Early Identification of ASD Through Telemedicine: Potential Value for Underserved Populations

Abstract

Increasing access to diagnostic services is crucial for identifying ASD in young children. We therefore evaluated a telemedicine assessment procedure. First, we compared telediagnostic accuracy to blinded gold-standard evaluations (n = 20). ASD cases identified via telemedicine were confirmed by in-person evaluation. However, 20% of children diagnosed with ASD in-person were not diagnosed via telemedicine. Second, we evaluated telediagnostic feasibility and acceptability in a rural catchment. Children (n = 45) and caregivers completed the telemedicine procedure and provided feedback. Families indicated high levels of satisfaction. Remote diagnostic clinicians diagnosed 62% of children with ASD, but did not feel capable of ruling-in or out ASD in 13% of cases. Findings support preliminary feasibility, accuracy, and clinical utility of telemedicine-based assessment of ASD for young children.

Use of the TELE-ASD-PEDS for Autism Evaluations in Response to COVID-19: Preliminary Outcomes and Clinician Acceptability

“…In addition to benefits of tele-assessment, providers identified several key barriers, with all providers endorsing technology-related challenges in their tele-assessment visits. This is a finding consistent with prior research on telehealth-delivered services (Juárez et al 2018 ). Families were unfamiliar with the required technology (software requirements, apps) and often had difficulty navigating the EMR system to begin the visit or access their evaluation reports.…”

“…Though feasibility and acceptability are important first steps, rigorous empirical evaluation on the accuracy and effectiveness of these innovative methods is critical. Prior work has demonstrated that many young children with ASD can be accurately identified using clinic-based tele-assessment procedures (Juárez et al 2018 ), but it is unclear how diagnostic accuracy varies within direct-to-home care. With regards to the TELE-ASD-PEDS, there is currently a large study underway examining the psychometric properties of the tool relative to traditional, gold-standard evaluations (1R21MH118539-01), and initial data support the diagnostic accuracy of the TELE-ASD-PEDS when implemented in a laboratory setting (Corona et al 2020b ).…”

“…One promising avenue for increasing access to early ASD assessment is telemedicine-based evaluation (Corona et al 2020b ; Juárez et al 2018 ). Most existing work regarding tele-assessment of ASD relies upon having a trained provider present with the family in one location, while a remote psychologist converses with the family and observes the child’s behavior (Juárez et al 2018 ; Stainbrook et al 2019 ). Additional preliminary work has explored tools for caregiver-mediated tele-assessment, in which caregivers complete assessment activities with their child, while being coached by a remote provider (Corona et al 2020b ).…”

COVID‐19 and Autism Research: Perspectives from Around the Globe

“…Domenech Rodríguez, 2009;Juárez et al, 2018;Kaonga & Morgan, 2019;Langdon, 2009;Stahmer et al, 2019].…”

“…Multiple cultural, linguistic, and socioeconomic factors affect when and if individuals in Spanish-speaking households access quality ASD care, including: differences in parenting views, availability of Spanish-speaking providers, transportation or employment challenges, access to information about ASD, and health insurance coverage [Stahmer et al, 2019]. Telehealth models for ASD offer promising solutions for closing the gap faced by Latino families, gaps that are now intensified by COVID-19 [Juárez et al, 2018]. As more professionals adopt telehealth, the research community has an opportunity to strengthen this tool for Latino families of children and adults with ASD.…”