Introduction: The Autism Diagnostic Observation Schedule (ADOS) Module 4 is an autism assessment designed for verbally fluent adolescents and adults. Because of a shortage of available clinical expertise, it can be difficult for adults to receive a proper autism spectrum disorder (ASD) diagnostic assessment. A potential option to address this shortage is remote assessment. The objective of this study was to examine the feasibility, usability, and reliability of administering the ADOS Module 4 remotely using the Versatile and Integrated System for Telerehabilitation (VISYTER). Materials and Methods: VISYTER consists of computer stations at the client site and clinician site for video communication and a Web portal for managing and coordinating the assessment process. Twenty-three adults with an ASD diagnosis participated in a within-subject crossover design study in which both a remote ADOS and a face-to-face ADOS were administered. After completing the remote ADOS, participants completed a satisfaction survey. Results: Participant satisfaction with the remote ADOS delivery system was high. The kappa value was greater than 0.61 on 21 of 31 ADOS items. There was substantial agreement on ADOS classification (i.e., diagnosis) between assessments delivered face-to-face versus assessments delivered remotely (interclass coefficient = 0.92). Nonagreement may have been due to outside factors or practice effect despite a washout period. Conclusions: The results of this study demonstrate that an autism assessment designed to be delivered face to face can be administered remotely using an integrated Web-based system with high levels of usability and reliability.
With the rising prevalence of patients with autism spectrum disorder (ASD), there has been an increase in the acute presentation of these individuals to the general health care system. Emergency medical services and emergency department personnel commonly address the health care needs of patients with ASD at times of crisis. Unfortunately, there is little education provided to front-line emergency medical technicians, paramedics and emergency nurses on the characteristics of ASD and how these characteristics can create challenges for individuals with ASD and their health care providers in the pre-hospital and emergency department settings. This paper describes the development of educational materials on ASD and the results of training of emergency medical services and emergency department personnel.
In experimental designs requiring the administration of more than one treatment to the same subject(s), the effect of one treatment may be influenced by the effect of another treatment (Campbell & Stanley, 1963), a phenomenon known as multiple treatment interference. We conducted two studies in which multiple treatment interference in an alternating treatments design was shown to be a function of the length of the intercomponent interval (ICI) separating treatment conditions. In the first study, we evaluated the effects of four different treatments on the mouthing of a severely retarded boy. Under a 1-min ICI no consistent differential responding to treatment was obtained. Differential responding emerged when the ICI was increased from 1 min to 120 min, thus suggesting multiple treatment interference in the lack of differential responding under a 1-min changeover interval. Functional control of the nondifferential and differential responding as a function of the ICI length was replicated in a reversal phase. In the second study, we compared two treatment procedures for the disruptive noncompliant behavior of a moderately retarded boy. Multiple treatment interference (i.e., the lack of differential responding) occurred with the 1-min intercomponent interval. An increase to a 120-min ICI again resulted in differential responding. A replication of multiple treatment interference by a reversal to a short interval phase was not achieved in the second subject. Results of this study support much of the basic literature on discrimination and multiple treatment interference. Major findings of this study are twofold: Multiple treatment interference can depend on the length of the changeover interval between treatments and multiple treatment interference can take the form of a lack of differential responding to various treatments. Implications for future research are discussed.
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