Revising Autism Interventions to Meet Demand, Improve Early Care

Summary of “Telehealth-based Systems for Diagnosis, Management and Treatment of Autism Spectrum Disorders: Challenges, Opportunities and Applications,” (2013), Angjellari-Dajci F., Lawless, W. F., Agarwal, N., Oberleitner, R.., Coleman, B., Warsi, S., and Kavoossi, M. In  I. M. Miranda and M. M. Cruz-Cunha eds. Handbook of Research on ICTs for Healthcare and Social Services: Developments and Applications, Hershey, PA: IGI

One out of every 110 American children has been diagnosed with Autism Spectrum Disorder (ASD), and the cost of caring for and treating ASD has risen to over 3 million dollars per person. Those are the numbers reported by authors of another chapter in IGI’s new book, Handbook of Research on ICTs for Healthcare and Social Services. With skyrocketing costs and ever-increasing demands, the current in-person delivery methods for ASD are understaffed and unable to handle the slew of problems currently facing the ASD community in America.

However, champions of new telehealth programs, including Behavior Imaging, say—and pilot studies appear to confirm—that telehealth diagnosis, treatment, and management of ASD have the potential to meet demand while also providing the effective early treatment that professionals have now realized is so important. Proponents of telehealth care for ASD argue that while the initial implementation of telehealth interventions could be costlier than in-person care, the long-term results would be more cost- effective, providing every family and individual with the accurate and early care they need.

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.

NIH Naturalistic Observation Diagnostic Assessment Project at AUCD

The Naturalistic Observation Diagnostic Assessment (NODA) from Behavior Imaging’s current NIH research project made an impact at the 2013 AUCD conference this month. SARRC’s Director of Research Dr. Christopher J. Smith presented on how NODA is designed to speed up autism diagnostic assessments. Behavior Imaging Solutions’ exhibit also allowed CEO Ron Oberleitner and others to talk about and demonstrate how Behavior Capture and Behavior Connect can revolutionize the way the disability community can diagnose, assess, and treat behavior disorders. The launch of Behavior Connect 2.0 and a suite of related smart phone apps have opened a lot of new opportunities for the behavioral health industry, including faster diagnosis and better oversight capabilities for supervisors.

Training Investigators and Expanding Our Apps’ Uses at the AACAP Annual Conference

Ron Oberleitner, CEO of Behavior Imaging Solutions, has been keeping busy attending several conferences this fall, including the 60th Annual Meeting of the American Academy of Child and Adolescent Psychiatry (AACAP) in Orlando, Florida late in October. At the conference, Ron and his team demonstrated our Med smartCapture App for dozens of doctors, researchers, and professionals and we were pleased to discover several new uses for this app. Some talked about its potential as a way doctors could stay connected with international or long-distance practices or research projects while others were interested in how it would help during pharmaceutical clinical trials. Most exciting, Ron and his team also trained investigators of a National Institute of Mental health-backed study on the use of Behavior Connect for another upcoming study using this technology.

Pharma Social Behavior Data in Home

The aim of this study is to customize SmartCapture, a mobile device app for caregivers to video capture social scenarios in natural environments, and share them with an expert clinician. We will conduct a feasibility study of using NODA (Natural Observational Diagnostic Assessment) SmartCapture, tailored to specifically measure elements of social behavior, to evaluate its ability to provide an accurate representation of social functioning.

Behavior Imaging Solutions will customize NODA to meet the needs of specific outcome measures of a research study. The system will guide families to capture ‘social situations’, compatible with the goals of the clinical trial targeting social behavior. For this study, one of our research partners, SARRC, will recruit will recruit adolescents with ASD and their caregivers. Participants will be asked to capture on video the adolescent participating in social interactions with parents, siblings or friends. Clinicians will view the videos online and then score the appropriate elements of social behavior. The results of these assessments will be compared results from structured informant based assessments conducted with a caregiver.

Some of the goals are:

  • Provide conclusions regarding the clinical value of having the added smartCapture information.
  • Study reception to technology, ease of use, and what type of video data gets shared via our modified system.
  • Show this ‘social disability’ sample data to related ‘social disability’ researchers, and learn if it is a recommended tool set for future FAST-ASD research.

Some of the broader implications are:

  • Improving the type and clarity of data that can be gathered while studying social scenarios.
  • Facilitating fast and secure transmission of study data.
  • Reducing subjectivity by adding visual evidence data to support existing methods of interview and description.

>> More to Come ….

Multi-Site Pharmaceutical Trial

A multi-site clinical trial, led by Principal Investigator (PI) 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. The variability in rater’s skill levels with these kinds of assessments administered at multiple sites can potentially mask a significant effect of the investigational product.

On HIPAA-conforming Behavior Connect-for Clinical Trials, the PI or designated clinicians at one site can watch the recorded assessment that took place at other sites, and then rate the behaviors observed during the assessment. This method of scoring will help to control for variability introduced by multiple raters with varying skills. As part of this clinical trial the Social Communication Interaction Test (SCIT) will be performed in examination rooms at 4 different sites around the country, Behavior Capture™ Online technology will automate the video images of these assessments to be securely uploaded to Behavior Connect for subsequent review by the PI to help him perform:

1. Inter-site Reliability checks
2. ease-of centralized scoring of primary assessments
3. Post hoc “microanalysis” of video’s assessments

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 Goals

The goals of this study are to Implement a System to Allow 4 Clinical Sites to Share Behavior Images to Improve Multi-site Operations of Ongoing Assessments:

a. Use of video capture technology in the proposed FAST-ASD Clinical Trial will require developing and implementing video capture technology in interview rooms with the ability of the clinician to control video enabling during the interview and to review and annotate video clips at a future time.

b. Support Principal Investigator(PI) and others regarding Security, Regulatory and Documentation Requirements for Behavior Connect 2.0 to have System compliant with IRB and other regulations

c. Ensure that each Clinical Site participant is able to use Behavior Capture to archive and securely share Assessment interactions via video capture

d. Customize Behavior Connect – Clinical Trials online Platform Customized for the Right Clinical UI Interface for PI to Interact with Clinicians at Multiple Sites, ‘Rate’ Video assessments in Behavior Connect, and other desired features he may want to improve project oversight

e. Maintain Technical and Client Support throughout FAST-ASD to ensure that platform can be accessed and used by authorized users identified by PI

f. Assess PI’s, Gold Standard Rater(s), and Remote Clinicians’ Perspective of use of Behavior Connect

g. Write Report re multiple stakeholders’ Strengths, Weaknesses, and Recommendations


School Behavior Assessment Study


The goal of this study is to evaluate the effectiveness and cost difference in using Behavior Imaging vs. traditional practices for evaluating children with special needs in the classroom, training teachers on interventions, and implementing behavior intervention plans.

Behavior Connect is an online portal that enables health and education professionals to remotely interact with students, specialists and other staff members via video, while building a secure library of shareable video and document assets and a continuous record.

The study will be conducted in collaboration with the Marcus Autism Center in Georgia, and will evaluate the use of the technology for assessment of student problem behavior and for assisting staff development – based on caregiver-captured video of child behavior or staff exercises in the classroom. The study will consist of at least 3-9 teachers and 15 students in at least 2-3 different schools, of which Marcus currently consults, that are furthest away from the Marcus experts. The experts at Marcus will use Behavior Connect 2.0, and a special Behavior Capture App in conjunction with the traditional practices in the assistance of said students and their teachers and gather data based on time spent, dollars spent, progress of each student, and teacher’s and Marcus experts’ evaluation of the product.


Diagnostic Assessment Study

Early Results

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. Invited to talk, Gregory D. Abowd of Georgia Tech, will speak about the pilot evaluation of hardware and software innovations to Behavior Capture and Behavior Connect for diagnostic assessment and its use in the two clinical studies.

Original Study Proposal

This research project will combine 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.

These technical innovations will significantly improve ease of deployment and Response to Intervention (RTI). The specific aims of the current project are:

(1) To introduce hardware and software innovations to Behavior Capture, with simplified video capture on commodity smartphones and novel interactive features

(2) To optimize clinicians’ workflow with Behavior Connect’s 2.0 telehealth custom modules for (autism) Diagnostic Assessment, and

(3) To conduct two clinical studies to demonstrate how the technology innovations impact clinical decision-making around diagnosing autism.

Study Sites

The first of these studies will be conducted in collaboration with the Autism Research Group at Georgia Tech – and this focus will be on the effectiveness of smartCapture to clinically guide a family remotely to collect and share behavior data in the home.

The second study will be conducted at the Southwest Autism Research & Resource Center (SARRC) in Arizona, and will evaluate the use of the technology to streamline the process of diagnosis for autism using Behavior Images (health-related video captures) recorded by parents in the home.



Doctor-Caregiver Med Management App

Thanks to Autism SpeaksBehavior Imaging Solutions announces the results of its research study funded by an Innovative Small Business grant from evaluating how doctors, patients and caregivers can utilize its Telehealth technology to better monitor the effectiveness of medications prescribed to individuals with autism. The research study involved the development and evaluation of a new mobile device app called Med SmartCapture.

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The results showed that caregivers who used the new Med SmartCapture app could avoid expensive and difficult (and therefore often postponed) follow-up appointments with their doctor and, instead, could submit recorded video data via the Behavior Connect platform. The participating doctors found that they could obtain necessary contextual information by requesting appropriate video data from the caregivers via the Behavior Connect online platform and the smartphone app. With such information, the doctors could successfully monitor and subsequently optimize their patient’s medication. Such a process normally involves numerous in- office visits.

Using the Med SmartCapture app, families in the research study were able to maintain a consistent and informative relationship with their prescribing doctor. With such positive results, Med SmartCapture gained the attention of several other professionals, including community medicine and public health professionals such as Uwe Reischl, PhD, MD, who concluded that “the Med SmartCapture technology can revolutionize the way people reach out to access healthcare services. The BIS technology can become a game-changer in telemedicine.”

Dr. Robert L. Hendren, D.O., Vice Chair and Director of the Autism and Neurodevelopment Program the UCSF Benioff Children’s Hospital, was equally impressed by the technology, saying, “I am very excited about what Med SmartCapture will be able to do for patient care and communication between parents, educators and providers so that we are all putting our integrated energies in the same direction to help the kids we are working with.”

Behavior Imaging Solutions provides an online HIPAA-conforming consultation platform (called Behavior Connect) where caregivers and doctors can upload and annotate video data of a child’s behavior, along with other medical records and notes. In this system, videos of behavior can be captured even after the fact thanks to Behavior Imaging’s time-buffering video capturing software. Med SmartCapture is yet another application for this internationally-used technology.

Learn about the Behavior Connect Platform and applications:

– Multiple Problems, One Innovative Solution
– Naturalistic Observational Diagnostic Assessment (NODA)
– Pharmaceutical Clinical Trials
– Clinical Staff Support, Training, Evaluation

USA Today Covers the Diagnostic Assessment Research

USA Today Covers the Diagnostic Assessment study to be initiated at SARRC later in 2013.