Implementação Remota do Protocolo Equilíbrio para Prevenção de Comportamentos-Problema em Criança Autista
DOI:
https://doi.org/10.31505/rbtcc.v28i1.2163Keywords:
applied behavior analysis; caregiver-mediated intervention; autism spectrum disorder; Balance Protocol; problem behaviors.Abstract
Abstract
The Balance Protocol (BP) is a program aimed at caregivers to prevent problem behaviors in autistic children through the teaching of socially relevant skills. This case study evaluated the remote implementation of the BP in a 3-year-old child, using direct and indirect measures of observation of the child–caregiver dyad. The BP increased social skills, promoted balance between child-led and caregiver-led activities, and reduced non-cooperative behaviors, while improving name-response and tolerance. Parents socially validated the goals and procedures of the protocol, confirming its applicability. The results demonstrate the feasibility and importance of remote BP implementation, indicating its potential to contribute to health services, particularly public ones, and to expand the still limited literature on remote interventions for children with autism spectrum disorder and caregiver training.
Keywords: applied behavior analysis; caregiver-mediated intervention; autism spectrum disorder; Balance Protocol; problem behaviors
Downloads
References
American Psychiatric Association. (2023). Manual diagnóstico e estatístico de transtornos mentais: DSM-5-TR. Artmed.
Bagaiolo, L. F., Pacífico, C. R., Moya, A. C. C., Mizael, L. de F., Jesus, F. S., Zavitoski, M., & Asevedo, G. R. C. (2018). Capacitação parental para comunicação funcional e manejo de comportamentos disruptivos em indivíduos com transtorno do espectro. Cadernos de Pós-Graduação em Distúrbios do Desenvolvimento, 18(2), 46–64. https://doi.org/10.5935/cadernosdisturbios.v18n2p46-64 DOI: https://doi.org/10.5935/cadernosdisturbios.v18n2p46-64
Barboza, A. A., Silva, A. J. M., Barros, R. S., & Higbee, T. S. (2015). Efeitos de videomodelação instrucional sobre o desempenho de cuidadores na aplicação de programas de ensino a crianças diagnosticadas com autismo. Acta Comportamentalia, 23(4), 405–421. http://www.revistas.unam.mx/index.php/acom/article/view/53794/47889
Dallery, J., & Raiff, B. R. (2014). Optimizing behavioral health interventions with single-case designs: From development to dissemination. Translational Behavioral Medicine, 4(4), 343–353. https://doi.org/10.1007/s13142-014-0258-z
Guimarães, M. S. da S., Martins, T. E. M., Keuffer, S. I. C., Costa, M. R. C., Lobato, J. L., Silva, A. J. M., Souza, C. B. A., & Barros, R. S. (2018). Treino de cuidadores para manejo de comportamentos inadequados de crianças com transtorno do espectro do autismo. Revista Brasileira de Terapia Comportamental e Cognitiva, 20(3), 40–53. https://doi.org/10.31505/rbtcc.v20i3.1217
Hanley, G. P., Iwata, B. A., & Thompson, R. H. (2001). Reinforcement schedule thinning following treatment with functional communication training. Journal of Applied Behavior Analysis, 34(1), 17–38. https://doi.org/10.1901/jaba.2001.34-17
Hanley, G. P., Jin, C. S., Vanselow, N. R., & Hanratty, L. A. (2014). Producing meaningful improvements in problem behavior of children with autism via synthesized analyses and treatments. Journal of Applied Behavior Analysis, 47(1), 16–36. https://doi.org/10.1002/jaba.106
Horner, R. H., Carr, E. G., Strain, P. S., Todd, A. W., & Reed, H. K. (2002). Problem behavior interventions for young children with autism: A research synthesis. Journal of Autism and Developmental Disorders, 32(5), 423–446. https://doi.org/10.1023/a:1020593922901
Jang, J., Dixon, D. R., Tarbox, J., & Granpeesheh, D. (2011). Symptom severity and challenging behavior in children with ASD. Research in Autism Spectrum Disorders, 5(3), 1028–1032. https://doi.org/10.1016/j.rasd.2010.11.008
Kokkinos, C. M., & Kargiotidis, A. (2016). Rating students’ problem behaviour: The role of teachers’ individual characteristics. Educational Psychology, 36(8), 1516–1532. https://doi.org/10.1080/01443410.2014.993929
Lindgren, S., Wacker, D. P., Suess, A. N., Schieltz, K. M., Pelzel, K. E., Kopelman, T. G., Lee, J. F., Romani, P., & Waldron, D. B. (2016). Telehealth and autism: Treating challenging behavior at lower cost. Pediatrics, 137(Supplement 2), S167–S175. https://doi.org/10.1542/peds.2015-2851O
Losapio, M. F., Silva, L. G., Pondé, M. P., Novaes, C. M., Santos, D. N., Argollo, N., Oliveira, I. M. S., & Brasil, H. H. A. (2011). Adaptação transcultural parcial da Escala Aberrant Behavior Checklist (ABC) para avaliar eficácia de tratamento em pacientes com retardo mental. Cadernos de Saúde Pública, 27(5), 909–923. https://doi.org/10.1590/s0102-311x2011000500008
Organização Mundial da Saúde. (2013). Autism spectrum disorders & other developmental disorders: From raising awareness to building capacity. https://apps.who.int/iris/handle/10665/103312
Pollard, J. S., LeBlanc, L. A., Griffin, C. A., & Baker, J. M. (2020). The effects of transition to technician-delivered telehealth ABA treatment during the COVID-19 crisis: A preliminary analysis. Journal of Applied Behavior Analysis, 54(1), 87–102. https://doi.org/10.1002/jaba.803
Ruppel, K. W., Hanley, G. P., Landa, R. K., & Rajamaran, A. (2021). An evaluation of “Balance”: A home-based, parent-implemented program addressing emerging problem behavior. Behavior Analysis in Practice, 14(2), 324–341. https://doi.org/10.1007/s40617-020-00490-3
Sella, A. C., & Ribeiro, D. M. (Orgs.) (2024). Análise do comportamento aplicada ao transtorno do espectro autista (2ª ed.). Appris.
Barboza, A. A., Silva, A. J. M., Barros, R. S., & Higbee, T. S. (2015). Efeitos de videomodelação instrucional sobre o desempenho de cuidadores na aplicação de programas de ensino a crianças diagnosticadas com autismo. Acta Comportamentalia, 23(4), 405–421. http://www.revistas.unam.mx/index.php/acom/article/view/53794/47889 DOI: https://doi.org/10.32870/ac.v23i4.53794
Dallery, J., & Raiff, B. R. (2014). Optimizing behavioral health interventions with single-case designs: From development to dissemination. Translational Behavioral Medicine, 4(4), 343–353. https://doi.org/10.1007/s13142-014-0258-z DOI: https://doi.org/10.1007/s13142-014-0258-z
Guimarães, M. S. da S., Martins, T. E. M., Keuffer, S. I. C., Costa, M. R. C., Lobato, J. L., Silva, A. J. M., Souza, C. B. A., & Barros, R. S. (2018). Treino de cuidadores para manejo de comportamentos inadequados de crianças com transtorno do espectro do autismo. Revista Brasileira de Terapia Comportamental e Cognitiva, 20(3), 40–53. https://doi.org/10.31505/rbtcc.v20i3.1217 DOI: https://doi.org/10.31505/rbtcc.v20i3.1217
Hanley, G. P., Iwata, B. A., & Thompson, R. H. (2001). Reinforcement schedule thinning following treatment with functional communication training. Journal of Applied Behavior Analysis, 34(1), 17–38. https://doi.org/10.1901/jaba.2001.34-17 DOI: https://doi.org/10.1901/jaba.2001.34-17
Hanley, G. P., Jin, C. S., Vanselow, N. R., & Hanratty, L. A. (2014). Producing meaningful improvements in problem behavior of children with autism via synthesized analyses and treatments. Journal of Applied Behavior Analysis, 47(1), 16–36. https://doi.org/10.1002/jaba.106 DOI: https://doi.org/10.1002/jaba.106
Horner, R. H., Carr, E. G., Strain, P. S., Todd, A. W., & Reed, H. K. (2002). Problem behavior interventions for young children with autism: A research synthesis. Journal of Autism and Developmental Disorders, 32(5), 423–446. https://doi.org/10.1023/a:1020593922901 DOI: https://doi.org/10.1023/A:1020593922901
Jang, J., Dixon, D. R., Tarbox, J., & Granpeesheh, D. (2011). Symptom severity and challenging behavior in children with ASD. Research in Autism Spectrum Disorders, 5(3), 1028–1032. https://doi.org/10.1016/j.rasd.2010.11.008 DOI: https://doi.org/10.1016/j.rasd.2010.11.008
Kokkinos, C. M., & Kargiotidis, A. (2016). Rating students’ problem behaviour: The role of teachers’ individual characteristics. Educational Psychology, 36(8), 1516–1532. https://doi.org/10.1080/01443410.2014.993929 DOI: https://doi.org/10.1080/01443410.2014.993929
Lindgren, S., Wacker, D. P., Suess, A. N., Schieltz, K. M., Pelzel, K. E., Kopelman, T. G., Lee, J. F., Romani, P., & Waldron, D. B. (2016). Telehealth and autism: Treating challenging behavior at lower cost. Pediatrics, 137(Supplement 2), S167–S175. https://doi.org/10.1542/peds.2015-2851O DOI: https://doi.org/10.1542/peds.2015-2851O
Losapio, M. F., Silva, L. G., Pondé, M. P., Novaes, C. M., Santos, D. N., Argollo, N., Oliveira, I. M. S., & Brasil, H. H. A. (2011). Adaptação transcultural parcial da Escala Aberrant Behavior Checklist (ABC) para avaliar eficácia de tratamento em pacientes com retardo mental. Cadernos de Saúde Pública, 27(5), 909–923. https://doi.org/10.1590/s0102-311x2011000500008 DOI: https://doi.org/10.1590/S0102-311X2011000500009
Organização Mundial da Saúde. (2013). Autism spectrum disorders & other developmental disorders: From raising awareness to building capacity. https://apps.who.int/iris/handle/10665/103312
Pollard, J. S., LeBlanc, L. A., Griffin, C. A., & Baker, J. M. (2020). The effects of transition to technician-delivered telehealth ABA treatment during the COVID-19 crisis: A preliminary analysis. Journal of Applied Behavior Analysis, 54(1), 87–102. https://doi.org/10.1002/jaba.803 DOI: https://doi.org/10.1002/jaba.803
Ruppel, K. W., Hanley, G. P., Landa, R. K., & Rajamaran, A. (2021). An evaluation of “Balance”: A home-based, parent-implemented program addressing emerging problem behavior. Behavior Analysis in Practice, 14(2), 324–341. https://doi.org/10.1007/s40617-020-00490-3 DOI: https://doi.org/10.1007/s40617-020-00490-3
Sella, A. C., & Ribeiro, D. M. (Orgs.) (2024). Análise do comportamento aplicada ao transtorno do espectro autista (2ª ed.). Appris.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Brazilian Journal of Behavioral and Cognitive Therapy
This work is licensed under a Creative Commons Attribution 4.0 International License.
The Brazilian Journal of Cognitive and Behavioral Therapy own the copyright of all articles published by it. The reproduction of articles in this journal in other publications, or for any other purpose, by any other means, requires permission from the Editor.
Pre-Print, Accepted Manuscript, and Final Published Version Archiving, Sharing and Re-Use Policy
The authors’ contribution to RBTCC has three versions, which are defined below and can be archived, shared, and re-used under the following conditions:
1. A pre-print (or original submission) is the author’s version of the article before peer-review has taken place. Prior to acceptance for publication, author(s) retain the right to make a Pre-Print of their article available: on their own personal, self-maintained website; or on a legally compliant pre-print server (e.g., PsyArXiv, arXiv). Once the article has been published, the author(s) should update their acknowledgement and provide a link to the definitive version on RBTCC’s website, adding a text such as: “This is a pre-print of an article published in the Brazilian Journal of Behavioral and Cognitive Therapy. The final authenticated version is available online at: https://doi.org/[insert DOI]”. RBTCC encourages posting of preprints of manuscripts on preprint servers, authors’ or institutional websites, and open communications between researchers whether on community preprint servers or preprint commenting platforms. Posting of preprints is not considered prior publication and will not jeopardize consideration from RBTCC. Authors should disclose details of preprint posting - including DOI and licensing terms - upon submission of the manuscript or at any other point during consideration at RBTCC publication process.
2. An accepted manuscript is the version accepted for publication in RBTCC following peer review but prior to copyediting and typesetting that can be made available under the following conditions:
(i) on their own personal, self-maintained website immediately on acceptance,
(ii) for public release, 12 months after first publication (i.e., "Embargo Period"), on any of the following: their employer’s internal website; their institutional and/or funder repositories. Accepted manuscripts may also be deposited in such repositories immediately on acceptance, provided that they are not made publicly available until after the Embargo Period.
An acknowledgement in the following form should be included with a link to the published version on the publisher’s website: “This is a post-peer-review, pre-copyedit version of an article published in the Brazilian Journal of Behavioral and Cognitive Therapy. The final authenticated version is available online at: http://dx.doi.org/[insert DOI]”.
3. The final published (PDF) version is the copy-edited and typeset RBTCC’s PDF, the same version published on the journal’s website. It can be archived in institutional or funder repositories and can be made publicly accessible immediately.
Any re-use terms for users of websites and repositories (where your pre-print or accepted manuscript are posted) are restricted to non-commercial and no derivative uses.
The authors may not republish or translate any version of their contribution in another journal without prior permission from RBTCC’s Editor-in-Chief.
