Leveraging telehealth to evaluate infants with prodromal autism spectrum disorder characteristics using the telehealth evaluation of development for infants

Abstract

This study investigated the feasibility of recruiting and assessing infants with prodromal autism characteristics in the first year of life via telehealth. Participants included 41 infants (Mage = 10.51 months, 51.2% female, 80.5% White) whose parents had concerns about social communication delays or autism. All infants met concerns criteria on a social communication screener. Infants were subsequently assessed via telehealth using the Telehealth Evaluation of Development for Infants protocol, wherein parents are coached through a series of semi-structured interactions from which key measures of autism characteristics, communication, developmental level, and clinical best estimates of autism spectrum disorder likelihood are scored. Parents completed online questionnaires and surveys measuring the acceptability of the telehealth visits. Across both parent report and examiner-derived measures, infants demonstrated high scores on measures of purported autism traits, decreased communication skills, and delayed achievement of developmental milestones. Caregivers’ acceptability ratings were uniformly positive. Results highlight the potential for telehealth to expand the scope of studies of emerging autism beyond infant sibling designs and to increase families’ access to early evaluation services. Lay abstract Many families seeking early evaluations for autism spectrum disorder face long waitlists, must often travel to centers with appropriate expertise, and are frequently told by providers to “wait and see.” This results in significant stress for families and delayed supports to infants and their caregivers who could benefit. This study evaluated whether telehealth could be used to identify and evaluate infants with early autism spectrum disorder characteristics in the first year of life. In this study, we evaluated 41 infants via telehealth using a standard set of probes and scored behavior related to social communication, play, imitation, and other developmental domains. We found the majority of infants demonstrated elevated likelihood of autism spectrum disorder on both parent-reported questionnaires and examiner-rated behavior. Caregiver ratings of the overall utility of the protocol used in this study were high. Overall, this study demonstrates the feasibility for telehealth-based approaches to evaluate infants’ with elevated likelihood of autism spectrum disorder in the first year of life, which could help to improve families’ access to care and to expand our capacity to conduct studies evaluating possible intervention supports.

Assessment of Autism Spectrum Disorder

“…The Telehealth Evaluation of Development for Infants (TEDI; Talbott et al, 2019; Talbott, Dufek, et al, 2022) is a tele-assessment protocol adapted from laboratory-based measures of early autism characteristics (e.g., AOSI), communication, language, play, and other related developmental domains. It was developed prior to the pandemic to evaluate infants 6 to 12 months of age.…”

Assessment Fidelity of Parents Implementing a Standardized Telehealth Infant Autism Screener

“…See Berger et al (2021) for a review of these tools. The Telehealth Evaluation of Development for Infants (TEDI; Talbott et al, 2020Talbott et al, , 2021) is a parent coaching protocol for conducting a social communication-focused developmental assessment for infants. In the full protocol, parents are coached through a series of semi-structured play activities designed to allow for the scoring of standardized tools, including the Autism Observation Scale for Infants (AOSI; Bryson et al, 2008) and the P-ESDM Infant-Toddler Curriculum Checklist (ITCC; Rogers et al, 2020).…”

“…In the full protocol, parents are coached through a series of semi-structured play activities designed to allow for the scoring of standardized tools, including the Autism Observation Scale for Infants (AOSI; Bryson et al, 2008) and the P-ESDM Infant-Toddler Curriculum Checklist (ITCC; Rogers et al, 2020). See Talbott et al (2021) for a more detailed description of the play activities and protocol. Initial pilot studies of the TEDI reported high inter-rater agreement (ICC’s of .94 and .89) and low to moderate test–retest reliability ( r = .46 and .25 ) for the AOSI and the ITCC in a sample of 6- to 12-month-olds with early social communication concerns (Talbott et al, 2021).…”

“…See Talbott et al (2021) for a more detailed description of the play activities and protocol. Initial pilot studies of the TEDI reported high inter-rater agreement (ICC’s of .94 and .89) and low to moderate test–retest reliability ( r = .46 and .25 ) for the AOSI and the ITCC in a sample of 6- to 12-month-olds with early social communication concerns (Talbott et al, 2021).…”

Short report: Experiences of Caregivers Participating in a Telehealth Evaluation of Development for Infants (TEDI)

“…In the current paper, we sought to gain a greater understanding of telehealth-based evaluations of infants’ development by qualitatively analyzing written feedback from caregivers participating in ongoing study of one such telehealth protocol, the Telehealth Evaluation of Development for Infants (TEDI; Talbott, Dufek, Young, and Rogers 2021 , Talbott et al, 2020 ). The TEDI protocol was initially developed prior to the COVID-19 pandemic in an effort to translate laboratory-based measures of early ASD characteristics, communication, language, play, and other related developmental domains into a telehealth format.…”