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Harrop C, Tomaszewski B, Putnam O, Klein C, Lamarche E, Klinger L. Are the diagnostic rates of autistic females increasing? An examination of state-wide trends. J Child Psychol Psychiatry 2024; 65:973-983. [PMID: 38181181 PMCID: PMC11161335 DOI: 10.1111/jcpp.13939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Autism has been considered a 'male-dominant' condition. However, recent research suggests that autistic females are underdiagnosed, misdiagnosed, and later diagnosed. Females may also have different and more nuanced behavioral profiles. To examine diagnosis rates of females, we used 20 years of state-wide data to characterize historical trends in the diagnosis of autism in females to determine whether the proportion of females diagnosed with autism has changed over time. METHODS Data were drawn from 10,247 participants (males = 8,319, females = 1928) who received an autism diagnosis between 2000 and 2021 from state-wide autism centers associated with the University of North Carolina TEACCH Autism Program. RESULTS The rates of females diagnosed with autism increased at a greater rate compared with males. Age of diagnosis remained consistently higher for females. Late diagnosis (defined as 13+) increased over time across both males and females, however, was more commonly associated with females, particularly those with co-occurring intellectual disability. CONCLUSIONS Our results indicate that the proportion of females diagnosed with autism has increased steadily over a 20-year period, which likely reflects greater societal knowledge of how autism may manifest differentially in females.
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Affiliation(s)
- Clare Harrop
- Department of Health Sciences, University of North Carolina at Chapel Hill, USA
- University of North Carolina TEACCH Autism Program
| | - Brianne Tomaszewski
- University of North Carolina TEACCH Autism Program
- Department of Psychiatry, University of North Carolina at Chapel Hill, USA
| | - Orla Putnam
- Department of Health Sciences, University of North Carolina at Chapel Hill, USA
| | - Claire Klein
- University of North Carolina TEACCH Autism Program
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, USA
| | | | - Laura Klinger
- University of North Carolina TEACCH Autism Program
- Department of Psychiatry, University of North Carolina at Chapel Hill, 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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4
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Fogler JM, Armstrong-Brine M, Baum R, Ratliff-Schaub K, Howe YJ, Campbell L, Soares N. Online Autism Diagnostic Evaluation: Its Rise, Promise, and Reasons for Caution. J Dev Behav Pediatr 2024; 45:e263-e266. [PMID: 38905007 DOI: 10.1097/dbp.0000000000001271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/12/2024] [Indexed: 06/23/2024]
Affiliation(s)
- Jason M Fogler
- Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Melissa Armstrong-Brine
- MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Rebecca Baum
- UNC Health, University of North Carolina School of Medicine, Chapel Hill, NC
| | | | | | - Lisa Campbell
- Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO; and
| | - Neelkamal Soares
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI
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5
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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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6
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Smith JV, Menezes M, Brunt S, Pappagianopoulos J, Sadikova E, O Mazurek M. Understanding autism diagnosis in primary care: Rates of diagnosis from 2004 to 2019 and child age at diagnosis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241236112. [PMID: 38456360 DOI: 10.1177/13623613241236112] [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: 03/09/2024]
Abstract
LAY ABSTRACT The current demand for autism diagnostic services exceeds the ability of the workforce to assess and diagnose children in a timely manner. One solution may be to equip primary care providers (PCPs) with the tools and expertise needed to diagnose autism within their practice. PCPs are often trusted professionals who have many touchpoints with children during early development, in which they can identify early signs of autism. Recent initiatives have focused on bolstering PCPs' diagnostic capabilities; however, no studies have examined how the rates of autism diagnosis in primary care have changed over time. We aimed to evaluate whether autism diagnosis in primary care has changed over time and how diagnosis in primary care relates to a child's age at the time of diagnosis. We found that the likelihood of a child being diagnosed by a PCP decreased by about 2% with every passing year from 2004 to 2019 when accounting for demographic characteristics. In our sample, PCPs diagnosed children approximately 1 year earlier than non-PCPs (e.g., psychologists and psychiatrists). Further research is needed to understand why the proportion of children diagnosed by PCPs decreases over time. However, this decrease suggests more work is needed to get capacity-building initiatives into community primary care practice. Though we must continue to find effective ways to build community PCPs' ability to diagnose autism, the present findings support the crucial role PCPs can play in early autism diagnosis.
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Affiliation(s)
- Jessica V Smith
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
| | - Michelle Menezes
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
| | - Sophie Brunt
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
| | - Jessica Pappagianopoulos
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
| | - Eleonora Sadikova
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
| | - Micah O Mazurek
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
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7
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Ozonoff S, Gangi D, Corona L, Foster T, Hill MM, Honaker M, Maqbool S, Ni R, Nicholson A, Parikh C, Stone C, Spitler AK, Swanson A, Vehorn A, Wagner L, Weitlauf A, Warren Z. Measuring Developmental Delays: Comparison of Parent Report and Direct Testing. J Autism Dev Disord 2024:10.1007/s10803-024-06292-8. [PMID: 38407697 DOI: 10.1007/s10803-024-06292-8] [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: 02/13/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE Developmental assessment is part of a comprehensive autism evaluation. During in-person evaluations, developmental assessment is completed via direct testing by an examiner. In telehealth evaluations, developmental assessment relies on caregiver-report instruments. This study examined correspondence between caregiver report and direct testing of developmental skills. METHODS Participants were 93 children, aged 18-42 months, undergoing evaluation for possible autism spectrum disorder (ASD). Caregivers were interviewed with the Developmental Profile, 4th edition (DP-4) via telehealth platform and children were tested in person 2-4 weeks later using the Mullen Scales of Early Learning (MSEL). RESULTS Correlations between the DP-4 and MSEL were high (ranging from 0.50 to 0.82) across standard scores, age equivalents, and functional categories, as well as across individual subtests and overall composite scores. CONCLUSION The high convergent validity found in this study suggests that the DP-4 provides a suitable proxy for direct developmental testing using the MSEL in the context of telehealth evaluations for ASD in young children, delivering a good estimate of both developmental functioning and presence of delays. TRIAL REGISTRATION Data were obtained from registered clinical trial NCT05047224, date of registration 2021-09-07.
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Affiliation(s)
- Sally Ozonoff
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California- Davis, 2825 50th Street, Sacramento, CA, USA.
| | - Devon Gangi
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California- Davis, 2825 50th Street, Sacramento, CA, USA
| | - Laura Corona
- Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tori Foster
- Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Monique Moore Hill
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California- Davis, 2825 50th Street, Sacramento, CA, USA
| | - Makayla Honaker
- Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shyeena Maqbool
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California- Davis, 2825 50th Street, Sacramento, CA, USA
| | - Rachel Ni
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California- Davis, 2825 50th Street, Sacramento, CA, USA
| | - Amy Nicholson
- Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chandni Parikh
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California- Davis, 2825 50th Street, Sacramento, CA, USA
| | - Caitlin Stone
- Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anna Kathleen Spitler
- Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amy Swanson
- Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alison Vehorn
- Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Liliana Wagner
- Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amy Weitlauf
- Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zachary Warren
- Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
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8
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Wagner L, Vehorn A, Weitlauf AS, Lavanderos AM, Wade J, Corona L, Warren Z. Development of a Novel Telemedicine Tool to Reduce Disparities Related to the Identification of Preschool Children with Autism. J Autism Dev Disord 2023:10.1007/s10803-023-06176-3. [PMID: 38064003 PMCID: PMC11161552 DOI: 10.1007/s10803-023-06176-3] [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: 10/29/2023] [Indexed: 12/20/2023]
Abstract
The wait for ASD evaluation dramatically increases with age, with wait times of a year or more common as children reach preschool. Even when appointments become available, families from traditionally underserved groups struggle to access care. Addressing care disparities requires designing identification tools and processes specifically for and with individuals most at-risk for health inequities. This work describes the development of a novel telemedicine-based ASD assessment tool, the TELE-ASD-PEDS-Preschool (TAP-Preschool). We applied machine learning models to a clinical data set of preschoolers with ASD and other developmental concerns (n = 914) to generate behavioral targets that best distinguish ASD and non-ASD features. We conducted focus groups with clinicians, early interventionists, and parents of children with ASD from traditionally underrepresented racial/ethnic and linguistic groups. Focus group themes and machine learning analyses were used to generate a play-based instrument with assessment tasks and scoring procedures based on the child's language (i.e., TAP-P Verbal, TAP-P Non-verbal). TAP-P procedures were piloted with 30 families. Use of the instrument in isolation (i.e., without history or collateral information) yielded accurate diagnostic classification in 63% of cases. Children with existing ASD diagnoses received higher TAP-P scores, relative to children with other developmental concerns. Clinician diagnostic accuracy and certainty were higher when confirming existing ASD diagnoses (80% agreement) than when ruling out ASD in children with other developmental concerns (30% agreement). Utilizing an equity approach to understand the functionality and impact of tele-assessment for preschool children has potential to transform the ASD evaluation process and improve care access.
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Affiliation(s)
- Liliana Wagner
- Vanderbilt Kennedy Center, Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1241 Blakemore Avenue, # 161, Nashville, TN, 37212, 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, 1241 Blakemore Avenue, # 161, Nashville, TN, 37212, 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, 1241 Blakemore Avenue, # 161, Nashville, TN, 37212, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ambar Munoz Lavanderos
- Vanderbilt Kennedy Center, Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1241 Blakemore Avenue, # 161, Nashville, TN, 37212, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joshua Wade
- Adaptive Technology Consulting, LLC, Murfreesboro, USA
| | - Laura Corona
- Vanderbilt Kennedy Center, Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1241 Blakemore Avenue, # 161, Nashville, TN, 37212, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zachary Warren
- Vanderbilt Kennedy Center, Treatment and Research Institute for Autism Spectrum Disorders, Vanderbilt University Medical Center, 1241 Blakemore Avenue, # 161, Nashville, TN, 37212, 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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9
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Honaker MG, Weitlauf AS, Swanson AR, Hooper M, Sarkar N, Wade J, Warren ZE. Paisley: Preliminary validation of a novel app-based e-Screener for ASD in children 18-36 months. Autism Res 2023; 16:1963-1975. [PMID: 37602567 PMCID: PMC10857772 DOI: 10.1002/aur.2997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/12/2023] [Indexed: 08/22/2023]
Abstract
The purpose of this study was to assess the validity of an autism e-screener, Paisley, when utilized in a clinical research setting via a tablet application. The Paisley application used a series of play-based activities, all of which incorporated varying aspects of the ASD-PEDS. Participants included children (18-36 months; n = 198) referred for evaluation of autism spectrum disorder (ASD) and community providers (n = 66) with differing levels of familiarity with ASD. Community providers administered the Paisley application to children who then completed a comprehensive psychological evaluation. Based on comprehensive evaluation, 75% of children met diagnostic criteria for ASD. Paisley scores were significantly higher for children diagnosed with ASD (15.06) versus those not diagnosed (9.34). The newly determined cutoff ASD-PEDS cutoff score of 13 had significantly higher specificity and positive predictive value than the originally proposed cutoff of 11. Results support the use of Paisley by community providers to identify autism risk in toddlers. Limitations and strengths of the work, as well as opportunities for future clinical validation, are described.
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Affiliation(s)
- Makayla G Honaker
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Kennedy Center, Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), Nashville, Tennessee, USA
| | - Amy S Weitlauf
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Kennedy Center, Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), Nashville, Tennessee, USA
| | - Amy R Swanson
- Vanderbilt Kennedy Center, Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), Nashville, Tennessee, USA
- Adaptive Technology Consulting, Nashville, Tennessee, USA
| | - Madison Hooper
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Nilanjan Sarkar
- Adaptive Technology Consulting, Nashville, Tennessee, USA
- Department of Mechanical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Joshua Wade
- Adaptive Technology Consulting, Nashville, Tennessee, USA
| | - Zachary E Warren
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, 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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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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Keehn RM, Swigonski N, Enneking B, Ryan T, Monahan P, Martin AM, Hamrick L, Kadlaskar G, Paxton A, Ciccarelli M, Keehn B. Diagnostic Accuracy of Primary Care Clinicians Across a Statewide System of Autism Evaluation. Pediatrics 2023; 152:e2023061188. [PMID: 37461867 PMCID: PMC10686684 DOI: 10.1542/peds.2023-061188] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of the Early Autism Evaluation (EAE) Hub system, a statewide network that provides specialized training and collaborative support to community primary care providers in the diagnosis of young children at risk for autism spectrum disorder (ASD). METHODS EAE Hub clinicians referred children, aged 14 to 48 months, to this prospective diagnostic study for blinded follow-up expert evaluation including assessment of developmental level, adaptive behavior, and ASD symptom severity. The primary outcome was agreement on categorical ASD diagnosis between EAE Hub clinician (index diagnosis) and ASD expert (reference standard). RESULTS Among 126 children (mean age: 2.6 years; 77% male; 14% Latinx; 66% non-Latinx white), 82% (n = 103) had consistent ASD outcomes between the index and reference evaluation. Sensitivity was 81.5%, specificity was 82.4%, positive predictive value was 92.6%, and negative predictive value was 62.2%. There was no difference in accuracy by EAE Hub clinician or site. Across measures of development, there were significant differences between true positive and false negative (FN) cases (all Ps < .001; Cohen's d = 1.1-1.4), with true positive cases evidencing greater impairment. CONCLUSIONS Community-based primary care clinicians who receive specialty training can make accurate ASD diagnoses in most cases. Diagnostic disagreements were predominately FN cases in which EAE Hub clinicians had difficulty differentiating ASD and global developmental delay. FN cases were associated with a differential diagnostic and phenotypic profile. This research has significant implications for the development of future population health solutions that address ASD diagnostic delays.
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Affiliation(s)
| | - Nancy Swigonski
- Department of Pediatrics, Indiana University School of Medicine
| | - Brett Enneking
- Department of Pediatrics, Indiana University School of Medicine
| | - Tybytha Ryan
- Department of Pediatrics, Indiana University School of Medicine
| | - Patrick Monahan
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine
| | | | - Lisa Hamrick
- Department of Psychological Sciences, Purdue University
| | - Girija Kadlaskar
- Department of Speech, Language & Hearing Sciences, Purdue University
- MIND Institute, University of California Davis
| | - Angela Paxton
- Department of Pediatrics, Indiana University School of Medicine
| | - Mary Ciccarelli
- Department of Pediatrics, Indiana University School of Medicine
| | - Brandon Keehn
- Department of Speech, Language & Hearing Sciences, Purdue University
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12
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de Marchena A, Wieckowski AT, Algur Y, Williams LN, Fernandes S, Thomas RP, McClure LA, Dufek S, Fein D, Stahmer AC, Robins DL. Initial diagnostic impressions of trainees during autism evaluations: High specificity but low sensitivity. Autism Res 2023; 16:1138-1144. [PMID: 37084079 PMCID: PMC10353016 DOI: 10.1002/aur.2933] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/05/2023] [Indexed: 04/22/2023]
Abstract
Reducing the age of first autism diagnosis facilitates access to critical early intervention services. A current "waitlist crisis" for autism diagnostic evaluation thus demands that we consider novel use of available clinical resources. Previous work has found that expert autism clinicians can identify autism in young children with high specificity after only a brief observation; rapid identification by non-experts remains untested. In the current study, 252 children ages 12-53 months presented for a comprehensive autism diagnostic evaluation. We found that junior clinicians in training to become autism specialists (n = 29) accurately determined whether or not a young child would be diagnosed with autism in the first five minutes of the clinic visit in 75% of cases. Specificity of brief observations was high (0.92), suggesting that brief observations may be an effective tool for triaging young children toward autism-specific interventions. In contrast, the lower negative predictive value (0.71) of brief observations, suggest that they should not be used to rule out autism. When trainees expressed more confidence in their initial impression, their impression was more likely to match the final diagnosis. These findings add to a body of literature showing that clinical observations of suspected autism should be taken seriously, but lack of clinician concern should not be used to rule out autism or overrule other indicators of likely autism, such as parent concern or a positive screening result.
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Affiliation(s)
| | | | - Yasemin Algur
- Department of Epidemiology & Biostatistics, Drexel University, Philadelphia, PA
| | | | | | - Rebecca P. Thomas
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | - Leslie A. McClure
- Department of Epidemiology & Biostatistics, Drexel University, Philadelphia, PA
| | - Sarah Dufek
- Department of Psychiatry and Behavioral Sciences, University of California, Davis MIND Institute, Sacramento, CA
| | - Deborah Fein
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | - Aubyn C. Stahmer
- Department of Psychiatry and Behavioral Sciences, University of California, Davis MIND Institute, Sacramento, CA
| | - Diana L. Robins
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA
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13
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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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14
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Ludwig NN, Child AE, Jashar DT, Mostow AJ, Wodka EL. Telehealth diagnosis of autism spectrum disorder through clinical cases. Clin Neuropsychol 2022; 36:960-980. [PMID: 34473008 PMCID: PMC10091235 DOI: 10.1080/13854046.2021.1970228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A diagnosis of autism spectrum disorder (ASD) provides access to interventions that are important for fostering development and improving quality of life. Thus, the timeliness of a diagnosis should not be limited by social-distancing limitations whenever possible. Despite this, clear guidance for transitioning autism diagnostic services to a telehealth model of care in the era of the COVID-19 pandemic is lacking. At our Institute, we have adapted our approach to ASD evaluation to promote continued access to evaluation services during this unprecedented time. The purpose of this case series is to provide examples of three different approaches to ASD differential diagnostic services via telehealth that we have taken at our Institute. We illustrate our methods and clinical decision-making, based on patient characteristics and referral aims, in providing telehealth diagnostic services and discuss the advantages and limitations of telehealth utilization in the differential diagnosis of ASD. At our Institute, telehealth services have provided an invaluable opportunity to continue to confirm (or rule out) an ASD diagnosis when appropriate to facilitate access to services during this time. Future research examining the utility of telehealth in the differential diagnosis of ASD is imperative given the potential advantages of telehealth services beyond the COVID-19 pandemic for some patients.
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Affiliation(s)
- Natasha N Ludwig
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amanda E Child
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dasal Tenzin Jashar
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Allison J Mostow
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Ericka L Wodka
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
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15
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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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16
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Guan X, Zwaigenbaum L, Sonnenberg LK. Building Capacity for Community Pediatric Autism Diagnosis: A Systemic Review of Physician Training Programs. J Dev Behav Pediatr 2022; 43:44-54. [PMID: 34907998 PMCID: PMC8687619 DOI: 10.1097/dbp.0000000000001042] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 10/12/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Training primary care providers to provide diagnostic assessments for autism spectrum disorder (ASD) decreases wait times and improves diagnostic access. Outcomes related to the quality of these assessments and the impacts on system capacity have not been systematically examined. This systematic review identifies and summarizes published studies that included ASD diagnostic training for primary care providers (PCPs) and aims to guide future training and evaluation methods. METHODS Systematic searches of electronic databases, reference lists, and journals identified 6 studies that met 3 inclusion criteria: training for PCPs, community setting, and training outcome(s) reported. These studies were critically reviewed to characterize (1) study design, (2) training model, and (3) outcomes. RESULTS All studies were either pre-post design or nonrandomized trials with a relatively small number of participants. There was considerable heterogeneity among studies regarding the training provided and the program evaluation process. The most evaluated outcomes were access to autism diagnosis and accuracy of diagnosis. CONCLUSION Training PCPs to make ASD diagnoses can yield high diagnostic agreement with specialty teams' assessments and reduce diagnostic wait times. Current data are limited by small sample size, poor to fair quality study methodology, and heterogenous study designs and outcome evaluations. Evidence is insufficient to draw conclusions about the overall effects of training PCPs for ASD diagnostic assessments. Since further research is still needed, this review highlights which outcomes are relevant to consider when evaluating the quality of ASD assessments across the continuum of approaches.
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Affiliation(s)
- Xiaoning Guan
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada;
| | | | - Lyn K. Sonnenberg
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada;
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17
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Bal VH, Wilkinson E, Fok M. Cognitive profiles of children with autism spectrum disorder with parent-reported extraordinary talents and personal strengths. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:62-74. [PMID: 34088226 PMCID: PMC8642487 DOI: 10.1177/13623613211020618] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
LAY ABSTRACT Previous research has suggested that focusing on impairments can be detrimental to the well-being of autistic individuals, yet little research has focused on strengths and positive qualities in autism. Some studies explored "savant skills" (herein referred to as "extraordinary talents"), that is, skills that stand out compared to the general population. These often group everyone who has a specific talent, rather than exploring subgroups with strengths in specific areas. There has been even less research focused on personal strengths (i.e. skills that stand out relative to the individual's other abilities, but not the general population). To expand this research, we use a sample of 1470 children (ages 4-18 years) from the Simons Simplex Collection without cognitive impairment to examine the relationship between having a parent-reported skill in a specific area and performance on a standardized cognitive test. Almost half (46%) had at least one parent-reported talent and an additional 23% without extraordinary talents had at least one personal strength. Children with these parent-reported skills had different patterns of performance on these standardized tests than children without skills in that area (i.e. visuospatial, drawing, computation, reading, and memory). Specific skills in computation or reading were associated with higher overall performance on the standardized tests. These results emphasize the importance of considering strengths separately by area, rather than combining individuals with different types of strengths. The high number of children with skills in this study underscores the need for more research in this area, particularly using instruments focused on understanding the nuances of these strengths. It is important for future studies to consider these skills in children with cognitive impairment.
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Affiliation(s)
- Vanessa H. Bal
- Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, New Jersey, USA
| | - Ellen Wilkinson
- Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, New Jersey, USA
| | - Megan Fok
- Psychology Department, Virginia Tech, Blacksburg, Virginia, USA
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18
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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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19
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Talbott MR, Dufek S, Young G, Rogers SJ. Leveraging telehealth to evaluate infants with prodromal autism spectrum disorder characteristics using the telehealth evaluation of development for infants. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:1242-1254. [PMID: 34549613 DOI: 10.1177/13623613211045596] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Many families seeking early evaluations for autism spectrum disorder face long waitlists, must often travel to centers with appropriate expertise, and are frequently told by providers to "wait and see." This results in significant stress for families and delayed supports to infants and their caregivers who could benefit. This study evaluated whether telehealth could be used to identify and evaluate infants with early autism spectrum disorder characteristics in the first year of life. In this study, we evaluated 41 infants via telehealth using a standard set of probes and scored behavior related to social communication, play, imitation, and other developmental domains. We found the majority of infants demonstrated elevated likelihood of autism spectrum disorder on both parent-reported questionnaires and examiner-rated behavior. Caregiver ratings of the overall utility of the protocol used in this study were high. Overall, this study demonstrates the feasibility for telehealth-based approaches to evaluate infants' with elevated likelihood of autism spectrum disorder in the first year of life, which could help to improve families' access to care and to expand our capacity to conduct studies evaluating possible intervention supports.
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20
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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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21
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Keehn RM, Tomlin A, Ciccarelli MR. COVID-19 Pandemic Highlights Access Barriers for Children with Autism Spectrum Disorder. J Dev Behav Pediatr 2021; 42:599-601. [PMID: 34191764 PMCID: PMC10712267 DOI: 10.1097/dbp.0000000000000988] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/21/2021] [Indexed: 11/27/2022]
Affiliation(s)
| | - Angela Tomlin
- Department of Pediatrics, Indiana University School of Medicine
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22
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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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23
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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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