TeleABA for Hospitalized Adolescents and Young Adults With Autism Spectrum Disorder

Adolescents and young adults with autism spectrum disorder (ASD) who require psychiatric hospitalization because of severe challenging behaviors often have complex behavioral support needs that may not be fully addressed through standard inpatient care alone. Behavioral crises during hospitalization can contribute to prolonged length of stay, increased use of restrictive interventions, caregiver distress, and challenges during the transition from hospital to home.

This randomized controlled trial will evaluate whether adding a Telehealth Applied Behavior Analysis (TeleABA) intervention to standard inpatient behavioral health care improves clinical, caregiver, and hospital outcomes compared with standard hospital care alone.

Participants will be randomly assigned in a 1:1 ratio to receive either standard hospital care or standard hospital care plus TeleABA. Standard hospital care includes routine inpatient behavioral health services provided by the treating hospital, including psychiatric evaluation, medication management, nursing care, therapeutic programming, and discharge planning.

The TeleABA intervention is delivered by a Board Certified Behavior Analyst (BCBA) and includes caregiver interviews, behavioral assessment, functional assessment when indicated, individualized behavior support recommendations, consultation and coaching for hospital staff, caregiver training, discharge planning, and four weekly telehealth caregiver coaching sessions following hospital discharge to support implementation of behavior support strategies and continuity of care.

The primary outcome is change in irritability measured using the Aberrant Behavior Checklist-Irritability (ABC-I). Secondary outcomes include clinician-rated improvement and severity, hospital length of stay, use of restrictive interventions, caregiver transition outcomes, and family perceptions of care. Assessments will be conducted during hospitalization and through 6 weeks after hospital discharge.

Inclusion criteria

• Age 12 years or older.
• Established or documented diagnosis of autism spectrum disorder (ASD) in the electronic medical record or confirmed by the attending provider using DSM-5 criteria.
• Admitted to a participating Hackensack Meridian Health hospital due to behavioral concerns (e.g., aggression, self-injury, elopement, or property destruction) that contribute to or prolong hospitalization.
• Behavioral support identified by the attending provider as a primary component of the current admission.
• Caregiver or legally authorized representative (LAR) able to provide informed consent.
• Patient assent obtained when applicable.
• Voluntary, court-mandated, and ward-of-the-state admissions are eligible.

Exclusion criteria

• Admission for an acute medical condition in which behavioral concerns are not a primary driver of hospitalization.
• Medical instability that precludes participation in telehealth sessions.
• Absence of a caregiver or legally authorized representative able to provide informed consent.