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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.

Eating disorder prevalence is increasing in males, perhaps more rapidly than in females.Theorists have proposed that cognitive biases are important factors underpinning disordered eating, especially those related to food, body, and perfectionism. We investigated these factors in relation to males' eating disorder symptomatology in the general population by using eye-tracking during reading as a novel and implicit measure. 180 males' eye movements were monitored while they read scenarios (thirdperson in Experiment 1 (n=90, 18-38(Mage=21.50, SD=3.65)); second-person in Experiment 2 (n=90, 18-35(Mage=20.50, SD=2.22)) describing characters' emotional responses (e.g., upset) to food-, body image-, and perfectionism-related events.Participants' eating disorder symptomatology was then assessed, and body mass index (BMI) was calculated. Results showed processing of characters' emotional responses (detected via eye-tracking) to body-and perfectionism-related events for third-person scenarios was related to eating disorder symptomatology. Processing of characters' emotional responses to body-related events for second-person scenarios was related to males' BMI. The moment-to-moment processing of characters' emotional responses to food-related scenarios was not related to eating disorder symptomatology or BMI.Findings support theories that include body-and perfectionism-related cognitive biases as underlying mechanisms of eating disorder symptomatology and the use of implicit measures of cognitive processes underlying males' eating disorder symptomatology.

BACKGROUND Expedient access to early intervention (EI) systems has been identified as a priority for children with developmental delays, identified disabilities, and other special healthcare needs. Despite the mandated availability of EI, it remains challenging for families to navigate referral processes and establish services. Such challenges disproportionately impact families from traditionally underserved communities. Mobile health apps have the potential to improve clinical outcomes, increase accessibility to health services, and promote adherence to health-related interventions. Though promising, implementation of apps within routine care is in its infancy, with limited research examining the components of what makes an effective app or how to reach families most impacted by inequities in healthcare delivery. OBJECTIVE We conducted focus groups with four unique participant groups to access a broad range of perspectives on families’ experiences navigating the EI system, with the dual goals of (1) identifying specific ways in which a patient-facing app might facilitate that process and (2) identifying barriers to its use with traditionally underrepresented and underserved groups. METHODS Focus groups included 29 participants across four groups (family members, clinicians and clinic staff, community providers, experts in health equity). Targeted sampling was used to recruit participants from traditionally underrepresented groups. The specific research questions addressed through the focus groups included (1) what barriers families are currently experiencing as they navigate the EI system; (2) what features a patient-facing app designed to track family engagement with the EI system would need to have to be useful/meaningful for families; and (3) what potential barriers are to such an app’s use and uptake in underserved communities. Focus group questions were informed by the Consolidated Framework for Implementation Research (CFIR) framework. Transcripts were analyzed using qualitative analysis coding methods, including a content analysis and predominately deductive approach guided by the CFIR. RESULTS Qualitative analysis revealed a desire for increased communication and information about the process of accessing EI services, the potential utility of a mobile app for communication purposes, and clear recommendations for app features. Insights from focus groups were used to inform the development of the Family on Track (FOT) app and related implementation supports. App features (developed in partnership with our university engineering department) included survey customization, timing and delivery of prompts, and questions related to barriers and service satisfaction. Implementation supports include a visual guide for app installation, resources related to common family questions, and availability of study personnel to guide families through installation and provide ongoing support. CONCLUSIONS Results of this study could support development of a new way for the EI system to communicate and connect with families, providing families with a means to communicate satisfaction and frustration, and access the supports they need to be active participants in their child’s care. CLINICALTRIAL The study was supported by funding from the Children and Youth with Special Healthcare Needs Network (UA6M31101) and the Learning Health Systems Scholars grant (K12 HS026395) from AHRQ/PCORI.

Background Expedient access to early intervention (EI) systems has been identified as a priority for children with developmental delays, identified disabilities, and other special health care needs. Despite the mandated availability of EI, it remains challenging for families to navigate referral processes and establish appropriate services. Such challenges disproportionately affect families from traditionally underserved communities. Mobile health apps can improve clinical outcomes, increase accessibility to health services, and promote adherence to health-related interventions. Though promising, the implementation of apps within routine care is in its infancy, with limited research examining the components of what makes an effective app or how to reach families most impacted by inequities in health care delivery. Objective In study 1, we conducted focus groups to access a broad range of perspectives on the process of navigating the EI system, with the dual goals of identifying ways in which a patient-facing app might facilitate this process and identifying barriers to use with traditionally underrepresented and underserved groups. In study 2, focus group findings informed the development of a patient-facing app, which was subsequently tested with a pilot sample of 5 families. Methods In study 1, the focus groups included 29 participants from 4 shareholder groups. Targeted sampling was used to recruit participants from traditionally underrepresented groups. Focus group questions sought information about barriers families experience as they navigate the EI system, ideal features of a patient-facing app designed to track family engagement with the EI system, and potential barriers. Focus group procedures were informed by the Consolidated Framework for Implementation Research framework. In study 2, a pilot app was developed. The app was tested with a sample of 5 families of young children involved in the EI system. Families provided information on app functionality and usability. Results Qualitative analysis revealed a desire for increased communication and information about the process of accessing EI services, potential utility of an app for communication purposes, and clear recommendations for app features. Insights from focus groups were used to inform the development of the Family on Track app and related implementation supports. App features included survey customization, timing and delivery of prompts, and questions related to barriers and service satisfaction. Implementation supports include a visual guide for app installation, resources related to common family questions, and availability of study personnel to guide families through installation and provide ongoing support. Field testing provided preliminary information about app usability, including identifying future directions. Conclusions The results of this study could support the development of a new way for the EI system to communicate and connect with families, provide families with a means to communicate satisfaction and frustration, and access the supports they need to be active participants in their child’s care.