Diagnostic Evaluations of Autism Spectrum Disorder during the COVID-19 Pandemic

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.

Transitioning to Telemedicine During COVID-19: Impact on Perceptions and Use of Telemedicine Procedures for the Diagnosis of Autism in Toddlers

“…In a survey of over 800 caregivers, the majority of families polled reported a loss of at least some educational or healthcare service since the start of the pandemic (Jeste et al, 2020). Many states, organizations, and providers have responded by offering telehealth services (Esper et al, 2020;Grossman et al, 2020;Perez et al, 2020), including providers in the field of developmental and behavioral pediatrics (Fung & Ricci, 2020;Jang et al, 2021). Specifically, telehealth solutions have been offered to address the pressing need for diagnostic clarification in young children deemed at risk for autism spectrum disorder (ASD), without which they may not be able to access critical early intervention services (Stahmer & Mandell, 2007).…”

“…Prior to COVID-19, barriers such as geographic distance, lack of qualified providers, and cost in terms of time and financial resources (Bishop-Fitzpatrick & Kind, 2017;Mazurek et al, 2014) prompted some groups to investigate tele-assessment options. The onset of the COVID-19 pandemic, including suspension of in-person appointments and ongoing social distancing requirements in clinic settings, hastened tele-assessment uptake (Berger et al, 2021;Jang et al, 2021;Wagner et al, 2020). Alfuraydan (2020) reviewed 10 studies investigating ASD tele-assessment from 2000 to 2019.…”

Rethinking autism spectrum disorder assessment for children during COVID‐19 and beyond

“…It is important to acknowledge that in‐person assessment may be required to establish a valid diagnosis, achieve an adequate understanding of an individual's profile to identify appropriate treatment goals, and/or provide appropriate emotional support in communicating these findings. Moving forward, a hybrid service model (Jang et al, 2021 ) may be preferable to allow for the benefits of both online and in‐person assessments. As part of this process, researchers and service providers across disciplines must work together with stakeholders with lived experience (Alexander et al, 2021 ) to assist in the conception and co‐production of valid, yet flexible, methods for ASD assessment.…”

“…Traditional face‐to‐face ASD assessments, which were associated with extremely long wait times before COVID‐19, have become more difficult to access, or entirely untenable in some settings. Many clinical programs have adapted to these constraints, leveraging telehealth‐based approaches that were developed pre‐pandemic (Corona et al, 2021 ; Schrader et al, 2020 ) or adopting novel online “virtual” screening and assessment models (Berger et al, 2021 ; Jang et al, 2021 ). Positive aspects of telehealth models include easier access for some families living in remote locations or with complex schedules, as well as multiple opportunities to observe children in their familiar home environment with other family members such as siblings (Ameis et al, 2020 ; Wagner et al, 2020 ).…”

The Brief Observation of Symptoms of Autism (BOSA): Development of a New Adapted Assessment Measure for Remote Telehealth Administration through COVID-19 and Beyond

“…Several measures that were developed pre-pandemic have been offered as potential remote assessment options. Some of the most widely used (Jang et al, 2021) include the TELE-ASD-PEDS (Corona et al, 2020), Systematic Observation of Red Flags of ASD (SORF; Dow et al, 2020), Naturalistic Observation Diagnostic Assessment (NODA; Smith et al, 2017), and the Childhood Autism Rating Scale (CARS-II; Schopler et al, 2010). While the TELE-ASD-PEDS and SORF offer promising options for young children under the age of three, the TELE-ASD-PEDS had only previously been studied in a laboratory setting and psychometric properties are not yet available for use in the home (Wagner et al, 2021), and research on the SORF has only been conducted on the full one-hour home observation by videographers with no data yet substantiating use of a shorter, more feasible timeframe.…”