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Tagavi DM, Dai YG, Berger NI, Petruccelli M, Scott SE, Oosting D, Howard M, Carter AS, Ingersoll B, Wainer AL, Broder-Fingert S, Stone WL. Applying a User-Centered Design Framework to Develop a Remote Research Assessment Protocol for a Randomized Clinical Trial for Toddlers with Early Autism Characteristics. J Autism Dev Disord 2024:10.1007/s10803-024-06455-7. [PMID: 38985370 DOI: 10.1007/s10803-024-06455-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/11/2024]
Abstract
COVID-19 required many research teams to shift from in-person to remote assessments, which posed both procedural and theoretical challenges. While research has explored the utility of remote assessments for autism diagnosis from the perspective of families and clinicians, less is known about their application in clinical trials. This paper describes the development of a remote research assessment protocol for a randomized clinical trial focusing on the implementation of reciprocal imitation teaching (RIT) with toddlers in Part C early intervention. This project spans two phases. For Phase 1, our team developed and documented a series of steps utilizing user-centered design (UCD) strategies (e.g., recruiting potential users, creating a prototype, engaging in iterative development) for the purpose of redesigning an assessment protocol for a remote environment. For Phase 2, we examined preliminary outcomes of the redesign process. Primary end users (assessors) rated post-redesign usability and acceptability, while acceptability was examined using attrition data from secondary end users (family participants). Preliminary fidelity of implementation was also examined. The iterative redesign process allowed the research team to refine aspects of the assessment that ultimately led to promising preliminary ratings of usability, acceptability, and feasibility, as well as high fidelity. Preliminary data suggest that the redesigned assessment appears to be an acceptable, feasible, and usable tool for autism clinical trial research and that assessors can use it with fidelity. Further research is needed to examine the reliability and validity of the assessment, as well as implementation characteristics on a larger scale.
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Affiliation(s)
- Daina M Tagavi
- Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA.
| | - Yael G Dai
- Department of Psychology, Florida International University, Miami, USA
| | - Natalie I Berger
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, USA
| | | | - Sabine E Scott
- Special Education and Clinical Sciences Department, University of Oregon, Eugene, USA
| | - Devon Oosting
- Department of Psychology, University of Massachusetts Boston, Boston, USA
| | - Mya Howard
- Department of Human Services, University of Virginia, Charlottesville, USA
| | - Alice S Carter
- Department of Psychology, University of Massachusetts Boston, Boston, USA
| | - Brooke Ingersoll
- Department of Psychology, Michigan State University, East Lansing, USA
| | - Allison L Wainer
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, USA
| | | | - Wendy L Stone
- Department of Psychology, University of Washington, Seattle, USA
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2
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Weitlauf AS, Foster T, Slaughter JC, Fleck M, Harris J, Coffield C, Simcoe K, Baggett J, Stainbrook A, Warren ZE. Screening Options in Autism Telediagnosis: Examination of TAP, M-CHAT-R, and DCI Concordance and Predictive Value in a Telediagnostic Model. J Autism Dev Disord 2024:10.1007/s10803-024-06427-x. [PMID: 38833028 DOI: 10.1007/s10803-024-06427-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2024] [Indexed: 06/06/2024]
Abstract
Tele-assessment of autism in early childhood has increased. However, it is unclear how autism screening tools (M-CHAT-R, DCI) function as part of tele-assessment and relate to a commonly used tele-assessment instrument, the TAP. 361 families from a clinically referred sample of children (mean age: 27.63 months, sd = 4.86 months) completed the M-CHAT-R and DCI prior to a tele-assessment visit utilizing the TAP. Data was collected on demographic background, measure scores, and diagnostic outcome. No significant differences in measure scores or diagnostic findings emerged in age at referral, age group, age at diagnosis, or child sex, ethnicity, or racial background. The M-CHAT-R and DCI correlated strongly and positively. Older age was associated with lower risk scores on screening instruments. Children with autism had significantly higher scores on all screener and subdomain scores, with the exception of DCI Behavior. Subdomains of the DCI emerged as the strongest predictor of diagnostic outcome. Both the DCI total score and the M-CHAT-R significantly related to diagnostic outcome and TAP score in this tele-assessment model, regardless of child age or sex. Findings also support use of the DCI for children under 24 months of age.
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Affiliation(s)
- Amy S Weitlauf
- Department of Pediatrics, Vanderbilt University Medical Center, 230 Appleton Place, PMB 74, Nashville, Tennessee, 37203, USA.
| | - Tori Foster
- Department of Pediatrics, Vanderbilt University Medical Center, 230 Appleton Place, PMB 74, Nashville, Tennessee, 37203, USA
| | - James C Slaughter
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mary Fleck
- Department of Pediatrics, Vanderbilt University Medical Center, 230 Appleton Place, PMB 74, Nashville, Tennessee, 37203, USA
| | - Jill Harris
- Department of Pediatrics, Children's Specialized Hospital, New Brunswick, New Jersey, USA
| | - Caroline Coffield
- Department of Pediatrics, Robert Wood Johnson Medical School at Rutgers University, New Brunswick, New Jersey, USA
| | - Kathleen Simcoe
- Department of Pediatrics, Vanderbilt University Medical Center, 230 Appleton Place, PMB 74, Nashville, Tennessee, 37203, USA
| | - Jenny Baggett
- Department of Pediatrics, Vanderbilt University Medical Center, 230 Appleton Place, PMB 74, Nashville, Tennessee, 37203, USA
| | - Alacia Stainbrook
- Department of Pediatrics, Vanderbilt University Medical Center, 230 Appleton Place, PMB 74, Nashville, Tennessee, 37203, USA
| | - Zachary E Warren
- Department of Pediatrics, Vanderbilt University Medical Center, 230 Appleton Place, PMB 74, Nashville, Tennessee, 37203, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Special Education, Vanderbilt University, Nashville, Tennessee, USA
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3
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Corona LL, Wagner L, Hooper M, Weitlauf A, Foster TE, Hine J, Miceli A, Nicholson A, Stone C, Vehorn A, Warren Z. A Randomized Trial of the Accuracy of Novel Telehealth Instruments for the Assessment of Autism in Toddlers. J Autism Dev Disord 2024; 54:2069-2080. [PMID: 37185923 PMCID: PMC10129298 DOI: 10.1007/s10803-023-05908-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE Telemedicine approaches to autism (ASD) assessment have become increasingly common, yet few validated tools exist for this purpose. This study presents results from a clinical trial investigating two approaches to tele-assessment for ASD in toddlers. METHODS 144 children (29% female) between 17 and 36 months of age (mean = 2.5 years, SD = 0.33 years) completed tele-assessment using either the TELE-ASD-PEDS (TAP) or an experimental remote administration of the Screening Tool for Autism in Toddlers (STAT). All children then completed traditional in-person assessment with a blinded clinician, using the Mullen Scales of Early Learning (MSEL), Vineland Adaptive Behavior Scales, 3rd Edition (VABS-3), and Autism Diagnostic Observation Schedule (ADOS-2). Both tele-assessment and in-person assessment included a clinical interview with caregivers. RESULTS Results indicated diagnostic agreement for 92% of participants. Children diagnosed with ASD following in-person assessment who were missed by tele-assessment (n = 8) had lower scores on tele- and in-person ASD assessment tools. Children inaccurately identified as having ASD by tele-assessment (n = 3) were younger than other children and had higher developmental and adaptive behavior scores than children accurately diagnosed with ASD by tele-assessment. Diagnostic certainty was highest for children correctly identified as having ASD via tele-assessment. Clinicians and caregivers reported satisfaction with tele-assessment procedures. CONCLUSION This work provides additional support for the use of tele-assessment for identification of ASD in toddlers, with both clinicians and families reporting broad acceptability. Continued development and refinement of tele-assessment procedures is recommended to optimize this approach for the needs of varying clinicians, families, and circumstances.
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Affiliation(s)
- Laura L Corona
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17th Avenue, Suite 202, Nashville, TN, 37203, USA.
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Liliana Wagner
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17th Avenue, Suite 202, Nashville, TN, 37203, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Madison Hooper
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Amy Weitlauf
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17th Avenue, Suite 202, Nashville, TN, 37203, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tori E Foster
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17th Avenue, Suite 202, Nashville, TN, 37203, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey Hine
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17th Avenue, Suite 202, Nashville, TN, 37203, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexandra Miceli
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17th Avenue, Suite 202, Nashville, TN, 37203, USA
| | - Amy Nicholson
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17th Avenue, Suite 202, Nashville, TN, 37203, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Caitlin Stone
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17th Avenue, Suite 202, Nashville, TN, 37203, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alison Vehorn
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17th Avenue, Suite 202, Nashville, TN, 37203, USA
| | - Zachary Warren
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17th Avenue, Suite 202, Nashville, TN, 37203, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Special Education, Vanderbilt University, Nashville, TN, USA
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Riva V, Villa L, Fulceri F, Arduino GM, Leonti G, Valeri G, Casula L, Zoccante L, Puttini E, Sogos C, Presicce M, Bentenuto A, Apicella F, Molteni M, Scattoni ML. The teleNIDA: Early Screening of Autism Spectrum Disorder Through a Novel Telehealth Approach. J Autism Dev Disord 2024; 54:1680-1690. [PMID: 36814040 PMCID: PMC9946866 DOI: 10.1007/s10803-023-05927-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 02/24/2023]
Abstract
The COVID-19 pandemic has fast-tracked interest in telehealth methods to guarantee the continuity of care of children with Autism Spectrum Disorder (ASD). Store-and-forward telehealth approaches offer the opportunity to facilitate timely screening of ASD, allowing parents to record videos of their child's behaviors, subsequently shared with clinicians that provide an assessment remotely. This study aimed to examine the psychometric properties of a new telehealth screening tool, the teleNIDA, administered in home settings for remote observation of early signs of ASD in toddlers aged 18-30 months. Results showed good psychometric properties of the teleNIDA, as compared to the gold standard in-person assessment, and the predictive validity on the diagnosis of ASD at 36 months was demonstrated. This study supports the teleNIDA as a promising level 2 screening tool for ASD able to speed up diagnostic and intervention processes.
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Affiliation(s)
- Valentina Riva
- Child Psychopathology Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Laura Villa
- Child Psychopathology Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Francesca Fulceri
- Research Coordination and Support Service, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | | | - Guido Leonti
- Centro Autismo e Sindrome di Asperger ASLCN1, 12084, Mondovì, Italy
| | - Giovanni Valeri
- Department of Neuroscience, Child Neuropsychiatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Laura Casula
- Department of Neuroscience, Child Neuropsychiatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Leonardo Zoccante
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126, Verona, Italy
| | - Elena Puttini
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126, Verona, Italy
| | - Carla Sogos
- Child Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Mariaelena Presicce
- Child Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Arianna Bentenuto
- Laboratory of Observation, Diagnosis and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38122, Trento, Italy
| | - Fabio Apicella
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Massimo Molteni
- Child Psychopathology Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Maria Luisa Scattoni
- Research Coordination and Support Service, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
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Shapter S, Carroll A, Roberts K. Clinician Opinions Regarding the Usefulness of the BOSA for ASD Assessment in a Service for Children Aged Under 12 Years. J Autism Dev Disord 2024:10.1007/s10803-023-06207-z. [PMID: 38565777 DOI: 10.1007/s10803-023-06207-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 04/04/2024]
Abstract
The COVID-19 pandemic and the subsequent social distancing policies forced healthcare teams to drastically alter the way they deliver services. This was particularly challenging for clinicians involved in diagnosing autism spectrum disorder (ASD), as assessment tools and methods required face-to-face social interactions between clinicians and children. To address this, the Brief Observation of Symptoms of Autism (BOSA) was developed to ensure that people suspected of ASD can receive diagnostic assessments during the pandemic. This project aimed to explore clinicians' opinions on the BOSA, particularly regarding the usefulness of the assessment for clinicians to clarify diagnostic outcomes of ASD assessments. Both quantitative and qualitative data was gathered within an NHS community paediatric team. This included a questionnaire for clinicians to complete, and data from the BOSA assessments done in the service. Thematic analysis and descriptive statistics revealed that many clinicians felt that the BOSA can be beneficial in certain cases, such as selective mutism, and found the BOSA particularly helpful for observing parent-child interactions. These findings highlighted important information that the Autism Diagnostic Observation Schedule Second Edition (ADOS-2) does not give opportunities to observe. Clinicians reported that at times, the BOSA materials, brevity and parental administration created barriers to gathering information for diagnostic decisions. As may be expected, clinicians showed a clear preference for the more familiar and validated ADOS-2. However, the study highlights perceived limitations of the ADOS-2 and strengths of the BOSA, with recommendations made for future practice and research.
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Affiliation(s)
- Sophie Shapter
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
| | - Amy Carroll
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - Kate Roberts
- Oak Tree Centre, Cambridgeshire Community Services NHS Trust, Huntingdon, PE29 7HN, UK
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Ludwig NN, Holingue C, Hong JS, Kalb LG, Pfeiffer D, Reetzke R, Menon D, Landa R. Diagnostic certainty during in-person and telehealth autism evaluations. JCPP ADVANCES 2024; 4:e12201. [PMID: 38486947 PMCID: PMC10933595 DOI: 10.1002/jcv2.12201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 08/24/2023] [Indexed: 03/17/2024] Open
Abstract
Background Many diagnostic evaluations abruptly shifted to telehealth during the COVID-19 pandemic; however, little is known about the impact on diagnosis patterns for children evaluated for autism spectrum disorder (ASD). The purpose of this clinical research study was to examine (1) the frequency of diagnoses evaluated beyond ASD; (2) the frequency of diagnoses made, including ASD; and (3) clinician diagnostic certainty for all diagnoses evaluated for children who received an evaluation due to primary concerns about ASD via telehealth during the pandemic compared to those evaluated in person before the pandemic at an ASD specialty clinic. Methods The sample included 2192 children, 1-17 years (M = 6.5 years; SD = 3.9), evaluated by a physician/psychologist at an ASD specialty center. A total of 649 children were evaluated in-person September 1, 2019-March 13, 2020 (pre-pandemic) and 1543 were evaluated via telehealth March 14, 2020-July 26, 2021 (during pandemic). Upon completion of each evaluation, clinicians provided a final diagnostic determination (i.e., "Yes," "No," "Possible," or "Not Assessed") for the following DSM-5 conditions: ASD, attention-deficit/hyperactivity disorder (ADHD), intellectual developmental disorder (IDD), anxiety (ANX), depression (DEP), and behavioral disorder (BD). "Possible" indicated lower certainty and the diagnosis was not provided. "Not Assessed" indicated the disorder was not evaluated. Results Diagnostic certainty for ASD and ADHD was lower and clinicians evaluated for and made diagnoses of IDD less often during evaluations that occurred via telehealth during the pandemic versus in person before the pandemic. DEP and BD were diagnosed more frequently, diagnostic certainty of DEP was lower, and no differences in the frequency of ANX diagnoses emerged during evaluations conducted via telehealth during the pandemic compared to those conducted in person before the pandemic. Conclusions Differences emerged in the frequency of diagnoses evaluated and made and diagnostic certainty for evaluations conducted via telehealth during the pandemic compared to in person before the pandemic, which likely impacted patients and reflect real-word challenges. Future work should examine whether these patterns are generalizable and the mechanisms that contribute to these differences.
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Affiliation(s)
- Natasha N. Ludwig
- Department of NeuropsychologyKennedy Krieger InstituteBaltimoreMarylandUSA
- Department of Psychiatry and Behavioral SciencesJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Calliope Holingue
- Center for Autism and Related DisordersKennedy Krieger InstituteBaltimoreMarylandUSA
- Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Ji Su Hong
- Department of Psychiatry and Behavioral SciencesJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Center for Autism and Related DisordersKennedy Krieger InstituteBaltimoreMarylandUSA
| | - Luther G. Kalb
- Department of NeuropsychologyKennedy Krieger InstituteBaltimoreMarylandUSA
- Center for Autism and Related DisordersKennedy Krieger InstituteBaltimoreMarylandUSA
- Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Danika Pfeiffer
- Department of Psychiatry and Behavioral SciencesJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Center for Autism and Related DisordersKennedy Krieger InstituteBaltimoreMarylandUSA
| | - Rachel Reetzke
- Department of Psychiatry and Behavioral SciencesJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Center for Autism and Related DisordersKennedy Krieger InstituteBaltimoreMarylandUSA
| | - Deepa Menon
- Center for Autism and Related DisordersKennedy Krieger InstituteBaltimoreMarylandUSA
- Department of NeurologyJohns Hopkins School of MedicineBaltimoreMarylandUnited States
| | - Rebecca Landa
- Department of Psychiatry and Behavioral SciencesJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Center for Autism and Related DisordersKennedy Krieger InstituteBaltimoreMarylandUSA
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7
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Deng L, He WZ, Zhang QL, Wei L, Dai Y, Liu YQ, Chen ZL, Ren T, Zhang LL, Gong JB, Li F. Caregiver-child interaction as an effective tool for identifying autism spectrum disorder: evidence from EEG analysis. Child Adolesc Psychiatry Ment Health 2023; 17:138. [PMID: 38098032 PMCID: PMC10722789 DOI: 10.1186/s13034-023-00690-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder that affects individuals across their lifespan. Early diagnosis and intervention are crucial for improving outcomes. However, current diagnostic methods are often time-consuming, and costly, making them inaccessible to many families. In the current study, we aim to test caregiver-child interaction as a potential tool for screening children with ASD in clinic. METHODS We enrolled 85 preschool children (Mean age: 4.90 ± 0.65 years, 70.6% male), including ASD children with or without developmental delay (DD), and typical development (TD) children, along with their caregivers. ASD core symptoms were evaluated by Childhood Autism Rating Scale (CARS) and Autism Diagnostic Observation Schedule-Calibrated Severity Scores (ADOS-CSS). Behavioral indicators were derived from video encoding of caregiver-child interaction, including social involvement of children (SIC), interaction time (IT), response of children to social cues (RSC), time for caregiver initiated social interactions (GIS) and time for children initiated social interactions (CIS)). Power spectral density (PSD) values were calculated by EEG signals simultaneously recorded. Partial Pearson correlation analysis was used in both ASD groups to investigate the correlation among behavioral indicators scores and ASD symptom severity and PSD values. Receiver operating characteristic (ROC) analysis was used to describe the discrimination accuracy of behavioral indicators. RESULTS Compared to TD group, both ASD groups demonstrated significant lower scores of SIC, IT, RSC, CIS (all p values < 0.05), and significant higher time for GIS (all p values < 0.01). SIC scores negatively correlated with CARS (p = 0.006) and ADOS-CSS (p = 0.023) in the ASD with DD group. Compared to TD group, PSD values elevated in ASD groups (all p values < 0.05), and was associated with SIC (theta band: p = 0.005; alpha band: p = 0.003) but not IQ levels. SIC was effective in identifying both ASD groups (sensitivity/specificity: ASD children with DD, 76.5%/66.7%; ASD children without DD, 82.6%/82.2%). CONCLUSION Our results verified the behavioral paradigm of caregiver-child interaction as an efficient tool for early ASD screening.
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Affiliation(s)
- Lin Deng
- Department of Developmental and Behavioral Pediatric and Child Primary Care & Ministry of Education, Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Wei-Zhong He
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, 300072, China
| | - Qing-Li Zhang
- Ministry of Education - Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Ling Wei
- College of Medical Imaging, Shanghai University of Medicine & Health Science, Shanghai, China
| | - Yuan Dai
- Department of Developmental and Behavioral Pediatric and Child Primary Care & Ministry of Education, Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Yu-Qi Liu
- Department of Developmental and Behavioral Pediatric and Child Primary Care & Ministry of Education, Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Zi-Lin Chen
- Department of Developmental and Behavioral Pediatric and Child Primary Care & Ministry of Education, Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Tai Ren
- Ministry of Education - Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Lin-Li Zhang
- Department of Developmental and Behavioral Pediatric and Child Primary Care & Ministry of Education, Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Jing-Bo Gong
- Shanghai Changning Mental Health Center, Shanghai, 200335, China.
| | - Fei Li
- Department of Developmental and Behavioral Pediatric and Child Primary Care & Ministry of Education, Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.
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8
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Bravo A, Ibañez LV, Scott S, Dick C, Carpentier P, Stone WL. Telehealth Delivery in Part C Early Intervention: Provider and Caregiver Perspectives. J Autism Dev Disord 2023; 53:4545-4559. [PMID: 36153443 PMCID: PMC9510265 DOI: 10.1007/s10803-022-05734-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/29/2022]
Abstract
Telehealth is a promising modality for Part C early intervention (EI), services typically implemented face-to-face in home and community settings. Barriers to telehealth in EI reported prior to COVID-19 included lack of training and access to reliable internet. The abrupt telehealth shift at the onset of the pandemic did not permit a phased adoption approach. This mixed-methods study aimed to characterize perspectives of service changes resulting from the telehealth transition. Providers (n = 39) and caregivers (n = 11) completed surveys about perceptions towards the telehealth switch. All providers indicated at least one aspect of services had changed. Approximately half of caregivers reported satisfaction with services decreased and half that satisfaction remained the same. Implications for telehealth in EI beyond the pandemic are discussed.
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Affiliation(s)
- Alice Bravo
- College of Education, University of Washington, Seattle, WA, 98115, USA.
| | - Lisa V Ibañez
- Department of Psychology, University of Washington, Seattle, WA, 98115, USA
| | - Sabine Scott
- Department of Psychology, University of Washington, Seattle, WA, 98115, USA
| | - Catherine Dick
- Department of Psychology, University of Washington, Seattle, WA, 98115, USA
| | - Pascale Carpentier
- Department of Psychology, University of Washington, Seattle, WA, 98115, USA
| | - Wendy L Stone
- Department of Psychology, University of Washington, Seattle, WA, 98115, USA
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9
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Khairetdinov OZ, Rubakova LI. Equivalence of the autism spectrum disorders diagnostics in children in telemedicine and face-to-face consultations: a literature review. CONSORTIUM PSYCHIATRICUM 2023; 4:55-64. [PMID: 38249532 PMCID: PMC10795948 DOI: 10.17816/cp12496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/31/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND The use of remote forms of mental health care has become widespread during the period of epidemiological restrictions due to the COVID-19 pandemic. Methodological and organizational issues remain insufficiently developed, including the level of equivalence of the use of telemedicine technologies in the diagnosis of autistic spectrum disorders. AIM Study of the equivalence of diagnostic tools in the framework of telemedicine and face-to-face consultations in children with autistic spectrum disorders according to modern scientific literature. METHODS A descriptive review of scientific studies published between January 2017 and May 2023 was carried out. The papers presented in the electronic databases PubMed, Web of Science, and eLibrary were analyzed. Descriptive analysis was used to summarize the obtained data. RESULTS The conducted analysis convincingly indicates sufficient equivalence of remote tools used in different countries for level I screening, assessment scales, and structured procedures for diagnosing autistic spectrum disorders with a high level of specificity from 60.0 to 94.4%, sensitivity from 75 dog 98.4%, and satisfaction of patients and their legal representatives. CONCLUSION The widespread use of validated telemedicine diagnostic systems in clinical practice contributes to the early detection of autistic spectrum disorders, increasing the timeliness and effectiveness of medical, corrective psychological, pedagogical, and habilitation interventions.
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Affiliation(s)
- Oleg Z. Khairetdinov
- Scientific and Practical Center for Mental Health of Children and Adolescents named after G.E. Sukhareva
| | - Luciena I. Rubakova
- Scientific and Practical Center for Mental Health of Children and Adolescents named after G.E. Sukhareva
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10
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Morrier MJ, Schwartz AJ, Rice CE, Platner A, Ousley OY, Kassem S, Krishnan AV, Lord C, Smith CJ, Oberleitner R. Validation of an Enhanced Telehealth Platform for Toddlers at Increased Likelihood for a Diagnosis of Autism Spectrum Disorder (ASD). J Autism Dev Disord 2023:10.1007/s10803-023-06116-1. [PMID: 37740876 DOI: 10.1007/s10803-023-06116-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/25/2023]
Abstract
Use of telehealth assessments for toddlers at increased likelihood of autism spectrum disorder (ASD) began prior to the global COVID-19 pandemic; however, the value of telehealth assessments as an alternative to in-person assessment (IPA) became clearer during the pandemic. The Naturalistic Observation Diagnosis Assessment (NODA™), previously demonstrated as a valid and reliable tool to evaluate asynchronous behaviors for early diagnosis, was enhanced to add synchronous collection of behaviors to assist clinicians in making a differential diagnosis of ASD. This study was conducted to validate the information gathered through NODA-Enhanced (NODA-E™) as compared to a gold standard IPA. Forty-nine toddlers aged 16.0-32.1 months of age, recruited through community pediatric offices and a tertiary ASD clinic, participated in both NODA-E and IPA assessments. There was high agreement between the two assessment protocols for overall diagnosis (46 of 49 cases; 93.6%; κ = .878), specific diagnostic criteria for social communication and social interaction (SCI; range 95.9-98%; κ = .918-.959), and for two of four criteria specified for restricted and repetitive behaviors (RRB; range 87.8-98%; κ = .755 and .959). There was lower agreement for two subcategories of RRBs (range 65.3-67.3%; κ = .306 and .347). NODA-E is a tool that can assist clinicians in making reliable and valid early ASD diagnoses using both asynchronous and synchronous information gathered via telehealth and offers an additional tool within a clinician's assessment toolbox.
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Affiliation(s)
- Michael J Morrier
- Emory Autism Center, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1551 Shoup Court, Decatur, GA, 30033, USA.
| | - Allison J Schwartz
- Emory Autism Center, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1551 Shoup Court, Decatur, GA, 30033, USA
| | - Catherine E Rice
- Emory Autism Center, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1551 Shoup Court, Decatur, GA, 30033, USA
| | - Amanda Platner
- Emory Autism Center, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1551 Shoup Court, Decatur, GA, 30033, USA
| | - Opal Y Ousley
- Emory Autism Center, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1551 Shoup Court, Decatur, GA, 30033, USA
| | - Sara Kassem
- Emory Autism Center, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1551 Shoup Court, Decatur, GA, 30033, USA
| | | | - Catherine Lord
- Center for Autism Research and Treatment, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
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11
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Gangi DN, Aishworiya R, Hill MM, Nguyen DT, Ni R, Parikh C, Solis E, Ozonoff S. Case report: Transient symptoms of autism spectrum disorder in a 2-year-old boy. Clin Case Rep 2023; 11:e07345. [PMID: 37180323 PMCID: PMC10172454 DOI: 10.1002/ccr3.7345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/06/2023] [Accepted: 04/15/2023] [Indexed: 05/16/2023] Open
Abstract
Though early ASD diagnosis is highly stable, this case report describes a rare situation in which symptoms resolved without intervention over a 4 month period. We do not recommend delaying diagnosis in symptomatic children who meet criteria but when major behavioral changes are reported after diagnosis, reevaluation may be beneficial.
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Affiliation(s)
- Devon N. Gangi
- Department of Psychiatry & Behavioral SciencesMIND Institute, University of California‐DavisSacramentoCaliforniaUSA
| | - Ramkumar Aishworiya
- Department of Psychiatry & Behavioral SciencesMIND Institute, University of California‐DavisSacramentoCaliforniaUSA
- Khoo Teck Puat‐National University Children's Medical InstituteNational University Health SystemSingaporeSingapore
- Department of Pediatrics, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Monique Moore Hill
- Department of Psychiatry & Behavioral SciencesMIND Institute, University of California‐DavisSacramentoCaliforniaUSA
| | - Dan Thu Nguyen
- Department of Psychiatry & Behavioral SciencesMIND Institute, University of California‐DavisSacramentoCaliforniaUSA
| | - Rachel Ni
- Department of Psychiatry & Behavioral SciencesMIND Institute, University of California‐DavisSacramentoCaliforniaUSA
| | - Chandni Parikh
- Department of Psychiatry & Behavioral SciencesMIND Institute, University of California‐DavisSacramentoCaliforniaUSA
| | | | - Sally Ozonoff
- Department of Psychiatry & Behavioral SciencesMIND Institute, University of California‐DavisSacramentoCaliforniaUSA
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12
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Enneking B, Ryan T, Tang Q, James C, Rouse M, Curtin M, Keehn RM. Acceptability and Access Metrics for Telehealth Consultation of Pediatric Neurodevelopmental Disabilities During COVID-19. J Pediatr Health Care 2023; 37:200-207. [PMID: 36175312 DOI: 10.1016/j.pedhc.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION We report caregiver agreement to attend telehealth neurodevelopmental consultation during COVID-19, demographic differences in agreement, reasons families declined, and clinical access metrics before and during COVID-19. METHOD Data were gathered from telehealth referrals and consultations from April to July 2020. Schedulers documented agreement status and reasons for the decline. Wait time, lag time, and missed appointment rates were calculated to measure access. RESULTS Ninety-one percent agreed to attend telehealth consultation; 55% of those who declined preferred in-person services. There were no demographic differences between those who accepted, declined, or did not respond. The median wait time from referral to appointment was 60 days. Missed appointment rates were consistent with prepandemic rates. DISCUSSION Findings support literature suggesting patients are agreeable to telehealth. They diverged from evidence suggesting telehealth reduces missed appointments. Overall, results indicate telehealth is an acceptable alternative; however, further telehealth innovation is needed to address existing disparities.
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13
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Haffner DN, Bauer Huang SL. Using Telemedicine to Overcome Barriers to Neurodevelopmental Care from the Neonatal Intensive Care Unit to School Entry. Clin Perinatol 2023; 50:253-268. [PMID: 36868709 DOI: 10.1016/j.clp.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Dedicated Neonatal Intensive Care Unit (NICU) follow-up programs are recommended for ongoing surveillance for infants at high-risk for future neurodevelopmental impairment (NDI). Systemic, socioeconomic, and psychosocial barriers remain for referrals and the continued neurodevelopmental follow-up of high-risk infants. Telemedicine can help overcome these barriers. Telemedicine allows standardization of evaluations, increased referral rates, and reduced time to follow-up as well as increased therapy engagement. Telemedicine can expand neurodevelopmental surveillance and support all NICU graduates, facilitating the early identification of NDI. However, with the recent expansion of telemedicine during the COVID-19 pandemic, new barriers related to access and technological support have arisen.
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Affiliation(s)
- Darrah N Haffner
- Division of Pediatric Neurology, Department of Pediatrics, Nationwide Children's Hospital and the Ohio State University, 700 Children's Dr, Columbus, OH 43205, USA.
| | - Sarah L Bauer Huang
- Department of Pediatric and Developmental Neurology, Department of Neurology, Washington University in Saint Louis School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110, USA
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14
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McNally Keehn R, Enneking B, Ryan T, James C, Tang Q, Blewitt A, Tomlin A, Corona L, Wagner L. Tele-assessment of young children referred for autism spectrum disorder evaluation during COVID-19: Associations among clinical characteristics and diagnostic outcome. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022:13623613221138642. [PMID: 36527227 PMCID: PMC9760512 DOI: 10.1177/13623613221138642] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The diagnosis of autism spectrum disorder (ASD) has traditionally been made through in-person evaluation. While the COVID-19 pandemic disrupted access to ASD services, there has been remarkable growth in research focused on novel ASD diagnostic practices, including the use of telemedicine. We implemented a standard ASD tele-assessment evaluation procedure, including use of a novel remote clinician-coached, caregiver-delivered ASD assessment tool (TELE-ASD-PEDS; TAP), with the goal of continuing to provide diagnostic services to young children and their families during the pandemic. We examined the relationship between child characteristics and diagnostic outcome for 335 children, ages 14-78 months, who received ASD tele-assessment conducted by psychologists and pediatricians in an outpatient clinic of a Midwestern academic medical center. We found that clinicians could make a determination about ASD diagnosis for most children (85%) evaluated using tele-assessment. Child clinical characteristics, including TAP scores and clinician ratings of ASD symptoms, were related to diagnostic outcome (i.e. diagnosis of ASD, no ASD, and Unsure about ASD). When all clinical characteristics were examined together, the presence of specific repetitive behaviors predicted ASD diagnosis. We also found that the TAP is effective for making an ASD diagnosis when used as part of comprehensive tele-assessment evaluation in children ⩾ 36 months of age with delayed language. Our study adds to an increasing body of research supporting use of tele-assessment for diagnosis of ASD. Although further research is needed, telemedicine may help families from different backgrounds and geographic locations to access high-quality diagnostic services.
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Affiliation(s)
- Rebecca McNally Keehn
- Indiana University School of Medicine,
USA,Rebecca McNally Keehn, Department of
Pediatrics, Indiana University School of Medicine, 410 West 10th Street, Room
2027, Indianapolis, IN 46202, USA.
| | | | | | | | - Qing Tang
- Indiana University School of Medicine,
USA
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15
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Talbott MR, Lang E, Avila F, Dufek S, Young G. Short report: Experiences of Caregivers Participating in a Telehealth Evaluation of Development for Infants (TEDI). J Autism Dev Disord 2022; 52:5266-5273. [PMID: 35945386 PMCID: PMC9362962 DOI: 10.1007/s10803-022-05607-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2022] [Indexed: 11/02/2022]
Abstract
A growing literature supports the feasibility and validity of telehealth-based assessments for autism spectrum disorder (ASD). Better understanding families' experiences is crucial for sustained use beyond the COVID-19 pandemic. This study qualitatively examines caregiver experiences with the Telehealth Evaluation of Development for Infants (TEDI) protocol to better understand benefits and challenges of telehealth-based evaluations. Caregivers (N = 32) completed an online survey following a telehealth-based evaluation with their 6-12 month-old infants. Open-ended text responses to queries about perceived benefits, challenges, and suggestions for future adaptations were coded. Most caregivers reported positive experiences with minor feedback relating to tailoring of individual needs. Responses suggest the TEDI is a feasible approach and provide guidance for components of successful telehealth evaluations more broadly.
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Affiliation(s)
- Meagan R Talbott
- MIND Institute, University of California Davis, 2825 50th Street, 95817, Sacramento, CA, United States.
- Department of Psychiatry and Behavioral Science, University of California Davis, Sacramento, USA.
| | - Ellisa Lang
- MIND Institute, University of California Davis, 2825 50th Street, 95817, Sacramento, CA, United States
| | - Felipe Avila
- MIND Institute, University of California Davis, 2825 50th Street, 95817, Sacramento, CA, United States
| | - Sarah Dufek
- MIND Institute, University of California Davis, 2825 50th Street, 95817, Sacramento, CA, United States
- Department of Psychiatry and Behavioral Science, University of California Davis, Sacramento, USA
| | - Gregory Young
- MIND Institute, University of California Davis, 2825 50th Street, 95817, Sacramento, CA, United States
- Department of Psychiatry and Behavioral Science, University of California Davis, Sacramento, USA
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16
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Rooney T, Stern YS, Hampton LH, Grauzer J, Hobson A, Levin A, Jones MK, Kaat AJ, Roberts MY. Screening for Autism in 2-Year-Old Children: The Application of the Systematic Observation of Red Flags to the Screening Tool for Autism in Toddlers and Young Children. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2759-2769. [PMID: 36306799 PMCID: PMC9911122 DOI: 10.1044/2022_ajslp-22-00132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE A multimeasure approach was developed to capitalize on the strengths of two screening measures: the Screening Tool for Autism in Toddlers and Young Children (STAT), an observational measure of social communication, and the Systematic Observation of Red Flags (SORF), a checklist including restricted and repetitive behavior (RRB) items. This approach offers a novel method of identifying autism in toddlers. METHOD This was a retrospective study of data collected from a multidisciplinary diagnostic program for 24- to 36-month-olds with developmental delays. Raters with autism expertise but naïve to diagnoses applied the SORF to STAT videos. Psychometrics were derived for the SORF on STAT observations and a multiple-measure approach that used a Least Absolute Shrinkage and Selection Operator modeling framework to construct a STAT-SORF RRB Hybrid, retaining SORF RRB items based on individual predictive abilities. RESULTS The SORF alone correctly classified 84% of the sample (84% sensitivity and 86% specificity). The STAT-SORF RRB Hybrid model, which retained four SORF RRB items, correctly classified 90% of a validation sample (95% sensitivity and 75% specificity). CONCLUSION These findings highlight the potential utility of using multiple autism identification tools and regression-based scoring to establish presumptive eligibility and facilitate early access to autism interventions.
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Affiliation(s)
- Tara Rooney
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Yael S. Stern
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | | | - Jeffrey Grauzer
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Amanda Hobson
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
- Center for Audiology, Speech, Language, and Learning, Northwestern University, Evanston, IL
| | - Amy Levin
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
- Center for Audiology, Speech, Language, and Learning, Northwestern University, Evanston, IL
| | - Maranda K. Jones
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Aaron J. Kaat
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Megan Y. Roberts
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
- Center for Audiology, Speech, Language, and Learning, Northwestern University, Evanston, IL
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17
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Age-Based Tracks: A Method to Tailor Autism Diagnostic Evaluation in Large-Scale Autism Specialty Centers. J Clin Med 2022; 11:jcm11216332. [DOI: 10.3390/jcm11216332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
This paper describes a proposed model of diagnostic evaluation for autism spectrum disorder (ASD) at a large-scale ASD specialty center. Our center has implemented age-based diagnostic tracks within an interdisciplinary team evaluation approach to assessing ASD. Data were collected as part of a program evaluation and included responses from provider surveys as well as patient medical record reviews. The results from 803 patients were included. The diagnostic outcomes, time for evaluation, and appropriateness of referral were analyzed in patients referred to the Younger (n = 155) and Older (n = 648) diagnostic tracks. In 92.8% of cases referred to the clinic’s standard team evaluation model, the provider teams were able to make a diagnostic decision within the allotted evaluation time. The results from an additional diagnostic pathway, termed the Autism Psych Team (APT), within the older track were also presented. The intake providers had the option to triage older patients to this pathway when they anticipated that the patient might be diagnostically complex. Most patients (45.1%) triaged to the APT were referred due to psychiatric complexity. In 96% of APT cases, the APT providers felt the patient was an appropriate referral. Overall, these results suggest a method to efficiently triage patients to diagnostic models equipped to serve them within a high-volume ASD center.
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18
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Meimei L, Zenghui M. A systematic review of telehealth screening, assessment, and diagnosis of autism spectrum disorder. Child Adolesc Psychiatry Ment Health 2022; 16:79. [PMID: 36209100 PMCID: PMC9547568 DOI: 10.1186/s13034-022-00514-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/21/2022] [Indexed: 11/18/2022] Open
Abstract
There is a significant delay between parents having concerns and receiving a formal assessment and Autism Spectrum Disorder (ASD) diagnosis. Telemedicine could be an effective alternative that shortens the waiting time for parents and primary health providers in ASD screening and diagnosis. We conducted a systematic review examining the uses of telemedicine technology for ASD screening, assessment, or diagnostic purposes and to what extent sample characteristics and psychometric properties were reported. This study searched four databases from 2000 to 2022 and obtained 26 studies that met the inclusion criteria. The 17 applications used in these 26 studies were divided into three categories based on their purpose: screening, diagnostic, and assessment. The results described the data extracted, including study characteristics, applied methods, indicators seen, and psychometric properties. Among the 15 applications with psychometric properties reported, the sensitivity ranged from 0.70 to 1, and the specificity ranged from 0.38 to 1. The present study highlights the strengths and weaknesses of current telemedicine approaches and provides a basis for future research. More rigorous empirical studies with larger sample sizes are needed to understand the feasibility, strengths, and limitations of telehealth technologies for screening, assessing, and diagnosing ASD.
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Affiliation(s)
- Liu Meimei
- grid.12380.380000 0004 1754 9227Vrije University Amsterdam, Amsterdam, The Netherlands
| | - Ma Zenghui
- Beijing ALSOABA Technology Co. LTD, ALSOLIFE, Beijing, China
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19
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La Valle C, Johnston E, Tager-Flusberg H. A systematic review of the use of telehealth to facilitate a diagnosis for children with developmental concerns. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 127:104269. [PMID: 35636261 PMCID: PMC10521149 DOI: 10.1016/j.ridd.2022.104269] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/04/2022] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Telehealth can reduce the gap between developmental concern and diagnosis. Evaluation of telehealth methods is needed for providers to make decisions about using telediagnostic assessments. AIM This systematic review examined telehealth in facilitating a diagnosis for children with developmental concerns and assessed 1) study characteristics and type of diagnostic evaluation; 2) comparison of telehealth technologies to in-person diagnostic methods; 3) feasibility and acceptability of telehealth technologies; and 4) methodological quality. METHOD AND PROCEDURES Peer-reviewed studies from PsycINFO, CINAHL, Web of Science, PubMed, Embase, and Cochrane published January 2000-July 2021 were searched using "telehealth" AND "developmental concern" AND "diagnosis". Data extraction included study characteristics, diagnostic evaluation, technology, diagnostic accuracy, feasibility, and acceptability. Methodological quality was assessed using NHLBI tools. OUTCOMES AND RESULTS Nine studies met inclusion. Children with suspected FAS, social-emotional concerns, suspected genetic conditions, and failed hearing screenings received a telediagnosis. Evaluations included dysmorphology, feeding, neurological, developmental, audiological, and psychiatric. Seven studies used videoconferencing in real-time and two used Store-and-Forward methods. High diagnostic agreement occurred between face-to-face and remote methods. Stakeholders reported high satisfaction and feasibility. Many of the studies were rated as fair quality. CONCLUSIONS AND IMPLICATIONS Findings underscore partnership models between local providers and remote specialists. Rigorous study designs with larger samples covering a wider range of developmental domains are needed to provide a stronger empirical base for providers.
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Affiliation(s)
- Chelsea La Valle
- Department of Psychological & Brain Sciences, Boston University Center for Autism Research Excellence, 100 Cummington Mall, Boston, MA 02215, USA.
| | - Emily Johnston
- Department of Psychological & Brain Sciences, Boston University Center for Autism Research Excellence, 100 Cummington Mall, Boston, MA 02215, USA.
| | - Helen Tager-Flusberg
- Department of Psychological & Brain Sciences, Boston University Center for Autism Research Excellence, 100 Cummington Mall, Boston, MA 02215, USA.
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20
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Holtman SJ, Winans KS, Hoch JD. Utility of Diagnostic Classification for Children 0-5 to Assess Features of Autism: Comparing In-person and COVID-19 Telehealth Evaluations. J Autism Dev Disord 2022; 52:5114-5125. [PMID: 35708824 PMCID: PMC9200933 DOI: 10.1007/s10803-022-05606-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2022] [Indexed: 11/26/2022]
Abstract
Logistic regression was used to examine the use of Autism Spectrum diagnostic categories from pre-COVID-19 in-person evaluations and COVID-19 telehealth evaluations at a specialist community mental health clinic. The diagnostic classification for children 0-5 (DC: 0-5) affords a wider range of diagnoses that allowed for inferences of clinician certainty of diagnosis. Use of full criteria diagnoses was significantly lower from telehealth evaluations during the pandemic, and was less certain for younger children, some non-English speakers, and children reporting Native American/Alaska Native race. Higher Child Behavior Checklist (CBCL) ASD subscale scores, lower CBCL total scores, and global developmental delay diagnoses predicted greater use of full ASD diagnoses. Findings suggest factors that could identify children appropriate for telehealth evaluations.
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Affiliation(s)
- Sara Julsrud Holtman
- College of Social and Behavioral Sciences, Northwest University, 6710 108th Ave NE, Kirkland, WA 98033 USA
- Fraser, 3333 University Ave SE, Minneapolis, MN 55414 USA
| | | | - John D. Hoch
- Fraser, 3333 University Ave SE, Minneapolis, MN 55414 USA
- Department of Educational Psychology, University of Minnesota, Twin Cities, 3333 University Ave SE, Minneapolis, MN 55414 USA
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21
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Expectations and Concerns about the Use of Telemedicine for Autism Spectrum Disorder: A Cross-Sectional Survey of Parents and Healthcare Professionals. J Clin Med 2022; 11:jcm11123294. [PMID: 35743364 PMCID: PMC9224762 DOI: 10.3390/jcm11123294] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022] Open
Abstract
Telemedicine has recently been used for diagnosis and interventions inpatients with autism spectrum disorder (ASD), traditionally performed in-person, but little attention has been paid to user expectations prior to its use. The aim of this study is to compare the expectations and concerns of 50 healthcare professionals and 45 parents of children with ASD regarding the use of telemedicine for diagnostic or treatment purposes. Parents have higher expectations for the use of telemedicine as an alternative (p = 0.0223) and supplement (p = 0.0061) to in-person diagnosis of ASD, as well as a supplement to traditional intervention (p ≤ 0.0001). In addition, while they also have greater hope for improvement in family routines (p = 0.0034) and parenting skills in child management (p = 0.0147), they express greater concern about the need for active parental involvement/supervision during telemedicine services (p = 0.015) and changes in the behaviour of the child with ASD during telemedicine services (p = 0.049). On the other hand, healthcare professionals are more concerned about barriers such as lack of devices (p = 0.000), unfamiliarity with the technology (p = 0.000), poor quality of internet connection (p = 0.006), and severity of ASD (p = 0.000). To achieve promising healthcare for ASD patients, the telemedicine service should try to meet the needs and preferences of both healthcare professionals and parents, as well as identify and, if possible, reduce perceived barriers.
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22
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McNally Keehn R, Enneking B, James C, Tang Q, Rouse M, Hines E, Raches C, Etling A. Telehealth Evaluation of Pediatric Neurodevelopmental Disabilities During the COVID-19 Pandemic: Clinician and Caregiver Perspectives. J Dev Behav Pediatr 2022; 43:262-272. [PMID: 34954761 DOI: 10.1097/dbp.0000000000001043] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to present clinician and caregiver perspectives regarding telehealth neurodevelopmental evaluation delivered at the onset of the coronavirus disease 2019 (COVID-19) pandemic. Specifically, we sought to describe telehealth neurodevelopmental evaluations, examine associations between child characteristics and diagnostic factors, determine the impact of technology and family barriers, and report on clinician and caregiver satisfaction with telehealth evaluation. METHODS In response to the COVID-19 pandemic, in-person clinical services at a large children's hospital neurodevelopmental clinic were transitioned to telehealth. Data are presented for 254 remote evaluations of children (18-212 months; referral concern: 51% autism spectrum disorder [ASD], 24% developmental delay/intellectual disability, 25% other neurodevelopmental concern) conducted from May to July 2020. Data were gathered from electronic health records as well as clinician and caregiver surveys. RESULTS A clinical diagnosis was provided in 72% of telehealth evaluations. Clinicians rated diagnostic certainty as "completely" or "somewhat" certain in 74% of evaluations. Certainty ratings were higher for evaluations in which a diagnosis of ASD was provided. Although technology and family challenges were reported, clinicians rarely identified these as disruptive to the evaluation process. Clinicians reported satisfaction with various aspects of delivering telehealth. Caregivers endorsed high satisfaction with receipt of telehealth and reduced travel burden. CONCLUSION The COVID-19 pandemic has rapidly transformed service delivery for individuals with neurodevelopmental disabilities and provided an unprecedented opportunity to evaluate the deployment of telehealth evaluation to meet the need for ongoing diagnostic care. Our findings suggest that telehealth holds significant promise for neurodevelopmental assessment both within the context of a global pandemic and beyond.
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Affiliation(s)
| | | | | | - Qing Tang
- Biostatistics, Indiana University School of Medicine, Indianapolis, IN
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23
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Reisinger DL, Hines E, Raches C, Tang Q, James C, Keehn RM. Provider and Caregiver Satisfaction with Telehealth Evaluation of Autism Spectrum Disorder in Young Children During the COVID-19 Pandemic. J Autism Dev Disord 2022; 52:5099-5113. [PMID: 35579789 PMCID: PMC9112250 DOI: 10.1007/s10803-022-05576-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 11/30/2022]
Abstract
The present study examines provider and caregiver satisfaction with telehealth evaluation of autism spectrum disorder (ASD) in young children during the coronavirus SARS-CoV-2 (COVID-19) pandemic. A telehealth model of ASD evaluation was implemented with 308 children ages 14 to 78 months between May 2020 to June 2021. Data were gathered from electronic health records, autism-specific telehealth diagnostic tools, and post-evaluation surveys. Overall, the majority of providers and caregivers were satisfied with telehealth ASD evaluation. Multiple variables were associated with ratings of satisfaction, differing by providers and caregivers. Findings have important implications for the feasibility and acceptability of telehealth ASD evaluations, in addition to key factors to consider in optimizing and sustaining telehealth evaluations beyond the COVID-19 pandemic.
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Affiliation(s)
- Debra L Reisinger
- Department of Pediatrics, Indiana University School of Medicine, 1002 Wishard Blvd, Suite 3120, 46202, Indianapolis, IN, United States.
| | - Elesia Hines
- Department of Pediatrics, Indiana University School of Medicine, 1002 Wishard Blvd, Suite 3120, 46202, Indianapolis, IN, United States
| | - Christine Raches
- Department of Pediatrics, Indiana University School of Medicine, 1002 Wishard Blvd, Suite 3120, 46202, Indianapolis, IN, United States
| | - Qing Tang
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Cristina James
- Department of Pediatrics, Indiana University School of Medicine, 1002 Wishard Blvd, Suite 3120, 46202, Indianapolis, IN, United States
| | - Rebecca McNally Keehn
- Department of Pediatrics, Indiana University School of Medicine, 1002 Wishard Blvd, Suite 3120, 46202, Indianapolis, IN, United States
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24
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Kreysa H, Schneider D, Kowallik AE, Dastgheib SS, Doğdu C, Kühn G, Ruttloff JM, Schweinberger SR. Psychosocial and Behavioral Effects of the COVID-19 Pandemic on Children and Adolescents with Autism and Their Families: Overview of the Literature and Initial Data from a Multinational Online Survey. Healthcare (Basel) 2022; 10:healthcare10040714. [PMID: 35455891 PMCID: PMC9028372 DOI: 10.3390/healthcare10040714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 02/04/2023] Open
Abstract
Since COVID-19 has become a pandemic, everyday life has seen dramatic changes affecting individuals, families, and children with and without autism. Among other things, these changes entail more time at home, digital forms of communication, school closures, and reduced support and intervention. Here, we assess the effects of the pandemic on quality of life for school-age autistic and neurotypical children and adolescents. First, we provide a comprehensive review of the current relevant literature. Next, we report original data from a survey conducted in several countries, assessing activities, well-being, and social life in families with autism, and their changes over time. We focus on differences between children with and without autism from within the same families, and on different outcomes for children with high- or low-functioning autism. While individuals with autism scored lower in emotional and social functioning than their neurotypical siblings, both groups of children showed comparable decreases in well-being and increases in anxiety, compared to before the pandemic. By contrast, decreases in adaptability were significantly more pronounced in autistic children and adolescents compared to neurotypical children and adolescents. Overall, although individual families reported some positive effects of pandemic restrictions, our data provide no evidence that these generalize across children and adolescents with autism, or even just to individuals with high-functioning autism. We discuss the increased challenges that need to be addressed to protect children and adolescents’ well-being under pandemic conditions, but also point out potentials in the present situation that could be used towards social participation and success in older children and young adults with autism.
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Affiliation(s)
- Helene Kreysa
- Social Potential in Autism Research Unit & Department of General Psychology and Cognitive Neuroscience, Friedrich Schiller University Jena, 07743 Jena, Germany; (A.E.K.); (S.S.D.); (J.M.R.)
- Correspondence: (H.K.); (S.R.S.)
| | - Dana Schneider
- Social Potential in Autism Research Unit & Department of Social Psychology, Friedrich Schiller University Jena, 07743 Jena, Germany; (D.S.); (C.D.)
- DFG Scientific Network “Understanding Others”, SCHN 1481/2-1, 10117 Berlin, Germany
| | - Andrea Erika Kowallik
- Social Potential in Autism Research Unit & Department of General Psychology and Cognitive Neuroscience, Friedrich Schiller University Jena, 07743 Jena, Germany; (A.E.K.); (S.S.D.); (J.M.R.)
- Early Support and Counseling Center Jena, Herbert Feuchte Stiftungsverbund, 07743 Jena, Germany;
- Department of Psychiatry, Jena University Hospital, 07743 Jena, Germany
| | - Samaneh Sadat Dastgheib
- Social Potential in Autism Research Unit & Department of General Psychology and Cognitive Neuroscience, Friedrich Schiller University Jena, 07743 Jena, Germany; (A.E.K.); (S.S.D.); (J.M.R.)
| | - Cem Doğdu
- Social Potential in Autism Research Unit & Department of Social Psychology, Friedrich Schiller University Jena, 07743 Jena, Germany; (D.S.); (C.D.)
| | - Gabriele Kühn
- Early Support and Counseling Center Jena, Herbert Feuchte Stiftungsverbund, 07743 Jena, Germany;
| | - Jenny Marianne Ruttloff
- Social Potential in Autism Research Unit & Department of General Psychology and Cognitive Neuroscience, Friedrich Schiller University Jena, 07743 Jena, Germany; (A.E.K.); (S.S.D.); (J.M.R.)
| | - Stefan R. Schweinberger
- Social Potential in Autism Research Unit & Department of General Psychology and Cognitive Neuroscience, Friedrich Schiller University Jena, 07743 Jena, Germany; (A.E.K.); (S.S.D.); (J.M.R.)
- Correspondence: (H.K.); (S.R.S.)
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25
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Vanegas SB, Dueñas AD, Kunze M, Xu Y. Adapting
parent‐focused
interventions for diverse caregivers of children with intellectual and developmental disabilities: Lessons learned during global crises. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2022. [DOI: 10.1111/jppi.12422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Ana D. Dueñas
- College of Education and Human Services Lehigh University Bethlehem Pennsylvania USA
| | - Megan Kunze
- Department of Special Education and Clinical Sciences and Center for Brain Injury Research and Training University of Oregon Eugene Oregon USA
| | - Yue Xu
- Department of Health Sciences Education University of Illinois College of Medicine at Rockford Rockford Illinois USA
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26
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Stavropoulos KK, Heyman M, Salinas G, Baker E, Blacher J. Exploring telehealth during COVID for assessing autism spectrum disorder in a diverse sample. PSYCHOLOGY IN THE SCHOOLS 2022; 59:1319-1334. [PMID: 35572181 PMCID: PMC9088649 DOI: 10.1002/pits.22672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 10/27/2021] [Accepted: 11/15/2021] [Indexed: 11/10/2022]
Affiliation(s)
| | - Michelle Heyman
- Graduate School of Education University of California, Riverside Riverside CA USA
| | - Giselle Salinas
- Graduate School of Education University of California, Riverside Riverside CA USA
| | - Elizabeth Baker
- Graduate School of Education University of California, Riverside Riverside CA USA
| | - Jan Blacher
- Graduate School of Education University of California, Riverside Riverside CA USA
- Department of Psychology University of California Los Angeles USA
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27
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Jones MK, Zellner MA, Hobson AN, Levin A, Roberts MY. Understanding Caregiver Satisfaction With a Telediagnostic Assessment of Autism Spectrum Disorder. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:982-990. [PMID: 35133855 PMCID: PMC9150683 DOI: 10.1044/2021_ajslp-21-00139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/31/2021] [Accepted: 11/10/2021] [Indexed: 05/28/2023]
Abstract
PURPOSE In light of the COVID-19 pandemic, it is critical to understand the feasibility and acceptability of the use of telediagnostic assessments in clinical settings. This study aimed to characterize caregiver satisfaction with a telediagnostic assessment of autism spectrum disorder (ASD). METHOD Twelve families completed a telediagnostic assessment of ASD through Illinois' Early Intervention program including a caregiver interview, administration of the TELE-ASD-PEDS, and a feedback visit. Following the evaluation, caregivers rated their satisfaction with the telediagnostic assessment. RESULTS Caregivers reported that the evaluation met their expectations, and they were satisfied with the assessment and feedback visit. However, caregiver satisfaction with the telehealth platform varied, and the majority of caregivers reported a preference for in-person visits. Qualitative analysis of caregiver responses noted the benefits and areas of improvement of telediagnostic assessment. Thematic analysis revealed the strengths of the telediagnostic assessment, including the logistical convenience of the teleassessment, ease of administration, rapport with and expertise of the clinicians, and qualification for intervention services. Although caregivers' perspectives varied, diagnostic accuracy and the amount of information provided about the diagnosis were reported areas of improvement. CONCLUSIONS Overall, telediagnostic assessments were well received by families. Caregivers' preference for in-person visits highlights the need to incorporate caregiver-reported areas of improvement in the development and administration of telediagnostic assessments.
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Affiliation(s)
- Maranda K. Jones
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Matthew A. Zellner
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Amanda N. Hobson
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Amy Levin
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Megan Y. Roberts
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
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28
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Kennelly AM, McIntyre B, Wood AC, Monteiro S, Voigt RG. Patient Satisfaction in Neurodevelopmental Pediatrics: In-Person vs Telemedicine. J Child Neurol 2022; 37:181-185. [PMID: 35410515 DOI: 10.1177/08830738221075451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND As a result of the COVID-19 pandemic, medical practices for children with neurodevelopmental disorders urgently adopted telehealth, despite limited data regarding patient satisfaction. OBJECTIVE To compare patient satisfaction survey scores for neurodevelopmental pediatric appointments completed in-person to appointments completed via telemedicine. METHODS Using routinely collected Press Ganey survey results, the proportion of Top Box scores (the percentage of responses in the highest possible category [ie, the percentage of "very good" or "always" responses]) for an in-person only group was compared to the proportion in a telemedicine-only group using Fisher's exact test. RESULTS Most respondents gave Top-Box scores in response to all of the questions for both in-person and telemedicine visits. There were no statistically significant differences in any domain of the Press Ganey surveys in Top Box percentages for in-person vs telemedicine visits. CONCLUSION This study provides preliminary evidence that telehealth may be an acceptable modality for families seeking care for their children with neurodevelopmental concerns.
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Affiliation(s)
- Ann M Kennelly
- Meyer Center for Developmental Pediatrics & Autism, Department of Pediatrics, 3984Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Brandon McIntyre
- Meyer Center for Developmental Pediatrics & Autism, Department of Pediatrics, 3984Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Alexis C Wood
- USDA Children's Nutrition Research Center, Department of Pediatrics, 3989Baylor College of Medicine, Houston, TX, USA
| | - Sonia Monteiro
- Meyer Center for Developmental Pediatrics & Autism, Department of Pediatrics, 3984Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Robert G Voigt
- Meyer Center for Developmental Pediatrics & Autism, Department of Pediatrics, 3984Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
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29
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Stavropoulos KKM, Bolourian Y, Blacher J. A scoping review of telehealth diagnosis of autism spectrum disorder. PLoS One 2022; 17:e0263062. [PMID: 35143494 PMCID: PMC8830614 DOI: 10.1371/journal.pone.0263062] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 01/11/2022] [Indexed: 12/16/2022] Open
Abstract
Background Considering the COVID-19 pandemic, understanding the reliability, validity, social validity, and feasibility of using telehealth to diagnose ASD is a critical public health issue. This paper examines evidence supporting the use of telehealth methods to diagnose ASD and outlines the necessary modifications and adaptations to support telehealth diagnosis. Methods and procedures Studies were identified by searching PubMed and PsychInfo electronic databases and references lists of relevant articles. Only peer reviewed articles published in English with a focus on using telehealth for the purposes of diagnosing ASD were included. Searches were conducted through June 3rd, 2021. Outcomes and results A total of 10 studies were identified as meeting inclusion criteria. Of the eight papers that reported on reliability (e.g., accuracy), telehealth methods to diagnose ASD were between 80–91% accurate when compared with traditional in-person diagnosis. Six studies reported on validity (i.e., sensitivity and/or specificity). All six studies calculated sensitivity, with values ranging from 75% and 100%. Five of the six studies calculated specificity, with values ranging from 68.75% and 100%. The seven papers that reported social validity indicated that caregivers, as well as adult participants and clinicians, were mostly satisfied with telehealth. Feasibility was reported by seven studies and suggests that telehealth methods appear largely viable, though some challenges were reported. Conclusions and implications Although findings reviewed here are promising, more research is needed to verify the accuracy, validity, and feasibility of utilizing telehealth to diagnose ASD. Studies with larger sample sizes and samples across sites will be critical, as these will allow clinicians to identify subjects most likely to benefit from telehealth as well as those more likely to require an in-person assessment. This research is important not only due to the current pandemic, but also due to increased prevalence rates of ASD and an insufficient number of diagnostic providers—particularly in rural and/or otherwise under-served communities.
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Affiliation(s)
| | - Yasamin Bolourian
- School of Education, University of California, Riverside, CA, United States of America
| | - Jan Blacher
- School of Education, University of California, Riverside, CA, United States of America
- Department of Psychology, University of California, Los Angeles, CA, United States of America
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30
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Mire SS, Keller‐Margulis MA, Izuno‐Garcia AK, Jellinek ER, Loría Garro ES. Evaluating the feasibility of remotely administered curriculum‐based measurement for students with autism: A pilot study. PSYCHOLOGY IN THE SCHOOLS 2022. [DOI: 10.1002/pits.22668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sarah S. Mire
- Department of Psychological, Health, and Learning Sciences University of Houston Houston Texas USA
| | | | - Amy K. Izuno‐Garcia
- Department of Psychological, Health, and Learning Sciences University of Houston Houston Texas USA
| | - Emily R. Jellinek
- Department of Psychological, Health, and Learning Sciences University of Houston Houston Texas USA
| | - Elías S. Loría Garro
- Department of Psychological, Health, and Learning Sciences University of Houston Houston Texas USA
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31
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Kryszak EM, Albright CM, Stephenson KG, Nevill RE, Hedley D, Burns CO, Young RL, Butter EM, Vargo K, Mulick JA. Preliminary Validation and Feasibility of the Autism Detection in Early Childhood-Virtual (ADEC-V) for Autism Telehealth Evaluations in a Hospital Setting. J Autism Dev Disord 2022; 52:5139-5149. [PMID: 35138558 PMCID: PMC9637241 DOI: 10.1007/s10803-022-05433-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 01/08/2023]
Abstract
This study provided preliminary validation of the Autism Detection in Early Childhood-Virtual (ADEC-V) for telehealth assessment of possible autism. Participants were 121 children (24.79% female) aged 18–47 months who completed telehealth evaluations at a large pediatric hospital in the Midwestern United States between October 2020 and February 2021. The ADEC-V showed good sensitivity (0.82) and specificity (0.78) and was significantly correlated with other ASD symptom measures (i.e., CARS-2, ADI-R). Internal consistency was acceptable (α = 0.77). These results need replication in a larger and broader sample including more children without ASD. This preliminary validation study identifies the ADEC-V as a promising measure for telehealth ASD assessments in young children.
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Affiliation(s)
- Elizabeth M Kryszak
- Nationwide Children's Hospital, Columbus, OH, USA. .,Department of Pediatrics and Psychology, The Ohio State University, Columbus, OH, USA. .,Child Development Center, Nationwide Children's Hospital, 187 W. Schrock Rd., Westerville, OH, 43081, USA.
| | - Charles M Albright
- Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics and Psychology, The Ohio State University, Columbus, OH, USA
| | - Kevin G Stephenson
- Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics and Psychology, The Ohio State University, Columbus, OH, USA
| | - Rose E Nevill
- School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
| | - Darren Hedley
- School of Psychology & Public Health, Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | | | | | - Eric M Butter
- Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics and Psychology, The Ohio State University, Columbus, OH, USA
| | | | - James A Mulick
- Department of Pediatrics and Psychology, The Ohio State University, Columbus, OH, USA
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32
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Kryszak EM, Albright CM, Fell LA, Butter EM, Kuhlthau KA. Clinician Perspectives on Telehealth Assessment of Autism Spectrum Disorder During the COVID-19 Pandemic. J Autism Dev Disord 2022; 52:5083-5098. [PMID: 35103899 PMCID: PMC8804366 DOI: 10.1007/s10803-022-05435-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 01/25/2023]
Abstract
This study examined clinician insights into telehealth assessment services for autism spectrum disorder implemented during the COVID-19 pandemic. 35 clinicians from multiple disciplines across 17 sites in the Autism Care Network were interviewed. Themes identified through qualitative analyses included factors related to confidence in diagnosis (impressions of in-home observation; child and family factors that affected diagnostic confidence; changes in rapport); patient and family factors related to telehealth (perceived family benefits of and barriers to telehealth; factors related to healthcare disparities; factors specific to non-native English speakers); and institutional and workplace factors related to transitioning to telehealth (institutional support; changes to efficacy, attendance, and work satisfaction). Results suggest that telehealth has potential to be an effective tool in autism assessment practice.
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Affiliation(s)
- Elizabeth M Kryszak
- Nationwide Children's Hospital, Columbus, OH, USA. .,Department of Pediatrics and Psychology, The Ohio State University, Columbus, OH, USA. .,Child Development Center, Nationwide Children's Hospital, 187 W. Schrock Rd., Westerville, OH, 43081, USA.
| | - Charles M Albright
- Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics and Psychology, The Ohio State University, Columbus, OH, USA
| | - Lucy A Fell
- Division of Pediatric Health Outcomes Research, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Eric M Butter
- Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics and Psychology, The Ohio State University, Columbus, OH, USA
| | - Karen A Kuhlthau
- Division of Pediatric Health Outcomes Research, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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33
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Hudock RL, Esler AN. Clinical considerations when conducting diagnostic evaluations to identify autism spectrum disorder in young children. Clin Neuropsychol 2022; 36:921-942. [DOI: 10.1080/13854046.2022.2025907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Rebekah L. Hudock
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Amy N. Esler
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
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34
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Phelps RA, Sample E, Greene RK, Duvall SW. Identifying Patient Characteristics to Understand Which Children May Receive Diagnostic Clarity in a Virtual Autism Spectrum Disorder Evaluation. J Autism Dev Disord 2022; 52:5126-5138. [PMID: 35064874 PMCID: PMC8783571 DOI: 10.1007/s10803-022-05434-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Randi A Phelps
- Division of Pediatric Psychology, Department of Pediatrics, Institute On Development and Disability, Oregon Health & Science University and Doernbecher Children's Hospital, Portland, OR, USA.
| | - Erika Sample
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| | - Rachel K Greene
- Division of Pediatric Psychology, Department of Pediatrics, Institute On Development and Disability, Oregon Health & Science University and Doernbecher Children's Hospital, Portland, OR, USA
| | - Susanne W Duvall
- Division of Pediatric Psychology, Department of Pediatrics, Institute On Development and Disability, Oregon Health & Science University and Doernbecher Children's Hospital, Portland, OR, USA
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35
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Vanegas SB, Dueñas AD, Kunze M, Xu Y. Adapting parent-focused interventions for diverse caregivers of children with intellectual and developmental disabilities: Lessons learned during global crises. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2022; na:1-13. [PMID: 35919414 PMCID: PMC9340799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Parent-focused interventions have been designed to provide training and support to caregivers who are essential in achieving positive outcomes for children with intellectual and developmental disabilities (IDD). In 2020, significant crises, including the COVID-19 pandemic and continued racial tensions, profoundly impacted the livelihood of children with IDD and their families. Many ongoing efforts to address disparities among this population were halted temporarily and required further adaptations. Researchers adapted interventions and support to address the disparities impacting children with IDD and their families with limited guidance. We provide a descriptive case analysis of four parent-focused interventions that responded to the global crises to continue serving children with IDD and their families. The four distinct programs were based on applied behavior analysis and naturalistic, developmental-behavioral paradigms that were culturally adapted for families of young children with IDD from diverse cultural and socioeconomic backgrounds. We present the qualitative reports on the challenges and benefits that arose with adapting the four parent-focused interventions for telehealth implementation. We focused specifically on adaptations made in recruitment and retention, instrumentation and measurement, research staff training, and intervention delivery. We synthesize our experience with challenges and solutions in adapting parent-focused interventions for racially/ethnically and socioeconomically diverse children with IDD and their families. We conclude with recommendations for researchers and practitioners on methods for adapting parent-focused interventions to address the significant health disparities that impact racially, ethnically, and socioeconomically diverse children with IDD and their families.
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Affiliation(s)
- Sandra B. Vanegas
- School of Social Work, Texas State University, San Marcos, Texas, USA
| | - Ana D. Dueñas
- College of Education and Human Services, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Megan Kunze
- Department of Special Education and Clinical Sciences and Center for Brain Injury Research and Training, University of Oregon, Eugene, Oregon, USA
| | - Yue Xu
- Department of Health Sciences Education, University of Illinois College of Medicine at Rockford, Rockford, Illinois, USA
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36
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Ruffini C, Tarchi C, Morini M, Giuliano G, Pecini C. Tele-assessment of cognitive functions in children: a systematic review. Child Neuropsychol 2021; 28:709-745. [PMID: 34856882 DOI: 10.1080/09297049.2021.2005011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cognitive Tele-Assessment approach (CTA) has been widely used in adults for clinical, research, and screening purposes. In the last decades, it has been considered a useful tool for evaluating child development in both clinical and educational settings and new instruments for CTA in children have been developed. In comparison to In Person Assessment (IPA), CTA can have several advantages, such as increasing accessibility, cutting waiting lists, reducing time and travel costs, and assisting with infection control by minimizing face-to-face contact in times of pandemic. Nevertheless, several issues related to the feasibility and reliability of using CTA to evaluate cognitive development are still open. The present systematic review has a twofold aim: 1. to describe the cognitive functions that are most frequently measured by CTA in children, the procedures used, and the characteristics of the samples investigated; 2. to investigate the agreement between CTA and IPA scores in children.In the present systematic review, 23 studies using CTA in children, with typical or atypical development, have been selected and analyzed. Results support the similarities in performance scores between IPA and CTA and good compliance by children and their families in participating in CTA. Nonetheless, most studies suggest that several methodological precautions must be taken to manage technical and procedural characteristics that may represent challenges for CTA of children. Suggestions for a correct use of CTA, factors affecting the validity of the results and directions for future research are discussed.
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Affiliation(s)
- Costanza Ruffini
- Department of Education, Languages, Intercultures, Literatures and Psychology (FORLIPSI), University of Florence, Firenze, Italy
| | - Christian Tarchi
- Department of Education, Languages, Intercultures, Literatures and Psychology (FORLIPSI), University of Florence, Firenze, Italy
| | - Monica Morini
- Department of Education, Languages, Intercultures, Literatures and Psychology (FORLIPSI), University of Florence, Firenze, Italy
| | - Gabriella Giuliano
- Department of Education, Languages, Intercultures, Literatures and Psychology (FORLIPSI), University of Florence, Firenze, Italy
| | - Chiara Pecini
- Department of Education, Languages, Intercultures, Literatures and Psychology (FORLIPSI), University of Florence, Firenze, Italy
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37
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Zwaigenbaum L, Bishop S, Stone WL, Ibanez L, Halladay A, Goldman S, Kelly A, Klaiman C, Lai MC, Miller M, Saulnier C, Siper P, Sohl K, Warren Z, Wetherby A. Rethinking autism spectrum disorder assessment for children during COVID-19 and beyond. Autism Res 2021; 14:2251-2259. [PMID: 34553489 PMCID: PMC8646364 DOI: 10.1002/aur.2615] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/21/2021] [Accepted: 09/09/2021] [Indexed: 12/29/2022]
Abstract
The COVID-19 pandemic has posed unique challenges for families and caregivers, as well as for autism-focused clinicians, who are faced with providing a thorough and accurate evaluation of children's specific needs and diagnoses in the absence of in-person assessment tools. The shift to telehealth assessments has challenged clinicians to reconsider approaches and assumptions that underlie the diagnostic assessment process, and to adopt new ways of individualizing standard assessments according to family and child needs. Mandates for physical distancing have uncovered deficiencies in diagnostic practices for suspected autism and have illuminated biases that have posed obstacles preventing children and families from receiving the services that they truly need. This Commentary outlines several considerations for improving diagnostic practices as we move forward from the current pandemic and continue to strive to build an adaptable, sustainable, equitable, and family-centered system of care. LAY SUMMARY: Physical distancing and the abrupt end to in-person services for many children on the autism spectrum has forced clinicians to examine the existing challenges with autism spectrum disorder (ASD) diagnostic assessment and consider things they want to keep and things that should be changed in the years ahead. New approaches such as telehealth both alleviated and exacerbated existing disparities, and brought into stark focus the importance of equitable and timely access to family-centered care. This commentary suggests ways of improving clinical practices related to ASD assessment to continue along this path.
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Affiliation(s)
- Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Somer Bishop
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | - Wendy L Stone
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Lisa Ibanez
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Alycia Halladay
- Autism Science Foundation, New York, New York, USA.,Department of Pharmacology and Toxicology, Rutgers University, Piscataway, New Jersey, USA
| | - Sylvie Goldman
- Department of Neurology, G.H. Sergievsky Center, Columbia University Medical Center, New York, New York, USA
| | - Amy Kelly
- Devereux Advanced Behavioral Health, Villanova, Pennsylvania, USA
| | - Cheryl Klaiman
- Department of Pediatrics, Emory School of Medicine, Atlanta, Georgia, USA
| | - Meng-Chuan Lai
- The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health and Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry and Autism Research Unit, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK.,Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Meghan Miller
- Department of Psychiatry & Behavioral Sciences and MIND Institute, University of California, Davis, California, USA
| | - Celine Saulnier
- Department of Pediatrics, Emory School of Medicine, Atlanta, Georgia, USA.,Neurodevelopmental Assessment & Consulting Services, Decatur, Georgia, USA
| | - Paige Siper
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kristin Sohl
- Department of Child Health, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Zachary Warren
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amy Wetherby
- Department of Clinical Sciences, College of Medicine, Florida State University, Tallahassee, Florida, USA
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38
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Corona LL, Stainbrook JA, Simcoe K, Wagner L, Fowler B, Weitlauf AS, Juárez AP, Warren Z. Utilization of telemedicine to support caregivers of young children with ASD and their Part C service providers: a comparison of intervention outcomes across three models of service delivery. J Neurodev Disord 2021; 13:38. [PMID: 34525940 PMCID: PMC8441955 DOI: 10.1186/s11689-021-09387-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 06/16/2021] [Indexed: 11/30/2022] Open
Abstract
Background Families of young children with autism spectrum disorder (ASD) frequently experience barriers to accessing evidence-based early intervention services. Telemedicine presents an opportunity to increase access to these services, particularly for families in rural and under-resourced areas. The present article describes a brief behavioral intervention and support model for families of young children with concerns for ASD. In the context of the COVID-19 pandemic, this service model shifted to telemedicine-only service delivery, resulting in an opportunity to analyze intervention outcomes from services delivered either via traditional in-person visits, telemedicine-only sessions, or a hybrid model including both in-person and telemedicine sessions. Methods Data are presented for 115 families with toddlers 16-33 months of age who participated in a six-session behavioral intervention and support service model either in-person, through telemedicine, or through a hybrid service model. This intervention was available for families referred for ASD evaluation through the state Part C early intervention program. Intervention feasibility, fidelity of implementation, child outcomes, and stakeholder satisfaction are compared across service delivery models. Results Caregivers, behavioral consultants, and Part C early intervention providers reported satisfaction with services, regardless of service delivery model. Caregivers and consultants also reported positive child outcomes. Statistically significant differences emerged for caregiver- and consultant-reported child outcomes in some domains, with stakeholders in the telemedicine-only group reporting slightly less improvement, compared to stakeholders in the in-person-only group. Caregivers and consultants in the telemedicine-only group also provided qualitative feedback on benefits and challenges related to telemedicine services. Conclusions Both caregivers and behavioral consultants reported positive outcomes following a brief behavioral intervention and support model targeted at families of young children with concern for ASD. Stakeholders reported improvement in child behavior and satisfaction with services across in-person, telemedicine-only, and hybrid models of service delivery. These results suggest that telemedicine presents a promising opportunity for increasing service access. Additional research is needed to continue optimizing the experience of telemedicine-based service delivery for both families and intervention providers.
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Affiliation(s)
- Laura L Corona
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17th Avenue South, Nashville, TN, 37203, USA. .,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - J Alacia Stainbrook
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17th Avenue South, Nashville, TN, 37203, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kathleen Simcoe
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17th Avenue South, Nashville, TN, 37203, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Liliana Wagner
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17th Avenue South, Nashville, TN, 37203, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bethena Fowler
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17th Avenue South, Nashville, TN, 37203, USA
| | - Amy S Weitlauf
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17th Avenue South, Nashville, TN, 37203, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - A Pablo Juárez
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17th Avenue South, Nashville, TN, 37203, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Special Education, Vanderbilt University, Nashville, TN, USA
| | - Zachary Warren
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17th Avenue South, Nashville, TN, 37203, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Special Education, Vanderbilt University, Nashville, TN, USA
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39
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Ellison KS, Guidry J, Picou P, Adenuga P, Davis TE. Telehealth and Autism Prior to and in the Age of COVID-19: A Systematic and Critical Review of the Last Decade. Clin Child Fam Psychol Rev 2021; 24:599-630. [PMID: 34114135 PMCID: PMC8191715 DOI: 10.1007/s10567-021-00358-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2021] [Indexed: 01/20/2023]
Abstract
There has been growing interest in the use of telehealth; however, the COVID-19 pandemic and the subsequent isolation and restrictions placed on in-person services have fast-tracked implementation needs for these services. Individuals with autism spectrum disorder (ASD) have been particularly affected due to the often-intensive service needs required by this population. As a result, the aim of this review was to examine the evidence base, methodology, and outcomes of studies that have used telehealth for assessment and/or intervention with children and adolescents with ASD as well as their families over the last decade. Further, the goal is to highlight the advances in telehealth and its use with this special population. A systematic search of the literature was undertaken, with 55 studies meeting inclusion criteria and quality analysis. Specified details were extracted from each article, including participant characteristics, technology, measures, methodology/study design, and clinical and implementation outcomes. Services provided via telehealth included diagnostic assessments, preference assessments, early intervention, applied behavior analysis (ABA), functional assessment and functional communication training, and parent training. Findings, although still emerging, encouragingly suggested that services via telehealth were equivalent or better to services face-to-face. Results support the benefits to using telehealth with individuals with ASD. Future research should continue to explore the feasibility of both assessments and interventions via telehealth with those having ASD to make access to assessment services and interventions more feasible for families, while acknowledging the digital divide it could create.
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Affiliation(s)
- Kimberly S Ellison
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Jerrica Guidry
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Paige Picou
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Paige Adenuga
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Thompson E Davis
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA.
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40
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Long M, Register-Brown K. Autism Spectrum Disorder. Pediatr Rev 2021; 42:360-374. [PMID: 34210755 DOI: 10.1542/pir.2020-000547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Kelly Register-Brown
- Division of Psychiatry and Behavioral Health Sciences, Children's National Hospital, Washington, DC
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41
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Posar A, Visconti P, Giuberti V. The impact of the COVID-19 pandemic on the assessment of autism spectrum disorder. Turk Arch Pediatr 2021; 56:280-282. [PMID: 34104925 DOI: 10.5152/turkarchpediatr.2021.20269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/25/2020] [Indexed: 01/02/2023]
Affiliation(s)
- Annio Posar
- IRCCS Institute of Neurological Sciences of Bologna, Autism Spectrum Disorders Unit, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Paola Visconti
- IRCCS Institute of Neurological Sciences of Bologna, Autism Spectrum Disorders Unit, Bologna, Italy
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42
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Wagner L, Weitlauf AS, Hine J, Corona LL, Berman AF, Nicholson A, Allen W, Black M, Warren Z. Transitioning to Telemedicine During COVID-19: Impact on Perceptions and Use of Telemedicine Procedures for the Diagnosis of Autism in Toddlers. J Autism Dev Disord 2021; 52:2247-2257. [PMID: 34085153 PMCID: PMC8175230 DOI: 10.1007/s10803-021-05112-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 12/25/2022]
Abstract
The COVID-19 pandemic has increased the use of telemedicine as an avenue to address the need for diagnostic clarification in young children at risk for autism spectrum disorder (ASD). Although preliminary research has supported the use of telemedicine for identifying ASD in toddlers, little is known about the experiences of practitioners attempting direct-to-home tele-assessment. We surveyed diagnostic providers regarding changes in practice behavior in the initial months of the COVID-19 pandemic and their perceptions of ASD tele-assessment. We also examined the use of the TELE-ASD-PEDS, a novel tool for ASD tele-assessment, in response to COVID-19 at seven sites across the country. Results support the clinical acceptability and diagnostic utility of ASD tele-assessment while also highlighting critical avenues of future investigation.
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Affiliation(s)
- Liliana Wagner
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17thAvenue, Suite 202, Nashville, TN 37203 USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN USA
| | - Amy S. Weitlauf
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17thAvenue, Suite 202, Nashville, TN 37203 USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN USA
| | - Jeffrey Hine
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17thAvenue, Suite 202, Nashville, TN 37203 USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN USA
| | - Laura L. Corona
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17thAvenue, Suite 202, Nashville, TN 37203 USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN USA
| | - Anna F. Berman
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17thAvenue, Suite 202, Nashville, TN 37203 USA
| | - Amy Nicholson
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17thAvenue, Suite 202, Nashville, TN 37203 USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN USA
- Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN USA
| | | | | | - Zachary Warren
- Vanderbilt Kennedy Center/Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1207 17thAvenue, Suite 202, Nashville, TN 37203 USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN USA
- Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN USA
- Department of Special Education, Vanderbilt University, Nashville, TN USA
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43
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Pulsipher DT, Lieb RW. Using latent profile analysis to evaluate the utility of a DSM-5 symptom checklist in screening children for autism spectrum disorder. Clin Neuropsychol 2021; 36:874-898. [PMID: 34080494 DOI: 10.1080/13854046.2021.1929495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: Currently available screening measures for Autism Spectrum Disorder (ASD) typically do not reflect DSM-5 diagnostic criteria and generally have weak positive predictive values. These factors result in missed opportunities for early intervention, delays in diagnosis, and contribute to inefficient usage of healthcare resources by inadequately discerning those in need of comprehensive assessment. This study examined a DSM-5 ASD symptom checklist to determine whether parent-report response patterns could accurately identify which children received an ASD diagnosis. Method: Data were examined from 376 ASD evaluations in a three-year period. Latent profile analysis was used to determine if subgroups could be identified according to parent response patterns, and network analysis was implemented to examine the relationship among DSM-5 ASD criteria within each latent profile. Results: A four-profile model was best supported based on fit indices and high probability classifications. The model was largely a product of how parents responded regarding their child's sensory behavior and minimally reflected other symptomatology. Subsequent network analyses by profile indicated weak coherence among DSM-5 symptoms within all profiles. Overall, direct assessment of DSM-5 criteria based on parent report did not add diagnostic value beyond that reflected in base rates. Conclusions: Although continued refinement of ASD screening tools is needed to improve accuracy of referrals for evaluations and reduce wait time for diagnosis, this study continues to support the need for behavioral observation and formal assessment by trained clinicians. Continued development of sensitive and specific screening tools, likely with embedded behavioral and/or objective observation, is needed.
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Affiliation(s)
- Dalin T Pulsipher
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Rebecca W Lieb
- NeuroDevelopmental Science Center, Akron Children's Hospital, Akron, OH, USA.,Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
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44
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Samadi SA. The Challenges of Bringing Up a Child with Autism Spectrum Disorders: Editorial for Brain Sciences Special Issue "Connections between Parental Involvement and Treatment of Children with Autism Spectrum Disorders (ASD)". Brain Sci 2021; 11:brainsci11050618. [PMID: 34066028 PMCID: PMC8151501 DOI: 10.3390/brainsci11050618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/29/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sayyed Ali Samadi
- Centre for Intellectual and Developmental Disabilities-Institute of Nursing Research, University of Ulster, Newtownabbey BT37 0QB, Northern Ireland, UK
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45
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Jang J, White SP, Esler AN, Kim SH, Klaiman C, Megerian JT, Morse A, Nadler C, Kanne SM. Diagnostic Evaluations of Autism Spectrum Disorder during the COVID-19 Pandemic. J Autism Dev Disord 2021; 52:962-973. [PMID: 33730320 PMCID: PMC7970766 DOI: 10.1007/s10803-021-04960-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 11/25/2022]
Abstract
A global pandemic has significantly impacted the ability to conduct diagnostic evaluations for autism spectrum disorder (ASD). In the wake of the coronavirus, autism centers and providers quickly needed to implement innovative diagnostic processes to adapt in order to continue serve patient needs while minimizing the spread of the virus. The International Collaborative for Diagnostic Evaluation of Autism (IDEA) is a grassroots organization that came together to discuss standards of care during the pandemic and to provide a forum wherein providers communicated decisions. This white paper is intended to provide examples of how different centers adjusted their standard approaches to conduct diagnostic evaluations for ASD during the pandemic and to provide insight to other centers as they go through similar challenges.
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Affiliation(s)
- Jina Jang
- Thompson Autism Center At CHOC Children’s, 170 S. Main Street, Orange, CA 92868 USA
| | | | - Amy N. Esler
- University of Minnesota Autism and Neurodevelopment Clinic, 2512 S 7th St., Suite R103, Minneapolis, MN 55454 USA
| | - So Hyun Kim
- Center for Autism and the Developing Brain, Weill Cornell Medical College/New York Presbyterian Hospital, 21 Bloomingdale Road, White Plains, NY 10605 USA
| | - Cheryl Klaiman
- Marcus Autism Center, 1920 Briarcliff Road NE, Atlanta, GA 30329-4010 USA
| | - Jonathan T. Megerian
- Thompson Autism Center At CHOC Children’s, 170 S. Main Street, Orange, CA 92868 USA
| | - Amy Morse
- Thompson Autism Center At CHOC Children’s, 170 S. Main Street, Orange, CA 92868 USA
| | - Cy Nadler
- Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108 USA
| | - Stephen M. Kanne
- Center for Autism and the Developing Brain, Weill Cornell Medical College/New York Presbyterian Hospital, 21 Bloomingdale Road, White Plains, NY 10605 USA
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46
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Berger NI, Wainer AL, Kuhn J, Bearss K, Attar S, Carter AS, Ibanez LV, Ingersoll BR, Neiderman H, Scott S, Stone WL. Characterizing Available Tools for Synchronous Virtual Assessment of Toddlers with Suspected Autism Spectrum Disorder: A Brief Report. J Autism Dev Disord 2021; 52:423-434. [PMID: 33606157 PMCID: PMC7893832 DOI: 10.1007/s10803-021-04911-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 02/06/2023]
Abstract
The COVID-19 pandemic, and associated social distancing mandates, has placed significant limitations on in-person health services, requiring creative solutions for supporting clinicians engaged in the diagnosis of autism spectrum disorder (ASD). This report describes the five virtual instruments available at the time of manuscript development for use by experienced clinicians making diagnostic determinations of ASD for toddlers across the 12- to 36-months age range. We focus on synchronous virtual assessments in which clinicians guide the child's caregiver through a range of assessment activities and observe spontaneous and elicited behaviors. Assessments are compared on dimensions of targeted behavioral domains, specific activities and presses employed, scoring approaches, and other key logistical considerations to guide instrument selection for use in varied clinical and research contexts.
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Affiliation(s)
- Natalie I Berger
- Autism Assessment, Research, and Treatment Center, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 603, Chicago, IL, 60612, USA
| | - Allison L Wainer
- Autism Assessment, Research, and Treatment Center, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 603, Chicago, IL, 60612, USA.
| | - Jocelyn Kuhn
- Department of Pediatrics, Boston University and Boston Medical Center, 801 Albany St., 3rd Floor, Boston, MA, 02119, USA
| | - Karen Bearss
- Seattle Children's Autism Center, Department of Psychiatry and Behavioral Sciences, University of Washington, 4909 25th Ave NE, Seattle, WA, 98105, USA
| | - Shana Attar
- Department of Psychology, University of Washington, CHDD Box 357920, Seattle, WA, 98195, USA
| | - Alice S Carter
- Department of Psychology, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, 02125, USA
| | - Lisa V Ibanez
- Department of Psychology, University of Washington, CHDD Box 357920, Seattle, WA, 98195, USA
| | - Brooke R Ingersoll
- Department of Psychology, Michigan State University, 316 Physics Rd., Room 105B, East Lansing, MI, 48824, USA
| | - Hannah Neiderman
- Department of Psychology, University of Washington, CHDD Box 357920, Seattle, WA, 98195, USA
| | - Sabine Scott
- Department of Psychology, University of Washington, CHDD Box 357920, Seattle, WA, 98195, USA
| | - Wendy L Stone
- Department of Psychology, University of Washington, CHDD Box 357920, Seattle, WA, 98195, USA
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47
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Dahiya AV, DeLucia E, McDonnell CG, Scarpa A. A systematic review of technological approaches for autism spectrum disorder assessment in children: Implications for the COVID-19 pandemic. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 109:103852. [PMID: 33465590 PMCID: PMC9761928 DOI: 10.1016/j.ridd.2021.103852] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/07/2020] [Accepted: 01/02/2021] [Indexed: 05/28/2023]
Abstract
BACKGROUND Screening and diagnostic assessments tools for autism spectrum disorder (ASD) are important to administer during childhood to facilitate timely entry into intervention services that can promote developmental outcomes across the lifespan. However, assessment services are not always readily available to families, as they require significant time and resources. Currently, in-person screening and diagnostic assessments for ASD are limited due to the COVID-19 pandemic and will continue to be a concern for situations that limit in-person contact. Thus, it is important to expand the modalities in which child assessments are provided, including the use of technology. AIMS This systematic review aims to identify technologies that screen or assess for ASD in 0-12 year-old children, summarizing the current state of the field and suggesting future directions. METHODS An electronic database search was conducted to gather relevant articles to synthesize for this review. OUTCOMES AND RESULTS 16 studies reported use of novel technology to assess children suspected of ASD. CONCLUSIONS AND IMPLICATIONS Results strongly supported live-video evaluations, video observations, and online or phone methods, but there is a need for research targeting the feasibility of these methods as it applies to the stay-at-home orders required by the pandemic, and other situations that limit clients from seeing providers in-person.
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Affiliation(s)
- Angela V Dahiya
- Virginia Polytechnic Institute and State University, Department of Psychology, 109 Williams Hall, Blacksburg, VA, 24060, United States; Virginia Tech Autism Clinic & Center for Autism Research, 3110 Prices Fork Road, Blacksburg, VA, 24060, United States.
| | - Elizabeth DeLucia
- Virginia Polytechnic Institute and State University, Department of Psychology, 109 Williams Hall, Blacksburg, VA, 24060, United States; Virginia Tech Autism Clinic & Center for Autism Research, 3110 Prices Fork Road, Blacksburg, VA, 24060, United States
| | - Christina G McDonnell
- Virginia Polytechnic Institute and State University, Department of Psychology, 109 Williams Hall, Blacksburg, VA, 24060, United States; Virginia Tech Autism Clinic & Center for Autism Research, 3110 Prices Fork Road, Blacksburg, VA, 24060, United States
| | - Angela Scarpa
- Virginia Polytechnic Institute and State University, Department of Psychology, 109 Williams Hall, Blacksburg, VA, 24060, United States; Virginia Tech Autism Clinic & Center for Autism Research, 3110 Prices Fork Road, Blacksburg, VA, 24060, United States
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48
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Toward Novel Tools for Autism Identification: Fusing Computational and Clinical Expertise. J Autism Dev Disord 2021; 51:4003-4012. [PMID: 33417138 PMCID: PMC7791904 DOI: 10.1007/s10803-020-04857-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2020] [Indexed: 01/04/2023]
Abstract
Barriers to identifying autism spectrum disorder (ASD) in young children in a timely manner have led to calls for novel screening and assessment strategies. Combining computational methods with clinical expertise presents an opportunity for identifying patterns within large clinical datasets that can inform new assessment paradigms. The present study describes an analytic approach used to identify key features predictive of ASD in young children, drawn from large amounts of data from comprehensive diagnostic evaluations. A team of expert clinicians used these predictive features to design a set of assessment activities allowing for observation of these core behaviors. The resulting brief assessment underlies several novel approaches to the identification of ASD that are the focus of ongoing research.
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49
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Use of the TELE-ASD-PEDS for Autism Evaluations in Response to COVID-19: Preliminary Outcomes and Clinician Acceptability. J Autism Dev Disord 2020; 51:3063-3072. [PMID: 33125622 PMCID: PMC7596626 DOI: 10.1007/s10803-020-04767-y] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 01/19/2023]
Abstract
The COVID-19 pandemic has caused unprecedented disruptions to healthcare, including direct impacts on service delivery related to autism spectrum disorder (ASD). Caregiver-mediated tele-assessment offers an opportunity to continue services while adhering to social distancing guidelines. The present study describes a model of tele-assessment for ASD in young children, implemented in direct response to disruptions in care caused by the COVID-19 pandemic. We present preliminary data on the outcomes and provider perceptions of tele-assessments, together with several lessons learned during the period of initial implementation.
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