely located children (i.e., rural areas, military bases, etc.), it can also enable clinical centers around the country to shorten their wait-lists by facilitating more timely communication with families about the nature and range of the child’s symptoms and needs. There is great potential for enabling these centers to quickly gather initial clinical impressions of the child by reviewing videos collected by caregivers in the home, and then to more effectively triage cases into those that are clear cut and those that require more extensive in-person assessment.

In addition, the system allows for multiple raters to view evidence thus providing a format for documenting inter-rater reliability. In cases where raters are not in full agreement as to a specific diagnosis or plan for treatment, this system also allows for a third rater to view the evidence and weigh in on the decision. This capability further allows clinicians and educational professionals to make more informed decisions based on visual evidence.

Capturing Behavior in a Natural Setting for More Efficient and Accurate Assessments

Behavior Imaging technology facilitates clinical decisions based on child behaviors captured as they occur in natural settings. In contrast, the current practice of observing the child in a specialized room at a clinic may produce reactivity effects in the child, both those introduced by a novel environment and unfamiliar observer (Gardner, 2000; Kazdin, 1982). Moreover, for many interventions like those targeting challenging behaviors, a key component of treatment planning involves understanding the function of the behavior. However, the stimuli that evoke the behavior as well as consequences that maintain it in the natural environment may not be observed in an artificial setting like a clinic.

parentconcern_psd-e1379549490516-150x150Thus, Behavior Imaging technology allows for families and caregivers to capture not only the behavior, but what happened right before it (i.e., antecedent) and what happened right after (i.e., consequence). With this knowledge, practitioners are able to further understand potential triggers for problem behaviors and actions that may be maintaining its occurrence. Results of a multi-site (Oberleitner et al., 2007) user study identified a need for this technology in the process of behavior assessment, supporting teaching practices, increasing administrative support, and the ability to gain input from experts in the field.

Enabling Collaboration between Families and Professionals

Behavior Imaging technology will further enable collaboration and consultation between families and professionals through a secure health record application that allows users to store, share, and annotate captured video. Our long-term vision is that this telehealth system will to a great extent replace current practices to provide patients with diagnoses and treatment plans based on information that is collected in natural environments, and is thus more ecologically valid. At the same time, our system will make more efficient use of professionals’ time and reduce office visit times for patients and their families. By providing a format for collecting and analyzing visual evidence, both diagnosis and treatment efforts will translate into a streamlined approach that is ultimately more reliable and cost effective for practitioners and families.

Active Conference Schedule for 2015


International Autism Research Meeting 2015 (IMFAR) May 13 – May 16 at the Grand America Hotel in Salt Lake City, Utah. Behavior Imaging presentations include:

  • NODA-clinical-study-parent-feedback-IMFAR-poster-May2015Analysis of Parent Responses to Using a Remote Autism Diagnostic Assessment System (NODA): A remote autism diagnostic assessment system was designed through a series of research studies conducted with clinicians and parents of children with autism. Through In-home evaluation parents confirmed that capture system facilitated a simplified capture experience. Currently through a systematic study, diagnostic assessments conferred through the proposed system are being compared with in-person diagnostic assessments.

  • IMFAR 2015 NODA FinalComparing Remote Diagnosis of ASD (NODA) to In-Person Assessment: Study – To compare a novel telehealth approach to diagnosing ASD to the gold standard, in-person assessment. Conclusion to the study provided that raters can accurately diagnose ASD with NODA for most cases. A small percentage of participants, particularly high functioning children with few observable behaviors may require an IPA.

  • IMFAR Pharma Trial Poster, - 051112015NODA to Improve Pharmaceutical Trials: Study – To provide a method for centralized assessment of inter-rater reliability for key assessments in a multi-site pharmaceutical trial. Conclusion: Study demonstrated practicality and ease of the BI technology to facilitate and document inter-rater reliability in pharmaceutical trials. Study also provided that use of this platform can help to improve the integrity of data collected at sites in a more efficient manner than is currently applied.

CCSSO Council of Chief State School Officers: National Conference on Student Assessment (NCSA 2015) June 22 – 24, Manchester Grand Hyatt, San Diego, CA.

  • The primary objective of the NCSA is to promote sharing of information and best practices that will help states achieve their educational purposes through having the strongest assessment systems possible. This year the conference theme is “Implementing High-Quality Assessments for ALL Students.” The goal of the 2015 conference is to provide a forum for states to share the best practices, strategies, lessons learned, and available resources relative to their implementation of high-quality assessments for all students.

Association for Behavior Analysis International: 41st Annual Convention – San Antonio, TX (ABAI) Poster (Marcus Autism Center, Children’s Healthcare of Atlanta, Emory University School of Medicine, Center for Leadership and Disability, Behavior Imaging):

  • ABAI-Autism-Poster-SBIR-final111111Feasibility of Conducting FBA’s in the Schools with Web-Based Video Recording Technology: Purpose of Current Study: To determine the efficacy of using web-based video recording technology to conduct functional behavioral assessments (FBA’s) in the schools for children with ASD or related disorders, in addition to exploring the cost-benefit )i.e., time and money) of using telehealth for FBA’s in the schools when compared to archival records of FBA’s conducted in person (I.e., traditional approach). Download

Applied Human Factors and Ergonomics 2015 (AHFE):

  • Use of a Novel Imaging Technology for Remote Autism Diagnosis: Applied Human Factors and Ergonomics Conference 2015 (AHFE International)July 26th – 30th, Caesars Palace Hotel, Las Vegas, Nevada, USA. Prevalence of Autism Spectrum Disorder (ASD), in children in the United States has significantly increased form 1 in 150 in 2000 to 1 in 68 in 2010. While the cause of this neurodevelopmental condition is unknown, clinical evidence has shown that early diagnosis and early intervention are critical to improving the long term functioning of a child with ASD. However, a major challenge facing parents is difficulty in obtaining on-time access to appropriate diagnostic services. To address this need, an imaging technology, NODA ® (Naturalistic Observation Diagnostic Assessment), has been successfully developed and field-tested.


20th Annual Telemedicine Meeting & Trade Show (ATA 2015) May 2 – 5, Los Angeles, Booth # 1430.

  • Telemedicine for Autism Collaborators: Treatment – Behavior Connect is an online portal that enables health and education professionals and their organizations to remotely interact with clients, specialists and other staff members, while building a library of shareable assets and a continuous health record. Better manage your: Records (a video record annotated for assessment, communication between users/clients, Functional Behavior Analysis, training or second opinions), Therapy and In-office Visit Intervals, Treatment Options and Capacity, Treatment Gaps, & Remote Technology – Distance and Time Gaps.
  • Southwest Autism Research & Resource Center (SARRC) hosted its 17th Annual Community Breakfast “Take The Next Step” on Friday, April 24th, 2015 at the Arizona Biltmore’s Frank Lloyd Wright Ballroom. The goal of the Breakfast was to raise funds for SARRC’s outreach, education and research programs and inform individuals about autism, which is now the most prevalent children developmental disorder in the United States, affecting one in every 68 children born today.

SARRC Outreach Magazine (Spring 2015) NODA:

Use of Behavior Imaging Technology to Verify Inter-Rater Reliability in a Multi-Site Pharmaceutical Trial

A multi-site clinical trial, led by Principal Investigator Dr. James McCracken of UCLA, is designed to measure the effects of an investigational product to mitigate social disability Changes in social functioning will be measured through the use of structured assessments that are administered by trained raters.

Use of Behavior Imaging during this study should show “proof of principle” that Behavior Imaging can improve multi-site clinical trial methodology for variety of symptoms associated with various brain disorders.


Study Objectives

Assess the use of Behavior Imaging technology to enhance multi-site inter-rater reliability.

  • Provide on-going training for observers
  • Introduce observer reliability checks
  • Timely intervention in response to inadequate inter-rater reliability

Methods and Procedures

  • Experimental design
  • Four medical research institutions located throughout the US
  • Assessments based on Autism Diagnostic Observation Schedule (ADOS) and the Social Communication Interaction Test (SCIT)
  • Observer training based on pre-recorded video patient interviews


  • Scoring used the Behavior Imaging on-line platform
  • Results were automatically compared to “Gold Standard”
  • Discrepancies were identified and recommendations offered to observers
  • Observers were then required to repeat training until the “Gold Standard” was achieved

Results (work in progress)

  • All independent raters at four sites completed reliability checks using the ADOS and the SCIT
  • Patients’ observations were completed and recorded
  • All observers (raters) varied how they matched the “Gold Standard”

Behavior imaging used in clinical research for autism pharmaceutical trials shows promise to improve periodic autism assessments, inter-rater reliability and multi-site collaboration.


Recent Research Presentations and Conferences

Behavior Imaging’s main purpose is to develop solutions to facilitate the observational, analytical and collaborative needs of behavior health care and special education professionals. By enabling collaboration and consultation between patients and professionals through the use of video capture and a secure health record, clients like the Department of Defense, State Departments of Education, universities, and other behavior health service providers now have the ability to store, share and annotate video files as a means of increasing disabled people’s access to care via technology.

Innovative Technology Demonstration at IMFAR Autism Research Conference

Recently on May 16th, 2014 our clinical partners from Georgia Tech spoke at the International Meeting for Autism Research (IMFAR) about their research using Behavior Imaging via the iterative design of a system to support diagnostic assessments for autism using home videos. IMFAR is an annual conference by the International Society for Autism Research (INSAR) to provide ASD researchers from around the world with a focused opportunity to share the rapidly moving scientific investigation of ASD.

With the understanding that direct observation in the natural environment is the key in diagnosing ASD, clinical professionals agree that while such observations are crucial at obtaining accurate and comprehensive assessments, such observations are currently not feasible to implement into clinical practices on a larger scale.

Georgia Tech then spoke of their objective and partnership with Behavior Imaging to iteratively design a system that would enable parents to record video examples of their child’s behavior at home under the guidance of a clinician in order to share these recordings for the purpose of diagnosing autism. Included with this system is a set of reordered instructions embedded within the capture application that would help guide parents while maximizing the clinical utility of the recordings as well. Currently a study is being conducted in which families of children recently diagnosed with autism will use this system in their homes, under the guidance of a remotely-located clinician in order to complete a diagnostic checklist for autism, which will then be compared to the child’s current diagnosis.

Recent Presentation on Innovation and Technology

In addition, Behavior Imaging was also proud to speak as one of the leading experts in healthcare technologies innovation at the 12th Annual 2014 Front End of Innovation Conference that is the #1 industry event for provoking change, and exchanging best practices for real world, best-in-class presentations by true visionaries that are passionate about innovation and deliver measureable results.


Upcoming Research Presentations and Conferences

Highlighting the work of researchers from around the world, Behavior Imaging is excited to announce, and take part in the following upcoming presentations and conferences via autism case studies, research, and supporting evidence-based practices for the diagnosis and treatment of individuals with autism spectrum disorders (ASD).

ITASD 2014 Paris Conference: Digital Solutions for People with Autism

October 3rd – 4th, 2014
Paris, France

Autism Speaks is co-sponsoring the 2nd International Conference on Innovative Technologies for Autism (ITASD 2014), at the Pasteur Institute in Paris, October 3rd and 4th. This year’s conference will focus on developing and using digital tools to improve the lives of people with autism. The conference & workshop will bring together individuals with autism and their families with scientists, educators, therapists and other professionals to create an opportunity for dialogue and exchange of best practices.

Invited to talk, Gregory D. Abowd, a distinguished Professor in the School of Interactive Computing at Georgia Tech, will be speaking about the pilot evaluation of a novel telemedicine platform to support diagnostic assessment for autism spectrum disorders. The diagnostic assessment study research project combines the expertise of Behavior Imaging Solutions, Georgia Institute of Technology, and leading diagnostic and behavioral health organizations to make state-of-the-art technical innovations to the Behavior Imaging telehealth system, and will evaluate the enhanced system in two critical clinical settings affecting Autism Spectrum Disorders.

5th International Conference on Applied Human Factors and Ergonomics AHFE 2014

July 19th -23rd, 2014
Kraków, Poland

The conference’s objective is to provide an international forum for the dissemination and exchange of scientific information on theoretical, generic, and applied areas of ergonomics, including, physical ergonomics, cognitive ergonomics, social and occupational ergonomics, cross- cultural aspects of decision making, ergonomics modeling and usability evaluation, human digital modeling, healthcare and special populations, safety management and human factors, and human side of service engineering.

This year’s speakers will include Behavior Imaging’s, Ron Oberleitner, and Uwe Reischl, who will be discussing “Telehealth Technology Enabling Medication Management of Children with Autism”.

This discussion will cover assisting healthcare providers in the management of autism symptoms with a newly developed smartphone application that will allow physicians to observe a patient’s behavior between office visits while managing their medication based on the symptoms observed. This smartphone application is able to better assist the physician in monitoring patients with autism spectrum disorders more accurately compared to the subjective reports provided by caregivers during office visits.

Georgia Tech via Agata Rozga will present BI research on Naturalistic Observation Diagnostic Assessment to the CDC Prevention Research Branch: Learn the Signs Act Early

Agata Rozga is a research scientist in the School of Interactive Computing at Georgia Tech. As a Developmental Psychologist with a research focus on autism spectrum disorders, she specializes in early identification and diagnosis, socio-emotional development, and verbal and nonverbal communication. Her current research explores the potential role of human-centered computing and computer-human interaction in impacting research on the social and communicative development of children with diagnoses within the autism spectrum.

The CDC recognizes the importance of early recognition of developmental disabilities such as autism for parents and providers. By understanding the impact this has on families the CDC invested in a campaign: Baby Steps: Learn the Signs. Act Early, in order to provide parents with help measuring their children’s progress by monitoring how they play, learn, speak and act.


Telehealth technology is a tool that allows behavior professionals and others to make valuable observations, gather data, and propose more targeted, appropriate remediation for areas in which an individual with an autism spectrum disorder needs to progress. This tool can be used across natural settings of home, school, and community, and it has practical applications including use in classroom observation and Individualized Education Program (IEP) meetings. The capability of telehealth technology to serve children and families remotely means that parents of children in rural settings can receive more frequent and consistent services from a greater variety of professionals.

This chapter will look at:

-Defining telehealth and asynchronous telehealth for autism (Behavior Imaging® technology)

-How Behavior Imaging® can help professionals observe problem behaviors in the classroom

-How the results of observation via Behavior Imaging can aid at the Individualized Education Program (IEP) of a student with an autism spectrum disorder (ASD)

-How telehealth technology further helps IEP team members

-Case study via the ‘Beacon Day School project’

(Chapter in Cutting Edge Therapies for Autism (May, 2014); available at  www.autismone.org  )

Behavior Imaging Technology: The Beginning of a New Era for Autism Diagnosis and Assessment

Summary of “Behavior Imaging®’s Assessment Technology: A Mobile Infrastructure to Transform Autism Diagnosis and Treatment,” (2013), Oberleitner, R., Abowd, G., Suri, J. S. In  M. F. Casanova, A. S. El-Baz, and J. S. Suri, eds. Imaging the Brain in Autism, New York: Springer

Today’s medical community may be looking at a new era of better understanding and better care for individuals with autism, according to the authors of a chapter in Springer’s new book, Imaging the Brain in Autism. Since many children with Autism Spectrum Disorder (ASD) cannot explain their behavior or what triggers it, treatments often require lots of at-home or at-school observation. This can be costly, however, due to the time it takes to travel to a home, and it can also be ineffective if the child isn’t comfortable with the observer. New telehealth technology Behavior Capture resolves both of these issues through home-based cameras that upload recorded videos to an online platform.

And it isn’t just the ability to upload video that makes Behavior Capture so valuable. Through its comprehensive documentation system (called Behavior Connect), doctors and clients or caregivers can annotate videos, upload test results and medical histories, and record questions and comments, all on a secure HIPAA-compliant online program. Professionals are already seeing promising results in Australia, where they have connected rural families with doctors in Melbourne.

Behavior Capture and Behavior Connect technology is also going mobile with a growing suite of smartphone apps. Electronic imaging like this is still in its early stages, but the opportunities for faster, cheaper, and more accurate healthcare are both encouraging and exciting.

Positive Feedback from Clinicians and Researchers at Important Industry Conferences

Throughout this fall, Behavior Imaging has been kept busy with invitations to key conferences in psychiatry (AACAP), education assessment (CCSSO), and disability (AUCD). Principle investigators in ongoing studies on behavior imaging technology and Behavior Imaging executives have presented NIH-backed research, trained investigators, and received a prestigious innovation award while continuing to receive feedback and foster connections among industry researchers and professionals at each conference.